renal pelvis cancer
Introduction
Introduction to renal pelvic cancer A tumor of the renal pelvis that occurs in the renal pelvis or pelvic epithelium, accounting for about 10% of all kidney tumors. Interstitial nephritis, long-term use of painkillers, chronic inflammation or stone stimulation, exposure to carcinogens is often the cause of renal pelvic tumors. The age is more than 40 years old, more men than women, about 3:1, there is no significant difference in the incidence of the left and right, both sides occur at the same time, accounting for about 2 to 4%. Because the renal pelvis wall is thin, surrounded by abundant lymphoid tissue, the tumor easily metastasizes to the para-aortic and cervical lymph nodes; the main organs of blood transfer are the lungs, liver and bones. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: Bladder Cancer Anemia
Cause
Causes of renal pelvic cancer
(1) Causes of the disease
Aromatic primary amines such as -naphthylamine and benzidine in industrial raw materials such as dyes, leather, rubber, paint, etc. are carcinogenic to renal pelvis cancer, disorder of tryptophan metabolism, smoking and long-term use of phenacetin. The incidence of renal pelvic cancer is significantly increased, infection or long-term stone stimulation can cause squamous cell carcinoma or adenocarcinoma, cystic pyelitis, and glandular pyelitis can develop into renal pelvis cancer.
(two) pathogenesis
Most of the disease is transitional cell carcinoma, and a few are squamous cell carcinoma and adenocarcinoma. The latter two account for about 15% of renal pelvic cancer. Their malignancy is much higher than that of transitional cell carcinoma. Clinically, transitional cell carcinoma can be seen in any coating. The urinary tract with the transitional epithelium appears sequentially or simultaneously. Therefore, it should be regarded as a whole in diagnosis and treatment. It is not possible to treat a certain part of transitional cell carcinoma in isolation.
The majority of renal pelvic cancer is transitional cell carcinoma, which can be divided into 4 grades, grade I: papillary with normal mucosa; grade II: papillary with a small number of polymorphic changes and nuclear division; grade III: flat transitional cells with significant polymorphism Metamorphosis and nuclear division; Grade IV: Extremely polymorphic, due to thin renal pelvis, prone to lymphatic or hematogenous metastasis, poor prognosis.
Squamous cell carcinoma accounts for about 15% of renal pelvic cancer. The lesion is flat, hard and rapidly infiltrated around the kidney. The renal hilum and regional lymph nodes have been metastasized at the time of diagnosis. The prognosis is poor. Adenocarcinoma is extremely rare. The renal pelvis tumor can occur in the renal pelvis. Any part of the site, with multi-center characteristics, can occur simultaneously or sequentially with ureteral tumor or bladder tumor, which is more common in patients with papilloma or papillary carcinoma, but less common in patients with flat invasive papillary carcinoma. There are four explanations for the multiple findings of renal pelvic tumors:
1 lymphatic pathway spread;
2 direct diffusion through the mucosa;
3 multi-center lesions;
4 Tumor cells are detached and planted on the ureter or bladder mucosa and continue to grow.
Prevention
Renal sputum cancer prevention
There are no special and effective preventive measures, and some adjustments can be made in the diet:
1. Maintain an ideal weight;
2. Ingest a variety of foods;
3. A variety of vegetables and fruits are included in the diet each day;
4. Ingest more high-fiber foods (such as whole grain cereals, beans, vegetables, and fruits);
5. Reduce total fat intake;
6. Limit the intake of alcoholic beverages;
7. Limit the intake of marinated, smoked, and nitrite-containing foods.
Complication
Renal pelvic cancer complications Complications bladder cancer anemia
30 to 50% of patients with renal pelvic transitional epithelial cancer can have bladder transitional epithelial cancer at the same time. If the renal pelvis and ureter have tumors at the same time, the possibility of bladder cancer increases to 75%. Patients with advanced disease have anemia and cachexia.
Symptom
Renal pelvis cancer symptoms common symptoms lower abdominal pain ureteral obstruction dysuria high blood pressure lumbar mass lymph nodes enlargement blood and urine loss of appetite
About 70-90% of patients have the most important symptoms in the early stage of clinical manifestations of painless gross hematuria. A small number of patients can cause lumbar discomfort, dull pain and pain after the tumor blockage of the ureteropelvic junction, even due to clots or tumors. The cause of renal colic, due to tumor growth or obstruction caused by water accumulation of lumbar mass is rare, there are still a small number of patients with urinary tract irritation, advanced patients with anemia and cachexia.
Renal squamous cell carcinoma is clinically divided into 5 stages, stage O: tumor is confined to the mucosa stage; stage A: tumor invades the lamina propria; stage B: tumor invades the muscle layer; stage C: tumor extends to the para-renal fat or renal parenchyma; : Regional lymph node involvement or metastasis in other areas.
1. Hematuria: The incidence rate is about 90%, which is intermittent, painless, and the naked eye, the whole process of hematuria, can discharge cord-like blood clots.
2. Pain: Blood urinary tract ureteral obstruction can cause renal colic, tumor caused by hydronephrosis may appear waist pain and discomfort.
3. Lump: mostly located in the waist or upper abdomen, the appearance of a mass indicates that the tumor obstruction leads to hydronephrosis or the disease is near late.
4. Systemic symptoms: general malaise, loss of appetite, weight loss is a common systemic symptom in patients with cancer, and some patients may be accompanied by varying degrees of fever, anemia or high blood pressure.
5. Tumor metastasis: Early metastasis often occurs in renal pelvis tumors, sometimes with enlarged lymph nodes on the clavicle.
Patients with the above clinical manifestations and signs should consider the possibility of renal pelvic tumors, combined with laboratory tests, cytology and imaging studies to confirm the diagnosis.
Examine
Examination of renal pelvic cancer
Laboratory inspection
1. Red blood cells can often be found in routine urine tests.
2. Urine cytology examination requires multiple examinations, the positive rate is 35% to 55%, using acridine orange staining fluorescence microscopy, the positive rate can be as high as 80%.
Film degree exam
1. Renal pyelography: IVU combined with retrograde pyelography is the basic diagnosis of renal pelvic tumor location, estimating the general morphology of tumors and tumor staging, IVU positive rate is 58% to 80.8%, retrograde pyelography 86% can be found in tumors, double A dose of contrast agent or retrograde pyelography of the undeveloped kidney helps to confirm the diagnosis.
Renal parenchymal tumors and renal pelvic tumors are sometimes indistinguishable due to changes in the shape of the kidney and the X-ray signs of the renal pelvis. Generally, the shape of the kidney is unchanged, and the filling of the renal pelvis is large, and the possibility of renal pelvic tumor is large, and the tumor is small. It is necessary to perform multiple pyelography for a clear time. It is advisable to use a contrast agent with a lighter concentration when retrograde pyelography, and to find it from different angles.
2. B-ultrasound: B-ultrasound is not high in the diagnosis of early renal pelvic tumors, but can make a correct diagnosis for the development of a certain degree of renal pelvic tumors. The filling defects indicated by pyelography are often difficult to distinguish from light-transmitting stones and blood clots. B-ultrasound can qualitatively distinguish renal pelvis tumor from negative stone and blood clot. The ultrasonographic image of renal pelvis tumor is characterized by renal sinus echo separation, which is a low echo area, and can clearly show the surface morphology of the tumor. The medullary structure is disordered, indicating that the tumor has invaded the renal parenchyma; if there is irregular deformation of the kidney outline on this basis, it indicates that the tumor has invaded the deep or infiltration of the renal parenchyma beyond the renal capsule, such as when the tumor causes water accumulation, An ultrasound image with hydronephrosis.
3. CT scan: CT scan has high resolution. After scanning and contrast-enhanced scan, it can clearly show the density of lesions, the extent of infiltration and the relationship between surrounding organs. The correct rate of diagnosis of renal pelvis tumors can reach 90%. The above, and the clinical stage of the tumor and the development of surgical plans have great value. The CT signs of renal pelvic tumors are related to the extent of tumor invasion. CT scan can also find peri-invasion and regional lymph node metastasis.
4. Renal angiography: generally not used for the diagnosis of renal pelvis tumor, renal angiography is not easy to distinguish because it is confused with inflammatory diseases of the kidney, the false positive rate can reach more than 40%, selective renal angiography can be the following Signs: arterial branch loss; tumor blood vessels are small, renal parenchyma is invaded when the renal parenchyma stage shows irregular density reduction area, renal angiography for the identification of renal pelvic tumors and other causes such as renal aneurysms, vascular compression caused by renal pelvic filling defects have certain value.
Diagnosis
Diagnosis and diagnosis of renal pelvic cancer
The diagnosis method of this disease is basically the same as kidney cancer, a large number of repeated gross hematuria, ureteral tubular blood clots can be seen when the hematuria is severe, and no positive signs are found in the examination. The cystoscopy of the ureteral orifice can be seen by cystoscopy in the hematuria. Urine cytology examination Visible tumor cells, B-ultrasound, CT examination showed renal parenchymal space occupying lesions, intravenous pyelography or retrograde pyelography showed irregular filling defects in the renal pelvis or renal pelvis, urine cell cytology can be found in cancer cells.
Differential diagnosis
1. Renal cell carcinoma: IVU can also be a filling defect of the renal pelvis, which must be identified, but the degree of hematuria is lighter, and it is more likely to touch the abdominal mass. Urinary angiography shows obvious deformation, elongation and distortion of the renal pelvis; renal artery Tumor blood vessels and contrast agents accumulate in the renal parenchyma.
2. Renal cavernous hemangioma: severe hematuria may occur when rupture, urography reveals renal pelvic filling defects, but most occur before the age of 40, skin, mucosa may have hemangioma lesions, for sudden gross hematuria, each time The interval between hematuria is longer.
3. Primary renal purpura: severe hematuria, but its sudden onset, frequent hematuria, fierce, general hemostasis measures are not effective, urography is not developed or renal pelvis filling defect.
4. Renal sputum blood clot: urography can also show filling defects, but it can be deformed, reduced or no longer existed within 2 weeks; repeated urinary cancer cell examination is negative.
5. Kidney stones: Negative stones in the renal pelvis can also appear as filling defects on the IVU. If gas is injected during retrograde pyelography, the image of the stone with higher density can be displayed. The ultrasound examination system is enhanced with light spots and sound shadows. CT scan can confirm the location and size of the negative stones.
6. Paracrine cysts: may have lumbar discomfort, hematuria and hypertension, etc., IVU shows renal pelvis, renal pelvis deformation, displacement, elongation and other performance, but no destructive changes, CT examination shows clear boundary of the renal pelvis, uniform low density The elliptical mass had a CT value of 0-20 Hu, and there was no significant change in CT values before and after enhancement.
The urinary tract film of some kidney cancers has calcification and must be differentiated from renal tuberculosis, teratoma, cysticercosis or aneurysm.
