Malignant renal pathology occupies a leading position in Oncology. Its causes continue to be studied. Already the influence of drinking water of poor quality (with increasing chlorine content), nicotine derived from the smokers, harmful industries.
It is found that women suffer in 2 times less often than men. This is due to the great attention towards their health. The symptoms of kidney cancer in women do not differ from symptoms in men. In children with gene mutations likely to develop such cancers as Wilms tumor.
Diagnosis of kidney tumors has been difficult due to:
- low severity of symptoms in the early stages of the disease;
- the necessity of application of special methods because of the limited availability of ultrasound machines.
The result is up to 30% of patients seek care for advanced disease.
Learn about one of the cancers of the kidney, its features and treatment here.
Symptoms of kidney cancer can be divided into General (typical of any malignant tumor), and specific to kidney damage.
What common symptoms indicate cancer?
Early signs of kidney cancer occur invisibly and are detected by accident. Patients go to the doctor with complaints of General weakness, intermittent hypertension with headaches.
Possible first symptoms are:
- strange weight loss;
- loss of appetite;
- nagging intermittent pain in the back or side.
A malignant tumor requires immediate differentiation and treatment
These are the signs of kidney cancer are found in women with diabetes mellitus, hormonal abnormalities associated with obesity, menopause and other diseases. Therefore, they are considered to be manifestations of other diseases or identify the cause of prolonged stay.
A more specific manifestation of cancer in the following ways:
- The increase in body temperature – usually it lasts a long time in the range of 37-38 degrees, but renal cell carcinoma parenchyma typical “jumps” in temperature to high numbers with chills. Reason – in the bloodstream of toxic substances secreted by the malignant cells.
- Anemia (anemia) – is found in about 1/3 of patients. There is no bleeding, hemolysis in the blood is normal colour the indicator. It occurs due to inhibition of production of red blood cells by toxic products of cells. Therefore, iron supplements and vitamins do not help.
- Rarely, the patient revealed elevated levels of red blood cells. This is possible when you activate tumor of the synthesis of the hormone erythropoietin or in response to the lack of oxygen in the cells of the renal parenchyma.
- Hypertension – is associated with the stimulation of the production of the hormone renin diseased kidney.
Metabolic disorder leads to an increase in the level of calcium in the blood is above 2.65 mmol/l in 20% of patients.
- ECG of the same picture, which are identified by an overdose of cardiac glycosides;
- bradycardia (heart rate less than 60 beats per minute).
Common signs are the basis for examination of the patient. Results of the subsequent treatment depends on the effectiveness of early detection.
What signs are specific to kidney tumors?
Specific symptoms appear, unfortunately, with significant growth of the tumor, extension into adjacent organs and tissues, destruction of blood vessels. At the clinic typical signs called “triad”.
- haematuria (blood in urine);
- pain syndrome;
- the increase and swelling of the kidneys, the possibility of palpation of the affected organ.
The complete triad is found in 15% of patients. Others – prevails one of the symptoms.
Hematuria accompanied with renal cell cancer. Blood in the urine, changes its color to maroon and brown. At the initial stage of hematuria can appear suddenly without other symptoms, disappears for an indefinite period, in the later period becomes permanent. Hematuria in nephroblastoma in children occurs only in 12% of cases.
In fact, internal bleeding caused due to the destruction of tumor vessels in the kidneys
For the diagnosis it is important to manage to establish the cause on a background of obscure bleeding, to spend at least a cystoscopy.
Lower back pain is caused by stretching of the renal capsule swelling, germinating tumor. It has a dull, but constant. The intensity is different. If the blood clots block the ureters and stop the flow of urine, pain is very strong, similar to the attack of renal colic.
The difference of hematuria urolithiasis are two things:
- prebolela – typical of the tumor;
- Petrolia – indicates a stone in the ureter or pelvis.
For Wilms ‘ tumor pain is not typical. Children begin to feel them only with significant compression of adjacent organs.
Palpation can reveal a tumor in the lower pole of the kidney. Obese people to determine thus, even a large tumor impossible. Experienced doctor performs palpation with the patient standing, lying on the back and the side.
Education more often felt as a nodular, dense, motionless. In children with Wilms ‘ tumor palpation is not difficult. The kidney is felt as increased smooth painless body.
Thin patients can palpate themselves, tell the doctor found a tumor
A symptom of kidney cancer in men is a varicocele (enlargement of the testicle). It was formed by dilated veins of the spermatic cord when the compression of the tumor or lymph nodes of the inferior Vena cava or renal veins. Resets of blood in the testicular venous network. Identification of varicocele in older men – a sign of trouble, since it appears already in the process of significant growth of the tumor.
For women more typical expansion of the venous ring of superficial vessels on the abdomen (picture of “Medusa head”), on the legs, the development of thrombosis and thrombophlebitis of the lower extremities.
As manifest metastases?
Next few metastatic spread to lymph nodes, veins in the area of gate kidney, adrenal glands.
Clinically, it can manifest:
- congestive symptoms along the veins of the lower extremities;
- swelling of the external genitalia;
- the enlargement of the abdomen with the formation of visible subcutaneous veins on the skin;
Distant metastases cause symptoms, depending on contact with a specific body:
- lung tissue and bronchi responds by cough with hemoptysis;
- in bone tissue is accompanied by excruciating pain throughout the body, appear only strong drugs;
- the liver compression of the wedges causes the flow of blood pigments in the skin of the patient and visible mucous membranes turn yellow, itching, dryness, thirst;
- getting into the brain leads to the development of bulk process in the cortical centres or the barrel, this causes multiple neurological symptoms (paresis, paralysis, impaired speech, vision and hearing).
What are the diagnostic methods?
Diagnosis begins with palpation of the left and right kidneys. According to statistics, differences in lesion of these organs is not revealed.
Delayed access to a doctor is associated with a long compensatory strengthening the work of healthy kidneys to provide support functions
Laboratory studies on the value in this pathology are not decisive.
In the blood find:
- ESR acceleration;
- polycythemia rarely.
Biochemical liver tests confirm metastasis to improve the level of:
- alkaline phosphatase;
- the gamma globulin;
- prothrombin time.
In the urine analysis reveals:
- kidney and the transitional epithelium;
Urine test for atypical cells has no diagnostic value.Decisive diagnostic methods that allow the confidence to talk about kidney cancer, are hardware research and Cytology biopsy samples is implemented material.
Cystoscopy – examination of the bladder and the orifices of the ureters, in the case of the spread of tumors in the pelvis by implantation allows to detect the release of blood from the ureter, sagging of the bladder wall. For the diagnosis of renal lesions is almost never used.
Ureteropyeloscopy replace cystoscopy. The method is applicable in the diagnosis of the tumor in the pelvis area. Endoscopic technique allows to have a thin flexible ureteroscope into the upper urinary ways. Inspection of the pelvis is carried out in the mode of monitoring, has the ability to take on the Cytology suspicious area of tissue.
Ultrasound examination (sonography) is applicable at the initial stage of diagnosis. Allows to suspect the development of tumors in the increased size of the kidney, the changed contours of the capsule.
Method of ultrasound does not give a complete picture of the damage inside the body as many types of cancer have agonisticescuu do not differ in density from healthy tissue
Radiological diagnostics of kidney cancer are able to give much more information, especially in combination with the introduction of contrast agents into a vein or through a catheter (excretory and retrograde urethrography). At the review the picture you just see the contours of both kidneys. Comparing the location, size, shape, presence of calcium deposits (calcification) can be caused by this tumor.
It is proved that calcification in the Central parts of the kidneys indicates the presence of malignant conversion of 90% of patients.
The value of excretory urography
Method excretory urography allows not only to identify radiological signs of the lesion, but also to explore the function of a healthy body. It is important to prepare the patient for surgery to remove a kidney.
The method is of value in the diagnosis of tumors of the pelvis of the kidney. The structure of the pelvis, calyx and ureter are visible very clearly. In the picture reveal filling defect (more than half of patients), expansion, deformation. Possible detection of hydronephrosis due to obstruction of the ureter or pelvis of a blood clot growing tumor.
Retrograde pielografia is carried out in the absence of hematuria. Otherwise the blood clot in the pelvis or the calyx may be mistaken for a tumor.
The most informative methods
Magnetic resonance and computed tomography is the most informative methods in diagnosis of kidney cancer. It is for them to judge the stage of the disease. Simultaneous intravenous administration of contrast become more noticeable border between the tumor and normal tissues.
It is possible to evaluate:
- the size of the tumor;
- precise localization;
- relationship to structural lesions of the kidney (the cups and pelvis);
- germination in surrounding organs and tissues;
- the condition of the vessels in the area of gate kidney;
- lose perinephric tissue;
- the introduction of the tumor in the renal and inferior caval vein;
- changes of the adrenal glands;
- the size of the regional lymph nodes;
- the likelihood of metastasis in adjacent organs.
After obtaining the opinion of determine the tactics of treatment, volume of the operation.
A method of angiography (the study of renal vessels and abdominal aorta) are used for special reasons.
It is limited because of the potential complications:
- thromboembolism in renal vessels;
- false aneurysms at the puncture site.
Angiography is indicated in:
- the inability to detect cancer in other ways;
- the differential diagnosis of renal tumors with extrarenal formations;
- need exact confirmation of the sizes, directions of growth;
- bilateral lesions;
- the development of the tumor in the abnormal kidneys (e.g., horseshoe).
The characteristics of the tumor:
- advanced renal artery on the affected side;
- increased vascularization in the areas of proliferation of tumor tissue;
- the accumulation of contrast agents at the nodes.
To check the degree of germination in Vienna is venacavography (contrast study of the inferior Vena cava).
- filling defect;
- areas of compression and expansion.
The use of isotopes in radionuclide studies is less common. It helps to evaluate the functional loss of the organ, it is particularly important – the preservation of healthy kidneys. The method is valuable for detecting distant metastasis.
Metastasis in the brain behaves like a mass lesion, the clinical manifestations depend on the localization
From what diseases it is necessary to distinguish kidney cancer?
Most often differential diagnosis is carried out with the following diseases.
Changes of renal solitary cyst on the CT scan in contrast to the tumor determine the reduction in contrast. Applied angiography. Considering the compatibility of these conditions using the method of cystografin. Through the puncturing of the kidney contrast medium injected into the suspicious area. The subsequent reveals the rounded cavity with clear boundaries. It is important that the method allows to pump out the contents of the cyst and avoid surgery to patients of advanced age.
Polycystic kidney disease – like a tumor, in case of defeat of one body and hematuria. Accompanied by the development of chronic renal failure. Pielografia gives a typical picture.
Hydronephrosis – is tight, but elastic consistency, smooth surface on palpation. Hematuria accompanied by rare. The characteristic deformity of the renal tissue detected by radiological methods.
Carbuncle (abscess develops less frequently) – similar x-ray pattern.
Clinical signs indicate acute inflammation:
- fever with chills;
- pronounced blood leukocytosis with a shift formula to the left;
- the sharp acceleration of ESR.
A distinctive method is angiography.
Differential diagnosis of tuberculosis of the kidney provides positive tuberculin tests, mention of contacts.
Retroperitoneal tumor is difficult to detect methods of examination. Excretory or retrograde pyelography should be conducted on the background of the introduction of air into the retroperitoneal space. Only in such circumstances, in the pictures you can separate the kidney from neighbouring local tumor.
The actual problem of Onco-urology is the search for diagnostic markers for early diagnosis of kidney cancer. For this, some time ago, used the definition in the urine concentration of degradation products of fibrinogen. Growth is characteristic of transitional cell carcinoma. But the specificity of the technique is insufficient for diagnosis, so it was abandoned.
Patients and doctors are left only with the hope to expect new studies and try to avoid known risk factors.