1.Does kidney cancer always have hematuria? Since the main connection between kidney and the outside world is urine, hematuria is indeed an important common symptom to detect kidney cancer. Early stage kidney cancer tumor is small and can have no symptoms and hematuria. The presence of hematuria indicates that the tumor has invaded the renal pelvis or calyces, and by this time the tumor is often larger. There is another kind of hematuria that cannot be seen by the naked eye, which is only found during microscopic examination in hospital, called microscopic hematuria. It is worth noting that sometimes kidney cancer patients have intermittent hematuria, which can be relieved naturally after a few days, or they may take some drugs to temporarily stop the hematuria, then they often neglect and think that the disease is cured, and do not make detailed examination in time. The tumor will continue to grow and erode the surrounding kidneys during this time. Such patients often have a very poor prognosis and the lessons learned are very painful and profound. Therefore, when patients have unexplained hematuria, regardless of the conditions, they should have a detailed examination by a specialist and should not be paralyzed. Especially in the case of microscopic hematuria that does not improve even with general drug treatment, it is important to pay high attention to it. Kidney tumor should be excluded through ultrasound and CT examination. 2.How should kidney cancer be diagnosed? In recent years, with the development of society, environmental pollution, social pressure and other factors, the incidence of many malignant tumors, including kidney cancer, has increased and the age of incidence has become younger; on the other hand, the progress of modern medical imaging technology has enabled more and more kidney cancers to be detected and diagnosed at an early stage. The case of Mr. Shen is a typical and representative example. As an initial screening tool, ultrasound has outstanding advantages such as sensitive, specific, convenient and inexpensive. When a tumor is found or suspected, the next test is often an enhanced CT scan to clarify the presence or absence of tumor, its location, size, scope, nature and the presence or absence of metastasis. Imaging examination not only provides the most direct diagnostic basis, but also can accurately estimate the tumor stage, which is crucial to the selection of future treatment. If the diagnosis is still not clear after ultrasound and CT examination, magnetic resonance imaging (MRI) and renal angiography can be used to help the diagnosis. At the same time of CT and MRI examination, digital subtraction technology can clearly show the distribution of blood vessels and the relationship with tumor in a non-invasive situation, which can provide valuable basis for the implementation of radical surgery of kidney cancer with preserved kidney units. 3.Can kidney cancer be prevented? The causes of kidney cancer are not very clear at present. There are no effective preventive drugs and foods. Epidemiological studies have confirmed that smoking and obesity are the only two certain risk factors for kidney cancer. Therefore, it is necessary to develop good living habits, quit smoking, exercise properly and avoid obesity. 4.How to detect kidney cancer in early stage? Since kidney cancer patients usually have no symptoms, it is easy to miss or misdiagnose. As the kidney is hidden, kidney cancer mostly has no obvious symptoms in the early stage. Although kidney cancer tends to occur in middle-aged and elderly patients, in actual clinical work, it is not uncommon for young people to have kidney cancer. Clinically, there are quite a number of patients whose kidney cancer is discovered through ultrasound physical examination every year, and they do not have any uncomfortable symptoms at this time, and these kidney cancers discovered through physical examination and screening are often in the early stage of tumor, and timely treatment can achieve a very good prognosis. Therefore, we should pay special attention to the usual health checkups and advocate that people should routinely receive kidney ultrasound examination every year starting from the age of 30. 5.What should I do if I have kidney cancer? So far, surgery is still the most effective and basic method to treat kidney cancer, among which the most commonly used is radical nephrectomy. Even for patients with metastatic kidney cancer, the kidney should be removed to reduce the tumor load and improve the efficacy of other treatments, and biological immune support therapy can be given after surgery according to the actual situation of patients; kidney cancer is not very sensitive to radiotherapy and chemotherapy, so it is generally not recommended as the first line. 6.What is small kidney cancer? Internationally, early stage kidney cancer with diameter less than 4cm is called “small kidney cancer”, like the case reflected by Mr. Shen belongs to the category of “small kidney cancer”. The surgical treatment of small kidney cancer can achieve a high cure rate, and at the same time, “kidney unit preservation surgery” has basically replaced the traditional radical kidney cancer surgery (i.e. removal of the whole kidney on the affected side) as the main surgical treatment for small kidney cancer. Therefore, Mr. Shen’s condition needs to be treated surgically, and the surgical method should be the kidney unit preserving surgery. 7.What is meant by renal unit preserving surgery? Nephron-Sparing Surgery (NSS) is a general term for surgery that preserves the kidney, including partial nephrectomy, wedge nephrectomy and renal tumor enucleation. For example, when we peel an apple, the rotten area is removed along with a small amount of normal tissue around it, while the good flesh is preserved, the principle is similar. 8.What can preserving the kidney bring to the patient? Kidney is an important organ in human body, which plays an important role in urine production, metabolism and red blood cell renewal. Kidney cancer resection with preservation of kidney units can completely remove the tumor lesion while maximizing the preservation of normal kidney function units, which adds a guarantee for the patient’s future healthy life. On the whole, after removing one kidney, the kidney function of the opposite side will be more or less affected. Once the disease occurs in the opposite kidney or is imaged by other systemic diseases, the kidney function may be seriously threatened and many treatments may be restricted and interfered. There are also many less options for treatment. Especially for patients with isolated kidney cancer, double kidney cancer, kidney cancer on one side with severe renal insufficiency, and kidney cancer on one side with contralateral renal failure or patients with chronic kidney disease tendency, it is extremely important to preserve kidney unit surgery, which can provide maximum guarantee for kidney function reserve and effectively avoid and reduce the risk of future renal insufficiency and uremia. 9.Is it possible to preserve kidney for all kidney cancers? Although kidney preservation surgery has many benefits, not every kidney cancer patients can preserve their kidneys. This kind of surgery is generally suitable for kidney tumors less than 4cm in diameter and confined to the edge of the kidney or the upper and lower poles; for kidney cancer patients with isolated kidney tumors that are large and close to the central part of the kidney, if conditions permit, isolated bench surgery can be performed to remove the tumor and then perform autologous kidney transplantation. It should be said that kidney preservation surgery is technically demanding and has very strict surgical indications, and its most important premise is that tumor removal should achieve complete removal of tumor. Therefore, the decision of whether to preserve kidney or not after kidney cancer must be made carefully by experienced surgeons who will integrate all factors and follow up closely after the operation. 10.What is the current success rate of kidney preservation surgery? A large amount of evidence-based medical evidence proves that the success rate of kidney unit preservation surgery for small renal tumors (less than 4 cm in diameter) can be maintained at more than 95%, and its 5-year cancer-related survival rate is basically similar compared to that of traditional radical resection for kidney cancer. At present, the technique of kidney preservation surgery is very mature in some hospitals, which can achieve less intraoperative bleeding and faster postoperative recovery, preserving the reserve function of the kidney and significantly reducing some complications that are difficult to completely avoid after radical nephrectomy such as renal insufficiency and proteinuria. It has significantly improved the quality of life of patients and has replaced a considerable part of radical nephrectomy surgery. 11. Can laparoscopy be used for kidney cancer surgery? In recent years, laparoscopic technology has developed rapidly, and general radical kidney cancer surgery can be completed laparoscopically. The surgical scope, requirements, safety and efficacy of laparoscopic radical kidney cancer treatment are exactly the same as those of open surgical kidney cancer treatment. The advantage of laparoscopic radical kidney cancer treatment is that the surgical incision is slightly smaller than that of open surgery, and the tissue damage of the surgical incision is relatively small. Laparoscopic surgery with preservation of the renal unit can also be performed with relatively high technical requirements, and the main problem is the difficulty in implementing effective local cooling to reduce renal injury due to blood flow control. Some renal cancers are large and even involve renal vessels and vena cava, which are extremely difficult to accomplish laparoscopically and are generally not used. At present, open surgery for large kidney cancer, kidney cancer preserved kidney unit surgery and patients with renal vein and vena cava thrombosis is still the gold standard internationally. 12.What does minimally invasive treatment for kidney cancer mean? Minimally invasive treatment for kidney cancer in the true sense refers to the emergence of various novel and less invasive surgical methods for kidney cancer in recent years, such as cryoablation, radiofrequency ablation, high energy focused ultrasound, intra-tissue irradiation, ethanol injection therapy, etc. Especially, cryoablation and radiofrequency ablation techniques have gained a certain degree of international recognition through clinical application in recent years. These minimally invasive modalities are completely different from open surgery in the general sense. Usually, under the guidance of image monitoring or direct laparoscopic view, the tumor is punctured precisely, and the malignant lesion of the kidney is fully and completely destroyed through the “knife head” of the puncture treatment, so as to achieve the purpose of eradicating the tumor. 13.What should be done when kidney cancer is in advanced stage? Patients with intermediate and advanced kidney cancer that cannot be completely removed by surgery or have metastasis can use interventional therapy to reduce the size of tumor or adopt some medical treatments, such as methoprene, interferon and interleukin-2, but the efficacy response is very limited. The new targeted therapies sunitinib, sorafenib, and mTOR blockers, which have been introduced in the last 2 years, are effective in prolonging progression-free survival (PFS) of the disease. Available studies have shown that a 1-2 month improvement in PFS can improve the overall survival time of patients by 2.5-7.5 months, and can improve the quality of life during survival. Like sunitinib it has now been shown that patients have had half survival times of up to 28 months. Thus, although such drugs are particularly expensive to treat, they are still of great clinical value and relevance.