Diagnosis of kidney cancer
l. General examination: hematuria is an important symptom, erythrocytosis to occur in 3% to 4%; can also occur for anemia. Bilateral renal tumors, the total renal function is usually no change in erythrocyte sedimentation rate increased. Some do not have bone metastases in patients with renal cell carcinoma, but may have symptoms of high blood calcium and serum calcium levels increased, symptoms of kidney cancer after excision of the rapid lifting of calcium is also back to normal. Can sometimes develop to liver dysfunction, such as the tumor nephrectomy, return to normal.
2. X-ray imaging technique for diagnosing the primary means of renal cell carcinoma
(1) X-ray: X-ray film can see that the increase in kidney shape, contour changes, occasional tumor calcification in the tumor or within the limitations of a wide range of floc shadow around the tumor may become calcified line, shell shape, especially young people, more common kidney cancer.
(2), intravenous urography, intravenous urography is a routine method of examination has not yet caused due to not show the undeformed calyceal renal pelvis tumors, as well as difficult to distinguish whether the tumor is renal cell carcinoma. Renal angiomyolipoma, renal cysts, so the importance of fall must be accompanied by ultrasound or CT examination for further identification. However, intravenous urography can understand both sides of kidney function and renal pelvis and ureter and bladder of lights on the diagnosis has important reference value.
(3) renal artery angiography: renal artery angiography imaging of urinary system can be found in the undeformed tumor, kidney manifestations of new blood vessels, arteriovenous fistula, contrast agent pool-like aggregation (Pooling) increased vascular capsule. Angiography great variation, and sometimes kidney may from time imaging, such as tumor necrosis, cystic degeneration, arterial embolism. Renal arteriography when necessary to the normal renal artery injection of epinephrine vasoconstriction and the tumor blood vessels to work.
In the relatively large renal cell carcinoma. Selective renal artery angiography can be followed for renal artery embolization can reduce the bleeding hands of unresectable renal cell carcinoma with severe bleeding and a viable renal artery embolization as a palliative treatment.
3. Ultrasonography: Ultrasonography is the most simple non-invasive examination methods can be used as part of routine physical examination. More than lcm mass within the kidney can be identified by ultrasound scan it is important to identify whether it is kidney mass. Renal cell carcinoma as a solid mass, may be due to internal bleeding, necrosis, cystic change, so echo uneven, generally low echo, kidney realm not very clear, which is different from and renal cysts. Renal space-occupying lesions may cause renal pelvis, renal calices, renal sinus fat, deformed or broken. Renal papillary cystadenocarcinoma ultrasound resemble cysts, and may have calcification. And cystic renal cell carcinoma can be difficult to identify puncture, in the ultrasound-guided puncture is relatively safe. Puncture fluid cytology can be used for parallel imaging cysts. Cyst fluid is often clear, non-tumor cells, low-fat, contrast can be sure when the cyst wall smooth as benign lesions. Such as the liquid to bloody puncture should be aware that cancer could be found in the extracted fluid tumor cells, the contrast is not smooth when the cyst can be diagnosed as malignant. Renal angiomyolipoma as a solid renal tumors, the ultrasound showed a strong echo of adipose tissue, easy and differentiated from renal cell carcinoma. In the ultrasound examination revealed renal cell carcinoma, they should also pay attention whether the tumor through capsule, perirenal adipose tissue, with or without enlarged lymph nodes, renal vein, inferior vena cava tumor thrombus and whether the liver metastasis and so on.
4. CT Scan: CT diagnosis of renal cell carcinoma has an important role, you can find no cause lights to change and non-renal pelvis of the kidney cancer symptoms may be an accurate determination of tumor density, and can be carried out in outpatient, CT can accurately staging. Some people calculate its diagnostic accuracy: 91% violation of renal vein, kidney around the proliferation of 78%, lymph node metastasis 87%, around 96% of organ involvement. CT examination showed renal cell carcinoma renal parenchymal mass, can also be prominent in the renal parenchyma, mass round and round or lobulated border clear or vague, uneven density scan when the soft tissue mass, CT value> 20Hu, often between 30 ~ 50Hu, slightly higher than the normal renal parenchyma, but also similar or slightly lower, its non-uniform system of internal bleeding due to necrosis, or calcification. Sometimes expressed as CT values of cystic soft-tissue nodules, but cystic wall. After intravenous injection of contrast agent, normal renal parenchymal CT value of about 120Hu tumor CT values have increased, but significantly lower than normal renal parenchyma, the tumor realm clearer. Such as the mass-enhanced CT values in no change, which may be cysts, combined with CT before and after contrast agent injected into the value of liquid density can confirm the diagnosis. Necrotic foci within the renal cell carcinoma, renal cystic carcinoma and renal artery embolization, the injection of contrast agent after the CT value is not increased. Renal angiomyolipoma because of its large number of fat contains, CT value is often negative, the internal non-uniform, the enhanced CT values increased, but still showed fat density, oncocytoma a clear edge in the CT examination, the internal density of uniform-enhanced CT was significantly higher.
CT examination to determine violations of standards in renal cell carcinoma.
(1) tumor confined within the renal capsule: normal or suffering from kidney shape limitations of projections, or even increase. Prominent smooth or slightly rough surface, such as the mass was nodular broke into the kidney capsule, the surface smooth and is still considered limited to the renal capsule. Adipose capsule clear, no irregular thickening of perirenal fascia. Can not be used to determine the existence of fat sac tumor is confined within the renal fascia, especially in patients with weight loss.
(2) confined to the kidney capsule of fat around the violation: tumor protruding and partially replace the normal renal parenchyma, renal surface rough significant, irregular thickening of renal fascia. Adipose capsule are ill-defined soft tissue nodules, linear soft-tissue shadow is not to diagnose.
(3) venous invasion: renal vein was thickened into a local Clostridium bulging, uneven density, abnormal increase or decrease the density change and the same tumor tissue. Vein thickening standards, renal vein diameter> 0.5cm, upper abdominal inferior vena cava diameter> 2.7cm.
(4) lymph node invasion: renal pedicle, abdominal aorta and inferior vena cava, as well as during the round soft tissue shadow. Enhanced density, no significant change could be considered as a lymph node, <1cm fails to be diagnosed, ≥ lcm consider metastatic carcinoma.
(5), adjacent organ invasion: lumps removed the boundary between the neighboring organs and have the shape and density of neighboring organs changed. If the mere expression of the tumor and adjacent organs, fat line between the disappearance of no diagnosis.
(6) invaded the renal pelvis: part of the tumor into the renal pelvis smooth rounded edges and a half months showed the formation of arc pressure, and delayed scanning in renal function better under pressure when the renal pelvis and lights can be seen in the contrast agent edges smooth and tidy, then considered to be renal pelvis and cup pure compression. Such as the renal pelvis and calyceal structure disappeared or occlusion, and all were tumor occupied, then the tumor has been prompted perforation pelvis.
5. Magnetic resonance imaging (MRI): MRI is more satisfactory in the kidney. Renal hilum and perirenal space to produce high signal intensity of fat. Renal outer cortical high signal intensity, which the Ministry of medulla of low signal intensity may be due to osmotic pressure within the kidney is different from the two parts of 50% contrast difference, this difference can be extended with the recovery time and hydration and reduced, renal artery and intravenous non-cavity signal, so for the low-intensity. Urine collection system has a lower intensity. MRI renal cell carcinoma great variation from the tumor blood vessels, the size, with or without necrosis of the decision. MRI can not be good to find calcification, because the proton density. MRI of the kidney violation of the scope of the surrounding tissue capsule, liver, mesentery, psoas easy to find the identification of the change. In particular, renal cell carcinoma of renal vein and inferior vena cava tumor thrombus and lymph node metastasis.
