Kidney cancer - early detection and early treatment are the key!

Author: Shi Hongzhe, deputy chief physician, Cancer Hospital, Chinese Academy of Medical Sciences

Reviewer: Li Changling, Chief Physician, Cancer Hospital, Chinese Academy of Medical Sciences

Currently, kidney cancer has been listed among the top ten tumors in the world. However, the incidence of kidney cancer is regional. It is higher in European and American countries than in Asian and African countries, higher in cities than in rural areas, and higher in men than in women.

In recent years, the incidence of kidney cancer in my country has increased rapidly. The current incidence is 8 per 100,000. 10-20 years ago, the incidence of kidney cancer in our country was only 2 per 100,000 or 1.5 per 100,000.

At present, the cause of kidney cancer is still unclear, but studies have found that several related factors, such as smoking, obesity, diabetes, high blood pressure, genetics, and advanced age, are related to the incidence of kidney cancer.

Figure 1 Original copyright image, no permission to reprint

However, in terms of genetic factors, only 1%-3% of kidney cancer is clearly caused by genetics.

In terms of age, kidney cancer usually occurs after the age of 50, but in recent years it has become younger, so even young people should pay attention to it. Especially young people with a family history of tumor inheritance, the age of onset is relatively young, and it often occurs bilaterally.

So young people should not always think that they are young and healthy, and do not pay much attention to a little discomfort. In the end, they will have symptoms and become serious. A checkup will reveal that they are mid- to late-stage kidney cancer, with external invasion and metastasis. So young friends should also have regular physical examinations.

There are no symptoms in the early stages of kidney cancer. The three main symptoms in the middle and late stages are lumps, hematuria, and pain.

So, how is early kidney cancer detected?

Normally, if you have a physical examination and B-ultrasound every year and find a lump on the kidney, you should go to the hospital for further examination immediately so that early kidney cancer can be detected.

Next, CT and MRI examinations are usually required. Because B-ultrasound examinations are subject to the doctor's subjectivity, but CT and MRI are objective and can show the size and location of the tumor in the kidney, which is very meaningful for determining the next treatment plan.

There are four types of kidney cancer:

First, clear cell carcinoma, accounting for 75%; second, papillary renal cell carcinoma, accounting for 10%-15%; third, chromophobe cell carcinoma, accounting for about 5%-7%; fourth, collecting duct carcinoma, medullary carcinoma, undifferentiated carcinoma and sarcomatoid carcinoma, accounting for only 1%-3%. Therefore, most renal cancers are clear cell carcinomas.

According to the degree of differentiation of tumor cells, which is also known as the degree of malignancy, there is a Fuhrman pathological grading system, which includes grade I, grade II, grade III, and grade IV. Grade I has the lowest degree of malignancy, and grade IV has the highest degree of malignancy.

Most clear cell carcinomas are Fuhrman grade II. Papillary renal cell carcinoma is less malignant than clear cell carcinoma. Chromophobe renal cell carcinoma is less malignant than papillary renal cell carcinoma. Collecting duct carcinoma, medullary carcinoma, and undifferentiated carcinoma are highly malignant and have a poor prognosis.

Therefore, kidney cancer is divided into different types to make treatment more accurate.

A brief introduction to the stages of kidney cancer:

In stage I, the tumor is less than 7 cm in size; in stage II, the tumor is more than 7 cm in size; in stage III, the tumor grows beyond the kidney, invading the fat around the kidney and the renal pelvis, and may even have renal vein and inferior vena cava tumor thrombi or lymph node metastases; in stage IV, the tumor has distant metastases.

Stages I and II are in the early stages, and early tumors are most effectively treated, with a five-year survival rate of 90%-95% and a ten-year survival rate of more than 80%.

Figure 2 Original copyright image, no permission to reprint

The treatment for stage III renal cancer is radical surgery. Because of metastasis in stage IV, targeted or target-immune combined therapy is mainly used.

Therefore, kidney cancer can be cured in the early stage, but the treatment effect in the late stage is not ideal. So we urge everyone to have regular physical examinations so that early detection and early treatment can be achieved.

Generally, for early-stage renal cancer, partial nephrectomy can be performed. The medical term is called nephron-preserving renal tumor or nephrectomy. In order to completely remove the tumor, depending on the size of the tumor, 1/3, 1/2, or 1/5 of the kidney tissue may need to be removed, that is, the tumor and part of the kidney tissue around the tumor are removed.

When performing partial nephrectomy, it is important to note that although the tumor is relatively small, in 13% of patients the tumor may have invaded the perirenal fat and is stage III renal cancer.

In general, kidney-saving surgery can be performed in the early stages. If the tumor invades the fat around the kidney, or if the tumor is not large but is in a bad location and grows to a place with large blood vessels or inside the kidney, a radical nephrectomy is also required, which means the entire kidney on one side must be removed.

There is also a method called tumor reduction surgery. Although metastasis occurs, there are not many metastatic lesions and the patient is in good condition. Resection of the primary lesion is also a treatment method, which has certain benefits on the patient's efficacy and prognosis.