The how to treat renal cell carcinoma

Renal cell carcinoma mainly depend on radical surgery. Radiotherapy and chemotherapy can not completely control the tumor, generally as a palliative treatment to relieve pain, prolong life, or as adjuvant therapy after surgery. Endocrine treatment of advanced renal cell carcinoma patients with small tumors can partly degraded. Immunotherapy of tumor development may have a certain extent. Renal cell carcinoma mainly depend on radical surgery. Radiotherapy and chemotherapy can not completely control the tumor, generally as a palliative treatment to relieve pain, prolong life, or as adjuvant therapy after surgery. Endocrine treatment of advanced renal cell carcinoma patients with small tumors can partly degraded. Immunotherapy of tumor development may have a certain extent.

(A) of the surgical treatment

This is the main method to cure kidney cancer. The principle of treating kidney cancer, in addition to removal of kidneys with tumors other than to remove the tumor cells should be spread to the surrounding tissue, including fat and fascia around the kidney, adrenal gland, regional lymph nodes and renal vein and inferior vena cava tumor thrombus within the . Should be used to better surgical exposure, incision, before the first fight for the separation of renal vascular renal pedicle ligation, to prevent the spread of cancer cells separation surgery and / or thrombosis of the transfer. The smaller the tumor volume I, section 11 can be used in renal cell intercostal incision. Or the tumor stage Ⅱ, Ⅲ kidney should be removed 10 or 9 ribs of the thoracoabdominal incision. According to Beare and McDonald on 488 cases of renal cell carcinoma specimens were huge physical and histological examination, was found in 343 patients (70%) of the cancer cells have infiltrated the renal capsule or perinephric fat arrival. The results suggest that the value of expanding the scope of operation. Foley According to the pathological examination results will be in clinical renal fascia and the fascia around the capsule contents for en bloc resection, follow-up results, efficacy has improved significantly. Shanghai Medical University reported the first radical nephrectomy be long-term follow-up of 21 patients were very high survival rate. This shows that radical nephrectomy in renal cell carcinoma prognosis and improve the efficacy of change has very important significance. According to Robson and other reports, the operation was within the renal vein tumor thrombus in 13 patients, 6 patients with tumor thrombus removal after 5 to 7 years of existence, the Shanghai First Medical College in 2 cases of renal vein thrombosis after removal up more than 10 years still alive.

Lymph node metastasis to survival in patients with renal cell carcinoma decreased significantly, but the value of lymph node dissection and removal of the range there is no uniform opinion. Some patients have blood in the early stage of metastasis, lymphatic drainage and renal cell carcinoma is very rich in the direction of its drainage and sometimes do not follow the normal channels, it clearly affects the efficacy of lymph node dissection. For these reasons, Dekernion advocate unilateral lymph node dissection limited to the limitations of lymph node metastasis of early opportunities for patients to be cured, and as the basis for staging renal cell carcinoma. He believes that in the absence of a clear line of this operation not before extensive retroperitoneal lymph node dissection. Unilateral removal of his range is under the inferior mesenteric artery level since the beginning, from the ligation of adrenal blood vessels cut off date. Only clear the aorta (vena cava) in front of and outside of the lymphatic tissue, blood vessels and the dorsal and large organizations are not clear, no lumbar artery ligation. Some advocates of the first stage Ⅱ, Ⅲ tumors, clear extended to the diaphragm to the aortic bifurcation level of the following major blood vessels around the lymph nodes.


For large tumors before surgery or renal artery embolization in vitro irradiation, can reduce tumor volume, varicose veins shrink to reduce the difficulty of operation and reduction of blood loss. Some advocate preoperative embolization of renal artery routinely, 1 weeks after the radical nephrectomy, in order to improve the circulation in the anti-tumor specific antibody concentration, after routine application of medroxyprogesterone acetate (400mg, intramuscularly, weekly 2) to enhance effectiveness.

Solitary kidney renal cell carcinoma in situ after cooling the kidney to remove the tumor. If the tumor is located in the central renal tumor size or large, difficult to estimate in situ operation, after cooling in vitro completely remove the tumor, then a kidney transplant in the iliac fossa. Bilateral renal cell carcinoma, without distant metastasis was found, according to two kidney conditions may be, will do part of the bilateral nephrectomy, or the larger side of the radical nephrectomy, the smaller side of the line part of the nephrectomy. Patients with endocrine therapy (medroxyprogesterone acetate), immunotherapy and chemotherapy.

Primary renal cell carcinoma has invaded adjacent organs Stage Ⅳ tumors with poor prognosis, such as the patient's condition permits, should seek the original tumor with invasion of adjacent organs and tissues be removed, adjuvant chemotherapy and immunotherapy. Very small number of patients can survive. If there are a wide range of preoperative local infiltration, radiation therapy can be used in vitro or renal artery embolization to shrink tumors before operation.

Renal cell carcinoma with distant metastasis, in addition to the following circumstances are not generally suitable palliative nephrectomy. ① primary tumors of gross hematuria, pain, hypertension, liver dysfunction and other serious symptoms, those with medical treatment can not alleviate; ② transfer of the small number of the estimated total surgical resection can be used; ③ only bone metastasis surgery, the relative mean Zheng, suffering from renal palliative

After resection, 1-year survival rate as high as 36%.

(B) radiation for renal cell carcinoma less sensitive to radiotherapy, it has long been the main method of treatment has not been used. However, this method has been widely used in preoperative or postoperative adjuvant therapy, as well as relieve pain and other symptoms of metastatic renal cell carcinoma treatment. The role of this therapy, which can improve patient survival, reduce the relapse rate, has not been determined. Renal cell carcinoma indication for radiotherapy as follows: ① the higher the degree of malignancy or stage Ⅱ, Ⅲ tumors, postoperative radiotherapy as an adjuvant therapy can be used; ② large primary tumor and / or infiltrative tumor blood supply fixed or venous engorgement who Preoperative radiotherapy can shrink tumors, vascular contraction to increase the resection rate; ③ bone pain caused by metastatic renal cell carcinoma, etc., can alleviate the symptoms of radiation; ④ advanced inoperable patient, radiotherapy can relieve hematuria, pain and other symptoms and prolong life.

(C) chemotherapy cytotoxic effect of poor treatment of kidney cancer, according to Bloom comprehensive literature 354 cases of the application of various drug treatment showed that only 7.6% of patients had a temporary objective response, there is little therapeutic value of cyclophosphamide amide, 6 - mercaptopurine, vinblastine, actinomycin and cyclohexyl nitrosourea (CCNU). In the application of CCNU in 26 patients, 5 patients with objective response. Vinblastine treatment of Stage Ⅳ kidney cancer, 25% had objective response. Huashan Hospital, Shanghai Medical University, apply the following chemotherapy regimens on the first objective Ⅳ Effect of renal cell carcinoma is about 50%; fluorouracil 1500mg soluble 1000ml5% glucose water or saline, intravenous drip, drop by 10 to 12 hours of completion. 1 day, 5 days for a course of treatment. Day 1 plus mitomycin 20mg by slow intravenous push. The chemotherapy 1 month.

(D) endocrine therapy less effective. Oral medroxyprogesterone, 100mg1 times, 3 times a day, or 400mg intramuscularly, 2 times per week, on average, 15% of patients with partial degradation. The effect of testosterone propionate worse. The above information is the first patient application of the results Ⅳ. Thus, as in the course of earlier applications, such as primary tumor resection adjuvant therapy after surgery may reduce the incidence of transfer opportunities and improve the cure rate.

(E) renal cell carcinoma immunotherapy is likely to cause the immune function of tumor. Use of immunotherapy may inhibit tumor development.