Kidney cancer(or renal cell cancer) is the most common malign cancer disease last period in adults, comprising about 3 % of cases of cancer in the world. About 200 thousand people worldwide are diagnosed with renal cell cancer each year, and about 50 thousand of them lived in China, Unfortunately, about 50% of them progress to advanced metastatic kidney cancer. In this article, we will talk about renal cell cancer bone metastasis.
About 33% of patients with renal cell carcinoma had distant metastasis. There are still 20 to 40% of patients with distant metastasis even after nephrectomy. The most common metastatic sites are bone, soft tissue, lungs, liver, etc.
The renal cell cancer bone metastasis causes great pain to the patients. The common metastatic sites are the proximal bones of the spine, pelvis, and extremities. This metastasis is often characterized by progressive pain in the lesion area (metastatic area), especially in the nighttime. X-ray is characterized by osteolytic destruction, pathological bone fracture or spinal cord compression resulting in paraplegia.
Renal cell carcinoma metastasis way
The metastasis of renal cell carcinoma is very different, some tumors are very large and no metastasis, some tumors are small, but have distant metastasis. There are three ways of spreading and transferring.
- Blood metastasis: cancer invades the renal vein, leading to the formation of tumor embolus in the vein, which can be transferred to the lung, liver, bone and so on. The incidence of cancer cell metastasis to the renal vein and inferior vena cava was 20% and 10%, respectively.
- lymphatic metastasis: about 15% of renal cell carcinoma metastasis through the lymphatic pathway.
- Direct metastasis: it can penetrate the renal envelope to the perirenal tissue or invade the renal vein along and down the inferior vena cava (IVC). If it invades kidney pelvis, urine blood may occur clinically, and renal cell carcinoma may also invade the surrounding organ tissues such as colon, pancreas, adrenal gland, peritoneum, liver, spleen and so on.
Renal cell cancer bone metastasis introduction
Many patients with advanced renal cell carcinoma will have bone metastases. Many patients do not understand the symptoms of bone metastases. Here we will introduce the symptoms of bone metastases.
Renal cell cancer bone metastasis symptoms
90% of the patients with bone metastasis of renal cell carcinoma had local bone pain, which showed persistent dull pain. This pain was gradually aggravated, which was difficult to be controlled by painkillers. Some patients have the pathological fracture, unknown causes of fever, anemia and other symptoms.
Malignant tumor bone metastasis is easy to appear in the spine, rib, pelvis and so on. The initial symptoms of most patients were the local pain, progressive aggravation, and night severity. Lumbar back, chest, and pelvis are more common and are easily misdiagnosed as herniation of intervertebral disc, periarthritis of shoulder, hip arthritis and so on. At the same time, about 20% of renal cell cancer bone metastasis patients develop bone metastasis without any symptoms.
Renal cell cancer bone metastasis test examination
Pain is the first symptom of bone metastasis in renal cell carcinoma. At present, the most commonly used examination is the whole body bone scan, which is sensitive and inexpensive, especially the bone metastases can be found before the symptoms appear. Therefore, a total body bone scan in the oncologic hospital has been done regularly as part of the routine examination.
- Pet-scan (sensitive)
- X-ray (sensitive, not expensive)
- CT (non-sensitive)
- MRI (non-sensitive)
The treatment of renal cell cancer bone metastasis includes surgical treatment, immunotherapy and targeted therapy.
Surgical treatment includes auxiliary nephrectomy and surgical treatment of bone metastases. It aims to remove lesions, reducing bone pain, and preventing pathological fractures and paraplegia. Simple bone metastases should be surgically removed and reconstructed and fixed bone defects. It including prosthetic replacement, intramedullary pin, and plate fixation. Curettage and decompression fixation should be performed for the spinal metastases with possible paraplegia.
Immunotherapy plays a role in controlling tumor recurrence after surgical resection.
Targeted therapy is an intervention treatment that aims to a cellular receptor, key genes and regulatory molecules such as biological targets, blocking the proliferation of tumor cells, to prevent tumor progression or resting, promote specific therapy of tumor cell apoptosis. The targeted therapy is currently due to a variety of malignant tumors of the new hope.