Carcinoma of kidney, also known as renal cell carcinoma and renal adenocarcinoma, originates from renal tubular epithelial cells and can occur in any part of the kidney parenchyma, but it is more common in the upper and lower parts of the kidney, with a few invading the whole kidney; it has equal chance to develop in the left and right kidney, and bilateral lesions account for 1%-2%. No matter the size of kidney cancer, about 80% of patients may not have any symptom in early stage, and only when they are examined by census or other reasons or ultrasound examination, they are found to have occupying lesions in kidney or abdominal masses are touched. Some patients with small primary cancer foci in the kidney and no urinary tract or intrarenal symptoms may first show symptoms of distant metastatic cancer. For example, if patients are found to have lumps under the armpit or abdomen, they are only found to be kidney cancer in order to find the primary lesion. Therefore, it is very important to understand the symptoms of kidney cancer in time. Kidney cancer symptoms are mainly as follows: 1. abdominal mass: about 20 of kidney cancer patients have abdominal masses, which are more likely to appear in long and thin body types, located under the rib cage of upper abdomen and can move up and down with breathing movement. What the examiner touches may be the tumor itself or the lower pole of kidney pushed by the tumor. If the mass is fixed, it means the tumor has invaded the organ structures around the kidney. It is difficult to remove the tumor in such patients and the prognosis is poor. 2.Hematuria: The kidney is connected with the outside world through urine, so hematuria is one of the most common clinical symptoms of renal cell carcinoma, which is caused by the tumor invading the mucous membrane of renal mons or renal calyces. About 40-60 patients will have different degrees of hematuria, which is usually intermittent and painless throughout the whole process, and sometimes there are streaks of blood clots, which is the ureteral tube type. When the blood clot blocks the ureter, it may cause renal colic. 3.Pain: The pain caused by kidney cancer mostly occurs in the lumbar region and is dull in nature, with an incidence of about 20, which is caused not only by the tumor growth stretching the kidney peritoneum, but also by the tumor invading the surrounding organs or lumbar muscles, the latter pain is often more severe and long-lasting. The latter kind of pain is often severe and long-lasting. Renal colic can occur when the hematuria is severe enough to form blood clots and cause ureteral obstruction. 4.Extra-renal manifestations: Besides being an important metabolic organ, kidney is also an endocrine organ, which can synthesize and secrete prostaglandin E1, 25D dihydroxyvitamin D3, renin and erythropoietin under normal condition, but kidney cancer can secrete much higher than normal levels of these hormones, as well as parathyroid-like factor, hyperglycemia, chorionic gonadotropin and insulin. These symptoms, except hypercalcemia, are difficult to be eliminated by conventional treatment, however, after removal of the primary focus, most of the indexes can be restored to normal. (1) Rapid hematocrit: The cause of rapid hematocrit in kidney cancer patients is not clear, and the incidence is about 50. In a retrospective study conducted by the University of Oslo in Norway on 236 patients with kidney cancer, it was found that 70.3 of the patients showed rapid hematocrit even 6 years before they were diagnosed with kidney cancer. (2) Fever: It is also more common in patients with kidney cancer, with an incidence of about 20. Recent studies have found that 25 of the primary tumors can ectopically secrete interleukin-6, and this ectopic secretion of interleukin-6 may be associated with fever. (3) Hypertension: About 20 of kidney cancer patients have hypertension, but recent epidemiological investigations have shown that hypertension and drugs used to treat hypertension are associated with the development of bone cancer; therefore, hypertension can be determined to be caused by kidney cancer only when it returns to normal after removal. Excessive renin secretion, intra-tumor arteriovenous fistula, and tumor compression of renal blood vessels may all be the causes of hypertension. (4) Hypercalcemia: The cause is not very clear, the incidence is about 10. It may be related to the production of a peptide similar to parathyroid hormone-related protein by the tumor. It returns to normal after removal of the tumor and can be re-elevated after tumor metastasis or recurrence. Sometimes hypercalcemia may also be caused by tumor metastasis to bone. (5) Erythrocytosis: the specific cause is unclear, it may be related to direct secretion of erythropoietin by tumor or ischemia of normal renal tissue caused by tumor compression, which stimulates secretion of erythropoietin. (6) Abnormal liver function: It is not caused by tumor metastasis to liver, also known as Staufer syndrome, the patient has leukopenia, fever and local necrosis of liver at the same time. Liver function returns to normal after removal of renal tumor, otherwise metastases are likely to be present. In rare cases, biliary stasis jaundice may also be present. (7) Other: anemia, weight loss, elevated serum alkaline phosphatase, amyloidosis and neuropathy may occur in patients with renal cancer. (5) Varicocele: characterized by not disappearing after lying down position, caused by the obstruction of blood return in the spermatic vein due to aneurysmal thrombus in the renal vein or inferior vena cava. 6. Metastases: Metastases often occur early in kidney cancer and can appear when the primary foci are very small, and the location of metastases is variable and can be seen in almost any part of the body. About 20D35 cases of kidney cancer patients had metastasis when they visited the doctor, and about 6D15 patients came to the doctor because of the symptoms of metastases. In addition to common tumor metastasis sites such as lung, liver, brain and bone, kidney cancer often metastasizes to other rare sites, such as in the lumen of the common bile duct, mediastinum, under the thumbnail, vagina, choroid, external ear canal and orbit. Thus, the possibility of kidney cancer metastasis should be thought of for abnormalities appearing in any part of the body, especially those of unknown origin. 7. Concomitant cancer: Di Silverio et al. have reported 17 cases of primary kidney cancer patients with primary tumors of steroid hormone target organs, including 10 cases of breast cancer, 4 cases of endometrial cancer and 3 cases of ovarian cancer. Although this does not indicate that kidney cancer is hormone-dependent, it somehow suggests that the link between kidney cancer and these tumors is estrogenic. The above is a comprehensive introduction of kidney cancer symptoms, the first three are mainly the early symptoms of kidney cancer, the later ones are the middle and late symptoms of kidney cancer, each patient’s symptoms are different, so the treatment plan is different. Through mobilizing the defense mechanism of human organism, biological therapy can stop the growth of tumor and realize the ‘independent anti-cancer’ of patient’s own organism, which can completely eliminate cancer cells and achieve the goal of eradication. Classification of kidney cancer 1.Common type (clear cell) renal carcinoma is the most common type, accounting for 70%~80% of renal cell carcinoma. Microscopically, the tumor cells are large, round or polygonal, with abundant cytoplasm, transparent or granular, and interstitially rich in capillaries and blood sinuses (Figure 11-23). Most cases of this type are sporadic, while a few are familial and associated with VHL syndrome. The occurrence of this type of kidney cancer is related to VHL gene alteration. Papillary carcinoma accounts for 10%-15% of renal cell carcinoma. It includes two types: basophilic cells and eosinophilic cells. The tumor cells are cubic or dwarf columnar in papillary arrangement. Sand granules and foam cells are commonly found in the interstitial matrix of the papillae, and edema may occur. This type also includes both familial and sporadic. The occurrence of papillary renal carcinoma is not significantly related to VHL. The cytogenetic alterations in sporadic papillary renal carcinoma are mainly trisomy 7, 16 and 17 chromosomes and loss of y chromosome in male patients [t(X,1)], whereas the alterations in familial papillary renal carcinoma are mainly trisomy 7 chromosomes. The occurrence of familial clear cell carcinoma is associated with mutations in the proto-oncogene MET, located on chromosome 7. 3. Chromophobe renal carcinoma accounts for about 5% of renal cell carcinoma. Under the microscope, the cells are of different sizes, with lightly stained or slightly eosinophilic cytoplasm and relatively dense cytoplasm near the cell membrane, and there is often a hollow halo around the nucleus. This type of tumor may originate from the epithelial cells of collecting ducts and has a better prognosis. Cytogenetic examination often shows multiple chromosomal deletions and severe subdiploidy. The chromosomes where deletions occur include chromosomes 1, 2, 6, 10, 13, 17, or 21. Other types of kidney cancer include collecting duct carcinoma and renal cell carcinoma (unclassified). The former is less common, accounting for less than 1% of kidney cancers. The latter includes renal cancer that cannot be classified into the above categories, accounting for about 3% to 5% of renal cell carcinoma. The causes of kidney cancer are unknown, but some data show that its development is related to smoking, antipyretic and analgesic drugs, hormones, viruses, radiation, coffee, cadmium, thorium, etc. Some other occupations such as oil, leather, asbestos and other industrial workers have high prevalence. (i) Smoking: A large number of prospective observations have found that smoking is positively associated with the development of kidney cancer. The relative risk factor (RR) for kidney cancer in smokers = 2, and the risk of kidney cancer increases in people who have smoked for more than 30 years and smoked unfiltered cigarettes. (ii) Obesity and hypertension: A prospective study published in the November 2, 2000 issue of the New England Journal of Medicine showed that high body mass index (BMI) and hypertension were two independent factors associated with an increased risk of kidney cancer in men. (iii) Occupation: Increased risk of kidney cancer incidence and death has been reported in workers exposed to metal stores, newspaper printers, coke workers, dry cleaners, and petrochemicals workers. (iv) Radiation: 26 of 124 cases of tumors confined to the kidney have been reported to have been caused by the use of a weak alpha particle radiation source, but no association between radiation exposure and kidney cancer has been reported in radiation workers and atomic bomb victims. (v) Genetic: There are some intrafamilial renal cancers that are found when chromosomal examination is performed. There is a defect on the third chromosome pair in those with a high incidence of kidney cancer. Most familial renal cancers develop at an early age , tend to be multifocal and bilateral. A rare hereditary disease, hereditary zebular pemphigoid (VHP) disease, occurs in up to 28%-45% of patients. (vi) Food and drugs: The survey 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 independently of the amount of coffee. In animal experiments, kidney cancer has been proven to be caused by female hormones (estrogen), but there is no direct evidence in humans. Abuse of antipyretic and analgesic drugs, especially those containing finasteride, may increase the risk of kidney cancer. Diuretics may also be a factor that promotes the development of kidney cancer. Animal studies have concluded that red vine herb, also known as “Chiken”, may induce kidney cancer, and the Korea Food and Drug Safety Agency has asked domestic companies to stop producing red vine herb as a food additive. (vii) Other diseases: In patients on long-term maintenance hemodialysis, cystic changes (acquired cystic disease) in the atrophied kidneys have increased, and kidney cancer has been found. Therefore, those on dialysis for more than 3 years should have annual ultrasound examinations of the kidneys. Patients with diabetes have been reported to be more likely to develop kidney cancer. Among kidney cancer patients, 14% of them have diabetes, which is 5 times more than normal people with diabetes. Early symptoms of kidney cancer (1) hematuria: It is mostly sudden hematuria with no pain or any discomfort, often intermittent and can stop on its own without being noticed; it is not until it recurs many times that it is examined in hospital; at this time, recurrent attacks indicate that the tumor has invaded the renal pelvis and calyces and is not early. If the first hematuria is taken seriously, early medical treatment can achieve better results. (2) Low back pain: It is the result of tumor enlarging and compressing the peripheral nerve and intramuscular tissue by the peritoneal membrane. Occasionally, it may be blocked by blood clot when discharging through ureter and cause severe colic, which may be mistaken as kidney or ureteral stone and delay the diagnosis and treatment. (3) Lumbar mass: When the tumor tissue grows to a large size and the patient is lying on the side, the mass can be felt in the waist or upper abdomen. If the mass is adhered to the surrounding tissues, fixed and not easily pushed, it is mostly in advanced stage. V. Precautions for kidney cancer prevention 1. Quit smoking, avoid radiation and use hormones carefully. Strengthen the protection against lead compounds. Reducing the exposure to chemical carcinogenic substances is a measure that cannot be ignored to prevent this disease. 2.Actively carry out cancer prevention publicity, popularize cancer prevention knowledge, and achieve early diagnosis and early treatment of kidney tumor, which is the key to determine the treatment effect and prognosis of the disease. 3.Cultivate good hygiene habits and do not consume moldy, rotten and pickled food. It is advisable to use light diet and eat fish, eggs and a small amount of lean animal meat appropriately. 4.Strengthen physical exercise to enhance the ability to resist disease. 5.Keep an optimistic outlook on life, stabilize emotions and improve the quality of life. 6, . Postoperative rehabilitation patients should be reviewed regularly, once every 1 to 3 months, and in good condition once every six months to a year, and adhere to comprehensive treatment.