Do you know how kidney cancer should be treated?

The treatment of kidney cancer is mainly surgical resection. The effects of radiotherapy, chemotherapy, and immunotherapy are not ideal and are not certain. Statistics show that radiotherapy combined with kidney cancer has no effect on 5-year survival. Let's learn about the knowledge of kidney cancer treatment.

1. Kidney cancer surgery is divided into simple nephrectomy and radical nephrectomy. It is currently recognized that radical nephrectomy can improve the survival rate. Radical nephrectomy includes the perinephric fascia and its contents: perinephric fat, kidney and adrenal gland. There is still controversy about whether to perform local lymph node dissection in radical nephrectomy. Some believe that lymph node metastasis often has hematogenous metastasis, and cases with lymph node metastasis will eventually have hematogenous metastasis. The lymph nodes are widely distributed and difficult to clear. However, some people believe that lymph node metastasis is mainly near the renal hilum; the inferior vena cava and aorta area can be radically removed, but radical lymph node dissection surgery finds that metastatic lesions rarely survive for more than 5 years. Kidney cancer is a multi-vascular tumor, often with large collateral veins, and surgery is prone to bleeding and difficult to control. Therefore, in the case of surgery for larger tumors, selective renal artery embolization can be performed before surgery, which can cause severe pain, fever, intestinal paralysis, infection, etc., and should not be used routinely.

Special Issues in the Treatment of Kidney Cancer:

(1) Kidney cancer surgery that preserves kidney tissue: Kidney cancer surgery that preserves kidney tissue can be considered for cases such as bilateral renal cancer or solitary kidney cancer, as well as poor function of the contralateral kidney, such as high renal vascularity (≥3cm in diameter) and located at the edge of the kidney. The surgical method is partial nephrectomy, and the tumor can also be removed by puncturing.

(2) Tumor thrombus in the inferior vena cava: Renal cancer is prone to tumor thrombus in the renal vein and inferior vena cava. In recent years, it is believed that if no local or distant metastasis is found, the tumor thrombus in the vein or the inferior vena cava can be removed at the same time during radical renal resection, and the prognosis is still good. During surgery, the inferior vena cava should be blocked above the level of the thrombus to avoid fatal pulmonary embolism. If the thrombus extends to the heart, the inferior vena cava can be blocked in the pericardium, and then the inferior vena cava can be cut open to remove the thrombus.

(3) Local spread of renal cancer and invasion of adjacent tissues and organs: This is a difficult problem in the treatment of renal cancer. Complete surgical removal of the tumor and its affected tissues is the only cure, and the 5-year survival rate of such patients is only 5%. Local spread of renal cancer may be accompanied by pain because the tumor invades the posterior abdominal wall, sacrospinal muscles and nerve roots. Direct infiltration of the liver by renal cancer is relatively rare, and intrahepatic metastasis is more common than direct infiltration. Involvement of the duodenum and pancreas is almost impossible to cure. Although there is distant metastasis, as long as surgery is possible, the primary kidney can still be removed in most cases, and the metastatic lesions may still have a fairly long survival rate. After the diseased kidney is removed, hematuria and pain are also eliminated, which is still worthwhile.

2. Immunotherapy: It has been proven for many years that lymphocytes in solid tumors of the human body have an immune response to their tumor cells, but the cytotoxic effect of such tumor-infiltrating lymphocytes (TIL) on autologous tumors is often low because there is an inhibitory mechanism in the tumor. Such TIL cells need to be stimulated and expanded in vitro to fully exert their cytotoxic effect on autologous tumors. Normal human lymphocytes and interleukin 2 (IL-2) culture can produce effector cells called lymphokine-activated killer cells, or LAK cells.

Tumor infiltrating lymphocytes, or TIL cells, can also be expanded in vitro with IL-2. Animal experiments have found that this adoptive transfer of TIL has a therapeutic effect 50 to 100 times stronger than LAK cells and can destroy its lung and liver metastases. The possibility of its clinical application is still under discussion.

3. Chemotherapy: The chemotherapy effect of renal cancer is not good, and the effect of single drug treatment is even worse. Experts have counted 37 chemotherapy drugs for single drug treatment of renal cancer, among which alkylating agents have the best effect. The combination with better efficacy in combined chemotherapy is: vinblastine + methotrexate + bleomycin + tamoxifem testis; vincristine + doxorubicin + BCG + methylacetaldehyde oxyprogesterone; vinblastine + doxorubicin + hydroxyurea + MA. In short, multi-drug treatment is better than single drug.

4. Combination of immunotherapy and chemotherapy: A group of 957 patients with renal cell carcinoma metastasis ± renal cell carcinoma recurrence were treated with interferon ALPHA-2A. The efficacy was 12% when used alone, and 24% when combined with vinblastine. The survival rate of effective patients was 50% to 70% in 2 years, and that of ineffective patients was 10% to 15%. The ideal dose was 1.8 million units of interferon injected subcutaneously or intramuscularly 3 times a week, and 0.1 mg/kg of vinblastine injected intravenously once every 3 weeks.

The above is some knowledge about kidney cancer treatment that we have prepared for you today. We hope it will be helpful to you. If you have any other needs, you can also consult our online consulting experts. We are always here to answer your questions.

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