1.Where are the kidneys located and what are their functions?
The kidneys are located in the waist, commonly known as the “waist”, the specific parts are on both sides of the spine, the upper pole is equivalent to the 11th or 12th thoracic vertebra, the lower pole is equivalent to the 2nd or 3rd lumbar plane. Feel your ribs from behind, the approximate location of the kidneys is at the bottom of your waist where the ribs are at the angle with the spine, this area is prone to kidney rupture and bleeding due to trauma and needs to be protected.
The kidneys are the body’s scavenger by filtering the blood and excreting toxins and elements that are over the limit in the body. Once the kidneys are negligent and toxins are not excreted, we may have swollen eyes or legs, and even affect heart and gastrointestinal functions. In addition, the kidneys also secrete and regulate many hormones, the important ones are erythropoietin, vitamin D, blood pressure adjustment-related hormones. In reality, we often see that patients with bad kidneys often have bad blood pressure, bad bones, and anemia, which may also be accompanied by many other endocrine problems throughout the body.
2.What is kidney cancer?
Generally speaking, we call malignant tumors occurring in kidney as kidney cancer, but there are also some rare tumors that can grow in kidney, such as nephroblastoma, etc. The treatment of these tumors should be different from the kidney cancer in the usual sense. If kidney cancer cells metastasize to other organs through blood and lymph, such as lung, liver, bone, etc., it is also called kidney cancer instead of lung cancer, liver cancer, bone tumor.
3.How to detect kidney cancer as early as possible?
Early diagnosis and early treatment are the key to determine the treatment effect and prognosis of kidney cancer. The common symptoms of kidney cancer patients are the triad of kidney cancer (hematuria, mass and pain), but they will appear only when the tumor grows very large. Localized kidney cancer usually does not have any symptoms or signs. Usually detected by health checkup or imaging for other reasons, thus there are more and more cases of limited small kidney cancer without any symptoms, and fewer and fewer kidney cancer patients with symptoms or signs, especially those with the classic triad of hematuria, pain and masses are rare. It was found that 62.7% of the patients did not have any clinical manifestations and were diagnosed with kidney cancer after abdominal imaging (ultrasound or CT/MRI) due to health checkup or other diseases. Only 37.3% of patients sought medical attention for symptoms or signs to diagnose kidney cancer. Among these patients with clinical manifestations, back pain was the most common (60.5%), followed by hematuria (45.6%), hypertension (12.7%), anemia (12.8%), wasting (11.8%), abnormal kidney function (9.1%), abnormal liver function (7.5%), swelling (7.0%), fever ( 5.5%), abnormal platelet count (5.1%), others (21.7%), and almost no patients with both pain, hematuria and masses classic clinical manifestations of kidney cancer.
Therefore, routine physical examination is very important for early detection of kidney cancer, and ultrasound examination of both kidneys should be performed at least once a year. And for people in the age of 40-60 years old, who have high incidence of kidney cancer, they should pay more attention to routine ultrasound checkup.
4.When kidney cancer is suspected, what tests should be done in hospital?
General examination.
Urine routine can clarify whether there is hematuria, blood routine can clarify whether there is anemia, in addition, blood biochemistry can be checked to clarify the kidney function and blood calcium (bone metastasis or paraneoplastic syndrome).
Imaging examinations.
(1) Ultrasound scan: Ultrasound is the easiest and non-invasive examination method, and can be used as part of routine physical examination. A mass in the kidney over 1 cm can be scanned by ultrasound, which is more sensitive and can identify the nature of the mass. Ultrasound-guided puncture is safer, and the punctured tissue can be examined cytologically and pathologically to diagnose malignant tumor.
(2) CT scan is the most reliable imaging method to diagnose kidney cancer as its accuracy of localization can reach over 90%, and it can show the extent of lesion and whether adjacent organs are involved. It is the most reliable imaging method to diagnose kidney cancer. Usually, CT examination can be used to diagnose kidney cancer if it is suspected by ultrasound.
(3) The sensitivity and accuracy of MRI scan for kidney cancer diagnosis are similar to CT, but it is better than CT in showing vascular involvement, surrounding organ involvement (which may affect the surgical approach) and differentiation from benign tumor or cystic occupancy, etc. The specific situation is decided by clinicians.
Pathological diagnosis.
Pathological diagnosis is the “gold standard” of kidney cancer diagnosis and the only basis for treatment, which is essential. It is obtained through surgery or puncture biopsy.
5.What factors can cause kidney cancer?
The specific causes of kidney cancer are not well understood, but the current research confirms that many factors are involved.
(1) Hereditary kidney cancer
What is clear now is that only a small number of kidney cancers are hereditary, and these patients are found to have abnormal chromosomal examination, which is called familial kidney cancer, but these hereditary kidney cancers, unlike other kidney cancers, are mostly multiple and may combine with lesions of pancreas, liver, skull and brain, fundus and other parts of the eye, and both kidneys have cancer, unlike general kidney cancer which usually starts in one kidney. The number of people with kidney cancer caused by this kind of heredity is relatively small, and most of them have kidney cancer among their fathers or siblings.
(2) Related to smoking
Numerous studies have found that smoking is associated with the development of kidney cancer. Compared with non-smokers, the risk of kidney cancer is twice as high in smokers, and the risk of kidney cancer is higher in long-term smokers, especially those who have smoked for more than 30 years and those who smoke filterless cigarettes.
(3) Obesity and high blood pressure
Some research studies have found that the risk of kidney cancer is two times higher in obese people than in people with normal weight. The specific reason is unclear, and some people think that obesity may lead to the elevation of some hormones, thus leading to kidney cancer. A study published by a world medical authority 10 years ago showed that obesity and hypertension are two independent factors related to the increased risk of kidney cancer in men.
(4) Occupation
There are reports of increased risk of kidney cancer and death among workers exposed to metal stores, newspaper printers, coke workers, dry cleaners and petrochemicals workers.
(5) Radiation
There are statistics that 26 out of 124 cases of tumors caused by the use of a weak alpha particle radiation source were confined to the kidney, but no association between radiation exposure and kidney cancer has been reported in radiation workers and atomic bombing victims.
(6) Food and drugs
It was found that high intake of dairy products, animal protein and fat, and low intake of fruits and vegetables are risk factors for kidney cancer. Coffee may increase the risk of kidney cancer independent of the amount of coffee used. It has been proved in animal experiments that female hormones (estrogen) cause kidney cancer, although there is no direct evidence in humans yet, but it is still a factor that cannot be ignored. In addition, the abuse of antipyretic and analgesic drugs, which are commonly used by the people to reduce fever as well as painkillers, can increase the risk of kidney Meng cancer. Diuretics may also be a factor to promote the occurrence of kidney cancer.
6.Are other diseases of kidney related to kidney cancer?
The cause of renal cell carcinoma is still unclear. There are many etiological hypotheses, mainly chromosomal abnormalities and mutations of oncogenes, as well as environmental and occupational exposures, but other diseases of kidney and kidney cancer have not been found to be related.
7.How to prevent kidney cancer and what are the foods that can prevent kidney cancer?
Although it is not clear what factors can lead to kidney cancer, some of the above mentioned reasons should be avoided as much as possible, so in order to prevent kidney cancer, the following aspects should be done: firstly, you should quit smoking, avoid radiation, use hormones carefully, workers engaged in petroleum, coke and other industries should strengthen protection and reduce the exposure to chemical carcinogenic substances, which is a measure that cannot be ignored to prevent this disease; secondly, develop Secondly, to develop good living habits and not to consume moldy, rotten and pickled food. It is advisable to use a light diet and eat fish, eggs and a small amount of lean animal meat appropriately. Strengthen physical exercise, control body weight and try to keep body weight in ideal condition; in addition, we should strengthen cancer prevention publicity and popularize cancer prevention knowledge.
Many people are concerned about whether there are foods that can prevent kidney cancer, and studies have been conducted abroad in this regard. Another study suggests that drinking coffee and tea may reduce the risk of kidney cancer, and although this is not directly proven to prevent kidney cancer, there may be potential benefits. Researchers point out that coffee and tea have many benefits, such as they enhance the body’s sensitivity to insulin and improve kidney function; over time, insulin levels may then affect the risk of kidney cancer. Also, coffee and tea contain antioxidant compounds that protect kidney cells from cancer damage.
8.How to differentially diagnose benign and malignant lesions of the kidney?
In recent years, due to the widespread use of ultrasound and CT in asymptomatic people, the proportion of small kidney tumors detected has been increasing, and consequently the chance of detecting benign kidney tumors has also increased. In addition, approximately 10% of tumors suspected to be kidney cancer are eventually confirmed to be benign. The two most common types of benign renal tumors are simple renal cysts and vascular smooth muscle lipomas, both of which have characteristic imaging manifestations and are relatively easy to diagnose. Renal cancer ultrasound examination is mostly echogenic and generally hypoechoic. Cysts are more uniform, while renal vascular smooth muscle lipoma is a solid tumor in kidney, and its ultrasound manifests as strong echogenicity of fatty tissue. if ultrasound is doubtful, usually CT examination of kidney can basically confirm the diagnosis; if CT is still difficult to differentiate, puncture can be performed, and it is safer to perform puncture under ultrasound guidance.
9.Can kidney cancer be contagious or hereditary?
Except for a small number of patients who are diagnosed as hereditary kidney cancer, all other kidney cancers are disseminated and have no special relationship with heredity, therefore, they will not be passed on to children. And kidney cancer will not be contagious, even if family members live together or have meals with relatives or friends, there will be no contagion.
10.How to confirm the diagnosis of kidney cancer and what other tests are needed after the diagnosis of kidney cancer?
At present, kidney cancer can be basically diagnosed by ultrasound or CT. Usually, if kidney cancer is considered by imaging examination, it can be removed surgically and pathological examination will be performed after surgery to confirm the diagnosis. Only for a small number of patients who cannot be operated, a puncture biopsy will be considered to confirm the diagnosis.
After the diagnosis of kidney cancer is clear, the next step is to see if it can be operated. The examination includes some routine tests before surgery, such as blood and urine bar routine, biochemistry, blood type, sensory screening, electrocardiogram, pulmonary function and so on. It should be emphasized that because kidney cancer is prone to lung metastasis, in addition to CT examination of abdominopelvic cavity, CT examination of lung is very important to clarify the stage and make the final treatment plan.
11.How is kidney cancer classified and does each type of kidney cancer have the same prognosis?
The classification of kidney cancer is based on pathological histology. Clear cell carcinoma is the most common pathological type, accounting for about 80-90% of the cases, and there are other relatively rare pathological types such as papillary renal cell carcinoma, suspicious cell carcinoma, collecting duct carcinoma and unclassified renal cell carcinoma. Among them, collecting ductal carcinoma has poor treatment response and poor prognosis compared with other pathological types.
12.How to stage kidney cancer?
Staging has certain clinical significance in formulating treatment plan and judging prognosis. The common staging method is to determine the TNM stage based on the size of tumor, the number of lymph nodes involved and the presence or absence of metastasis, combined with surgery and pathological examination. Stage I to stage III tumors are confined to the kidney and surrounding areas, and treatment is mainly surgical. For stage IV tumor with distant metastasis, treatment should be mainly based on internal medicine.
13.How should I choose the treatment plan after the diagnosis of kidney cancer?
If the doctor considers kidney cancer, first of all, systemic examination should be conducted to clarify whether there is metastasis from other parts, if there is distant metastasis, the prognosis is poor, if there is no distant metastasis, the prognosis should be relatively good.
The treatment of early stage kidney cancer is mainly surgical resection. The 5-year survival rate after surgery reaches over 90%, and some patients can even be cured. Regular review after surgery is not necessary for further treatment. As for patients with distant metastases in primary treatment, if they can tolerate surgery, surgery of primary renal lesions is still the first choice of treatment, and targeted therapy is carried out for metastatic lesions after surgery.
14.Do I still need treatment after kidney cancer surgery?
However, there is no treatment to prevent recurrence and metastasis. Neither interferon, interleukin-2 nor biological therapy can be proven to control recurrence and metastasis, therefore, the most important treatment for post-operative patients is regular review.
15.What is targeted therapy and what kinds of targeted therapy are available for kidney cancer?
Targeted therapy mainly targets certain key targets in the tumor cell growth pathway or tumor angiogenesis process to kill tumor cells by specific blockade. It is more tumor-specific than traditional chemotherapy drugs. Currently, the targeted therapies for advanced kidney cancer include: sunitinib, sorafenib, bevacizumab, everolimus, axitinib, pazopanib, and tesilimus. The last 3 drugs are not yet available in China. The specific drug selection should be chosen by clinicians according to the patient’s condition.
16.What matters need to be noted during the treatment of kidney cancer and how to cooperate with doctors to complete the treatment successfully?
After all the examinations are finished, the doctor will decide whether to start the treatment, what treatment plan and the approximate treatment plan according to the condition. At this time, the communication between the doctor in charge and the patient and family members is very important. Both parties need to talk about the condition frankly, especially for patients with advanced kidney cancer, when to operate, how to carry out targeted therapy after surgery, the selection of targeted drugs, cost, efficiency, possible adverse reactions, how to deal with adverse reactions, future recurrence rate, possible treatment principles after recurrence, etc.
Due to the differences between individual patients, the efficacy and adverse reactions vary, and preventive treatment of various common adverse reactions, such as skin reactions in hands and feet, hypertension and other drugs, should be routinely done during the treatment. Even so, some adverse reactions cannot be completely avoided, such as bone marrow function suppression, hair loss, gastrointestinal reactions, liver and kidney function damage, etc., but the degree of occurrence and the focus of these reactions are different, so for safety, any abnormalities should be reported to the doctor in charge and the doctor on duty in a timely manner, and regular follow-ups should be conducted as required. For advanced kidney cancer, whether it is effective or not is mainly related to the individual differences of patients. Some patients naturally carry certain drug resistance genes and are born resistant to certain drugs, therefore, an examination to evaluate the efficacy of treatment should be conducted after 2-3 cycles. The purpose of efficacy assessment is to evaluate the effectiveness of the treatment regimen, and if the desired effect is not achieved, it may be necessary to increase the dose or change the new treatment regimen.