For the diagnosis and treatment of renal cell carcinoma

The natural history of renal cell carcinoma has provided us with the evaluation of patients and phased basis. When an evaluation of hematuria, flank pain or abdominal mass lumbar patients should be asked whether weight loss, fever and discomfort, and other systemic symptoms. The whole strip naked eye with hematuria, blood clots suggested that bleeding occurred in the upper urinary tract. Medical attention should be paid to whether hypertension and supraclavicular lymph node disease, Department or abdominal mass may be accompanied by noise. The right side of varicocele supine have not disappeared suggested that the inferior vena cava tumor thrombus may. Standard laboratory tests should include the whole blood cell counts, and coagulation function of serum chemistry inspection. Have increased in the serum alkaline phosphatase bone pain symptoms or bone scan to be done. The preoperative diagnosis of renal cell carcinoma depends on the results of imaging examination, can provide the most direct diagnosis. At the same time, diagnostic imaging techniques can in most cases to make accurate tumor staging, which after treatment choice is crucial. Under normal circumstances, imaging examination from the beginning ultrasound, intravenous pyelography the diagnostic value of relatively small. CT scanning is the understanding of tumor location, size, scope, nature and the best way to transfer there, as the most reliable tool in the diagnosis of renal cell carcinoma. Smaller tumors generally do not have to do the cavity-clock inspections. Patients with larger tumors should be done the right superior vena cava angiography or MRI, MRI is now commonly used to understand whether the tumor trip involving inferior vena cava and differential diagnosis. There should also be considered when hematuria conducted cystoscopy. Renal artery angiography in the diagnosis of renal cell carcinoma has a role, especially at the same time can be selective or super-selective renal artery embolization is conducive to the conduct of future operations. Needle Road as a result of the transfer may be planted, conducted by Tru-cut needle biopsy of the value of controversy, fine needle aspiration cytology biopsy technology to significantly reduce the cultivation of the possible. 1. X-ray: X-ray and urography in the diagnosis of renal cell carcinoma of little value, especially plain film of limited effect. (1) plain film: the larger kidney renal cell carcinoma can show that the prominent profile localized renal outer edge can be a nodular. About 5-10 of renal cell carcinoma can show that the calcification, the density of calcified often lower, a sustained fine point, and occasionally the arc. (2) intravenous urography: Urography see kidney tumors depend on the size, location and extent of violations of the pool system. When tumors are smaller and limited to the substance, urography can be displayed no abnormal changes. Along with the development of lesions, tumors and oppression will be the first passage of urine collection system, causing pyelonephritis and renal calyceal deformation, a narrow, elongated, truncation, occlusion or translocation. When the tumor has just begun violations pool system, will enable pelvis, renal calyceal the irregular contours, coarse. When long into the renal pelvis cancer, renal calyceal, can be a filling defect. The diffuse infiltrative tumor growth may be showing a polycystic kidney-like changes in the renal pelvis, renal calyceal of irregular shape, but also caused suffering from kidney function loss, angiography without contrast, the video only showed renal anomalies increased. Huge tumor can cause renal axis deviation, but also oppression goes ureter. When the renal tumor doors or sudden transfer to renal hilar lymph nodes, the Depression normal renal hilum shadow disappeared. (3) retrograde on Urography: The inspection of little help in the diagnosis of renal cell carcinoma, but not intravenous urography image of the kidney can be used with other upper urinary tract lesions were identified. 2. Ultrasound: Ultrasound examination is user-friendly and on subjects not to cause pain and anguish, many units have become regular physical examination one of the main items. A growing number of such asymptomatic renal cell carcinoma that is found. Ultrasound found that the higher the sensitivity of the kidney tumor can be regarded as the preferred method. The Mission renal parenchyma massive Echo Ultrasound diagnosis of renal cell carcinoma is the direct signs. However, we should also note that the B ultrasonic as renal cell carcinoma no specific plans, especially on tumor diameter <2> 2 cm diameter tumor metastasis to the lymph nodes. 4. MRI: MRI in the diagnosis of renal cell carcinoma with the sensitivity and accuracy of CT similar, but show that renal vein or inferior vena cava involvement, violations and the surrounding organs or with benign tumors, such as cystic footprint differential is superior to CT. A typical expression of renal cell carcinoma MRI: (1) round, oval or irregularly shaped tumors can be caused by kidney shape change, greater than 3 cm border often unclear; bolt; (3) tumor signal uneven, T1-weighted images on low signal or signal. 15 have calcification within the tumor, a low signal; (4) tumor necrosis Center District showed long T1 and long T2 values on the T1-weighted images showed low signal on the T2-weighted images showed high signal; surrounding tissues signal uneven; (5) free of internal bleeding in the MHB showed high signal; (6) about 5 renal tumor angiogenesis little structure, envelope, the lower the degree of malignancy and MRI showed only on the uneven signal, no characteristic. (7) in the diagnosis of lymph node enlargement with standard CT. (8) of suspected renal vein or inferior vena cava tumor thrombus in the case, the use of MRI-like facial images can clearly show the scope of tumor thrombus. 5. Renal angiography: Under normal circumstances, renal cell carcinoma is rich in blood supply, when suspected renal cell carcinoma, a angiography can be clearly displayed lesions. In recent years, with the development of imaging technologies, use of selective renal artery digital subtraction method. Renal cell carcinoma arteriography may have the following features: (1) renal artery thickening: Description of tumor blood supply; (2) branch renal artery compression shift: more common in tumors neighboring artery branch, a small number of circumstances surrounding the vascular tumor was - enveloping; (3) artery by tumor erosion: for the performance limitations of thinning, irregular or uneven thickness; (4) tumor angiogenesis: Tumor zone in the most tortuous and irregular thickness uneven distribution of small vascular disorders, such as development of immature neovascularization. The tumor angiogenesis lacunar in the cavernous building on the performance of the film was for the contrast agent pool-shaped lake, or in the distribution aggregation. Sometimes a fine mesh tumor angiogenesis, distribution and morphology are more rules; (5) tumor staining: Contrast this levy is seen at the real phase, when the tumors were high-density areas, the Department of intravascular contrast agent tumor accumulation results; (6) Developing advanced renal vein: As accelerate blood circulation within the tumor or tumor within the arteriovenous fistula, can be see in the arterial phase and the renal vein intrarenal vein trunk image; (7) tumor edge translucent belt: a fake capsule found in the renal cell carcinoma. The real period, fake capsule scarce due to vascular density below shows tumor area, forming a narrow translucent enveloping the tumor with some of the edge. (8) Identification: When the renal artery injection of epinephrine, normal renal vasoconstriction, hamartoma, and other benign vascular within the shrinkage will occur, but within the renal cell carcinoma tumor angiogenesis not contraction. 6. Except metastases: It is reported that renal cell carcinoma patients attending a 20-35 have occurred transfer, and the treatment will be changed accordingly, during radical nephrectomy ago, except to the presence of metastasis. (1) chest X-ray, except for lung metastases. When suspected positive nodules, chest CT should be done to further clarify the diagnosis. (2) except for the liver ultrasound hepatic metastasis. When kidney tumors smaller when the primary tumor is often difficult to determine where the primary, where for the transfer, if necessary, to be done puncture cells or histological examination to clear diagnosis. (3) systemic isotope bone scan when the patient's serum alkaline phosphatase levels increased when, suggesting that there may be broken bone Central, should do isotope bone scan whole body except for bone metastases to. (4) When the brain CT patients had neurological symptoms or signs, to be done except to the brain CT brain metastases.