Post-nephrectomy care for renal cancer

Written by Zou De Bo
Urology
Updated on September 02, 2024
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Postoperative care measures for kidney cancer primarily include observing the patient's vital signs. After a radical nephrectomy for a large renal tumor, a significant amount of tissue is removed including the kidney, surrounding adrenal fat, and lymph nodes at the renal hilum, which results in larger surgical wounds and potentially more bleeding. Therefore, it is crucial to closely monitor for signs of bleeding and ensure that transfusions and fluid administrations are unobstructed. Secondly, careful observation and management of the wound drainage tubes are required. Thirdly, for radical nephrectomies, once the patient is past the anesthesia phase and the blood pressure is stable, a semi-reclined position can be adopted. Patients who have undergone partial nephrectomy should remain in bed for one to two weeks to prevent further bleeding, and kidney functions should be monitored. Additionally, attention should be paid to symptoms such as breath holding and difficulty in breathing. Postoperative feeding should commence once gastrointestinal function is restored; thereafter, nutrition should be enhanced to boost bodily resistance. Calming medications may be appropriately used to ease pain, facilitating movement, effective coughing, and expectoration.

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kidney cancer immunotherapy drugs

The immunotherapy for kidney cancer often involves the use of interferons or interleukins, and the results are generally satisfactory. The effects of radiotherapy and chemotherapy for kidney cancer are not very certain. Typically, after kidney cancer is diagnosed, radical nephrectomy is performed. During the surgery, adequate exposure is essential. The renal hilum should be ligated first to prevent cancer cells from being squeezed into the bloodstream during surgery. It is also necessary to remove the fascia and fat around the kidney, along with the lymph nodes at the renal hilum. Combining these surgical measures with immunotherapy usually yields very ideal results.

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Ultrasound manifestation of renal cancer

Kidney cancer is the most common type of kidney malignancy. Pathologically, it is mainly divided into clear cell renal cell carcinoma, chromophobe renal cell carcinoma, papillary renal carcinoma, and collecting duct carcinoma, with clear cell renal cell carcinoma being the most common. Ultrasonographically, it usually appears as round or oval masses, varying in size but generally around 2-4 cm, exhibiting low to medium echo patterns. If the tumor is larger, greater than 5 cm, it may show changes in mixed echo patterns due to possible internal bleeding or cystic changes when the tumor is large. When kidney cancer is suspected on ultrasound, it is best to further proceed with enhanced MRI or enhanced CT scanning.

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Clinical Manifestations of Renal Cancer

In the early stages of kidney cancer, most patients do not experience any discomfort symptoms, making it difficult to detect. As the tumor progresses to the middle and late stages and increases in size, it can cause symptoms of back pain. If the tumor breaches the renal pelvis, leading to ruptured blood vessels, this condition will be accompanied by obvious gross hematuria, which often appears intermittently and is painless. If the tumor is large, a mass can be felt in the back. If these symptoms arise, it is crucial to promptly visit the hospital's urology department for tests such as ultrasound and CT scans to establish a clear diagnosis. If necessary, active surgical intervention should be considered.

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How many centimeters is kidney cancer in the early stage?

Generally speaking, kidney cancers smaller than 4 centimeters are usually considered early stage, but it still depends on individual circumstances, such as whether the tumor has spread or metastasized, and the malignancy level of the tumor cells. Thus, assessing whether it is early or advanced stage requires consideration of these specific factors, and it cannot be simply determined by size alone.

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What are the characteristics of hematuria in renal cancer?

What we commonly refer to as kidney cancer actually includes two aspects. One is renal cell carcinoma, and the other is renal pelvis cancer or ureteral cancer. The characteristics of hematuria are different in these two types. Renal cell carcinoma, simply understood, grows inside the kidney and is not connected with urine. Only when the kidney tumor grows large enough to breach the kidney or renal pelvis will the tumor rupture and bleed, causing hematuria. This generally occurs in the middle to late stages of kidney cancer. On the other hand, renal pelvis cancer or ureteral cancer exhibits intermittent hematuria in the early stages without significant symptoms, but as it progresses to the middle and late stages, symptoms like kidney hydronephrosis and hematuria slowly appear. When diagnosing these conditions, any occurrence of hematuria must be investigated to determine the cause. Initial screening can be done using urinary system ultrasound, urinalysis, or routine urine tests. More precise methods include enhanced CT or MRI of the urinary system, which facilitate easier diagnosis.