Posted by papapa on July 8, 2008 in Cancer
Overview
Renal cell carcinoma, also known as renal cell carcinoma, kidney cancer, is the most common kidney cancer in real terms, due to extend the average life expectancy and medical imaging advances, the incidence of renal cell carcinoma compared to the previous increase, there is no obvious clinical symptoms in Physical examination, occasionally found growing number of renal cell carcinoma, up to 1 / 2 to 1 / 5. Renal cell carcinoma at the age of onset more than 45 to 60-year-old, male patients Most of the male urinary and reproductive system cancer, bladder cancer incidence rate after. Because of renal cell carcinoma is common in clinical hematuria, such as low back pain and mass Syndrome, in the medical literature in more than a .female blood,. and .low back pain,. .plot of. range.
[ET]
The cause of kidney cancer is not clear so far, all ethnic groups and geographical conditions were not the cause of kidney cancer an important factor. It is reported aromatic hydrocarbons, aromatic amines, aflatoxin, hormones, radiation and viruses can cause renal cell carcinoma; certain hereditary diseases such as tuberous sclerosis, multiple nerve fibers, such as tumor can be associated with renal cell carcinoma; kidney Cell carcinoma of the renal pelvis cancer combined, may be partially related to chronic stimulation.
Some scholars have made in 1990 the relationship between smoking and kidney cancer, ex-smokers than never-smokers suffering from renal cell carcinoma of the high-risk 2 times less severe smokers higher incidence rate of smokers, smoking The duration and the prevalence rate are directly related, and that smokers urine mutation within the active substance in increased tobacco in dimethyl Nokia nitro-amine lead to renal cell carcinoma, although not yet confirmed clinical, but animal experiments have The rabbit induced renal cell carcinoma, which they think smoking habits, together with other risk factors such as alcohol abuse, occupational exposure, can further increase in the risk of renal cell carcinoma.
[TCM Pathogenesis]
In medicine for the disease more debilitating Shenqi, Shuishi not, Shidu, health, or in the wet, hot Xiedu, Chengxi income, but not to stay, both inside and outside of evil, a guitar in the kidney, gradually falling into Into cancer. Clinical common cause of kidney deficiency is a disease-Yun drugs, hot and humid stasis drugs, blood and qi deficiency. This disease more common in the frail elderly, the decline at this time Shenqi, easy Xiedu by the invasion. Perturbation of blood and kidney deficiency can not be drowning hematuria; waist of the House for the kidney, kidney deficiency, back pain, hot and humid guitar drugs, and falling into Qizhixueyu formed mass.
[Clinical]
Renal cell carcinoma patients complained of changing and clinical performance, easily mistaken for other hidden location of kidney disease and Bolivia, the main contact with the outside world is urine, urine is found that the most common symptoms of renal cell carcinoma, but must appear in the urine penetrated the renal pelvis cancer The rear is possible, therefore has not early symptoms. Over the years, the urine, pain and mass known as renal cell carcinoma of the .triple sign., the majority of patients have been attending a one-two symptoms, triple the total levy sale of around 10 percent, few may be cured.
1. Hematuria:
Hematuria often painless intermittent attacks throughout hematuria visible to the naked eye, with intermittent period of development and shorten the disease. Renal cell carcinoma may be bleeding for a long time with renal colic, often through the ureter caused by blood clots. Hematuria renal cell carcinoma of the blood clots may form through the ureter Strip. Hematuria the extent size has nothing to do with renal cell carcinoma. Renal cell carcinoma can sometimes lasting for the performance of microscopic hematuria.
2. Low back pain:
Low back pain is another common symptom of renal cell carcinoma, the most for Duntong, confined to the waist, pain due to bulging mass growth derived from kidney capsule, can also cause blood clots through the ureter had low back pain as the aforementioned. Violations of the surrounding organs and tumors Yao Ji, heavier and pain for continuity.
3. Mass:
Masses are also common symptoms, about 1 / 3 to 1 / 4 treatment in patients with renal cell carcinoma can be found at the enlargement of the kidney. Kidney position than concealed, renal cell carcinoma achieved a considerable volume in the previous mass difficult to find. General abdominal tumor had reached a late stage symptoms.
4. Pain:
Met with pain in 50 percent of the cases, also advanced symptoms of kidney or renal pelvis for the capsule gradually grew up by the tumor involved, or because of violations of oppression abdominal tumor the back wall of connective tissue, muscle, or lumbar spinal nerve caused by the side Persistent back pain.
5. Other symptoms:
Of unknown causes of fever, or just find that when the transfer, fatigue, weight loss, loss of appetite, anemia, cough and hemoptysis, and other lung symptoms. In addition, the role of kidney cancer tumor is caused by endocrine activities, including erythrocytosis, hypertension, low blood pressure, hypercalcemia, fever syndrome. Although these systemic, toxic and endocrine the role of the special nature of right and wrong, but about 30 percent of the first patients have many mixed performance. So it is valuable clues, such as tumor found to consider the role of the system.
[Transfer and dissemination]
Renal cell carcinoma can be through direct invasion, blood circulation and lymphatic channels in three ways transfer. Iliac bone and lung is a common part of the transfer.
1. Infiltration directly: renal cell carcinoma gradually grow up and perforation proliferation of tumor capsule in all directions, penetrated inside the renal pelvis, kidney capsule breakthrough in the field transgression and renal fat and fascia week, spread to neighbouring organizations such as the colon, adrenal gland, liver , And spleen, such as diaphragmatic.
2. Lymphatic channels: According to statistics 15% to 30% of renal cell carcinoma can be transferred via lymphatic channels. Beattie moved to the left kidney, aorta and left lateral lymph nodes before; involving the right of the door near the kidney, lymph nodes before the inferior vena cava, the aorta and vena cava between the lymph nodes.
3. Revascularization transfer: the transfer is an important means of renal cell carcinoma, cancer of vein from the capillaries, the renal vein to the renal vein, in the vein tumor thrombus to form, could be further Shenru of IVC at the right atrium and Lung, iliac bone and other organs, the blood supply caused widespread transfer.
[Diagnosis]
l. General inspection:
Hematuria is important symptoms, Erythrocytosis occurred in more than 3 percent to 4 percent for anemia may occur. Bilateral kidney cancer, renal function normally without the change, ESR increase. Some patients with renal cell carcinoma no bone metastases, it may have symptoms of high blood calcium levels and increased serum calcium, renal cell carcinoma removed quickly after the lifting of symptoms, calcium also back to normal. Sometimes to the development of liver dysfunction, such as kidney tumor removed, could resume normal.
2. X-ray angiography for the diagnosis of renal cell carcinoma of the major means of
(1) X-ray lines:
X-ray film, we can see increased kidney shape, contour changes, sometimes calcified tumor, within the limitations of the tumor in a wide range of floc or video, or around a calcified tumor lines, shell, especially young peoplerenal cell carcinoma.
(2) intravenous urography, intravenous urography is the conventional method, can not be displayed because Bangladesh has not yet caused kidney renal beacon of deformation of the tumor and the tumor is difficult to distinguish between renal cell carcinoma. Renal angiomyolipoma, renal cysts, so the importance of decline, must be accompanied by ultrasound or CT scan to further identify. However, intravenous urography can understand both the function of the kidney and renal pelvis beacon of the bladder and ureter, the diagnosis has important reference value.
(3) renal angiography:
Renal artery imaging contrast can be found urinary system is not deformation of tumors, renal cell carcinoma performance of angiogenesis, arteriovenous fistula, the contrast agent pool-like gathering (Pooling) coated vascular increase. Angiography variation, sometimes from time to enhancement of renal cell carcinoma, such as tumor necrosis, cystic changes, such as artery embolization. Renal angiography if necessary, to the renal artery in the normal injection of adrenaline vasoconstriction and vascular tumors without response.
In relatively large renal cell carcinoma. Selective renal artery imaging, can also be a result of renal artery embolization can reduce bleeding hand surgical resection of renal cell carcinoma can not have serious bleeding and possible renal artery embolization as a palliative treatment.
3. Ultrasound scan:
Ultrasound is the most simple non-invasive screening method can be used as part of routine medical examination. More than lcm kidney tumor can be discovered by ultrasound scanning, it is important to identify whether the tumor is renal cell carcinoma. Renal cell carcinoma for the solid mass, there may be due to its internal hemorrhage, necrosis, cystic changes, Echo uneven, is generally low echo, the realm of renal cell carcinoma not clear, and renal cysts that different. Kidney lesions are likely to cause renal pelvis, kidney-, renal sinus fat deformation or fracture. Cystadenocarcinoma papillary renal ultrasonography like cysts, and may have calcification. Identification of cysts and renal cell carcinoma can be difficult to puncture, ultrasound-guided puncture is relatively safe.
Puncture of cytology for parallel imaging cyst. Cyst fluid often clear, non-tumor cells, low-fat, smooth wall at the contrast can be sure of benign lesions. As for the bloody puncture should be thought of cancer, may be found in extracts of tumor cells, the contrast is not smooth at the wall can be diagnosed as malignant tumors. Renal angiomyolipoma for kidney and solid tumors, the ultrasound showed a strong echo of fat tissue, and renal cell carcinoma is easy to identify. In ultrasound examination revealed renal cell carcinoma, we should pay attention to whether the tumor penetration capsule, kidney-fat, swollen lymph nodes there, renal vein, the vena cava, whether thrombosis, liver metastasis, and so on.
4. CT scan:
CT for the diagnosis of kidney cancer has an important role, can be found not cause renal pelvis beacon of change and no symptoms of renal cell carcinoma, accurate determination of tumor density, and in the clinic, CT can accurately stages. Some statistical accuracy of their diagnosis: 91% of renal vein, the proliferation of renal around 78 percent, 87 percent of metastasis, near the organ involved 96%. Renal cell carcinoma CT scan showed renal mass, can also be prominent in the kidney essence, for the mass round, round or sub-fronds, clear or fuzzy border, plain uneven density at the soft tissue, CT Value> 20 Hu, often in the 30 ~ 50 Hu, slightly higher than normal kidney essence, can also be similar or slightly lower, uneven in its internal bleeding caused by calcification or necrosis.
Sometimes expressed as cystic CT value but a wall of soft tissue nodule. Intravenous injection of contrast agents, the normal kidney CT real value of around 120 Hu, tumor CT value also increased, but significantly lower than kidney essence, the tumor state more clearly. In CT Masses such as the enhanced value after no change, may be cysts, with before and after contrast agent injected into the CT value for the density of the liquid to confirm the diagnosis. Necrosis in the primary renal cell carcinoma, kidney cancer and cystic renal artery embolization, the injection of contrast agent after the CT value is not increased. Renal angiomyolipoma because of its large number of containing fat, CT values often negative, internal uneven, enhanced CT value increased, but still showed fat density, oncocytoma in the CT scan at the edge of clarity, the internal density Uniform, enhanced CT value increased significantly.
5. Magnetic Resonance Imaging (MRI):
MRI examination kidney is a good choice. Kidney and kidney-week gap doors have a high fat signal intensity. Renal outer cortex higher signal strength, the Ministry of medullary lower signal strength, perhaps because of different osmotic pressure within the kidney, the two parts of 50 percent of poor contrast, this difference can be extended with the recovery time and hydration and narrow, renal artery No signal cavity and veins, so for the low-intensity. Urine collection system for low-intensity. The MRI variant of renal cell carcinoma, by the tumor vessels, size, whether necrosis decision. MRI can not be found calcification stove, because of their low-density Proton. MRI on violations of renal cell carcinoma, the capsule surrounding tissue, liver, mesentery, Yaoji of the change easily found identification. In particular, there is renal cell carcinoma renal vein, the vena cava, thrombosis and metastasis.
[TCM and treatment]
(1) hot and humid Yun-kidney
Main card: hematuria appeared frequently, low back pain Zhuizhang does not apply, with low heat, thirst, weakness, Nadai, nausea, vomiting, abdominal waist can be palpable mass, Shezhianhong, Moss huangbai, sliding a few veins.
Treatment: heat Lishi, Huoxue Sanjie
Recipe: Long Yi-chuen, sheep Decoction.
(2) kidney deficiency drug Yun -
Main card: short Chek urinating blood, hot flashes night sweats, dizziness tinnitus, and fatigue fatigue, satisfied that the small, low back pain-by, lumbar abdominal mass, She Zhi-hong, Moss thin yellow veins breakdown.
Treatment: Ziyin Bushen, cooling blood detoxification.
Recipe: Liuweidihuang Tonga flavor.
(3) spleen-deficiency
Main card: the waist or abdomen an increasing mass, low back pain, abdominal distention, hematuria heavier, looking pale Wu Hua, thinner, less satisfied, I desalination weakness, nausea, vomiting, Shezhi desalination, Moss white, Shen Fine veins.
Treatment: Jianpi Yishen, Ruanjiansanjie.
Prescriptions; right to the pill addition and subtraction.
(4) deficiency of qi and blood
Main card: make them apathetic, shortness of breath fatigue, looking Huang white, body weight loss, palpitations upset, waist or abdominal mass increased significantly, low back pain, abdominal distention, mouth 1000, low heat, tongue short, white huangbai moss or moss, Shen virtual network Fine.
Treatment: Air Yixue, Fuzhengquxie.
Recipe: Bazhen Decoction.
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