The majority of kidney tumors are malignant tumors, which we call renal cancer. Its subtype is most common in clear cell carcinoma, which is more common in men than women, about 2 to 4 times more common than women, and more common in patients over 40 years old. There are also a small number of benign malignant tumors. In recent years, kidney tumor patients are gradually getting younger, and with the popularization of medical checkups, the detection is getting earlier and earlier. When kidney tumor is found, how to choose the surgery method? Today I will talk about the related knowledge with you.
Are there any symptoms of kidney tumor? Many patients want to know whether there are any typical symptoms of kidney tumor, so that they can compare the symptoms and detect kidney tumor earlier. Kidney cancer has the classic triad of “hematuria, back pain and abdominal mass”, but these symptoms appear in less than 20% of patients.
1. Hematuria will occur only when the tumor tissues erode into the renal calyces and pelvis. Typically, it is painless carnal hematuria. When this happens, urinary tract tumor should be highly suspected.
2.As the tumor keeps expanding and growing, the kidney envelope will be under certain tension, and then the patient will feel a kind of vague swelling pain in the back.
3.When the tumor is bigger, the hard lump can be felt in the back.
When the above situations occur, it is necessary to go to hospital for detailed examination immediately to exclude the existence of kidney tumor.
How to discover kidney tumor in time? For the early detection of kidney tumor, it is simple and clear to do an abdominal ultrasound. Generally, for kidney tumor of 1cm or above, ultrasound can detect it. When ultrasound once detects an occupying lesion, it is extra important to do a kidney CT, which will diagnose kidney cancer more accurately than ultrasound. Of course, CTA and GFR will follow. CTA can help surgeons to clarify the blood supply of kidney and tumor before surgery, which is a great guidance for intraoperative operation; GFR can evaluate the kidney function of patients before surgery, which is a certain guidance for the preservation or retention of the affected kidney. As shown in Figure 1, it is a case of a kidney tumor operated by us. The tumor is 6 cm in diameter, accounting for one-half of the whole kidney volume, and the location is deep, which makes the operation difficult.
As shown in Figures 6, 7 and 8, some benign renal malformation tumors are even more difficult to operate because they are found late or the patient is afraid of surgery until the tumor bleeds.
Figure 1: Kidney-preserving surgery for 6-cm tumor
Figure 2 and 3: Complete resection of huge tumor
Figure 4 and 5: Renal preservation surgery for dumbbell-shaped hilar tumor resection
Figure 6: Renal preservation surgery for resection of giant misshapen tumor
Figure 7: Renal preservation surgery for resection of endogenous misshapen tumor
Figure 8: Renal preservation surgery for resection of completely endogenous giant mismatched tumor
What are the treatment methods of renal tumor?
For most kidney tumor patients, the most confusing thing is that they have kidney cancer, but they do not know what kind of treatment to choose. At present, for patients with advanced kidney cancer, especially when kidney cancer has metastasis (metastasis of kidney cancer usually occurs in lung, bone, liver, brain and other organs), they have lost the chance of surgery and can only use targeted therapy or biological therapy; for early and middle stage kidney cancer, surgery is the most effective way to achieve the purpose of radical cure. However, many patients are at a loss as to whether to choose radical kidney cancer surgery or partial nephrectomy when faced with the surgery method. (Radical kidney cancer surgery: The whole kidney is cut off to completely remove the tumor and cure the kidney cancer. Partial nephrectomy: It is to remove the whole kidney tumor, that is, to remove a part of the kidney, commonly known as “kidney preservation surgery”.) If you choose to remove the whole kidney, many patients are afraid that the tumor will grow on the opposite kidney in the future, or they are worried that they only have one kidney left and cannot maintain the daily metabolic function of kidney; if you choose partial nephrectomy, you are worried that the tumor will not be cut cleanly and will recur or metastasize in the future.
What are the advantages of “kidney preservation surgery”?
At present, for exophytic kidney tumors less than 4cm in diameter, it is the indication for partial nephrectomy. 4-7cm kidney tumors can also be treated by partial nephrectomy, but it is very difficult, and it is more suitable for tumors that grow on the surface of kidney and are exophytic in growth. According to foreign statistics, the cure rate of kidney tumor less than 7cm using partial nephrectomy has been comparable to radical nephrectomy for kidney cancer, so we urologists should spare no efforts to keep the kidney of patients. In terms of postoperative patient recovery, partial nephrectomy significantly preserves the kidney function of patients. However, for doctors, “kidney preservation surgery” is much more difficult than cutting off the kidney, which requires careful finding of each artery of the kidney, temporary blocking of the artery, removal of the tumor within 30 minutes, and stitching up the kidney layer by layer, if the stitching is too slow and takes more than 45 minutes, the function of the kidney will be affected. If the stitching is too slow and takes more than 45 minutes, the function of the kidney will be greatly damaged. “Kidney surgery” is a landmark and difficult surgery for every urologist, which requires complete removal of the tumor, fast suturing as possible, and minimal bleeding, so that the patient will recover quickly after surgery.
The kidneys are like a human sewage treatment plant, the “root” of the human body. Although theoretically one kidney can maintain the daily human metabolism, the residual kidney after partial excision cannot be ignored to share the work of the opposite kidney and give the opposite kidney a chance to rest. Nowadays, there are more and more patients with chronic diseases such as hypertension and diabetes, and these diseases are the diseases that lead to the deterioration of kidney function, as the saying goes, “if you keep the green hills, you are not afraid of not having wood to burn”, so the significance of partial excision of the kidney is particularly important.
What are the characteristics of minimally invasive treatment for kidney tumor?
Nowadays, most of the partial nephrectomy can be done under laparoscopy, which is less invasive, less bleeding, faster recovery and shorter hospital stay. From a 20 cm incision to only 3-5 cm incision, there is no doubt that it is quite beneficial to the patient’s recovery. During the surgery, the surgeon will remove the tumor completely along the kidney tumor envelope, and then carefully remove the tumor along the channel established by the minimally invasive surgery, without breaking the tumor envelope during the whole process. The tumor is then carefully removed along the channel established by the minimally invasive surgery, without breaking the tumor envelope. Moreover, laparoscopy is now equipped with high-definition camera, which enables the surgical field of view to be enlarged, so that there is no dead angle in the surgical area; now there is also 3D laparoscopy, which more significantly improves the three-dimensional sense of the tiny surgical area, making the operator’s observation of the surgical area more comprehensive and the operation of the surgical area more delicate compared with the previous open surgery. Our department has more than 150 laparoscopic kidney tumor surgeries every year, and we have rich experience in partial nephrectomy of complex kidney tumors, radical treatment of giant kidney tumors and minimally invasive treatment of kidney tumors, and many patients come to us. Many patients who can only have their kidneys removed because of large and deep tumors in local hospitals have been treated with “kidney preservation” in our department.
What are the best ways to prevent kidney cancer?
At present, the causes of kidney cancer are unknown, but a large sample of clinical investigation data shows that
1. kidney cancer is highly correlated with smoking, so we should avoid smoking and reduce exposure to second-hand smoke.
2, environmental pollution is also closely related to kidney cancer, such as frequent exposure to some toxic and harmful chemical pollutants.
3, the incidence of kidney cancer is relatively higher in obese people
4. hypertension is also a predisposing factor of kidney cancer
5, kidney cancer is also related to genetics, such as VHL syndrome and hereditary papillary kidney cancer, so patients with family history of kidney cancer should especially pay attention to regular medical checkups for early prevention.
6. Drinking more water also has a certain preventive effect, keeping the daily urine volume at 1500~2000ml can discharge as much metabolic waste as possible and reduce the accumulation of toxins in the kidneys.
7, usually can eat more fresh fruits and vegetables, can be appropriate to eat some fish, especially deep-sea fish, nowadays some are considered anti-cancer food, such as mushrooms and garlic, etc., also have certain benefits to the body.
8, usually forbidden to eat moldy food, less pickled, smoked, fried and barbecued food.
9. Of course, having a positive and healthy mind and regular aerobic exercise is also important for the prevention of kidney cancer.
Figure 9 and 10: Removal of 3 kidney tumors using intraoperative ultrasound for precise localization