Cancer of the kidney and ureter

Cancer of the kidney and ureter. Kidney cancer can come from the kidney parenchyma (renal cell carcinoma, hypernephroma) and from the epithelium of renal pelvis (adenocarcinoma).

Renal cancer of kidney-kidney occurs more often in the age after 50 years. The tumor can reach large sizes, the capsule of the kidney, the renal and lower vena cava, sprouts, lymph nodes, lungs, bones, liver. The first sign of the disease is often massive hematuria (in 40-70% of patients). Hematuria in the future with inoperable kidney cancer becomes a significant severe manifestation of the disease, leading to a sharp anemia. During the hematuria, pain increases and symptoms of renal colic appear. Another early symptom is a rise in body temperature in the afternoon to 38-39 C. All episodes of hematuria should be carefully analyzed by a detailed examination.In every case of unexplained fever with evening aspirations, one should remember about the possibility of developing kidney cancer. The first episode of massive hematuria, to a more than 1 month of temperature reaction, a real way to an earlier detection of kidney cancer.Other symptoms include the detection of a tumor on palpation, varicocele on the right, which is a sign of venous vasoconstriction, increased ESR, sometimes (in 2% of cases ) Increase in the number of erythrocytes and hemoglobin in connection with the secretion of the tumor by erythropoietin.

The diagnosis is made with intravenous and retrograde pyelofafia, ultrasound and computed tomography. However, selective renal angiography is of primary importance in diagnosis. The degree of spread of the disease is established by radiography and scintigraphy of the lungs and bones of the skeleton.

Treatment. With localized renal cell carcinoma, the kidneys produce a nephrectomy, after which the 5-year survival rate is 40-70%. Nephrectomy is performed in the presence of metastases in the lungs, and sometimes in the bone. Indications for surgery in such a situation may be the possibility of removing a large tumor, delivering the patient from painful symptoms (hematuria, pain).

Drug therapy is sometimes effective. Apply fluorobenzotate - 40 mg IV three times a week for 2-3 weeks; Tamoxifen - 20 mg / day for a long time. The efficacy of reaferon (interferon 2) (3 000 000 units IM daily, 10 days, interval 3 weeks) with lung metastases, occurs in 40% of patients with small pulmonary metastases. Nephrectomy should be carefully monitored for patients with chest radiography every 3 months for 2 years.When early detection of metastases can be more likely to rely on the success of treatment.

Cancer of the renal pelvis is 7% of all kidney tumors. Papillary adenocarcinoma of the pelvis is characterized by morphological heterogeneity, which shows similarity to bladder cancer.

The diagnosis is often difficult. The main symptoms are hematuria, insignificant or massive, attacks of renal colic. Common signs of the disease, so common in renal cell carcinoma, are less common in cancer of the pelvis. For diagnosis, intravenous and retrograde pyelography is used, which reveals a defect in filling in the pelvis, as well as ultrasound and computer X-ray tomography. Angiography is poorly informative. Differential diagnosis is carried out with tuberculosis, urolithiasis, pyelitis. Detection of a filling defect in a pelvis in a pelvis in a patient aged 60-70 years who did not previously have a kidney stone disease and who had the first episode of hematuria, will give grounds for suggesting a cancer of the renal pelvis.

Ureteral cancer is morphologically similar to the structure of bladder cancer. More often affects the lower third, manifested by pain in the lower back and hematuria. It leads to obstruction of the ureter with the development of atrophy or hydronephrosis of the kidney. Infiltrates the submucosal and muscular layer, with lymphogenous and hematogenous metastases.

Diagnosis is established with X-ray (including computed tomography), endoscopic and ultrasound.

Cancer of the pelvis and ureters refers to very aggressively metastasizing tumors (metastasizes to the liver, lymph nodes, lungs, brain, bones and other organs). Treatment in the early stages of surgery. Mandatory removal of the kidney with the ureter. When dissiminating the process, it is possible to use a wide spectrum of action-cisplatin, adriamycin, vincristine, bleomycin, fluorouracil.