Kidney Cancer

Kidney Cancer Diagnosis & Stages

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How is kidney cancer diagnosed?

In the past, 肾癌是在肿瘤变得相当大并出现症状(侧腹疼痛)后才被诊断出来的, blood in the urine). Today, 大多数肾肿瘤是在超声等影像学检查中偶然发现的, CT scan or MRI.

而一些小的肿瘤注定会一直很小，不会造成伤害, 其他人可能有攻击性行为，及早发现可以改善结果. 肿瘤变大或扩散(转移)到身体其他部位更难治疗，死亡风险也会增加.

Staging of Kidney Cancer

In addition to taking a complete medical history, performing a physical exam, and obtaining laboratory tests, your physician may order various imaging tests. 这些研究是为了确定肾肿瘤的特征，并评估癌症是否已经扩散到肾外(转移)。.

  • Chest X-ray. Evaluation of the chest for any lung involvement.
  • Ultrasound Examination. 使用高频声波来生成你的内部器官的图像，比如你的肾脏.
  • 计算机断层扫描(CT)或磁共振成像(MRI)扫描. CT扫描使用计算机聚焦x射线来创建详细的图像. 核磁共振扫描使用磁场和无线电波来生成你身体的横截面图像.
  • Bone Scan. 使用非常少量的放射性物质与成像来检测骨骼受累.
  • Sestamibi Spect/CT Scan. Nuclear medicine scan to detect less aggressive renal tumors. 这是一项研究方案，以确定这是否有助于决策.
  • PET/CT Scan. 使用含有放射性示踪剂的特殊染料进行CT扫描(仅在特定情况下使用).

Staging Factors of Kidney Cancer

The most important factor in predicting prognosis, as well as the treatment options, is the "stage" or extent of the cancer. 分期是从身体检查和诊断测试中收集信息的过程，以确定肿瘤的大小和位置以及癌症的传播程度. Important Staging Factors in Kidney Cancer are:

  • Tumor size
  • Spread to tissues surrounding the kidney (fat and vein)
  • Spread to contiguous organs (organs next to the kidney)
  • Spread to nearby lymph nodes (the lymphatic filtration system)
  • 扩散到其他器官，如肺、骨、肝(远处转移)

Common staging systems for Kidney Cancer

Fuhrman grading system for Kidney Cancer

医生在评估肾细胞癌时使用的另一个重要因素是其Fuhrman分级(以开发该系统的病理学家命名). 这是指癌细胞在显微镜下看起来与正常肾细胞有多接近.

福尔曼分级系统将肿瘤细胞分为1到4级.

1级肿瘤细胞看起来与正常肾细胞没有太大区别. 1级癌症通常生长和扩散缓慢，通常预后良好. On the other hand, 4级肿瘤细胞与正常肾细胞有很大不同，预后较差.

TNM Staging System

最常用的分期系统是美国癌症联合委员会(AJCC)的分期系统。, also known as the TNM Staging System. TNM(肿瘤-淋巴结-转移)系统使用的分期与Robson系统大致相似，由于它对肿瘤提供了更详细的描述，因此越来越被广泛接受。.

  • The letter T 后面的数字从0到4表示肿瘤的大小和向附近组织的扩散情况. 其中一些数字用字母进一步细分，如T1a和T1b. 较高的T值表明肿瘤较大和/或更广泛地扩散到肾脏附近的组织.
  • The letter N 然后是0到2的数字表示癌症是否已经扩散到肾脏附近的淋巴结, if so, how many are affected. 淋巴结是豆子大小的免疫系统细胞集合，帮助身体对抗感染和癌症.
  • The letter M 然后是0或1表示癌症是否已经扩散(转移)到其他器官，如肺或骨骼, or to lymph nodes that are not near to the kidneys.

The UCLA Integrated Staging System (UISS)

The UCLA Integrated Staging System (UISS), 由皇冠hga025大学洛杉矶分校泌尿科的转化研究人员开发, 是一个更复杂但可能更精确的系统，它包含了TNM分期系统, a person's overall health and the Fuhrman grade of the tumor.

在usiss系统中:无肿瘤扩散的患者分为三组:低危组, intermediate risk and high risk.

  • The Low Risk group is considered Stage I; are in excellent health other than the cancer and have a low Fuhrman grade tumor.
  • The Intermediate Risk group is all others, without any spread.
  • The High Risk group is either Stage III (but without lymph node spread), in poor health and have a high Fuhrman grade score; or Stage IV (without any spread, T4, N0, M0).

低风险组最近的五年癌症特异性生存率为91%, for the intermediate risk group is 80%, and for the high risk group is 55%.

Patients with tumor spread, to lymph nodes or distance sites such as bone, lung or liver, are also divided into these three groups. Low risk patients have a tumor that is T1-3, N1, M0. 高危患者为T4肿瘤，健康状况不佳，Fuhrman分级高或远处扩散. Intermediate grades are all others. 肿瘤扩散的患者的五年癌症特异性生存率较低:低风险组为32%, 中等风险组20%高风险组0%.