I. Overview
Primary lung cancer (hereinafter referred to as lung cancer) is one of the most common malignant tumors in China. 2010 Health Statistical Yearbook shows that in 2005, the mortality rate of lung cancer accounted for the first place of mortality rate of malignant tumors in China. In order to further standardize lung cancer diagnosis and treatment behavior in China, improve the level of lung cancer diagnosis and treatment in medical institutions, improve the prognosis of lung cancer patients, and guarantee medical quality and medical safety, this specification is formulated.
II. Diagnostic Techniques and Applications
1.High-risk factors. Those who have a history of smoking and smoking index greater than 400 cigarettes/year, a history of high-risk occupational exposure (such as exposure to asbestos) and a family history of lung cancer, and those who are 45 years of age or older are the high-risk group of lung cancer.
2.Clinical manifestations.
(1) Irritating dry cough.
(2) Blood in sputum or bloody sputum.
(3) Chest pain.
(4) Fever.
(5) Shortness of breath.
When the respiratory symptoms cannot be relieved by treatment for more than two weeks, especially blood in sputum or irritating dry cough, or the existing respiratory symptoms are aggravated, the possibility of the existence of lung cancer should be highly alerted.
2.When lung cancer invades surrounding tissues or metastases, the following symptoms may appear.
(1) Hoarseness when the cancer invades the laryngeal nerve.
(2) The cancer invades the superior vena cava, and the symptoms of superior vena cava obstruction syndrome such as facial and neck edema may appear.
(3) The cancer invades the pleura and causes pleural effusion, which is often bloody; a large amount of effusion can cause shortness of breath.
(4) Invasion of pleura and chest wall by cancer can cause continuous and severe chest pain.
(5) Upper lobe apical lung cancer can invade and compress the organ tissues located at the entrance of the thorax, such as the first rib, subclavian artery and vein, brachial plexus nerve, cervical sympathetic nerve, etc., producing severe chest pain, upper limb venous anger, edema, arm pain and upper limb movement disorder, ipsilateral upper eye and face drooping, pupil narrowing, eye inversion, facial sweating and other cervical sympathetic syndrome manifestations.
(6) Recent neurological signs and symptoms such as headache, nausea, vertigo or blurred vision should be considered as possible brain metastases.
(7) Bone metastasis should be considered as a possible cause of bone metastasis, such as persistent bone pain at fixed sites and elevated plasma alkaline phosphatase or blood calcium.
(8) Right upper abdominal pain, hepatomegaly, elevated alkaline phosphatase, glutamic transaminase, lactate dehydrogenase or bilirubin should be considered as possible liver metastases.
(9) In case of subcutaneous metastasis, nodules may be palpated under the skin.
(10) Bloodstream metastasis to other organs may show corresponding symptoms of metastatic organs.
3.Physical examination.
4. Imaging examination.
5. Endoscopy.
6.Other examination techniques.
7.Blood immunobiochemical examination.
8.Histological diagnosis. Histopathological diagnosis is the basis of lung cancer diagnosis and treatment. When the diagnosis of lung cancer is confirmed by biopsy, standardized treatment should be carried out. If the pathology of biopsy cannot confirm the pathological diagnosis due to the limitation of biopsy sampling, it is recommended that clinicians repeat biopsy or combine with imaging examination to further choose the treatment plan, and if necessary, joint consultation between clinical and pathological physicians should be conducted to confirm the pathological diagnosis.
9.Differential diagnosis of lung cancer.