Renal clear cell carcinoma
Renal parenchymal carcinoma is an adenocarcinoma derived from renal tubular epithelial cells. 85% of them are clear cell carcinoma, and some of them are granular cell carcinoma and mixed cell carcinoma. There is often hemorrhage, necrosis, cystic changes and calcification in the carcinoma. They are born in the renal parenchyma and grow up to infiltrate, compress and destroy the renal pelvis and calyces, and develop outside the renal envelope to form angioma plugs or metastasize to lymph nodes and other organs.
In terms of pathology, Western medicine usually classifies kidney cancer into 4 types: clear cell kidney cancer, granular cell kidney cancer, mixed cell kidney cancer, and undifferentiated cell kidney cancer. Among them, most of them are renal clear cell carcinoma, accounting for 70%~80% of kidney cancer. The cancer cells are often arranged into sheets, strips, vesicles or tubes, much like renal tubules.
In early stage, it is often asymptomatic or only has systemic symptoms such as fever and fatigue, and is only discovered when the tumor increases in size. The main clinical manifestations are hematuria, pain in the kidney area and masses.
1.Urography:It can show the distortion, twisting and thinning of renal calyces, destruction of calyces, or expansion and deformation of calyces. When the tumor is extremely large and grows in all directions, most of the calyces are elongated, thinned and deformed, and sometimes they enter the renal pelvis, or push the upper ureter to the opposite side, or even exceed the midline, the shape of which resembles a spider’s foot, so it is called “spider’s foot sign”.
2.B-ultrasound manifestation: It can show a solid mass with uneven border echogenicity and uneven internal echogenicity in the kidney parenchyma. The whole kidney shape is deformed, and there is a local mass protruding beyond the normal field outline.
3.CT manifestation: The plain scan shows localized elevation of kidney with uneven and low internal density, and patches or small dots of calcification can be seen within it, sometimes in the shape of eggshell; the enhancement of normal part of kidney is obvious after enhancement scan, while the enhancement of cancer is low, the internal enhancement degree is irregular, and there are necrotic areas with lower density. The cancer can penetrate the perinephric fat layer and spread to extra-renal tissues in advanced stage by penetrating the renal fascia. Robson’s staging method is mostly used for staging renal cell carcinoma, that is, stage I carcinoma is confined to the perirenal membrane; stage II carcinoma has penetrated the perirenal membrane and invaded the fatty layer, but still confined to the renal fascia; stage III carcinoma has invaded the renal vein or (and) inferior vena cava, and local lymph nodes may have metastasis; stage IV carcinoma has penetrated the renal fascia and invaded the neighboring organs or distant metastasis.
4.MRI performance: It is slightly better than CT in understanding the scope of tumor invasion by multi-position observation.
Although clear cell carcinoma is the least malignant among kidney cancers, it is often mixed with granular cell carcinoma and spindle cell carcinoma in clinical practice, so microscopic grading is actually very difficult.
1. It is generally treated by radical kidney surgery. The metastasis rate of kidney cancer through blood transport is high, and about 60% of patients have metastasis possibility. The frequency of metastatic organs in order are: lung (52%), bone (40%), liver (23%), distant lymph nodes (23%), renal vein (22%), adrenal gland (20%), contralateral kidney (18%), pleura (10%), central nervous system (8%), pancreas (7%), etc. Therefore, close attention should be paid to the above-mentioned tissues and organs (e.g., finding hemiplegia, sciatica, back pain, swollen lymph nodes in the neck, frequent coughing, pain in the liver area, abnormal liver function, etc. generally indicates metastasis). If no new metastatic lesions are found to appear within two years, it is basically safe.
2.Immunotherapy: immunotherapy and chemotherapy can be used to prolong the life of patients. Interferon, IL-2, BCG and other drugs are commonly used. Interferon therapy has positive significance and should be accepted as long as economic conditions allow. Other nutrition and care are the same as general post-operative oncology patients, with no special requirements. Considering that the patient has only one kidney, attention should be paid to avoid all factors that increase the burden on the kidney such as cold and fever, alcohol consumption, strenuous exercise, exertion, nephrotoxic drugs (cold medicine, painkillers, diuretics, etc.).
3.Post-surgery treatment
a.Interleukin 2 (1-2 million units)/5 days, stop two days after every five days of zapping.
b, interferon / once every three days. For the first two years after surgery, the above treatment twice a year. Once a year after two years.
Chinese medicine
Traditional Chinese medicine, as the traditional medicine of China, is one of the important methods for the treatment of renal clear cell carcinoma, which can be used throughout the whole process of treatment of renal clear cell carcinoma. TCM treatment of renal clear cell carcinoma can consider the characteristics of the whole body of the patient from a holistic concept, instead of just limiting to the lesion itself, effectively combining the overall treatment with local treatment. In the treatment of renal clear cell carcinoma, TCM believes that we cannot blindly pursue the visual elimination of tumor and maximize the killing of tumor cells, because while killing the cancer cells, the normal cells of human body will be damaged and patients will have various adverse reactions and symptoms. The kidney is a very important organ in human life and should be protected as much as possible. Overly aggressive treatment will cause great harm to the body and even lead to the spread and metastasis of cancer cells, thus endangering life. In the treatment of renal clear cell carcinoma, while suppressing and killing cancer cells, TCM treatment can support the vital energy, improve the immunity, protect the normal functions of the body and improve the clinical symptoms of patients.
According to the various clinical manifestations of renal clear cell carcinoma, with reference to the identification of blood in urine, back pain and accumulation of symptoms, renal clear cell carcinoma is divided into 7 types.
1.Spleen and kidney deficiency type
Symptoms: back pain, abdominal distension, blood in urine or lump in waist and abdomen, poor appetite, nausea, vomiting, emaciation, weakness and anemia, pale tongue, thin white tongue coating, sunken and weak pulse.
Treatment: Strengthen the spleen and kidney, soften the hardness and disperse the knots.
2.Weak kidney yin type
Symptoms: short, red urine with blood, hot flashes and night sweats, dry mouth and dry throat, soreness and weakness of the waist and knees, lumbago and abdominal mass, red tongue, fine pulse.
Treatment: Nourishing Yin, clearing heat and cooling the blood.
3.Dampness and heat in the kidney type
Symptoms: lumbago, swelling and discomfort, blood in urine, low fever, drowsiness, poor diet, abdominal masses in the waist, white and yellow tongue coating, fat tongue, smooth pulse.
Treatment: Clearing heat and dampness, detoxifying and resolving blood stasis.
4.Blood stasis internal obstruction type
Symptoms: dull complexion, frequent occurrence of hematuria, dull pain in the lumbar region, increasing swelling in the lumbar and abdominal masses, discomfort in the kidney region, dry mouth and tongue, purple dull tongue or petechiae, thin yellow tongue coating, stringent or astringent pulse or knotted pulse.
Treatment: Promote blood circulation, resolve blood stasis, regulate qi and disperse nodules.
5.Heart fire hyperactivity type
Symptoms: hot red urine with blood, light burning sensation when urinating, disturbed heart and thirst, sore mouth and tongue, restless sleep at night, swollen back pain, red tongue, large and strong pulse.
Treatment: Clearing the heart and draining fire, cooling the blood and stopping bleeding
6.Cancerous toxin running away, Qi and blood deficiency type
Symptoms: advanced disease, distant metastasis, fatigue, sweating, night sweats, dull complexion, hematuria, lumbar pain and abdominal distension, anemia and emaciation, shortness of breath, sometimes cough with low fever, dry mouth, red or deep red tongue, dull purple with petechiae, weak pulse or large and numbered pulse.
Treatment: Double tonification of qi and blood, support and suppress cancer.
7.Cancer attacked, residual poison not yet cleared
Symptoms: After surgery, radiotherapy or chemotherapy, weakness and weakness of the waist and knees, mental weakness, occasional low fever or hematuria, pale face, poor appetite, light red tongue, thin white or white greasy tongue coating, soft and weak pulse or fine count.
Treatment: Benefit the kidneys, strengthen the spleen, and help to dispel evil
With the development of modernization of Chinese medicine, more and more Chinese patent medicines and Chinese injection have been applied in the treatment of renal clear cell carcinoma, which is based on the idea of Chinese medicine to support the righteousness and strengthen the root, dispel the evil and eliminate the tumor.