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何为肾细胞癌?该如何治疗它?

  • 腎 細胞 癌 病人 之 癌 細胞

    中为Toni Choueiri博士(Toni Choueiri, MD)

  • 肾细胞癌(renal cell carcinoma,简称RCC)是一种肾癌(kidney cancer),它产生于肾脏内小的黏膜(the lining of tubules in the kidneys)。一般情况下,一个肿瘤以单个形式生长,但有时,单侧或双侧肾脏内都可能出现不止一个肿瘤。肾细胞癌是成人肾癌里最常见的类型,对50岁到70岁的男性往往影响最大。

    肾脏是如何作用的?

    肾脏将人体内的废物、水和盐以尿液(urine)的形式排出,它的作用是过滤和清洁血液。肾脏位于人体脊柱(backbone)的左右两侧、腰的上方。尿液从肾脏进入膀胱(bladder),其通过的长管道叫做输尿管(ureters)。肾脏也可以帮助控制血压(blood pressure)以及调控红细胞的生成(red blood cell production)。

    肾细胞癌有哪些风险因素(risk factors)?

    肾癌的风险因素或包括:吸烟(smoking)、肥胖(obesity)、高血压(high blood pressure)、肾癌家族史(family history of kidney cancer)、晚期肾脏疾病(advanced kidney disease)和长期肾透析(long-term kidney dialysis),以及偶尔滥用止痛药物(occasionally some prolonged misuse of pain medications)。此外,多食用红肉或奶制品也可作为肾癌的风险因素之一,有一些遗传学症状——如: 希-林病(von Hippel-Lindau disease)或遗传性乳头状肾细胞癌(hereditary papillary renal cell carcinoma)。尽管上述风险因素会影响一个人患肾细胞癌的几率,但医生尚未了解到它们引发癌基因突变(cancerous gene mutations)的机制。

    肾细胞癌有哪些表征和症状?

    肾癌早期阶段通常不具有症状,然而,一旦肿瘤开始形成,最常见的症状则有:尿液中带血(hematuria,血尿)以及腹腔内出现一个肿块。其它的症状包括:身体侧面、腹部或背部出现持续不断的疼痛、食欲不振、无原因体重骤降、贫血(anemia,红细胞计数低)、脚踝和腿肿胀以及无法解释的发热或疲惫。

    了解更多:

    • 谁应当接受免疫疗法?
    肾癌有哪些阶段(stages)?

    癌症的阶段(the stage of cancer)描述的是癌症在人体内生长的程度,肾癌阶段的判定取决于癌症的大小以及它在肾脏以外和人体其它部位扩散的程度。癌症阶段的判定对于医生制定治疗计划最为重要。

    在1期和2期肾癌(Stage I and Stage II kidney cancers)病例中,肿瘤仅存于肾脏,但大小不一。在3期肾癌中(Stage III),癌细胞或许存在于肾脏和肾脏周围的一个淋巴结(lymph node)、一个肾上腺(an adrenal gland)、组织上,或在肾脏的主要血管内。最后,肾细胞癌(RCC)属于4期肾癌(Stage IV),暨癌细胞从肾脏周围的组织中扩散到一个或多个淋巴结或其它器官上。

    肾细胞癌有哪些疗法选择?

    肾癌的治疗很大程度上取决于这些因素:肾癌的阶段和扩散情况、患者的整体健康水平以及确诊的年龄。一个肾可以满足人体的需求,因此早期的肾细胞癌(early-stage RCC)往往经手术摘除病变的部分或整个肾脏治疗。丹娜—法伯癌症研究所兰科泌尿生殖肿瘤学中心(Lank Center for Genitourinary Oncology at Dana-Farber)的主任Toni Choueiri博士(Toni Choueiri, MD)指出,手术有时甚至可以在4期肾细胞癌患者中展开。4期肾细胞癌的患者们有多个疗法选择,往往是靶向疗法(targeted therapy)和免疫疗法(immunotherapy)结合。对于任何一个阶段的肾细胞癌患者而言,医生或许会推荐临床试验(clinical trials)和靶向免疫疗法(targeted immune therapies)。

    从丹娜—法伯/布莱根和妇女医院兰科泌尿生殖肿瘤学中心(Lank Center for Genitourinary Oncology at Dana-Farber/Brigham and Women’s Cancer Center)了解更多信息。

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  • 腎 細胞 癌 病人 之 癌 細胞

  • 转载须知

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I'm Dr. Brad Leibovich, urologic oncologist at Mayo Clinic. In this video, we'll cover the basics of kidney cancer: What is it? Who gets it? The symptoms, diagnosis, and treatment. Whether you're looking for answers for yourself or for someone you love, we're here to give you the best information available. First, let's talk about the kidney. You have two of these bean-shaped organs, each about the size of your fist. They sit right behind your abdominal organs with one on each side of the spine. It's their job to filter excess water, salt, and waste products from your body, turning those substances into urine. Like other organs, kidneys are made up of cellular tissue. Sometimes the cells in this tissue behave irregularly. Changes in their DNA make them grow in abnormal ways, forming tumors. This is how cancer develops. The most common type of kidney cancer is renal cell carcinoma. About nine out of 10 kidney cancers are this type. With improvements in technology, thankfully, come improvements in treatment. So in an encouraging turn, kidney cancer has never been more treatable than it is today.

The average age of those diagnosed with kidney cancer is 64. It is about twice as common in men as it is in women. The exact causes of kidney cancer, like many other cancers, are not known. However, we do know that certain things can increase your chances of developing kidney cancer. Older age, smoking, obesity, high blood pressure, long-term dialysis, and a family history of kidney cancer can all increase your risk.

Unfortunately, kidney cancer is often hard to diagnose, as it doesn't have clear signs or symptoms in its early stages. Over time, the following may develop: Blood in your urine, which may appear pink, red or cola colored. Pain in your back or side that does not go away. Loss of appetite. Unexplained weight loss. Persistent tiredness. Fever. Or night sweats. If you're worried that you may be experiencing these symptoms, please talk to your doctor.

The way doctors evaluate kidney tumors may include one or more of the following tests and procedures: Blood and urine tests. Imaging tests like ultrasounds, x-rays, CT scans and MRIs, which can help visualize the tumor or abnormality. On occasion, your doctor may recommend a biopsy. This involves removing a small sample of tissue from the tumor with a needle for further testing. If it's determined that you have kidney cancer, the next step is staging that cancer. Staging is a medical term to describe how advanced your cancer is. Specific tests for staging could include further CT scans or other imaging tests. Once the doctor has enough information, they'll assign a Roman numeral ranging from 1 to 4 to indicate the stage of your cancer. The lower end means your cancer is confined to the kidney. The higher means the cancer is considered advanced and may have spread to the lymph nodes or other areas of the body.

There are a few small upsides to kidney cancer versus others. The fact that we have two kidneys, and our bodies typically only need one to function normally, means that in many occasions, if the kidney cancer is localized and hasn't spread to other parts of the body, not only are the odds of surviving very good, but typically we do not have any negative impact on quality of life from the treatment for kidney cancer. For most, surgery is the first step. Depending upon the stage and severity of cancer, surgeons may remove the affected kidney altogether - a procedure known as a nephrectomy or radical nephrectomy. Sometimes they may opt to remove the tumor from the kidney. This is known as a partial nephrectomy or kidney-sparing or nephron-sparing surgery. In addition to surgery, some kidney cancers are destroyed by non-surgical methods. Cryoablation is a treatment that freezes and kills cancerous cells. Radiofrequency ablation is a treatment that causes the mutated cells to heat up, in effect disintegrating them. The best treatment for you depends on a handful of factors, including your overall health, the kind of kidney cancer you have, whether the cancer has spread and your preferences for treatment. Together, you and your medical team can decide what's right for you.

Learning you've been diagnosed with cancer is never easy. But there are ways to cope with the daily challenges of processing your disease, treatment and recovery. Learning about your condition can help you feel comfortable when it comes to making decisions. Taking care of yourself is another. Stay active. Sleep well. Eat healthy. And if you feel up to it, keep doing the things you enjoy. Reach out to others. Your doctor can help you find a support group. Don't be afraid to ask for help if you need it. It's normal to feel overwhelmed, depressed or anxious. Sometimes talking to a mental health specialist can make all the difference. Remember, with the right treatment, the right team and the right mindset, there's always a road forward. If you'd like to learn even more about kidney cancer, here are our other related videos or visit mayoclinic.org. We wish you well.