Waist Pack
Introduction
Introduction Kidney cancer is manifested in the waist, and the lumbar mass is one of the three major warnings of kidney cancer. If you have a lumbar mass on your body, you should pay enough attention to it because kidney cancer is not like other diseases. It is not easy to catch, so when the waist mass appears, you should go to the hospital immediately to prevent the kidney cancer from being diagnosed and treated promptly. Kidney cancer lesions are enlarged to a considerable extent that the mass can be felt (or seen) from the waist or upper abdomen. About 20% to 30% of patients have this symptom. When the lateral position is taken, the mass is easier to touch, and sometimes the mass can be seen moving up and down with the breathing. If the mass adheres to the surrounding tissue, the mass is fixed and cannot be pushed, which is late. If there is a disease of the waist mass, seek medical advice in a timely manner, and do not wait until the bag is fast adhering to the surrounding tissue. It is a great possibility that the kidney cancer is advanced, so the symptoms should be sooner rather than later. Renal cell carcinoma, also known as renal cell carcinoma, originates from renal tubular epithelial cells and can occur in any part of the renal parenchyma, but the above and lower levels are more common, and a few invade the whole kidney; the left and right kidneys have equal chances of attack, and bilateral lesions account for 1%~2%.
Cause
Cause
The cause of the lumbar mass:
The cause of kidney cancer is unknown, but there are data showing that the incidence is related to smoking, antipyretic and analgesic drugs, hormones, viruses, radiation, coffee, cadmium, strontium, etc.; other occupations such as oil, leather, asbestos and other industrial workers prevalence rate high.
(a) Smoking:
A large number of prospective observations have found that smoking is positively associated with kidney cancer. Relative risk factors for renal cancer (RR) = 2, and smokers who smoked for more than 30 years and who smoked filterless cigarettes have an increased risk of kidney cancer.
(ii) Obesity and high blood pressure:
A prospective study published in the November 2, 2000 issue of the New England Journal of Medicine showed that high body mass index (BMI) and hypertension are two independent factors associated with increased risk of kidney cancer in men.
(3) Occupation:
Workers exposed to metal shops, newspaper printers, coke workers, dry cleaning and petrochemical workers have reported increased risk of kidney cancer morbidity and mortality.
(iv) Radiation:
There are statistics on 26 cases of 124 tumors caused by a weak alpha particle radiation source confined to the kidney, but there are no reports of radiation exposure and kidney cancer by radiologists and atomic bomb victims.
(v) Genetics:
There are some intra-renal kidney cancers that are found during chromosome examinations. The third pair of chromosomes in people with a high incidence of renal cancer are defective. Most familial renal cancers have an early onset age and tend to be multi-focal and bilateral. In a rare hereditary disease, hereditary canthile hamartoma (VHP), up to 28% to 45% of patients with kidney cancer.
(vi) Food and medicine:
The survey found that high intake of dairy products, animal protein, fat, low intake of fruits, vegetables is a risk factor for kidney cancer. The risk that coffee may increase kidney cancer is not related to coffee consumption. In animal experiments, kidney cancer has been proven due to female hormones (estrogen), but there is no direct evidence in the human body. Abuse of antipyretic analgesics, especially those containing phenacetin, may increase the risk of renal cancer. Diuretics may also be a factor in promoting the development of kidney cancer. Through animal experiments, it was concluded that red vine grass, also known as thousand roots, may induce kidney cancer. The Korea Food and Drug Safety Agency has requested domestic companies to stop producing red vine grass food additives.
(7) Other diseases:
In patients undergoing long-term maintenance hemodialysis, cystic changes (acquired cystic diseases) occur in the atrophic kidney, and cases of renal cancer are found to increase. Therefore, those who have been dialysis for more than 3 years should check the kidneys every year. It has been reported that diabetic patients are more likely to develop kidney cancer. 14% of patients with kidney cancer have diabetes, which is five times more common in people with diabetes.
Examine
an examination
Related inspection
Kidney ultrasound examination kidney CT examination kidney MRI examination urine routine retrograde pyelography
1. General examination: hematuria is an important symptom, polycythemia usually occurs in 3% to 4%; progressive anemia can also occur. In bilateral renal tumors, total renal function usually does not change and erythrocyte sedimentation rate increases. Some patients with kidney cancer do not have bone metastases, but may have symptoms of hypercalcemia and increased serum calcium levels. Symptoms are quickly relieved after renal cancer resection, and blood calcium returns to normal. Sometimes it can progress to liver dysfunction, such as tumor nephrectomy, can return to normal.
2. X-ray angiography is the main means of diagnosing kidney cancer:
(1) X-ray film: X-ray film can see the shape of the kidney is enlarged, the contour is changed, occasional tumor calcification, limited or extensive flocculation in the tumor, can also become a calcification line around the tumor, shell It is more common in young people with kidney cancer.
(2) intravenous urography, intravenous urography is a routine examination method, because it can not show the tumor that has not caused kidney and kidney sputum undeformed, and it is difficult to distinguish whether the tumor is kidney cancer. Renal angiomyolipoma, a renal cyst, is therefore of decreasing importance and must be further identified by ultrasound or CT. However, intravenous urography can understand the function of bilateral kidneys and the ureter and ureter and urinary tract of the renal pelvis, which has important reference value for diagnosis.
(3) renal angiography: renal angiography can be found in urinary tract angiography undeformed tumors, renal cancer showed neovascularization, arteriovenous fistula, contrast pooling (Pooling) envelope vascularization. Angiographic variation is large, and sometimes kidney cancer may not be developed, such as tumor necrosis, cystic changes, arterial embolism, and the like. Renal artery angiography may inject normal adrenaline vasoconstriction into the renal artery and the tumor blood vessels are unresponsive. In the relatively large kidney cancer. Renal artery embolization can also be performed during selective renal angiography, which can reduce renal hemorrhage in patients with hemorrhagic renal cell carcinoma and can be treated with renal artery embolization as a palliative treatment.
3. Ultrasound scan: Ultrasound is the easiest and most non-invasive method of examination and can be used as part of a routine physical examination. More than 1cm of mass in the kidney can be found by ultrasound scan. It is important to identify whether the tumor is kidney cancer. Kidney cancer is a solid mass. Because of the possible internal hemorrhage, necrosis and cystic changes, the echo is not uniform, generally low echo, and the state of kidney cancer is not clear. This is different from renal cyst. Intrarenal space-occupying lesions may cause renal pelvis, renal pelvis, renal sinus fat deformation or fracture. Ultrasound examination of renal papillary cystadenocarcinoma resembles a cyst and may have calcification. When kidney cancer and cysts are difficult to identify, they can be punctured. It is safe to puncture under ultrasound guidance. Puncture fluid can be used for cytology and cystoscopy. The cyst fluid is often clear, no tumor cells, low fat, and the smooth wall of the cyst can be definitely a benign lesion. If the puncture fluid is bloody, the tumor should be thought of, and the tumor cells may be found in the extract solution. The tumor wall may be diagnosed as a malignant tumor when the stenosis is not smooth. Renal angiomyolipoma is a solid intratumoral tumor, and its ultrasound manifests as a strong echo of adipose tissue, which is easily differentiated from renal cancer. When ultrasound examination reveals kidney cancer, it should also pay attention to whether the tumor penetrates the capsule, perirenal adipose tissue, with or without enlarged lymph nodes, whether there is a tumor thrombus in the renal vein or inferior vena cava, and whether the liver has metastasis or the like.
4. CT scan: CT plays an important role in the diagnosis of renal cell carcinoma. It can be found in renal cell carcinoma without renal pelvis and renal pelvis change. It can accurately measure tumor density and can be performed in outpatient clinics. CT can be accurately staged. Some people have statistically diagnosed the diagnosis: invading the renal vein 91%, spreading around the kidney 78%, lymph node metastasis 87%, and nearby organ involvement 96%. CT examination of renal cancer is characterized by a mass in the renal parenchyma, which can also be prominent in the renal parenchyma. The mass is round, round or lobulated, with clear or blurred borders. Soft tissue blocks with uneven density during plain scan, CT value> 20Hu, often between 30 ~ 50Hu, slightly higher than the normal renal parenchyma, can also be similar or slightly lower, and its internal heterogeneity is caused by hemorrhagic necrosis or calcification. Sometimes it can be expressed as a cystic CT value but with a soft tissue nodule on the wall. After intravenous injection of contrast agent, the CT value of normal renal parenchyma is about 120Hu, and the CT value of the tumor is also increased, but it is significantly lower than the normal renal parenchyma, which makes the tumor boundary clearer. If the CT value of the tumor does not change after the enhancement, it may be a cyst. The CT value before and after the injection of the contrast agent can be used to determine the diagnosis. After necrosis of renal cancer, renal cystic adenocarcinoma, and renal artery embolization, the CT value did not increase after the injection of contrast agent. Renal angiomyolipoma due to its large amount of fat, CT value is often negative, internal unevenness, enhanced CT value, but still showed fat density, eosinophils edge clear CT, internal density Uniform and enhanced CT values increased significantly.
Diagnosis
Differential diagnosis
Symptoms of lumps in the waist mass:
Reflex low back pain: low back pain does not hinder waist activity.
Lumbosacral Pain: The lumbosacral region is the hub connecting the upper body and the lower body (including the pelvis and lower limbs) in the trunk. The structure is more complicated. Four out of five adults have experienced significant lumbosacral pain in one person. It usually occurs after being exposed to the cold. In people under the age of 45, it is the most common cause of loss of working ability due to low back pain.
Dull pain in the lower back: pain in the waist or lumbosacral region, repeated attacks, pain can change with climate change or fatigue, when it is light and heavy, lingering. The nature of the pain is mostly dull pain, can be limited to one part, and can spread the entire back.
The initial diagnosis of kidney cancer is based first on clinical manifestations. Patients with typical symptoms such as hematuria, back pain, and lumps are not difficult to diagnose, but such tumors are often advanced. Some patients have atypical clinical manifestations, the symptoms are not in the urinary system, and there are a few patients, the symptoms of metastatic cancer can be earlier than the symptoms of kidney cancer itself, so the diagnosis is more difficult. Tianjin Medical College reported that 50 cases of kidney cancer, some patients simply showed extra-renal performance, but no hematuria, lumps, low back pain. And pointed out that many patients with extrarenal appearance appeared before the three major symptoms, is an early signal of kidney cancer. Be vigilant and pursue the causes of extra-renal manifestations such as fever, anemia, liver dysfunction, polycythemia, hypertension, and hypercalcemia.
Hematuria is the most common symptom of kidney cancer. Most of the hematuria caused by kidney cancer is painless whole blood urine, which usually appears intermittently. When the bleeding is not much, the urine is thick or dark red, and the urine is bright red when the amount of bleeding is high. Urine routine examination, mainly erythrocytosis, protein and white blood cells are not much.
