Diagnosis and treatment of kidney cancer

The history of the natural disease of kidney cancer provideds the evaluation the foundation that the patient and cent expects for us.While evaluating a patient who has blood in urine, lumbago or waist belly lump should inquire to have no weight to descend, have fever, unwell etc. whole body symptom.Hint issue of blood for the naked eye whole distance blood in urine companion to has one-like in shape thrombus occurrence at up wet road.Check-up should notice to have no lymphoid knot pathological changes of high blood pressure and lock bone, waist Xie department or belly pack the piece possible companion contain miscellaneous sound.The right side Jing Suo varix is even to lie don't disappear to hint chamber vein the lump bolts of possibility.The laboratory check of standard should include whole blood the cell count, the Ning blood function measurement and serum bio-chemical learn a check.Need to do a bone to scan a check while having the serum the alkaline phosphoric acid Mao to increase Gao or having the bone the painful symptom.
The before the Shu diagnosing of the kidney cancer depends on the result that the image learns a check, can provide the most direct diagnosis basis.In the meantime, the image diagnosis learns a technique to make under still just majority of circumstances for an accurate tumor cent to expect, this rightness of later of the choice of treatment method is go to close important.Usually under the circumstance, the image learns a check super from the B start, the vein pelvis builds the diagnosis of shadow to be worth of smaller.CT's scanning is the position, size, scope, property that understands tumor and doesn't transfer of had better method, therefore become currently the tool of the most dependable diagnosis kidney cancer.The smaller tumor is general need not have the check concerning chambers vein.If the patient should does while hasing bigger right side tumor the chamber vein builds a shadow or MRI check, now iner common use MRI to understand if the tumor involves in chamber vein and line to discriminate diagnosis.Should also consider to carry on an urine bladder mirror a check while having blood in urine.The kidney artery builds a shadow to have certain function to the diagnosis of the kidney cancer, particularly is carry on selectivity or super selectivity kidney artery to bolt to fill in the meantime and be advantageous to carrying on of later surgical operation.In order to having already resulted in needle way plants to transfer of possible, to carry on with Tru-cut wear the sting lives check of application value existence controversy, but the thin needle cytology lived a developing of check technique to consumedly reduce to plant the possibility for transfering.
1. X line:The X line is even slice of and the urine road build to don't greatly copy the value to the kidney cancer diagnosis, particularly even slice of of the function is limited.
(1)even slice of:The bigger kidney cancer can show the kidney outline part is outstanding, the kidney exterior can present knot stanza-like in shape.About 5-10 kidney cancers can show calcify, the density of calcify is often lower and much present thin point-like in shape, occasionally is an arc-shaped.
(2)vein urine the road build a shadow:Wet the road builds a shadow of the size of being decided by the kidney tumor, part seen and to the degree that gathers system invasion.When the tumor physical volume is smaller and only be limited by substantial inside, wetting road to build a shadow can show that the just like often changes.Along with the development of pathological changes, the tumor will change to gather urine with oppression system first and result in transforming of pelvis, kidney, narrow, make longer, cut off, stop up or move.But when the tumor just started invasion gathering system, can make the outline of pelvis, kidney irregular, hair Cao.After the tumor is long into the pelvis, kidney, can immediately appear the defection and damage of Chong Ying.The tumor that fills the air gradually sex growth can present a many bag kidney kind changes, the appearance of the pelvis, kidney irregular, can also cause the function of suffering from the kidney's losing, don't develop while building shadow, shows kidney shadow of irregular aggrandizement.The huge tumor can result in being partial to of kidney stalk, can also oppress to change urethra.When tumor Tu to hilum of kidney or transfer to hilum of kidney lymph to knot, the normal hollow hilum of kidney copies disappearance.
(3)build a shadow on urine road of treacherous acts:That diagnosis help of check to kidney cancer isn't big, but for vein urine road's building to copy doesn't develop of kidney, can use to carry on with other top urine road pathological changeses to discriminate.
2.Super voice:The B super check is simple to easily go and have become many one of the key items that the units periodically carry on a healthy check-up towards being not resulted in by check painful and wound, now.Having is more and more of have no symptom kidney cancer is so disheveled hair now of.The B is super and discovers kidney of the sensitivity of tumor is higher, can be a check method for choosing.The kidney is substantial inside of the conglomeration-like in shape echo is a directly advertising for of the super voice diagnosis kidney cancer elephant.But should also notice, the B super voice of kidney cancer is like diagram have no particularity, particularly to the tumor diameter<2 cms, or the voice is like chart now not typical model, diagnose a certain difficulty, need to closely combine a clinical and other check a result, carry on comprehensive analysis and judgment.Be like diagram toward the B super voice up, typical model of the kidney cancer can have a following performance:
(1)the change of kidney outline:When tumor to compare with hour, , the kidney outline can have no obvious change.The bigger tumor rises to the kidney surface Tu and makes the kidney outline presented to limit sex aggrandizement, the surface cave convex gravamen.The kidney shape loses normal.Tumor and around organize boundary clearer.But later period kidney cancer to around and extensively and gradually, the boundary is often not clear.
(2)the kidney substantial echo abnormality:The kidney is substantial inside appear excrescent echo conglomeration, present circular or oval, the boundary is more clear, there is orb.Its internal echo much changes, win wait big of the tumor much present to loiter a voice, only minority present strong or weak don't wait of hybrid echo or etc. echo.When there are issue of blood, bad dead or liquefaction in the bigger lump body inner part, the part displays an edge anomaly of have no echo area.If have calcify, present a point and piece-like in shape strong echo companion voice shadow.The physical volume smaller kidney cancer sometimes expresses for the high echo conglomeration.
(3)kidney Dou the echo is pressed to transform:When the tumor is ingrown to oppress or infringe upon a kidney of Dou, the kidney Dou part can appear a cave form to transform, move and interruption is to show not pure, the minority can appear extend, accumulating of pelvis, kidney water.
(4)the kidney surrounding blood vessel unusually change:Kidney cancer later period, be cancer organization to invade and or transfer to sell kidney vein and legs vein with the blood line, together side kidney the vein or bottom chamber vein increase breadth and jam, inside have an anomaly low, medium the level order form or conglomeration-like in shape echo.
(5)the kidney cancer transfer to advertise for elephant:Swollen big lymphoid knot after the hilum of kidney, peritoneum, liver, adrenal glands and to side kidney etc. dirty machine of excrescent conglomeration-like in shape loiter a voice.
(6)discriminate with the kidney normal variation:The plump kidney pillar is in the kidney lengthways cross section up present loitering of circular or oval an area, is more familiar than kidney of in, up pole, the echo of very much resembling kidney tumor.But cautiously observation can discover kidney pillar and kidney Dou boundary clear, inner part present to distribute even small point-like in shape loiter a voice, cross section shows that the kidney pillar loiters voice and kidney skin quality to connect with each other continuously, the mutual has no explicit of boundary.But kidney cancer the cross section contain obvious boundary with kidney skin quality and there is obvious spheroid feeling.Some kidneys present an excrescent cent leaf's form, make kidney outline the part swell up, is more familiar than in the left kidney and descend very and outside a side, severity blend for the kidney not whole.It swells up scope more big, but with the kidney skin quality echo have no boundary, have no tumor to reach a type.
(7)the much more colorful Pu Lei super voice:Mainly used for understand the vein is infringed upon of degree.Habboub etc. reports, at to 46 confirms to have the vein the check of kidney cancer that the lump bolts through the surgical operation in, kidney vein and the bottom chamber lump inside the vein bolt the accuracy of diagnosis to 93, sensitivity is 81, particularity is 98.
3. CTs:The fixed position accuracy of CT to kidney cancer can reach to 100, and can show that scope and close by organ of pathological changes didn't implicate, its accuracy was higher, can with Shu see basic the image of kidney cancer match, being the most dependable diagnosis currently learn a method.Applied 3D CT and spiral CT check even can understand tumor is a still not- transparent transparent cell type cell type.But to minority of cases before Shu not can make settle sex diagnosis.
(1)the kidney cancer of typical model present circular, oval or anomaly form to share on the CT picture and compare the big kidney partial skin quality to swell up, huge occupy big parts of kidneys, make the appearance disappearance of normal kidney.Under majority of circumstances, tumor and the surroundings kidney substantial boundary aren't pure, kidney cancer and the surroundings kidney substantial boundary of 3 cm diameter are more obvious.
(2)even sweep, the density of kidney cancer is more slightly low than a kidney substantial, but approach very much, therefore even sweep easy lapse smaller tumor focus.After to build up scans, the density light degree of the kidney cancer focus strengthen, but the normal kidney substantial density present obvious strengthen, two formation contrast, the focus can show.In order to including the bad dead that the degree doesn't wait more, bleeding in the kidney cancer focus, the bag become calcify cooking stove even, therefore on the CT picture performance for the density is not and all.If there is fresh issue of blood in the tumor, then make parts of tumors presented is higher than the normal kidney substantial density on the CT slice.Parts of kidney cancers contain calcify cooking stove, majority present an anomaly to distribute in the kidney cancer, very few number form in the tumor edge imperfect of calcify wreath.
(3)kidney cancer infringe upon kidney surroundings organization, CT performance for the kidney surface hair Cao the gravamen is whole, kidney week fat bag misty or disappear, swollen thing shadow and the waist big muscle, Ge muscle the feet or surrounding dirty machine copy to connect with each other.
(4)be a kidney cancer to involve in to suffer from a side kidney vein, the performance increases for the anomaly of kidney vein thick.But while cancer happening to bolt inside kidney vein or the bottom chamber vein, then in the vein it is thus clear that low density area, the to build up scans it is thus clear that the tube chamber breaks off or has the Chong Ying the defection and damage area inside the chamber.
(5)anythe 2 cm diameter transfer lymphoid knot for tumor.
4. MRIs:MRI is similar to CT to sensitivity and accuracy of kidney cancer diagnosis, but surpass CT in the aspects of showing that kidney vein or bottom chamber vein implicate, the surroundings organ be subjected to invasion and share with benign tumor or bag to discriminate waiting.The typical model performance of kidney cancer MRI is:
(1)circular, oval or anomaly form lump, can change to the kidney shape, is bigger than the 3 cm boundary usually not pure;
(2)the tumor afferent structure is abundant, it is thus clear that flow a black blood vessel shadow inside the empty lump, circuit but extend;Return it is thus clear that the peritoneum is behind provide blood artery, lump surroundings side afferent dark shadow;MRI can clearly show that kidney vein and the bottom chamber intravenous lump bolt;
(3)tumor signal asymmetry, add power to be like in the T1 up often present low signal or etc. signal.15 can there is calcify inside the lump, present low signal;
(4)bad dead area in the tumor center present long T1 with long the T2 be worth and add power to be like in the T1 up present obviously low signal, add power to be like in the T2 up present obviously high signal;The surroundings lump organizes signal not and all;
(5)visit MHB leaving to present high signal in the lump internal bleeding;
(6)about 5 kidney tumors afferent structures are few and have already wrapped a film, the malignant degree is lower and only show on MRI that the signal has no characteristic not and all.
(7)knot swollen diagnosis standard to the lymph the CT is together.
(8)have the kidney the case that the vein or the bottom chamber lump inside the vein bolts towards doubting, using the MRI sum-like in shape noodles picture can clearly show the scope that the lump bolts.
5.The kidney artery builds a shadow:Under the general circumstance, the kidney cancer contains abundant blood supply, while being Yi to have a kidney cancer carry on blood vessel to build a shadow can clearly show a pathological changes.In recent years, along with build to copy a technical development, adopt the selectivity kidney artery number more to reduce a shadow method.The kidney cancer can have following artery to build a shadow to advertise for elephant:
(1)the kidney artery increase thick:Explain the tumor blood provides abundant;
(2)the artery branch inside the kidney is pressed to move:The artery branch that much is seen to the tumor closing to, under minority of circumstances the blood vessel of tumor surroundings present a pack to round a form;
(3)the artery is eroded by tumor:Express for limit sex to become thin, irregular or thick thin not and all;
(4)tumor blood vessel:The tumor area appears majority of circuits, anomaly, thick thin not and all, distribute the small blood vessel of mess, this is to develop not mature of new-born blood vessel.The Dou-like in shape chamber Xi in the tumor blood vessel is in building film performance for build a shadow to assume lake-like in shape or pond-like in shape to distribute gathering.Sometimes the tumor blood vessel presents a thin net and distributes to compare rule with appearances all;
(5)tumor dyeing:This advertise for Be seen to build a shadow of substantial period, namely the tumor area present a high definition and fasten to build a shadow inside the tumor blood vessel a result for coming together;
(6)the kidney vein develop in advance:Because the blood inside the tumor circularly accelerates or tumor memory at action vein Lou, expect to can immediately see vein inside the kidney and developing of the kidney vein lord stem in the artery;
(7)the tumor edge Be deeply bright to take:It Be seen to there is the kidney cancer that the leave wraps a film.At substantial expect, the leave wraps a film because of the blood vessel scarcity displays density is lower than tumor area, form a narrow deeply bright take parts of edges that the pack rounds tumor.
(8)discriminate:When to kidney artery inside inject adrenaline, the normal kidney afferent constringency, wrong reach lump etc. blood vessel in the benign tumor will also take place constringency, but kidney cancer the tumor blood vessel inside the organization can't constringency.
6.Excepted transfer cooking stove:According to the report way, the kidney cancer patient had while seeking medical advice 20-35 already the occurrence transfers, treatment method because of will but have variety, therefore before carrying on and curing for good sex kidney resection, have to excepted transfer the existence of cooking stove.
(1)the chest X line slice is used for excepted the lung transfers cooking stove.While doubting masculine gender to knot stanza, should do chest CT to further and definitely diagnose.
(2)the liver B Be super to used for excepted the liver transfers cooking stove.When the original hair cooking stove of kidney tumor to compare with hour, , usually hard make sure which place in order to deliver at first, which place in order to transfer, need to do to wear sting cell or histology to check when it's necessary to definitely diagnose.
(3)whole body isotope the bone scans the serum alkaline phosphoric acid Mao level of being the patient to increase Gao, hinting may have a bone to break wreath occurrence, should do whole body the isotope bone scans checks with excepted the bone transfers.
(4)when the brain CT is a patient to have nervous system symptom or body to advertise for need to do brain CT with excepted the brain transfers.