Renal clear cell carcinoma

　　1. Renal cell carcinoma is often due to insufficient kidney qi, water dampness not being transformed, endogenous damp toxicity, or external attack by damp-heat pathogenic factors, entering the interior and forming toxins, and the internal and external pathogenic factors are combined with the waterway. Kidney deficiency cannot control blood, leading to hematuria. The lumbar region is the residence of the kidney, so kidney deficiency leads to back pain. Damp-heat toxins combined over time lead to Qi stasis and blood stasis, forming a mass.

　　2. Modern medicine is also unclear about the etiology of renal cell carcinoma and renal pelvis cancer, and it is believed that it may be related to the long-term stimulatory effect of carcinogens, such as the higher incidence of renal cancer in smokers, and the frequent occurrence of pyelonephritis in those who have long-term use of non-opioid analgesics for pain and fever relief, which also increases the incidence of renal pelvis cancer. Long-term kidney stones and infections can induce epithelial metaplasia and atypical hyperplasia, which can develop into cancer.

　　3. The etiology of kidney tumors is still unclear, and it is believed in recent years that aromatic amines, aromatic hydrocarbons, aflatoxins, nitrosamines, alkyl compounds, hydrazines, lead, cadmium, and certain drugs such as anticancer drugs, phenacetin, amphetamines, diuretics, and potassium bromate, as well as additives in coffee and food, have carcinogenic effects. Most scholars believe that renal cell carcinoma originates from the proximal tubule. In the population that smokes directly through a pipe or cigar, the incidence of renal cancer is significantly increased. A study shows that the incidence of renal cancer in smokers is 1.7 times higher than that in non-smokers, and there is a direct and significant relationship between the amount of smoking and the risk, with a relative risk of 1.1 for light smoking, 1.9 for moderate smoking, and 2.3 for heavy smoking. The degree of smoking and the length of smoking duration are positively correlated with the incidence of renal cancer, and even if smokers quit smoking, the risk of developing renal cancer is still twice as high as that of non-smokers. The dimethyl nitrosamine in tobacco has been confirmed to induce renal cancer in animal experiments. Vecchia believes that factors such as smoking, alcoholism, and occupational exposure can further increase the risk of developing renal cancer. β-Naphthylamine and ethylamin-7-naphthol are present in the urine of smokers, and these substances have been confirmed to cause bladder cancer, and they may also lead to renal cancer. The Luck'e. Herpesvirus and murine mammary tumor virus can cause renal tumors in animals, but their carcinogenic effects on humans have not been confirmed. Renal cell carcinoma is more common in males, especially in elderly males with male hormone decline, indicating that sex hormones are related to the occurrence of renal cell carcinoma, but the exact mechanism is not clear. Overweight females have a higher incidence of renal cell carcinoma, while overweight males do not. What kind of nutrients promote the occurrence of renal cell carcinoma is still unknown. Certain genetic diseases such as tuberous sclerosis and multiple neurofibromatosis can be associated with renal cell carcinoma. Nephrolithiasis can lead to renal pelvis cancer due to long-term local inflammatory stimulation. Long-term hemodialysis patients may develop acquired renal cystic disease and cancer due to the accumulation of substances such as polyamines that cannot be cleared by hemodialysis.

　　In summary, the occurrence of renal cell carcinoma may be related to many chemical and biological factors. Smoking and (or) obesity, other factors including aluminum phosphate, dimethyl nitrosamine, long-term estrogen intake, aflatoxin B1, streptozotocin, and certain special diseases such as Von-Hippel-Lindau disease can all cause renal cell carcinoma. Some chronic renal failure patients or those with acquired kidney cysts due to dialysis treatment may also develop renal cell carcinoma. Approximately 30% to 50% of long-term dialysis patients may develop acquired kidney cysts, among whom 6% may develop renal cell carcinoma associated with acquired cystic disease.

　　Secondary polycythemia often occurs. Renal cell tumors often metastasize to the lungs, bones, liver, and other organs, and there are many extrarenal manifestations of non-urinary systems such as high fever, liver dysfunction, anemia, hypertension, polycythemia, and hypercalcemia. The most serious complication is death.

　　A small number of renal cancers are associated with increased gonadotropin levels, which cause breast enlargement, pigmented areola, and decreased libido in males. In females, it can cause hirsutism and amenorrhea, etc.

　　1. Renal cell carcinoma patients may develop secondary amyloidosis. Amyloidosis itself can lead to renal failure, and patients with secondary amyloidosis have poor prognosis. Proteinuria and nephrotic syndrome may also occur in renal cell carcinoma patients. Some chronic renal failure patients or those with acquired kidney cysts due to dialysis treatment may also develop renal cell carcinoma. Approximately 30% to 50% of long-term dialysis patients may develop acquired kidney cysts, among whom 6% may develop renal cell carcinoma associated with acquired cystic disease.

　　2. Renal cell carcinoma often presents with metastasis and multiple organ tumors.

　　Renal clear cell carcinoma often has no symptoms in the early stage, or only systemic symptoms such as fever and fatigue. It is only discovered when the tumor volume increases. Clinically, it is mainly manifested as hematuria, renal area pain, and mass.

　　I. Primary prevention

　　Abstain from smoking and drinking, establish good living habits, engage in regular and moderate physical exercise, and provide strict protection for personnel exposed to cadmium industrial environments.

　　1. Quit smoking and do not overindulge in alcohol.

　　2. Be cautious when using antipyretics, such as phenacetin and other drugs.

　　3. People with kidney cysts and other kidney diseases should seek active treatment.

　　4. Regular physical exercise, balanced diet, increased nutrition, maintaining a pleasant mood, and enhancing the body's immune system.

　　5. Regularly consuming foods with anticancer and anti-tumor effects.

　　Two-level prevention

　　Screening is one of the methods for early detection of renal tumors, using simple ultrasound renal examination methods; further examination should be conducted for those with rapid erythrocyte sedimentation rate, high blood calcium, and anemia. The complaints and clinical manifestations of renal cancer patients are variable, and the kidney is located covertly, making early self-diagnosis and self-examination difficult. Hematuria is the most common symptom of renal tumors, often painless, intermittent, and gross hematuria. Attention should be paid to the fact that hematuria in the elderly is often considered to be due to benign prostatic hyperplasia and stones, and the possibility of renal cancer should be警惕. Only 10% of hematuria accompanied by back pain and mass is due to renal tumors, and one should be vigilant about the extrarenal manifestations, such as fever, hypertension, hypercalcemia, rapid erythrocyte sedimentation rate, anemia, abnormal liver function, weight loss, increased red blood cells, and varicocele on the left testicle that does not disappear when lying flat, all of which may indicate renal cancer, and one should seek medical attention promptly. Regular health check-ups, especially for those with a history of exposure to carcinogenic mutagens, should focus on blood and urine routine checks, renal ultrasound examination, and strive to detect tumors less than 1 cm in diameter early. Once renal cancer is detected, it should be removed surgically as soon as possible. Radical nephrectomy includes the removal of perirenal fascia, fat, adrenal glands, lymphatic tissue, and middle and upper ureter. The renal vein and inferior vena cava thrombi should be removed. Chemotherapy and radiotherapy for renal cancer are not very effective, and immunotherapy has some efficacy.

　　Three-level prevention

　　In the late stage, patients may develop cachexia, with local pain being obvious. Hemorrhage within the tumor can cause severe anemia. Supportive therapy, such as blood transfusion, intravenous hyperalimentation, palliative nephrectomy, or selective regional arterial chemotherapy with embolization, can be used for severe hemorrhage, pain, and extrarenal symptoms, such as compression of surrounding organs. Symptomatic treatment such as pain relief can reduce patient suffering and prolong life.

　　1. Urinary tract imaging:It can show distortion, narrowing, and destruction of the renal calyces, or expansion and deformation of the calyces. When the tumor mass is very large and grows in all directions, most of the renal calyces become elongated, narrowed, and deformed, sometimes even entering the renal pelvis, or pushing the upper ureter to the opposite side, even beyond the midline, resembling the shape of a spider's legs, hence the name 'spider foot sign'.

　　2. Ultrasound manifestations:It can show irregular boundary echoes within the renal parenchyma, with internal echoes being chaotic, uneven, and uneven in height and lowness, forming a solid mass. The entire kidney shape is deformed, with local masses protruding beyond the normal field contour.

　　3. CT manifestations:The unenhanced scan shows local prominence of the kidney, with unevenly low density inside, visible as patchy or pinpoint calcifications, sometimes shell-like in appearance; after contrast-enhanced scan, the normal renal tissue shows marked enhancement, while the tumor area has lower enhancement and irregular enhancement, with areas of lower density necrosis. The cancer can penetrate the capsule into the perirenal fat layer, and in the late stage, it can penetrate the renal fascia and spread to extrarenal tissues. The staging of renal cell carcinoma often uses the Robson staging method, where stage I cancer is limited to within the renal capsule; stage II cancer has penetrated the capsule, invaded the fat layer, and is still confined within the renal fascia; stage III cancer has invaded the renal vein or (and) inferior vena cava, with possible metastasis to local lymph nodes; stage IV cancer has penetrated the renal fascia, invaded adjacent organs, or developed distant metastasis.

　　4. MRI manifestations:Observing and understanding the extent of tumor invasion in multiple positions is slightly better than CT.

      In addition to routine treatment, patients with renal clear cell carcinoma should pay attention to light diet, try to stay away from spicy and刺激性 food, and pay attention to nutrition at the same time, in order to help the disease recover faster.

　　Although clear cell carcinoma is the lowest in malignancy among renal cancers, in clinical practice, it often coexists with three types of granular cell carcinoma and spindle cell carcinoma. The classification under the microscope is actually very difficult.

　　FirstGenerally, radical nephrectomy surgery is adopted

　　The rate of metastasis of renal cancer through blood transportation is very high, with about 60% of patients having the possibility of metastasis. The frequency of metastasis organs is as follows: lung (52%), bone (40%), liver (23%), distant lymph nodes (23%), renal vein (22%), adrenal gland (20%), contralateral kidney (18%), pleura (10%), central nervous system (8%), pancreas (7%) and so on. Therefore, it is necessary to pay close attention to the condition of the above tissues and organs (such as hemiplegia, sciatica, back pain, cervical lymph node enlargement, frequent cough, pain in the liver area, abnormal liver function, etc., which generally indicate metastasis). If there is no new metastatic focus found within two years, it is basically safe.

　　SecondImmunotherapy

　　Combination of immunotherapy and chemotherapy can extend the life of patients. Commonly used drugs include interferon, IL-2, BCG, etc. Interferon therapy has a positive significance, and it should be accepted as long as the economic conditions allow. Other nutrition and care are the same as general postoperative tumor patients, with no special requirements. Considering that the patient only has one kidney, it is necessary to avoid all factors that may increase the burden on the kidney, such as common cold with fever, alcohol consumption, strenuous exercise, fatigue, nephrotoxic drugs (cold medicine, analgesics, diuretics, etc.).

　　3. Postoperative Treatment

　　1. Interleukin-2 (1-2 million units) / 5 days, stop for two days after every five-day injection.

　　2. Interferon / once every three days. Twice a year of the above treatment in the first two years after surgery. Once a year after two years.