Kidney cancer is also classified and appropriate treatment should be selected

Experts point out that the incidence of kidney disease is increasing year by year. Currently, kidney cancer accounts for 3% of all malignant tumors, and is increasing at a rate of 2.5% per year. The incidence of kidney cancer is very high in Western countries, and in the United States it is among the top ten tumors in men and women. Let's learn about some knowledge about the classification and treatment of kidney cancer.

1. Classification

Renal cell carcinoma is divided into 4 types: ① clear cell type; ② granular cell type; ③ mixed cell type; ④ undifferentiated cell type.

2. Dissemination and Metastasis

The metastasis of kidney cancer varies greatly. Some tumors are very large but have no metastasis, while some tumors are very small but have distant metastasis. There are three ways of metastasis.

1. Direct spread Direct spread can pass through the renal capsule to the surrounding tissues of the kidney or invade the renal vein and the inferior vena cava. If the renal pelvis is invaded, hematuria may occur clinically. At the same time, renal cancer can also invade the surrounding tissues such as the colon, pancreas, adrenal glands, peritoneum, liver, spleen, etc.

2. Lymphatic metastasis About 15% to 30% of renal cancer metastasizes via the lymphatic pathway. On the left side, it metastasizes to the renal pedicle, preaortic and left lymph nodes, and on the right side, it involves the lymph nodes near the renal hilum, pre-inferior vena cava, and between the aorta and the inferior vena artery. It can also metastasize to the neck, causing cervical lymph node enlargement.

3. Hematogenous metastasis: Cancer invades the renal vein, resulting in the formation of cancer thrombi in the vein, which can metastasize to the lungs, liver, bones, etc. At the same time, the cancer thrombi can extend from the renal vein to the internal spermatic vein (clavicular vein), or the ovary and internal vaginal veins, causing metastasis to the spermatic cord, epididymis, broad ligament of the uterus, vagina, labia, etc. The incidence of cancer cells metastasizing to the renal vein and inferior vena cava is different.

Treatment of Kidney Cancer

Surgical treatment

(1) Radical nephrectomy: It is the most basic treatment for renal cancer. The scope of surgery includes the removal of the diseased kidney, perirenal fat, perirenal fascia, and ipsilateral adrenal gland. The transabdominal approach can provide good exposure.

(2) Regional lymph node dissection: Performing regional lymph node dissection at the same time as radical renal cell carcinoma resection can achieve the following goals: 1. Reduce the local tumor recurrence rate; 2. Help correct clinical staging; 3. Improve survival rate.

(3) Treatment of intracaval tumor thrombus: Most experts believe that caval tumor thrombus surgery is suitable for patients without distant metastasis or regional lymph node infiltration. Patients using this surgery can expect to survive longer.

Renal artery embolization

It refers to the selective percutaneous puncture of the renal artery catheter, the injection of embolic material, and the occlusion of the artery. Main effects: ① After embolization, the tumor undergoes extensive necrosis and shrinks, creating conditions for surgery, reducing intraoperative bleeding, making it easier to separate the tumor and shortening the operation time; ② reducing the spread of tumor cells; ③ For huge tumors that are difficult to remove, embolization can increase the chance of surgical resection; ④ palliative embolization therapy can control and relieve the patient's symptoms; ⑤ activating the host's immune mechanism, etc. Embolization can also be used to treat massive bleeding in renal cancer by selectively embolizing the renal artery, which is a treatment method with minimal damage. Since 80% of the efficacy of embolization therapy is embolization, and renal cancer is not sensitive to chemotherapy, and the side effects of chemotherapy drugs are large, chemotherapy drugs should be used with caution in renal cancer intervention.

Other treatments

(1) Immunotherapy and biological therapy: The most commonly used non-specific immune therapy is BCG. Although it has no direct anti-tumor effect, it can amplify the effects of cellular and antibody immune responses through immune-active cells to enhance the host's anti-tumor ability. The specific immune therapy currently used in clinical practice includes: ① Immune ribonucleic acid (IRNA), which can shrink advanced renal cancer with an effective rate of 22% and few adverse reactions. ② Interferon, through its cytotoxic effect on tumors, inhibits intracellular protein synthesis and thus inhibits the division of tumor cells. Interferon can enhance the activity of natural killer cells and is currently the most effective drug for the treatment of metastatic renal cancer. ③ Interleukin-2 (IL-2) can promote and regulate the immune function of lymphocytes and improve the effect of treating advanced renal cancer.

(2) Hormone therapy: Renal cancer is significantly dependent on hormones. Recent research results suggest that androgen and progesterone receptors are present in normal kidney and renal cancer tissues, as well as experimental observations on the inhibition of tumor growth by progesterone and testosterone, leading to the use of hormones in the treatment of renal cancer. Hormones do have a good effect in alleviating symptoms and prolonging survival in patients with advanced renal cancer, which may be related to hormone receptors. Commonly used hormones include: ① medroxyprogesterone acetate; ② hydroxyprogesterone acetate; ③ testosterone propionate; ④ prednisolone. Hormone therapy has few adverse reactions, and medroxyprogesterone acetate is the preferred drug.

(3) Chemotherapy: The effect of chemotherapy for renal cancer is poor. According to literature reports, commonly used chemotherapy drugs include: VLB, MMC, hydroxyurea (HU), UFT, bleomycin (BLM), doxorubicin (ADM), 5-fluorouracil (5-FU), cyclophosphamide (CTX) and cisplatin (DDP).

(4) Radiotherapy: The therapeutic effect of radiotherapy on renal cell carcinoma is still uncertain. At present, it is mainly used as an adjuvant therapy before and after surgery. It is suitable for: ① Patients with rapid tumor growth in a short period of time and obvious toxic symptoms. Preoperative radiotherapy can reduce the size of the tumor and reduce the spread of cancer cells during surgery; local edema and tumor blood vessels are reduced after radiotherapy, which is helpful for separation and surgical operation. The preoperative radiotherapy dose is 45Gy. ② For cases with stage II and III renal cancer or lesions that have spread to adjacent organs and incomplete tumor resection, postoperative radiotherapy can reduce local recurrence with a dose of 45~50Gy. ③ For advanced renal cancer that cannot be surgically removed, radiotherapy can relieve local pain, hematuria and relieve toxic symptoms.

The above is some knowledge about the classification and treatment of kidney cancer 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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