Diagnosis and classification
Inevitable for the detection and staging of renal cancer are physical (clinical) examination, ultrasound (sonography), excretory urography (evaluates urinary excretion) and computed tomography (CT). There are two common stage classifications, the TMN system and the Robson classification. Both are based on the extent of the original tumor (primary tumor), lymph node or distant metastases, and tissue differentiation (i.e., when the original tissue of the tumor can still be identified).
Staging has an influence on further therapy and on the patient’s prognosis. TMN classification according to UICC/WHO (1997) Before surgery, an angiography (imaging of the arteries), a cavography (looking at the inferior vena cava) and an MRI of the abdomen are optional. To search for metastases, an x-ray of the thorax (chest) in two planes, CT of the lungs, or a skeletal scintigram (accumulation of radioactive substances in tumor tissue) is made.
- T- primary tumor:T1 (tumor limited to kidney, < 7cm)T2 (tumor limited to kidney, > 7cm)T3 (vein or adrenal infiltration; Details: a,b,c)T4 (infiltration beyond the Gerota fascia)
- N- Regional lymph nodes:N0 (not infested)N1 (solitary, regional)N2 (> 1 regional LK)N3 (multiple infestation, >5cm)
- M- distant metastases:M0 (no distant metastases)M1 (distant metastases; organ code)
Differential diagnoses
Renal cysts may also be responsible for the above-mentioned symptoms. This can be clarified with imaging procedures such as:.
- Sonography (ultrasound)
- CT (computer tomography)
- MRT (magnetic resonance imaging of the abdomen)
Therapy and prevention
Contribute to the prevention of renal cell carcinoma: In the case of an as yet undifferentiated renal cell carcinoma, the standard therapy is surgical removal of the tumor (radical tumor nephrectomy) together with the kidney, adrenal gland and adjacent lymph nodes. If necessary, affected blood vessels are removed and replaced with a vascular prosthesis (replacement for vascular incisions). The operation also has advantages in the case of already existing metastases: so-called paraneoplastic symptoms (symptoms that are not directly caused by the tumor or its metastases, but are related to the occurrence of the tumor; e.g. increased blood sedimentation rate 56%, anemia 36%), as well as tumor-related pain and bleeding are reduced.
Individual metastases can also be removed. In patients who have only one kidney from the outset, this is only partially removed. A local recurrence, i.e. a new tumor at the same site, is removed again, if possible.
The benefit of adjuvant therapy (subsequent chemo-, hormone, radiation therapy or similar) has not been proven. Interventions that do not aim to cure but to alleviate the symptoms (palliative interventions) are the removal of metastases from the lungs, brain and bones. Renal cell carcinomas react little to radiation or chemotherapy.
- Abstaining from smoking
- Avoidance of certain groups of painkillers (e.g. painkillers containing phenacetin, e.g. paracetamol)
- Weight Loss
- Screening of patients with severe renal weaknessKidney failure (terminal renal insufficiency), cystic kidneys, von-Hippel-Lindau syndrome, tuberous sclerosis
A more recent development is the use of so-called “biological response modifiers”, which intervene in the patient’s immune system in a supportive way to treat the tumor. Messenger substances of the immune system (interleukin-2, tumor necrosis factors) are used to restrict the growth of tumor cells and mark them as targets for cell-killing (cytotoxic) T-lymphocytes and macrophages (the body’s own defense cells).
These white blood cells (leukocytes) ensure that the tumor cells destroy themselves (apoptosis) or actively participate in the destruction (e.g. through phagocytosis). However, the positive effects are usually quite short and usually do not outweigh the observed side effects. They may be suitable for palliative treatment.
