Introduction
Kidney cancer, also known as renal cell carcinoma, originates from renal tubular epithelial cells. It may occur in any part of the renal parenchyma but mostly at the upper and lower ends, with some invading the whole kidney. Incidence of cancer to the left and right kidneys has equal chance. The clinical appearance rate of hematuria, back pain, and abdominal mass, known as the “kidney cancer triad,” is less than 15%, which often indicates that the lesion has entered the advanced stage. The majority of patients show only one or two symptoms of the triad.
The prognosis is mainly related to factors such as tumor size, histological type, clinical stage, degree of differentiation, and so on. Clinical stage and treatment as well as state of the patient’s own immune function are the key factors affecting prognosis. Malignancy of clear cell carcinoma is low and the prognosis is good. Malignancy of granular cell carcinoma is higher and the prognosis is poorer. Differentiation of spindle cell carcinoma is the worst and the prognosis is also the worst.
Surgery is the main treatment for kidney cancer; but there is the possibility of postoperative recurrence or metastasis, and kidney cancer has had poor sensitivity to chemotherapy. As a result, the combination application of hyperthermia and naturopathy with TCM has better prospects in improving symptoms, bettering the quality of life, and prolonging survival time.
Treatments
1.Surgery
Radical nephrectomy is the most basic method of treatment for renal cell carcinoma. In recent years, nephron sparing surgery has been advocated. The scope of renal parenchyma resection from the cancer margin is 0.5–1.0 cm. It is stated in the European Association of Urology Guidelines on Renal Cell Carcinoma that as long as the complete cancer is resected the thickness of the edge does not affect the rate of cancer recurrence.
2.Radiotherapy
It is not recommended to have radiotherapy because kidney cancer has low radiosensitivity. Palliative radiotherapy for local recurrence of the tumor bed, regional or distant lymph node metastasis, and bone or lung metastasis can achieve the purpose of relieving pain and improving quality of life.
3.Chemotherapy
Kidney cancer also has low chemosensitivity, and chemotherapy is not generally considered. If the pathological type is sarcoma, the programs of gemcitabine or capecitabine can be given for chemotherapy.
4.Hyperthermia
In recent years, hyperthermia has gradually been tried in the treatment of kidney cancer, and the clinical applications of the technology are minimally invasive thermal ablation and high-intensity focused ultra- sound. Noninvasive microwave or radio-frequency deep heating has obtained a certain effect and is mostly used as auxiliary treatment.
5.Chelation Detoxification Therapy
Chelation detoxification therapy can effectively remove toxins from the body and improve immune function. It is best to conduct it simultaneously with hyperthermia for better efficacy. Chelation detoxification therapy is one of the preferred methods for the treatment of advanced renal cell carcinoma, and the dosage varies from person to person. Long-term patients need to adhere to sufficient amounts of medications, and it is better to conduct hyperthermia simultaneously. Be sure to monitor renal function when applying chelation detoxification therapy for kidney cancer. For patients with end-stage renal failure (uremia stage), in principle chelation detoxification therapy is no longer applicable. If the patient undergoes hemodialysis therapy, chelation detoxification therapy can still be implemented because chelates can be safely cleared during the dialysis process.
6.Medical Ozone Therapy
Medical ozone therapy can stimulate autoimmunity, kill cancer cells directly, increase the oxygen supply for normal tissue cells, and promote the healing of surgical wounds. For medium-advanced renal cell carcinoma, EBOO is the preferred treatment. For patients with physical difficulty tolerating it, with coagulation abnormalities, less blood volume, or venous return obstruction, intravenous medical ozone or major autohemotherapy can be given. At the same time, medical ozone acupoint injection can be applied. The selected points are the same as those with acupuncture on acupoints.
7.Traditional Chinese Medicine
The syndrome of deficiency of both spleen and kidney can appear at the early stage. The prescriptions recommended are Siwu Decoction plus modified Yougui Drink. For the syndrome of dampness and heat stagnation in kidney, the prescription recommended is modified Bazheng Powder. For the syndrome of exuberance of heart fire, the prescriptions recommended are Xiaoji Yinzi and modified Daochi Powder. The syndrome of blood stasis obstruction in the interior is mostly seen at the medium-advanced stage, and the prescription recommended is modified Taohong Siwu Decoction. For the syndrome of deficiency of both blood and qi, the prescription recommended is modified Bazhen Decoction.
8.Acupuncture
The main syndromes of early kidney cancer are stagnation of pathogenic dampness and heat. The therapeutic principle should focus on clearing heat and eliminating dampness, as well as stimulating the circulation of blood and effecting relaxation in muscles and joints.
The main syndrome of medium and advanced kidney cancer is deficiency of both spleen and kidney. The therapeutic principle should focus on reinforcing spleen and nourishing kidneys, as well as benefiting qi and nourishing blood.
9.Medicated Diet, Nutrition, and so on
Focus on a medicated diet for nutrition. Rationally supplement amino acids, digestive enzymes, and trace elements. Medium-advanced patients need to be strengthened with nutritional support treatment. Patients who can eat can be given medicated conditioning, supplemented with enough amino acids, vitamins, and digestive enzymes. For patients who have difficulty in eating, total parenteral nutrition can be given for supplementing appropriate proportion of amino acids, fat emulsion, and so on.
10.Others
Actively practicing qigong, exercising sensibly, TCM, and a psychologically adjusting attitude for maintaining a good state of mind can achieve the best prognosis and are important parts of the therapeutic regimen.
Typical Case
40 year old male patient, was treated in 1984 for acute nephritis, which turned into a chronic condition. Serum creatinine in 1997 was 170 mmol/L. Treatment was in the form of herbal medicine. In July, 2003, his chronic nephritis developed into chronic renal failure and uremia. Creatinine rose to 700 mmol/L, requiring reneal dialysis. Hematuria appeared at the end of 2003. In June, 2004, left renal occupation was shown by abdominal CT, resulting in a left kidney resection. Postoperative pathology show “transitional cell carcinoma of renal pelvis”. No further treatment followed after surgery. A right kidney transplant was done in September 2005. Patient started taking cyclosporine for anti-rejection therapy after surgery. From June 2006, patient switched to Leipaming for oral administration. Postoperative urine volume remained above 1000ml daily. In May 2006, patient experienced lower back pain, later diagnosed with left supraclavicular lymph node metastasis. Patient had 10 sessions of chemotherapy since June 2006 (specific dosage was unknown). Abnormal liver function was indicated during chemotherapy, which resulted in hepatic-protection treatment. After femoral venous catheter chemotherapy, patient showed swelling of the lower limbs, more significant in the right lower limb. In November 2006, patient complained of abdominal distension, which was aggravated after eating, increase in lower limb edema, loose stool and frequent bowel movement after application of drugs, but no nausea or vomiting and no acid regurgitation.
Diagnosis: kidney cancer (transitional cell carcinoma of renal pelvis of stage IV), postoperative left kidney resection, and post-chemotherapy for metastasis; postoperative right renal transplantation.
Integrative treatment prescription: patient diagnosed with kidney cancer, chronic renal failure, uremia. After right renal transplantation, patient was prescribed immunosuppressive agent for a long term. The patient’s condition did not respond to radiotherapy and chemotherapy. Metastasis appeared after surgery and chemotherapy. Integrative treatment of TCM, hyperthermia, medical ozone, acupuncture was recommended after specialists consultation. 2 weeks following treatment, his abdominal distension was reduced. The waist was narrowed. With no further lower extremity edema. Laboratory report: Hb 118g/L,BUN 9.6mmol/L，ALB 34g/L and Ca2＋ 2.21 mmol/L. A small amount of ascites in abdominal cavity was found in ultrasound, which was significantly reduced compared with the previous one done at time of admission.
Treatment outcome: patient was hospitalized for 65 days. Nutritional support immediately focused on combatting renal anemia. TCM was applied to nourish kidney yang, strengthen spleen, eliminate dampness, promote diuresis and to treat both the manifestation and root cause of the disease. Chelation and detoxification therapy, medical ozone and hyperthermia were conducted to eliminate internal toxin. After 2 weeks of treatment, symptoms of abdominal distension and lower limb edema disappeared. Ascites was significantly reduced. The patient’s symptoms were significantly improved. Anemia was corrected and his renal function returned to near normal. Further treatment was continued on this basis. As patient had poor kidney function after the renal transplantation he was not suitable for whole body hyperthermia. Instead, local hyperthermia was applied. Abdominal CT done before discharge showed that “the number of lymph nodes at the side of lesser curvature, the hepatic portal area and the retroperitoneal area of the upper, middle and lower abdomen were reduced when compared with those on April 12. The diameter of the largest was 2cm, which was narrower than before; the pancreatic metastases were decreased in size. There was no intra-abdominal effusion.” Laboratory test showed that liver and kidney functions was normal. The KPS was 90. After discharge, patient returned to the hospital regularly for 1 week of treatment per month, which included chelation and detoxification therapy, local hyperthermia and EBOO. Follow up was for more than 1 year after discharge. His condition became more stable.
