Η αιμορραγία των ούρων είναι σημαντικό σύμπτωμα του καρκίνου των νεφρών, η ερυθροκυτταροπενία παρατηρείται συχνά3％～4％; μπορεί επίσης να προκύψει progressive anemia, διπλός όγκος των νεφρών, η συνολική λειτουργία των νεφρών συνήθως δεν αλλάζει, η ταχύτητα της αιμορραγίας αυξάνεται, κάποιοι ασθενείς με καρκίνο των νεφρών δεν έχουν μεταμόσχευση οστών, αλλά μπορεί να έχουν συμπτώματα υπεργλυκαιμίας και αυξημένου επιπέδου του σακχάρου στο αίμα, η αφαίρεση του καρκίνου των νεφρών μπορεί να ανακτήσει γρήγορα τα συμπτώματα, η σίδηρος στο αίμα να επιστρέψει στο φυσιολογικό, μερικές φορές μπορεί να εξελιχθεί σε ανεπαρκή λειτουργία του ήπατος, αν αφαιρεθεί ο όγκος του νεφρού, μπορεί να επιστρέψει στην κανονική κατάσταση.
Η ακτινογραφία με ραδιενέργεια είναι η κύρια μέθοδος διάγνωσης του καρκίνου των νεφρών
1Η ακτινογραφία X μπορεί να δείξει ότι τα νεφρά είναι μεγαλύτερα, με αλλαγές στην περιγράμματα, μερικές φορές η καρστενοποίηση του όγκου, περιορισμένες ή ευρείες αμυγδαλωτές σκιές εντός του όγκου, μπορεί επίσης να γίνει γραμμή καρστενοποίησης γύρω από τον όγκο, σαν κέλυφος, ιδιαίτερα συχνά στους νέους καρκίνους των νεφρών,
2Η φλεβική ουρογράφηση είναι μια κανονική μέθοδος εξέτασης, λόγω της ανεπαρκούς δυνατότητας να δείξει όγκους που δεν έχουν προκαλέσει αλλαγές στα πνεύματα και τις κύστες των νεφρών, καθώς και της δυσκολίας να διακρίνει αν ο όγκος είναι καρκίνος των νεφρών, λιποματώματα των νεφρών, κυστίτιδα νεφρών, έτσι η σημασία της μειώνεται, πρέπει να γίνει υπερηχογράφημα ή CT για περαιτέρω διάγνωση, αλλά η φλεβική ουρογράφηση μπορεί να ενημερώσει για τη λειτουργία των δύο νεφρών και την κατάσταση των πνευμάτων, των κύστεων, των ουροφόρων αγγείων και της ουροδόχου κύστης, έχει σημαντική αξία για τη διάγνωση,
3、renal arteriography:Renal arteriography can detect tumors that have not changed in urological imaging, renal cell carcinoma shows new blood vessels, arteriovenous fistula, contrast agent pooling (Pooling) increased capsule blood vessels, vascular造影 variability is large, sometimes renal cell carcinoma may not be visible, such as tumor necrosis, cystic change, arterial embolism, etc., if necessary, renal arteriography can be performed by injecting adrenaline into the renal artery, normal blood vessels contract while tumor blood vessels do not respond, in larger renal cell carcinomas, selective renal arteriography can also be performed with renal arteriography, which can reduce bleeding during surgery, renal cell carcinoma that cannot be surgically resected and has severe bleeding can be treated by renal arteriography as palliative therapy.
Two, ultrasound scan
Ultrasound examination is the simplest and non-invasive examination method, which can be part of a routine physical examination, a renal mass larger than 1cm can be detected by ultrasound, it is important to differentiate whether the mass is renal cell carcinoma, renal cell carcinoma is a solid mass, due to possible hemorrhage, necrosis, cystic change, the echo is usually inhomogeneous, generally low echo, the boundary of renal cell carcinoma is not very clear, this is different from renal cysts, renal space-occupying lesions may cause deformation or fracture of renal pelvis, calyces, renal sinus fat, renal papillary cystadenocarcinoma ultrasound examination is similar to cysts, and may have calcification, when renal cell carcinoma and cysts are difficult to differentiate, puncture can be performed, puncture under ultrasound guidance is relatively safe, the puncture fluid can be used for cytological examination and cyst造影, the cyst fluid is usually clear, without tumor cells, low fat, the smooth wall of the cyst during contrast can be definitely considered as benign lesions, if the puncture fluid is bloody, it should be considered that the tumor may be found in the aspirate, if the wall of the cyst is not smooth, it can be diagnosed as malignant tumor, renal angiomyolipoma is a renal solid tumor, its ultrasound manifestation is strong echo of adipose tissue, which is easy to differentiate from renal cell carcinoma, when renal cell carcinoma is found in ultrasound examination, attention should also be paid to whether the tumor penetrates the capsule, whether there is enlargement of perinephric fat tissue, lymph nodes, renal vein, whether there is thrombus in the inferior vena cava, whether there is metastasis in the liver, etc.
Three, CT scan:
CT plays an important role in the diagnosis of renal cell carcinoma, it can detect renal cell carcinoma that has not caused changes in renal pelvis and calyces and has no symptoms, it can accurately determine the tumor density, and can be performed on an outpatient basis, CT can accurately stage, some people have statistically determined its diagnostic accuracy: invasion of renal vein91％, perinephric diffusion78％, lymph node metastasis87％, adjacent organs are involved96％, renal cell carcinoma CT examination shows a mass within the renal parenchyma, which can also protrude from the renal parenchyma, the mass is round, oval or lobulated, with clear or blurred boundaries, on plain scan it is a soft tissue mass with inhomogeneous density, CT value >20Hu，usually in30～50Hu间，slightly higher than normal renal parenchyma, can also be close or slightly lower, the internal inhomogeneity is due to hemorrhagic necrosis or calcification, sometimes it can be manifested as cystic CT value but with soft tissue nodules on the cyst wall, after intravenous injection of contrast agent, the normal renal parenchyma CT value reaches120Hu around, the CT value of the tumor also increases, but it is significantly lower than that of the normal renal parenchyma, making the tumor boundary clearer, if the CT value of the mass does not change after enhancement, it may be a cyst, combined with the CT value of the liquid density before and after the injection of contrast agent can determine the diagnosis, the necrosis focus in renal cell carcinoma, renal cystadenocarcinoma, and renal artery embolism after injection of contrast agent, the CT value does not increase, renal angiomyolipoma due to its large amount of fat, the CT value is often negative, uneven inside, the CT value increases after enhancement, but still shows fat density, acidophilic cell tumor has clear edges in CT examination, the internal density is uniform, the CT value increases significantly after enhancement.
CT examination standards for determining the degree of invasion of renal cell carcinoma
1Mass localized within the renal capsule:The shape of the affected kidney is normal or locally bulging, or uniformly enlarged, the surface is smooth or slightly rough, if the mass is nodular and protrudes into the renal capsule, the surface is smooth and still considered to be localized within the renal capsule, the fat capsule is clear, the perinephric fascia is not irregularly thickened, it cannot be judged whether the tumor is localized within the renal fascia by the existence or not of the fat capsule, especially in emaciated patients.
2Localized invasion around the fat capsule within:The tumor protrudes and replaces the local normal renal parenchyma, the renal surface is rough, the renal fascia is irregularly thickened, there are unclear soft tissue nodules in the fat capsule, the linear soft tissue shadow is not diagnosed.
3Invasion of veins:The renal vein thickens locally into a梭状bulge, the density is uneven, abnormally increased or decreased, the density change is the same as the tumor tissue, the standard of venous thickening is renal vein diameter > 0,5cm, the diameter of the inferior vena cava in the lower abdomen is >27cm.
4Invasion of lymph nodes:The renal pedicle, abdominal aorta, inferior vena cava, and the round soft tissue shadow between them, the density change is not significant after enhancement, can be considered as lymph nodes,
5Invasion of adjacent organs:The boundary between the mass and adjacent organs disappears, and there are changes in the shape and density of adjacent organs, if only the disappearance of the fat line between the tumor and adjacent organs is shown, it is not diagnosed.
6Invasion of renal pelvis:The part of the tumor entering the renal pelvis has smooth and rounded edges in the shape of a crescent arc, under delayed scanning, when the renal function is good, the contrast agent edge in the compressed renal pelvis and calyces is smooth and regular, which is considered to be simple compression of the renal pelvis and calyces, if the structure of the renal pelvis and calyces disappears or is blocked, or is completely occupied by the tumor, then it indicates that the tumor has penetrated the renal pelvis.
Four, Magnetic Resonance Imaging (MRI)
Magnetic resonance imaging examination of the kidney is ideal, the renal hilum and perinephric fat produce high signal intensity, the outer cortex of the kidney is of high signal intensity, and the middle medulla is of low signal intensity, possibly due to different osmotic pressure in the renal tissue, the contrast between the two parts is poor.50%, this difference can be reduced with extended recovery time and hydration, the renal artery and vein have no intraluminal signal, therefore it is of low intensity, the collecting system has urine of low intensity, the MRI variation of renal cell carcinoma is large, determined by tumor vessels, size, and presence or absence of necrosis, MRI does not well detect calcification foci due to its low proton density, MRI is easy to find and investigate the invasion range of renal cell carcinoma, surrounding tissue capsule, liver, mesentery, lumbar muscle changes, especially when renal cell carcinoma appears with renal vein, intrahepatic vein thrombus and lymph node metastasis in the inferior vena cava.
