Description: Renal tumors are more common in urinary tumors, second only to bladder tumors. The vast majority of primary renal tumors are malignant, including renal cell carcinoma, nephroblastoma (Wilms tumor), and renal pelvic cancer. Benign tumors of the kidney include renal adenomas, angiomyolipoma, hemangiomas, lipomas, fibroids, and renal parablastomas. Renal cancer is also known as renal cell carcinoma, renal adenocarcinoma, clear cell carcinoma, and renal parenchymal cancer. Renal parenchymal carcinoma is an adenocarcinoma derived from renal tubular epithelial cells, 85% is clear cell carcinoma, and some are granulosa cell carcinoma and mixed cell carcinoma. Causes: (1) Causes of the disease Renal cell cancer is mostly due to lack of kidney gas, water is not wet, wet poison is endogenous, or externally exposed to damp heat and sinister poison, into Libo poison, internal and external Hefei City caused by evil. Kidney deficiency can not take blood for hematuria, waist is the kidney of the house, kidney deficiency is low back pain, damp heat and poisoning, and stagnation of blood stasis forms a mass. The cause of kidney cancer and renal pelvic cancer is also unknown in modern medicine. It is thought to be related to the long-term stimulating effect of carcinogens. For example, the incidence of renal cancer in smokers is high, and those who take long-term pain and antipyretic phenacetin often occur. The sputum nephritis, renal pelvic cancer and the incidence rate have also increased. Long-term kidney stones and infections can induce epithelial metaplasia and dysplasia, and the latter two can develop into cancer. The etiology of kidney tumors is still unknown. In recent years, aromatic amines, aromatic hydrocarbons, aflatoxins, nitroso compounds, alkyl compounds, hydrazines, lead, cadmium, etc., and certain drugs such as anticancer drugs, phenaceta have been considered. Coffee, food additives such as statins, amphetamines, diuretics and potassium bromate have carcinogenic effects. Most scholars believe that renal cell carcinoma originates from the proximal convoluted tubules, and the incidence of renal cancer is significantly increased in people who directly inhale tobacco or cigars with tobacco tubes. One study showed that the incidence of kidney cancer in smokers was 1.7 times higher than that of non-smokers. There was a direct and significant relationship between smoking and risk. The relative risk of mild smoking was 1.1, with a moderate 1.9. The severity is 2.3. The extent of smoking and the length of smoking are positively correlated with the incidence of kidney cancer. Even if smokers quit smoking, they are twice as likely to have kidney cancer as never smokers. Dimethylnitrosamine-induced kidney cancer in tobacco has been confirmed in animal experiments. Vecchia believes that smoking and alcohol, occupational exposure and other risk factors can further increase the risk of kidney cancer. Smokers have beta-naphthylamine and ethylamino-7naphthol in the urine. These substances have been shown to cause bladder cancer and may also cause kidney cancer. Luck'e. HerpesVires and mouse milk tumor virus can cause kidney tumors in animals, and the carcinogenic effect on human kidney has not been confirmed. Kidney cancer occurs mostly in men, especially in older men with male hormone decline, which indicates that sex hormones are related to the occurrence of kidney cancer. The exact mechanism is still unclear. The incidence of renal cell carcinoma is higher in overweight women, but not in overweight men. What kind of nutrients contribute to the occurrence of kidney cancer is still unknown. Certain hereditary diseases such as tuberous sclerosis, multiple neurofibromatosis, etc. may be associated with renal cell carcinoma. Kidney stones can be combined with renal pelvic cancer due to long-term local inflammation. Long-term hemodialysis patients induce acquired renal cystic disease and cancer due to accumulation of cysts and carcinogenic substances that cannot be removed by hemodialysis such as polyamines. In conclusion, in the development of renal cell carcinoma, it may be related to many chemical and biological factors. Smoking and/or obesity, other factors include aluminum phosphate, dimethyl nitrosamine, long-term estrogen intake, aflatoxin B1 and streptozotocin, and certain special diseases such as Von-Hippel-Lindau disease Can cause renal cell carcinoma. Renal cell carcinoma can also occur in some patients with chronic renal failure or acquired renal cysts due to dialysis treatment. About 30% to 50% of long-term dialysis patients can develop acquired renal cysts, of which 6% can occur with kidney cancer with acquired cystic disease. (B) the pathogenesis of renal cancer is often a unilateral single lesion, about 2% of bilateral or multi-focal, the incidence of the left and right side is similar. Typical kidney cancer is round and disproportionate. According to a group of 100 cases of renal cell carcinoma, the lesions are: upper 44 cases, lower part 41 cases, and multiple lesions 15 cases. The tumor has no histological envelope, but has a pseudo-envelope formed by the compressed renal parenchyma and fibrous tissue. A few are yellow or brown, most with bleeding, necrosis, fibrotic plaque, hemorrhage, necrosis can form cystic. Tumors may have calcifications in a punctate or plaque arrangement. Juvenile patients have more calcifications in renal cell carcinoma than in elderly patients. Tumors can destroy the whole kidney and can invade adjacent adipose tissue, muscle tissue, blood vessels, lymphatic vessels, and the like. Kidney cancer easily expands into the vein to form a tumor thrombus, which can enter the renal vein, inferior vena cava, and even the right atrium. The perirenal fascia is a barrier to prevent localized spread of tumors. Ipsilateral adrenal gland involvement accounts for about 10%, and distant metastasis is common in lung, brain, bone, liver, skin, and thyroid. Renal cancer tissues and cells are diverse, and the gross specimens can be solid lamella, trabecular, papillary, honeycomb, glandular. A typical renal cancer cell is a transparent cell, which is polygonal, cuboidal or columnar, and has a cell diameter of 10 to 40 μm. Since the cytoplasm contains glycogen and lipids, HE stains cytoplasm transparent or vacuoles. The lipids contained in the cytosol were mainly phosphonates and neutral lipids. Hale colloidal iron staining was observed by electron microscopy. Focal microvilli development and cytoplasmic vesicle formation were observed. The nucleus is small and regular, with a few mitosis. Kidney cancer is a granulosa cell, its cytoplasm is glassy, uniform, and the size of cells and nucleus is different, and the division is more common. Most of the kidney cancers are clear cells, and there are also granulosa cells at the same time. Some kidney cancers are spindle cells, which are difficult to distinguish from fibrosarcoma. The clear cells, granulosa cells or spindle cells of the tumor of kidney cancer may be present alone or in combination. Pathological grade of renal cancer: The renal morphological grading system proposed by Fuhrman et al. (1982) has been accepted and adopted by most scholars in the world. Grading according to the shape and size of the nucleus has the advantages of clear standards and easy to grasp. When there are different grades of cells in different grades in the same tumor or in the same region, the highest grade of cancer cells is the final grade of pathological diagnosis. For example, most cells are G2, and a few tumors with G3 should be designated as G3. Staging: Renal cancer staging is not uniform, and it is currently widely used in Robson's staging and TNM staging. Robson staging: Stage I: The tumor is confined to the renal capsule. Stage II: The tumor penetrates the renal capsule and invades the fat around the kidney, but is confined to the renal fascia. The renal vein and local lymph nodes are not infiltrated. Stage III: The tumor invades the renal vein or local lymph nodes, with or without inferior vena cava, and involvement of fat around the kidney. Stage IV: distant metastasis or invasion of adjacent organs. The above is a simplified Robson staging, which is easy to apply. The disadvantage is that the prognosis of stage II and III is the same. The TNM staging proposed by the International Anti-Cancer Association in 1987 is as follows. TNM staging: T0: no primary tumor. T1: The maximum diameter of the tumor is ≤2.5 cm, which is confined within the renal capsule. T2: The maximum diameter of the tumor is >2.5 cm, which is confined within the renal capsule. T3: Tumors invade large blood vessels, adrenal glands, and peri-renal tissues, and are confined to the renal fascia. T3a: Invades the periplasmic adipose tissue or adrenal gland. T3b: Invades the renal vein or inferior vena cava. T4: Invades the renal fascia. N0: no lymph node metastasis. Nl: single, unilateral lymph node metastasis, maximum diameter ≤ 2.5cm. N2: multiple local lymph node metastasis, or a single lymph node with a maximum diameter of 2 to 5 cm. N3: The maximum diameter of the locally metastatic lymph nodes is more than 5 cm. M1: Transfer in the distance. Symptoms: The clinical manifestations of renal cell carcinoma vary from typical triads, hematuria, pain, and possible renal masses to more concealed peri-tumor syndrome. Triads often occur in the late stages, and usually only 10% of patients have typical symptoms, most of which are accidentally discovered. The location of the kidney is concealed. When the lesion occurs, most of it is through the change of urine. As a signal to remind the patient to seek medical treatment, hematuria is a common symptom of kidney cancer. However, before the appearance of hematuria, the clinical manifestations of renal cancer vary widely, sometimes the tumor volume. Very large, even signs of metastasis such as lungs and bones, can be without any symptoms. In addition to the three typical symptoms of hematuria, back pain and mass, kidney cancer also has many extra-renal manifestations of non-urinary system, such as fever, abnormal liver function, anemia, hypertension, polycythemia and hypercalcemia. 1. Hematuria Gross hematuria or microscopic hematuria is the most common symptom. Most cases show tumor invasion of the renal pelvis and renal pelvis, which is intermittent, often without pain. Clinically, it is often called intermittent, painless gross hematuria, which is a unique symptom of urinary tumors. However, colic can occur when a blood clot passes through the ureter. 2. Most of the low back pain is dull pain, discomfort, and is limited to the waist or back. Because the tumor envelope grows, the renal capsule tension increases, and if the tumor invades the surrounding tissues of the kidney, it can cause pain. Persistent pain appears, suggesting that the tumor has invaded the nerves and lumbar spine. Hematuria is coagulated into a cord-like blood clot in the ureter and is excreted in the urine, which can cause renal colic. 3. In patients with kidney cancer, the waist and upper abdomen can reach 10% of the mass, sometimes it is the only sign. The mass is hard and the surface is uneven or nodular. When the patient is thin and the tumor is at the lower pole, a physical examination can cause a mass. If the mass is fixed, it indicates that there is infiltration around the kidney and the prognosis is poor. There are not many cases of hematuria, low back pain and lumps triad at the same time, if they occur at the same time. It is often a sign of advanced tumors. The flank pain (abdominal) and the mass are common in children and more common in adults; the tumor located in the lower pole of the kidney is easily accessible. The mass is substantial, no tenderness, and moves with the breath. 4. The varicocele kidney tumor invades the renal vein, or the tumor compresses the internal spermatic vein, which often occurs on the left side. When the inferior vena cava is invaded, it can be accompanied by lower extremity edema. 5. Systemic symptoms of fever is one of the common extrarenal manifestations of kidney cancer, with low fever or high fever, accounting for 45% below 38 °C, accounting for 7% above 38 °C, and a few can be as high as 39 °C. Elevated body temperature is likely to be related to the heat source generated by kidney cancer tissue, and is not directly related to tumor necrosis and hemorrhage. The body temperature returned to normal after renal cancer resection. 2% to 3% of patients with renal cancer show only fever in the clinic. Therefore, the cause of middle-aged and elderly people is unexplained. It is thought that kidney cancer may be possible in order to carry out related examinations. Because kidney cancer is a highly malignant tumor, many patients have obvious cachexia, anemia, hypothermia, loss of appetite and other cachexia manifestations, sometimes with lung and bone metastases, or due to pathological fractures. Patients with large amounts of hematuria can cause anemia. Clinically, some patients with kidney cancer do not have hematuria, but there is obvious anemia, indicating that the patient's anemia is related to hematuria. There are other reasons. Some people think that it is related to tumor toxin or the destruction of a large number of kidney tissues affecting hematopoietic function. About 15% of renal clear cell carcinomas have reversible liver dysfunction, and liver function returns to normal after renal cancer resection. Therefore, liver dysfunction is not a contraindication for renal cancer surgery. The indicators of abnormal liver function include increased serum alkaline phosphatase activity, delayed bromine sulfonium excretion, decreased plasma albumin, prolonged prothrombin time, elevated indirect bilirubin, and abnormal globulin. The liver function of most patients recovers after renal cancer resection. If the liver function persists abnormally, it indicates that there are residual foci or metastases in the body. These patients have poor prognosis. 6. Symptoms of endocrine disorders Read more...
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