What Is Stage 4 Kidney Cancer?

Renal cancer is a malignant tumor that originates from the renal parenchymal urinary tubular epithelial system. The academic term is called renal cell carcinoma, also known as renal adenocarcinoma, which is referred to as renal cancer. Includes various renal cell carcinoma subtypes originating from different parts of the urinary tubule, but excludes tumors derived from the renal interstitial and pelvic tumors. As early as 1883, German pathologist Grawitz looked at adenocarcinoma cells under the microscope, and proposed that kidney cancer is the origin of adrenal tissue remaining in the kidney. Therefore, in books before China's reform and opening up, kidney cancer was called Grawitz Tumor or adrenal tumor. It was not until 1960 that Oberling proposed that renal cancer originated from the proximal tubules of the kidney based on the observations of the electron microscope, and this error was corrected.

Basic Information

nickname: Renal adenocarcinoma, renal cell carcinoma
English name: renal carcinoma
Visiting department: Urology
Multiple groups: 50 to 70 years old

Common causes: Unknown, may be related to heredity, smoking, obesity, hypertension, etc.
Common symptoms: Low back pain and hematuria
Contagious: no

Kidney Cancer Epidemiology

Kidney cancer accounts for about 2% to 3% of adult malignant tumors, and 80% to 90% of adult kidney malignant tumors. The incidence rates are different in different countries or regions around the world. Generally speaking, the incidence rate in developed countries is higher than that in developing countries, and in urban areas is higher than in rural areas. There are more men than women. The ratio of male and female patients is about 2: 1. Found in all ages, the age of high incidence of 50 to 70 years. According to statistics from the National Cancer Prevention and Research Office and the Ministry of Health's Health Statistics Information Center, the incidence and mortality of tumors in pilot cities and counties in China show that the incidence of kidney cancer in China is increasing year by year, and by 2008 it has become the 10th most common male cancer in China.

The cause of kidney cancer is unknown. The factors related to the onset of kidney cancer have been clearly related to heredity, smoking, obesity, hypertension and antihypertensive treatment.

Renal cancer clinical manifestations

In recent years, most kidney cancer patients are due to asymptomatic kidney cancer found during health examinations, and these patients account for more than 50% to 60% of the total number of kidney cancer patients. The most common symptoms of symptomatic kidney cancer patients are low back pain and hematuria. A few patients come to the hospital with abdominal masses. 10% to 40% of patients develop paraneoplastic syndrome, manifested as hypertension, anemia, weight loss, cachexia, fever, erythrocytosis, abnormal liver function, hypercalcemia, hyperglycemia, increased erythrocyte sedimentation, neuromuscular disease , Amyloidosis, galactorrhea, abnormal coagulation mechanism and other changes. 20% to 30% of patients can see a bone pain, fracture, cough, hemoptysis and other symptoms caused by tumor metastasis.

Kidney Cancer Diagnosis

Diagnosis of kidney cancer requires laboratory, imaging, and pathological examinations. The purpose of the laboratory test is to evaluate the general conditions of the patient before surgery, liver and kidney function, and prognosis, mainly including urea nitrogen, creatinine, liver function, whole blood cell count, hemoglobin, blood calcium, blood glucose, blood sedimentation, alkaline phosphate Enzymes and lactate dehydrogenases. At present, there are no recognized tumor markers that can be used for clinical diagnosis of kidney cancer. The clinical diagnosis of kidney cancer mainly relies on imaging examination, and the diagnosis requires pathological examination.

Common imaging examination items include: chest X-rays (front and side), abdominal ultrasound, abdominal CT, abdominal MRI, PET or PET-CT tests are rarely used to diagnose renal cancer, and are mostly used for advanced renal cancer Patients should be able to detect distant metastatic lesions or be used to evaluate the efficacy of patients undergoing chemotherapy, molecular targeted therapy or radiotherapy. Those who do not have enhanced CT scans and cannot evaluate the contralateral renal function should undergo radionuclide renal blood flow or intravenous urography. Patients with renal cancer who have one of the following three items should undergo radionuclide bone imaging:

1. Have corresponding bone symptoms.

2. Alkaline phosphatase is high.

3. Clinical stage . A chest CT scan should be performed on patients with renal cancer who have suspicious nodules on the chest radiograph or clinical stage stage III. Patients with renal cancer with headache or corresponding neurological symptoms should also undergo head MRI and CT scans.

Renal biopsy is usually not performed because of the consistency of imaging diagnosis of renal cancer as high as 90% and the limited value of renal biopsy pathological diagnosis of renal cancer. However, for patients with small tumors whose imaging diagnosis is difficult to determine, nephron-sparing surgery or regular follow-up inspections (1 to 3 months) can be selected. For patients who are old or infirm or have contraindications to surgery or advanced kidney cancer that cannot be operated and require energy ablation (such as radiofrequency ablation, cryoablation, etc.) or chemotherapy, a clear diagnosis can be selected before treatment. Biopsy for pathological diagnosis.

Kidney Cancer Treatment

Treatment principle: Surgical treatment is the main treatment method for patients with localized or locally progressive (early or intermediate stage) renal cancer. Comprehensive medical treatment should be used for metastatic renal cancer (advanced).

Surgical treatment of kidney cancer is usually the first choice, and it is currently recognized as a cure for kidney cancer. For patients with early kidney cancer, nephron-sparing surgery (kidney-sparing surgery) or radical nephrectomy can be used. These operations can be performed using laparoscopy or traditional open surgery. Radical nephrectomy is usually used for patients with intermediate and advanced stage renal cancer, and this type of surgery is usually performed with open surgery.

For patients with small and small kidney cancer (tumor diameter 4cm) who are frail or have contraindications to surgery, energy ablation (radiofrequency ablation, cryoablation, high-intensity focused ultrasound) can be used for treatment.

Renal artery embolization through interventional therapy for patients with renal cancer who cannot tolerate surgery can relieve hematuria, which is a palliative treatment.

At present, there is no recommendable adjuvant treatment plan for patients with early and intermediate stage renal cancer to effectively prevent recurrence or metastasis.

Advanced renal cancer should be treated with a combination of medical treatment. Surgical removal of the affected kidney can clarify the type of kidney cancer and reduce tumor burden, and can improve the effectiveness of immunotherapy (such as interferon-) or targeted therapy.

In December 2005, the U.S. FDA approved the recommendation of sorafenib, sunitinib, temsirolimus, bevacizumab in combination with IFN-, everolimus, perazolam, axitinib And eight erlotinib targeting programs are used for first-line or second-line treatment of patients with metastatic kidney cancer.

Renal cancer prognosis and follow-up

The five-year survival rates of patients with stage , , , and renal cancer after treatment can reach 92%, 86%, 64%, and 23%, respectively.

The main purpose of follow-up after treatment is to check for recurrence, metastasis, and new tumors. For patients undergoing nephron-sparing surgery, abdominal CT scans should be performed within 3 months after surgery, so that doctors can grasp the changes of kidney morphology after surgery and can be used for comparison in future review. The follow-up content includes:

1. Medical history inquiry;

Physical examination

3. Blood routine and blood biochemical examinations, such as liver and kidney function and abnormal blood biochemical indicators before the operation;

4. Chest X-ray or chest CT scan;

5. Abdominal ultrasound or CT scan.

The follow-up time of each stage of renal cancer: patients with stage and stage renal cancer will be followed up every 3 to 6 months after surgery for 3 consecutive years, and thereafter every year. Patients with stage and stage renal cancer should be followed up every 3 months for 2 consecutive years, followed by every 6 months in the third year, and every year thereafter.