Comprehensive treatment of malignant tumors

The treatment of tumor has entered the era of comprehensive treatment. Clinical practice has proved that it is often difficult to achieve the best effect by any single treatment method at this stage. Therefore, except for some early stage tumors and some special types of tumors, the principle of treatment for most tumors is comprehensive treatment. The concept of comprehensive treatment is to apply the existing treatments in a planned and rational way according to the patient’s body condition, pathological type, invasion scope (disease stage) and development trend of tumor, in order to improve the cure rate, prolong the survival period and improve the quality of life of patients. The correct understanding of the concept of comprehensive tumor treatment and its scientific connotation has important clinical practical significance, which will help to formulate a reasonable individualized comprehensive treatment plan for each tumor patient in order to achieve the best treatment effect. To correctly understand and master the connotation of comprehensive tumor treatment, the following basic points need to be mastered: (1) Comprehensive tumor treatment should pay equal attention to the patient’s whole body condition and specific characteristics of the tumor in order to avoid one-sidedness and reduce decision-making errors. Firstly, if in selecting and formulating the comprehensive treatment mode, only the immediate efficacy of killing tumor cells and shrinking tumor volume is emphasized, but not the patient’s whole body condition and long-term efficacy, not paying attention to protecting the patient’s immune function and body’s positive energy, and carrying out dialectical treatment, the tumor may appear to be “smaller” or “gone”. If we do not pay attention to the protection of the patient’s immune function and the body’s vital energy and carry out dialectical treatment, the tumor may be “small” or “gone”, but the patient’s body is “collapsed” or “disabled”. Secondly, if in the process of tumor treatment, the toxic side effects of tumor treatment are overly considered and feared without paying attention to the characteristics of tumor types, development trends and biological behaviors, and the relationship between “positive” and “evil” is not correctly understood, the tumor cells will grow vigorously and the external evil will be strong. If the tumor cells are growing vigorously and the external evil is strong, they dare not take the correct treatment method in time to effectively kill the tumor cells to get rid of the evil, which will not achieve the best therapeutic effect and may even make the tumor that may be cured lose the chance to be cured. (2) Comprehensive treatment of tumor is not a simple combination of surgery, chemotherapy, radiotherapy, biological treatment and Chinese medicine treatment, but a planned, step-by-step and sequential individualized treatment collection, which is a systematic treatment process that requires the effective collaboration of multiple disciplines such as surgery, radiotherapy and chemotherapy to complete successfully. Although the comprehensive treatment plan is not a fixed treatment model, it may be appropriately adjusted in the process of diagnosis and treatment with the gradual improvement of diagnosis and the difference of therapeutic effect. (3) There are two types of comprehensive tumor treatment: radical treatment and palliative treatment. Once diagnosed with tumor, systematic and comprehensive adjuvant examination should be carried out, and the empirical efficacy and treatment purpose of the tumor should be initially evaluated. However, since the treatment of many advanced tumors at this stage is palliative treatment, and the basic goal is to prolong the survival time and improve the quality of life, therefore, when formulating the comprehensive treatment plan, we should not only pay attention to the recent efficacy of patients, but also pay attention to the long-term efficacy and quality of life of patients. (4) Not all tumors need comprehensive treatment. For some early stage tumors without dissemination and limited stage tumors with low metastasis rate, a single treatment method can achieve good therapeutic effect, so comprehensive treatment is generally not needed. For example, the metastasis rate of basal cell carcinoma of the skin is very low, so a single surgical treatment can often cure it, and there is no need to choose radiotherapy and chemotherapy for comprehensive treatment after surgery. The 5-year survival rate of gastric intra-mucosal carcinoma is close to 100% with simple surgical resection, and there is no need to use chemotherapy and radiotherapy for comprehensive treatment after surgery. There are various modes of comprehensive treatment for tumor. In clinical application, the appropriate mode of comprehensive treatment should be reasonably selected according to the patient’s general condition and the specific conditions of the tumor, so as to achieve the best treatment effect. (1. Surgery + adjuvant therapy: This model is the most classic and still the most commonly used model of comprehensive tumor treatment. The basic treatment strategy is to remove the tumor by radical surgery after the clinical diagnosis of early and middle stage tumor, and then to use chemotherapy, radiotherapy, biological treatment and Chinese medicine treatment according to the surgery and pathological examination results to eliminate the possible subclinical metastases in the body and consolidate the effect of surgery to achieve the ultimate cure. Generally speaking, breast cancer, gastric cancer, esophageal cancer, colorectal cancer, non-small cell lung cancer, cervical cancer, etc., which are clinically diagnosed as early and intermediate stage, are often treated with this comprehensive treatment model. Breast cancer is a successful example of this comprehensive treatment model. After the clinical diagnosis of early and intermediate stage breast cancer, the primary foci of breast cancer and axillary lymph nodes are firstly removed by modified radical surgery, and after surgery, endocrine therapy, chemotherapy, radiotherapy, molecular targeted therapy and Chinese medicine are reasonably selected according to the surgery, menstrual status, hormone receptor measurement and pathological examination results, etc. After surgery, endocrine therapy, chemotherapy, radiotherapy, molecular targeted therapy and traditional Chinese medicine can be used as a comprehensive treatment to eliminate the possible subclinical metastases in the body to achieve the ultimate cure. According to current research, if the breast cancer has one or more of the following conditions: axillary lymph node metastasis, tumor diameter greater than 1 cm, low differentiated cancer, vascular and lymphatic embolism, endocrine therapy, chemotherapy, radiotherapy or molecular targeted therapy should be considered for postoperative comprehensive treatment. 2. Neoadjuvant chemotherapy and/or radiotherapy + surgery: The basic treatment strategy of this model is to first undergo chemotherapy and/or radiotherapy for a certain period of time after clinical diagnosis of the tumor and then undergo surgery, and after surgery, to further select chemotherapy, radiotherapy, biological treatment and Chinese medicine treatment according to the surgery and pathological examination results to achieve a curative effect. The indications of this mode are mainly two types: the first type is the middle stage tumor which is close to the advanced stage; after the diagnosis of this type of tumor, due to the large size of the primary tumor mass or the regional lymph node metastasis, it is difficult to remove the tumor directly by surgery and the long-term effect is not satisfactory. After surgery, the tumor is reduced in size and lymph node metastasis is effectively controlled before surgery. For example, if a patient is clinically diagnosed with breast cancer, non-small cell lung cancer, gastric cancer, esophageal cancer, colorectal cancer, etc., if one or more of these conditions exist, such as large tumor size, heavy local invasion or obvious lymph node metastasis, this comprehensive treatment mode is often used. The second category is some tumors with strong tendency of local and systemic dissemination, such as osteosarcoma, small cell lung cancer and ovarian cancer, etc. Due to the strong tendency of local and systemic dissemination of these tumors, there are often obvious local spread and/or distant subclinical metastases in the early stage, and the long-term effect of direct surgical resection after diagnosis is not good and the 5-year survival rate is low. Therefore, a certain period of chemotherapy and/or radiotherapy is often performed first, and then surgery is performed after the primary tumor and subclinical metastases have been effectively controlled, and after surgery, chemotherapy, radiotherapy, biological therapy and Chinese medicine therapy are further selected according to the patient’s specific conditions. One of the more successful examples of this comprehensive treatment model is osteosarcoma. Since osteosarcoma has a strong tendency to disseminate systemically, blood metastasis to distant organs often occurs at an early stage, after clinical diagnosis of osteosarcoma, in order to control the possible subclinical metastases as soon as possible and improve the long-term efficacy, chemotherapy and/or radiotherapy are often administered first, followed by surgery, and after surgery, chemotherapy, radiotherapy and biologic therapy are reasonably selected according to the situation. Osteosarcoma treated with this comprehensive treatment model has improved efficacy compared to surgical resection directly after diagnosis, with a 5-year survival rate of about 40%.