Renal pelvis tumor and ureteral tumor

　　The chemical carcinogens similar to bladder cancer will be discussed in detail in the next section.

　　Balkan nephropathy is interstitial nephritis, a common cause of renal pelvis and ureteral cancer, including Yugoslavia, Romania, Bulgaria, Greece, and other regions with obvious regional characteristics, even with boundaries between villages. It develops slowly, causes renal function impairment, and has a similar number of male and female patients, with a bilateral incidence of 10%. Investigations on environment, occupation, and genetics have been conducted, but the cause is still unclear. Because of the ease of renal function injury, superficiality, and multiplicity, treatment should strive to preserve renal tissue as much as possible.

　　Painkillers can cause renal pelvis cancer, and it is believed in recent years that acetaninophen (Tylenol) is a metabolite with carcinogenic properties. The carcinogenic effect of painkillers often requires accumulation of more than 5kg, which is similar to the carcinogenic opportunity of smoking 15 cigarettes a day for 20 years.

　　Chronic irritation caused by inflammatory conditions such as urinary stones can lead to renal pelvis cancer, most of which are squamous cell carcinomas, with more than 50% of patients with a history of calculus disease among squamous cell carcinoma patients.

　　There is a familial occurrence. McCullough reported that a father and two sons developed multiple upper urinary tract tumors, and Gitte observed multiple tumors in three brothers, starting with bladder tumors. Familial occurrence may be related to infection with the measles virus, metabolic abnormalities, and exposure to carcinogens.

　　Ureteropelvic junction cancer has the nature of multi-organ involvement, and there may be symptoms of bladder irritation, which may be the manifestation of bladder tumors. Local spread may lead to complications such as varicocele and retroperitoneal lumbar muscle sign. It can also directly combine with bladder tumors, manifesting as painless gross hematuria throughout the course, which is the most common symptom of bladder cancer. In cases of mild hematuria, it may be manifested as microscopic hematuria. The time and severity of hematuria do not necessarily correlate with the severity of the tumor. Patients with bladder cancer may also have urinary frequency and urgency as the initial manifestation, which may be caused by the stimulation of the bladder by in situ cancer.

　　The ratio of male to female is 2:1, 40 to 70 years old accounts for 80%, with an average age of 55. Hematuria is the most common initial symptom, visible to the naked eye, intermittent, painless. When blood clots pass through the ureter, it can cause renal colic, with worm-like blood streaks. Sometimes, patients may present with dull pain in the lumbar region. Most patients have no obvious positive signs, but about 7% show cachexia, which is a case in the late stage. 5% to 15% can feel an enlarged kidney, and there may be costovertebral angle tenderness. There are reports that 10% to 15% have no clinical symptoms and are accidentally found during examination for other diseases. Renal pelvis and ureteral cancer have the nature of multi-organ onset, and there may be bladder irritation symptoms, which are the manifestation of bladder tumors. Local spread can cause varicocele, para-peritoneal lumbar muscle sign, etc. Squamous cell carcinoma often presents with symptoms of calculus or infection.

　　Firstly, eat recommended foods

　　1. Eat more foods that have an anti-bladder and urethra tumor effect, such as toads, frogs, snails, kelp, seaweed, tortoise shell, turtle, sea cucumber, water snake, Job's tears, water chestnut, walnut, sheep kidney, pork kidney, broad bean, sand worm, perch, and mackerel.

　　2. Seaweed, wakame, and seaweed are recommended for urethral obstruction.

　　3. Foods such as yellowfish bladder, shark fin, water snake, pigeon, jellyfish, lotus root starch, buckwheat, malan head, earth ear, turnip, olive, eggplant, fig, mung bean sprouts, soy milk, amaranth, seaweed, and loach are recommended for infection.

　　4. Foods such as celery, chrysanthemum, leek, winter melon, black plum, dried persimmon, sesame seeds, lotus seeds, sea cucumber, and mouse meat are recommended for bleeding.

　　Secondly, avoid eating certain foods

　　1. Avoid smoking, alcohol, coffee, and cocoa.

　　2. Avoid spicy, hot and blood-activating foods.

　　3. Avoid moldy, fried, and greasy foods.

　　Third, prognosis

　　The factors determining the survival of renal cell carcinoma have been mentioned before. Generally, the 5-year survival rate after nephrectomy for renal cell carcinoma is 35% to 40%, and the 10-year survival rate is 17% to 30%. The prognosis of renal cell carcinoma is sometimes difficult to estimate, and metastatic lesions may appear 20 to 30 years, or even longer, after nephrectomy for renal cell carcinoma.

　　First, excretory urography of the urinary system:Filling defects can be seen, which should be differentiated from uric acid stones and matrix stones. Sometimes, defects may be caused by blood clots. Renal parenchymal tumors and cysts may all show filling defects in the renal pelvis and calyces. Sometimes, B-ultrasound and CT are needed for diagnosis. Small defects in the renal pelvis may be caused by renal arteries and their branches. Tumors can cause non-visualization of the ureter, especially in the case of ureteral tumors. There are statistics that when renal pelvis cancer does not show up, 1/3 is in the late stage, that is, infiltrative cancer. When ureteral cancer causes non-visualization, 60% to 80% are infiltrative. Renal hydronephrosis accounts for 35%, and 20% of those with filling defects in the ureter and found to have hydronephrosis. 85% of those with normal urinary system imaging are in the early stage of tumors.

　　When excretory urography is poor, it should be combined with retrograde urography or other examinations.

　　Second, retrograde urography of the urinary system:Its importance is:

　　1. Contrast imaging is clearer, especially when excretory contrast imaging is poor.

　　2. Blood may be seen to spurt from the ureteral orifice on the affected side, and the lower ureteral tumor protrudes towards the ureteral orifice.

　　3. Directly collect urine from the affected side for tumor cytological examination or brush biopsy.

　　4. Cystoscopy is used to exclude bladder tumors.

　　During retrograde urography, excessive contrast agent injection into the renal pelvis may obscure small filling defects. Ureteral urography must ensure full ureteral filling for an accurate diagnosis. Bulb-shaped (bulb) catheter ureteral urography, the tip of the ureteral catheter resembles an olive or acorn, and contrast agent is injected below the ureteral orifice under the screen. The tumor can be seen being pushed upwards, and the ureteral expansion below is like a 'tumbler cup', if it is a calculus, the lower part does not expand. The surface of infiltrative tumors is not smooth, and misdiagnosis may occur when urinary stones are accompanied by edema. Sometimes urinary stones can be associated with tumors. Ureteral polyps often appear as smooth, elongated filling defects with possible branches.

　　In ureteral tumors, the following catheters may bend or form a loop, and if the catheter passes through the tumor, it can be found that the urine above is clear, while the urine flowing out next to the catheter is hematuria.

　　It is necessary to prevent the introduction of air bubbles during contrast imaging to avoid misdiagnosis.

　　Three, brush biopsy:When clinical suspicion of tumor is present and cytological examination is positive, a biopsy can be taken from the suspected site after intravenous injection of contrast agent, with a small brush passed through an F5 catheter, and tissue can adhere to the bristles of the brush. After removing the brush, there may be small tissue fragments in the effluent of the ureteral catheter. The fluid should be repeatedly flushed with a small amount of saline and collected for examination. The ureteral catheter should be left in place overnight before removal.

　　Four, ultrasound examination:Can distinguish calculus from soft tissue lesions, and it is difficult to differentiate between tumors and necrotic papillae, clots, matrix stones, etc., and ultrasound examination of ureteral lesions is unreliable.

　　Five, CT:Can distinguish transitional cell carcinoma within the renal pelvis and calyces from renal cell carcinoma, and renal pelvis carcinoma is characterized by

　　1. Solid mass in the renal pelvis or renal calyces showing a spherical shape, with displaced and compressed renal sinus fat.

　　2. No significant enhancement after injection of contrast agent.

　　3. Curved curve of contrast agent filling around the tumor.

　　4. Renal parenchyma enhancement extension (when the tumor is large and affects drainage).

　　5. Retain the renal shape.

　　Six, renal arteriography:Can detect the narrowing or obstruction of renal intravascular arteries, which often indicates that there is infiltration, and tumors with a diameter of 3cm or more can be seen to hemorrhage.

　　Seven, ureteroscopy and renal pelvisoscopy:May be used for diagnosis and treatment, and renal pelvisoscopy may cause tumor transplantation, and its practical value is still difficult to conclude.

　　Eight, magnetic resonance imaging:Can be used to distinguish renal cell carcinoma and renal pelvis carcinoma, and can also be used for diagnosis of ureteral lesions, and can avoid the use of contrast agents (for those allergic to contrast agents), if contrast agents can be developed and applied, it can improve the accuracy of diagnosis.

　　Nine, cytological examination:Well-differentiated low-grade tumors have 80% false-negative results, while poorly differentiated tumors have 60% positive results or are highly suspected.

　　Firstly, eat recommended foods

　　1. Eat more foods that have an anti-bladder and urethra tumor effect, such as toads, frogs, snails, kelp, seaweed, tortoise shell, turtle, sea cucumber, water snake, Job's tears, water chestnut, walnut, sheep kidney, pork kidney, broad bean, sand worm, perch, and mackerel.

　　2. Seaweed, wakame, and seaweed are recommended for urethral obstruction.

　　3. Foods such as yellowfish bladder, shark fin, water snake, pigeon, jellyfish, lotus root starch, buckwheat, malan head, earth ear, turnip, olive, eggplant, fig, mung bean sprouts, soy milk, amaranth, seaweed, and loach are recommended for infection.

　　4. Foods such as celery, chrysanthemum, leek, winter melon, black plum, dried persimmon, sesame seeds, lotus seeds, sea cucumber, and mouse meat are recommended for bleeding.

　　Secondly, avoid eating certain foods

　　1. Avoid smoking, alcohol, coffee, and cocoa.

　　2. Avoid spicy, hot and blood-activating foods.

　　3. Avoid moldy, fried, and greasy foods.

　　The history of renal and ureteral cancer surgery including the bladder wall segment has a history of 50 years, and if the entire ureter is not resected, the possibility of ureteral tumor development is as high as 84%. Among 17 cases of renal pelvis cancer with residual ureter, 7 cases (41.2%) developed tumors at the residual end within three years, half within one year. Some believe that renal pelvis cancer is planted in the ureter, but actually it is due to the multifocality of the tumor, and the carcinogenic effect is based on implantation.

　　In recent years, with the understanding of the biological characteristics of tumors, the surgery for renal and ureteral tumors cannot be uniform. For low-grade and low-grade renal and ureteral cancer, partial resection and radical surgery have the same efficacy. For high-grade and high-grade cancer, radical surgery should be performed, otherwise it is difficult to cure, especially for those with positive cytology. Some advocates for partial resection surgery for localized advanced cancer lesions, and finally found that 90% died of cancer, while those undergoing radical surgery only accounted for 30%. Ureterectomy must include the bladder wall segment, otherwise 60% may develop bladder cancer. Whether to perform lymph node dissection in radical surgery? Generally, a negative attitude is held, because there are very few lymph node metastases that exceed one year from below.

　　For patients with solitary kidney or both kidneys with tumors, if they belong to low stage and low grade, and urine cytology is negative, efforts should be made to preserve as much renal tissue as possible. For high stage and high grade, radical surgery under dialysis should be performed. Sometimes, for cytology-negative low-grade tumors, renal pelvoscopic resection is performed to remove the tumor. About 20% of ureteral tumor patients undergo partial resection to preserve the kidney.

　　The 5-year survival rate of renal pelvis cancer without infiltration is 40% to 59%, and 10% to 25% with infiltrative and poor differentiation. The 5-year survival rate of Beijing University of Medicine after renal pelvis cancer surgery is up to 60.3%.

　　As mentioned before, renal pelvis and ureteral tumors are prone to organ tumors, and it is necessary to closely follow up with advocates for urine cytology examination every 6 months and cystoscopy follow-up for 2 years.

　　When treating renal and ureteral tumors, it is necessary to differentiate from ureteral polyps. Ureteral polyps are thin benign urothelial layers on mesenchymal tissue, with a long pedicle and can have branching smooth appearance, and are positive in cytology. The tissue contains blood vessels and fibrous tissue, and those with more blood vessels are called 'hemangiomas'. Severe hematuria, those with more fibrous tissue are called 'fibroids'. Polyps are more common in young people.