After being diagnosed with lung cancer, patients and family members have to face a lot of things. They are confused to hear many unheard terms at once: small cell or non-small cell, PET, staging and staging, hard to remember names of chemotherapy drugs, targeted therapy, biologic therapy, etc. Regarding the diagnosis, treatment and recovery of lung cancer, both patients and family members should know at least some of the following.
I. Imaging and pathological examinations
1.CT of the chest, which is used to determine the location and size of tumor, the condition of lymph nodes in the mediastinum, and the presence of pleural fluid, etc.
2.Tracheoscopy or puncture. Puncture can obtain the pathological type of lung cancer (adenocarcinoma, squamous carcinoma, small cell lung cancer, etc.). Patients or family members are often hesitant or afraid of puncture or bronchoscopy, not knowing that the chemotherapy regimens corresponding to different pathological types are different, and choosing the wrong chemotherapy regimen will definitely affect the treatment outcome. Before clinical treatment, the pathological type of lung cancer should be clarified and then the chemotherapy regimen should be selected according to the pathological staging, so bronchoscopy or percutaneous lung puncture is of great importance. These tests are invasive and may cause a small amount of hemoptysis, cough or low-grade fever after the procedure, which usually resolves on its own without special treatment, or symptomatic treatment with hemostatic and anti-inflammatory drugs. Many patients or family members refuse to perform these tests because they are concerned that puncture or bronchoscopy may cause the spread of the disease. In fact, clinical exacerbations due to such tests are rare. On the contrary, obtaining pathological tissue not only provides a basis for chemotherapy, but also allows for further genetic analysis to see if it is sensitive to targeted drug therapy. In addition, if the pathology is clearly small cell lung cancer, surgery is usually not an option, and chemotherapy is the first choice of treatment.
3.PET-CT and other examinations such as abdominal ultrasound, etc. PET-CT can determine the metastasis of the whole body, which is a self-financed examination and more expensive, and is the best choice to determine the whole body. Abdominal ultrasound can be used to check the liver, bile, pancreas, spleen, both kidneys and the presence of ascites, etc. It is not as accurate as CT, but it is a non-invasive examination, and there is no X-ray radiation damage.
4.Head MRI. Brain metastasis is common in adenocarcinoma and small cell lung cancer in lung cancer. The accuracy of brain MRI is better than brain CT and PET-CT, so head MRI is preferred to determine whether there is brain metastasis. For head and neck tumors such as nasopharyngeal carcinoma, MRI can also reflect the location and size of the lesion more accurately.
5. Blood routine, blood biochemistry (especially liver and kidney function), tumor markers, etc. should be checked before surgery and radiotherapy to assess whether the patient can receive corresponding western medical treatment and to prepare for post-chemotherapy evaluation.
II. Further understanding of the possible progression of lung cancer
Common metastatic sites of lung cancer: multiple metastases in both lungs, mediastinal lymph node metastases, bronchial metastases, brain metastases, axillary and neck lymphatic metastases, bone metastases, kidney and adrenal metastases, liver metastases, metastases to other organs, etc. If patients are found to have abnormal enlargement of axillary and neck lymph nodes (especially painless enlargement) or unexplained hoarseness (mostly caused by compression of posterior regurgitant nerve by enlarged lymph nodes), they should consult a doctor as early as possible for further examination according to the situation so as to detect the progress of the disease early and intervene early to control the disease.
Small cell lung cancer is sensitive to chemotherapy and can be treated more satisfactorily with chemotherapy and radiotherapy. Therefore, chemotherapy is preferred over surgery for small cell lung cancer in limited stage (no metastasis in organs outside the lung). Even for advanced small cell lung cancer (also called extensive stage, referring to metastasis outside the lung), a considerable number of patients can obtain satisfactory results after chemotherapy.
Common treatment means of lung cancer
1.Surgery. Surgery is the first choice of treatment for early and middle stage lung cancer. However, in fact, not all patients can undergo surgery, such as age, combination of other diseases, tumor location and size, etc., which may not be removed surgically. Therefore, patients should follow doctors’ advice, properly evaluate the benefits and risks of surgery, and make an appropriate choice with the help of professional doctors. Nowadays, there are a lot of irresponsible propaganda in the society, saying that “doctors are determined not to operate or chemotherapy even if they have cancer”, “metastasis is faster after surgery”, etc. There is no scientific basis for these propaganda. In fact, as oncology clinicians, we see more recovered patients precisely after reasonable treatment, and even after recurrence, they undergo surgery again, multiple chemotherapy to control the progress of the disease and obtain clinical remission or long-term survival with tumor, etc.
2. Chemotherapy. Chemotherapy is a systemic treatment, which can target the lesions scattered throughout the body. It is generally divided into preoperative chemotherapy and postoperative chemotherapy. For patients who lose the chance of surgery because the lesions are too large, preoperative chemotherapy is expected to shrink the lesions and fight for the chance of surgery. Post-operative chemotherapy is mainly to remove the residual cancer cells in the body. Patients who cannot be operated can use chemotherapy, radiotherapy and targeted drug therapy.
3.Radiation therapy. Radiotherapy is a local treatment. For example, radiotherapy is used for brain metastasis and bone metastasis. In addition, radiotherapy is also used for pain relief.
4.Gamma knife. It is a kind of radiation therapy, which uses gamma rays to target local lesions for treatment.
5.Interventional therapy. Interventional therapy includes local chemotherapy or embolization, in which drugs or embolic agents are injected into the lesion or the blood vessels supplying the lesion through interventional operations. Interventional chemotherapy is a local treatment with less systemic reaction, but it cannot kill the tumor outside the interventional lesion, so in many cases, systemic chemotherapy is needed after intervention to achieve better results. The efficacy of interventional therapy is related to the sensitivity of the tumor to chemotherapy drugs, the size of the lesion and the vascular condition.
6.Bio-therapy. Biological therapy is the practice of harvesting peripheral blood from patients, isolating single nucleated cells, culturing them in vitro and giving biological agents for induction stimulation to produce a larger number of immune cells with anti-tumor properties, and then returning them to patients. At present, the side effects of biological therapy are relatively small, expensive and the effect is not exact.
7.Chinese medicine treatment. TCM treatment includes internal and external treatment of Chinese medicine. Chinese medicine can regulate the body’s own immunity, reduce the side effects of radiotherapy and other treatments, improve the function of the internal organs, relieve clinical symptoms and improve the quality of survival of patients. In the post-surgery and radiotherapy period, it can play an auxiliary therapeutic role; in the rehabilitation phase, it can promote recovery, stabilize the disease and delay recurrence and metastasis; in the palliative treatment phase, it can also alleviate ascites, abdominal distension, pain, constipation and other symptoms and improve the quality of survival. The external treatment of Chinese medicine includes acupuncture, massage, fumigation and external application, which can also play a good supporting role in each treatment stage.
8.Targeted therapy. Targeted therapy is a targeted treatment for some characteristics of tumor cells. Targeted drugs enter the body and selectively kill the target cells, but targeted drugs are not 100% effective, genetic testing is needed, and patients with genetic mutations at special chromosomal loci can obtain better efficacy. The problem of resistance to targeted drugs is currently the main problem hindering treatment. After the emergence of drug resistance, there is also the option of switching to other targeted drugs or chemotherapy and other treatments to control the progress of the disease.
9, other treatment means, any new treatment means or folk propaganda treatment means, if not clinically verified, based only on individual case reports (illegal medical advertising is always based on a certain medical history was sentenced to death by the hospital, met with a “famous doctor” to take a hundred diseases cured by drugs) can not prove the effectiveness of its treatment, are The efficacy of the treatment is inaccurate, and even damage to the body, so patients and their families should choose carefully.
Fourth, the side effects of treatment
Any drug or treatment may have side effects, and this is especially true for anti-tumor treatment.
1.Surgery directly removes the diseased tissue and part of normal tissues, which may cause damage to human vital energy. After surgery, many patients will have symptoms of deficiency of both qi and blood. Such as dizziness, tinnitus, anemia, loss of appetite, palpitation, shortness of breath and weakness.
2. Common side effects of chemotherapy include: Gastrointestinal reactions: nausea, vomiting, loss of appetite, constipation, etc. Gastrointestinal reactions can occur as early as 12 hours, therefore, patients and family members should be prepared. In addition, some chemotherapy drugs may cause pulmonary fibrosis, liver and kidney damage, in addition to side effects due to bone marrow suppression such as hair loss, peripheral neuropathy (numbness in hands and feet), anemia, leukopenia or bleeding. Many side effects can be prevented or alleviated by giving certain drugs at the same time as chemotherapy. Most side effects can be alleviated or disappear completely after chemotherapy is finished, while some side effects have longer effects and may bring some pain to patients. Chinese medicine can alleviate the side effects of chemotherapy to some extent and promote the recovery of the body in the interval between chemotherapy treatments (the time between chemotherapy treatments, usually 2~3 weeks, varies according to the choice of chemotherapy regimen), which is conducive to the smooth implementation of chemotherapy. The physician, family and patient should carefully consider the benefits and risks of chemotherapy if chemotherapy is really needed in frail and elderly people. In some cases, chemotherapy is contraindicated and cannot be given and must be judged by the clinician based on the patient’s test results. In addition, the efficacy of chemotherapy is limited, and resistance to chemotherapy may develop after a period of treatment, which requires the physician to change the chemotherapy regimen based on previous treatment and the patient’s condition. In addition, patients should listen to the doctor’s advice, regular treatment, arbitrary “treatment stop” or insufficient dose, not only can not get the desired effect, but also easily lead to the occurrence of drug resistance, which is currently considered to be the main cause of chemotherapy failure.
5, although radiotherapy is a local treatment, in addition to local reactions (inflammation) may also be accompanied by systemic symptoms. Radiation dermatitis, radiation pneumonia and radiation esophagitis are frequent side effects of lung cancer patients. For the more serious radiation reactions, a certain amount of hormone can be given to relieve them. Chinese medicine has a good effect on relieving the side effects of radiotherapy, which can be reduced by internal and external treatment with Chinese medicine at the same time of radiotherapy.
6. Chinese medicine is based on evidence-based treatment, and each person’s condition is different and their performance is different, so the prescribed medication is certainly different. There are many partial prescriptions circulating on the Internet, and they are even advertised as very attractive, but they cannot be taken indiscriminately. Therefore, lung cancer patients and their families should consult with TCM oncologists when using herbal medicine. Some western doctors, because they do not understand the mechanism of action and efficacy of TCM and lack experience, coupled with the confusing or even illegal propaganda of “Chinese medicine against tumor” in the society, have deep misunderstanding about TCM and may convey to patients that “Chinese medicine must not be taken” or “Western medicine cannot be combined with TCM”. This may convey wrong information to patients such as “you can never take TCM” or “Western medical treatment cannot be combined with TCM treatment”. Therefore, patients who want to choose TCM treatment should go to qualified TCM oncologists for evidence-based treatment, as TCM oncologists usually have medical knowledge and experience in Western medicine, and can give appropriate medical treatment according to the patient’s condition and treatment history. In addition, you should not blindly take proprietary Chinese medicine, which is also traditional Chinese medicine and should be treated according to the evidence. If you need to take proprietary Chinese medicine, it is better to consult a specialist in traditional Chinese medicine and choose the most suitable medicine for you.
V. Choice of doctors and hospitals
The choice of doctors and hospitals is also very important. A responsible and experienced doctor will make a complete and feasible treatment plan for the patient according to the patient’s condition, the family’s opinion and the economic situation. The equipment of oncology specialty hospital can provide reliable examination results for the development of treatment plan faster and more reasonably. Nursing care is also important in the treatment process. The configuration, injection and observation of many chemotherapy drugs require experienced nurses to operate, and nurses in oncology specialty hospitals are obviously more experienced in the treatment and nursing of tumor patients.
Psychological health of patients
At the beginning of lung cancer diagnosis, patients and family members often have some psychological problems, such as doubts about the diagnosis result at the early stage of diagnosis. Some patients have to go through multiple hospitals before they accept the reality. In addition, panic and aggression are also common psychological problems. At this point, family members need to calm down first, help the patient face the reality, actively seek help from the doctor, start standardized treatment early, and at the same time take care of the patient’s life and accompany the patient through the difficult journey. Therefore, family members should adjust their emotions as soon as possible and comfort and take good care of the patient, planning time, money and energy to help the patient successfully complete the treatment and enter the recovery period.
For the psychological, nutritional, physical recovery and Chinese medicine adjustment problems faced by lung cancer patients in various stages of carrying out treatment after diagnosis, they all belong to the scope of cancer rehabilitation and can seek help from experienced rehabilitation treatment teams. Cancer rehabilitation is not only a continuation of clinical treatment, but also plays a positive role in improving patients’ survival quality and delaying tumor recurrence and metastasis.