Preface: “Global Lung Cancer Awareness Month” is a global initiative launched by the World Lung Cancer Alliance in November 2001, which aims to call on countries around the world to pay attention to lung cancer prevention, raise people’s awareness of lung cancer prevention and fight against it, and popularize the knowledge of standardized lung cancer treatment. Wang Huijuan, Department of Internal Medicine, Henan Cancer Hospital Lung cancer has become the number one “cancer killer” in the world, with 1.2 million new cases and deaths every 30 seconds. In China, lung cancer is also the cancer with the highest incidence and mortality rate. If we do not control the number of smokers and pay attention to environmental protection, theoretically, China will reach the peak of lung cancer by 2025: 1 million new cases per year! The effectiveness of lung cancer treatment has not improved significantly in the last decade, with an overall cure rate of about 10%. One of the main reasons is that the biological characteristics of lung cancer are very complex, its malignancy is high, and 80% of lung cancer patients are already in advanced stage when they are diagnosed. Patients are often in a hurry after visiting hospitals due to the discovery of lung masses and fail to achieve correct staging and typing in the initial treatment stage, which makes subsequent treatment more difficult and even misses the best time for treatment. The following is an introduction to the factors that have a great influence on the treatment effect in our clinical treatment process.1. Scientific understanding of lung cancer —- lung cancer is not an incurable disease The first thing many lung cancer patients and family members ask doctors after hospitalization is “How long can I live?” . We must admit frankly that nearly 70-80% of clinically diagnosed lung cancer patients belong to the middle and late stage lung cancer and have lost the opportunity of surgery, which is the main reason for the high mortality rate of lung cancer. However, lung cancer is not an incurable disease. As long as early detection and standardized treatment, many early stage lung cancer patients can achieve long-term survival; even locally advanced non-small cell lung cancer can be cured or prolonged through synchronous or sequential chemoradiotherapy; and for advanced patients with distant metastases, with the increased development of new targeted therapeutic drugs, new drugs are constantly entering the clinic, creating the greatest possibility for long-term survival of advanced patients. For patients with advanced metastases, with the increasing development of new targeted therapies, new drugs are entering the clinic, creating the greatest possibility for long-term survival. The advancement of modern thoracic surgery technology and the rapid development of device surgery and minimally invasive surgery, as well as the clinical application of new generation chemotherapeutic drugs and modern radiotherapy equipment and technology, have laid a solid material foundation for the comprehensive multidisciplinary treatment of lung cancer. It should be especially noted that minimally invasive thoracic surgery techniques and TV thoracoscopic radical lung cancer treatment have enabled more patients with low lung function and advanced lung cancer to receive surgical treatment, and most patients can recover and be discharged from the hospital within one week after surgery. Third generation lung cancer chemotherapy drugs and new generation adjuvant drugs to address the toxic effects of chemotherapy have enabled those who require pre-surgical neoadjuvant chemotherapy and post-surgical adjuvant chemotherapy to be completed safely and in adequate doses, thus further improving the long-term survival of lung cancer patients. The rapidly updated radiation therapy equipment and technology, guided by the new generation of 3D and 4D positioning system, locks the tumor target organs through conformal intensity modulated radiotherapy technology, and protects the surrounding healthy tissues and organs from damage to the maximum extent. In other words, all three traditional lung cancer treatments have undergone significant changes in recent years, and the organic combination of the three treatments brings new hope for long-term survival to more patients with locally advanced non-small cell lung cancer. All this requires the communication and cooperation of multidisciplinary teams. It is on this premise that the Henan Provincial Lung Cancer Treatment Center was established, which gathers the leaders of thoracic surgery, medical oncology and radiotherapy science of Henan Provincial Cancer Hospital to jointly study and formulate regional lung cancer prevention and treatment strategies, and to study and formulate individualized multidisciplinary and comprehensive treatment plans for each lung cancer patient so that patients can achieve the best treatment results. What is encouraging is that, starting from November this year, Henan Provincial Lung Cancer Treatment Center and Henan Provincial Esophageal Cancer Treatment Center pooled the advantages of experts from Henan Provincial Cancer Hospital and integrated the leaders of Thoracic Surgery, Medical Oncology, Radiotherapy, Pathology, Molecular Pathology and Imaging of Henan Provincial Cancer Hospital to start the multidisciplinary consultation for chest tumor, so that patients only need to register as an outpatient to get the joint consultation of multiple specialists in chest tumor. 2. Pathological diagnosis —- is the gold standard for confirming lung cancer diagnosis. This is mainly because some benign diseases such as tuberculosis and nodular disease are difficult to distinguish from lung cancer in imaging, which can easily lead to misdiagnosis and cause serious trauma to patients’ health if they are rashly treated as tumors; in addition, pathological diagnosis can further clarify the histological type of lung cancer, which also plays a decisive role in the correct treatment plan. In recent years, with the advancement of science and technology, we can also test the tissue specimens of lung cancer patients for genes related to targeted lung cancer therapy, such as EGFR, EML4-ALK, ROS1, MET, K-ras and other genes. Patients with EGFR gene activity mutation in advanced lung cancer can be treated with targeted drugs, such as Eressa, Troche and domestic Kemena; patients with gene expression of EML4-ALK, ROS1 and MET can be treated with crizotinib, which can avoid toxic side effects of chemotherapy, improve clinical efficacy, prolong patients’ survival time and further improve life quality. In addition, repeated biopsies of drug-resistant tumor cells during treatment can also help us determine the mechanism of drug resistance and adjust the treatment plan in a timely manner. It can be said that histological pathological examination of lung cancer is crucial to the treatment of lung cancer. The commonly used means to obtain histopathological diagnosis of lung cancer include: sputum exfoliative cytology, cytological examination of pleural and peritoneal fluid and malignant pericardial effusion, fiberoptic bronchoscopy and CT-guided lung aspiration biopsy, etc. The appropriate examination means are generally selected according to the location and specific conditions of tumor growth of patients. The recently developed circulating blood tumor cell test can detect tumor cells in just 5 ml of blood, which can help to diagnose lung cancer at an early stage and help to judge the prognosis and predict the treatment effect by differentiating the circulating cell count and cell type. Although circulating tumor cell detection has not yet been approved for clinical use and the detection technology still needs to be improved, it can be predicted that with the continuous progress of science and technology, the sensitivity of tumor diagnosis will be greatly improved and the diagnosis methods will become faster and more convenient. 3. Correct staging —- is the prerequisite for standardized treatment. Scientific and correct clinical staging is the prerequisite for standardized treatment. Many patients are eager to start treatment after admission and do not understand the checklist prescribed by doctors. Current medicine considers most tumors as systemic diseases, and lung cancer is no exception. Patients visiting hospitals for lung masses often think that the disease is only in the lungs, unaware that metastases may have occurred in other parts of the body. Common distant metastatic sites of lung cancer include tissues such as brain, bone, adrenal gland and liver, and these insidious metastatic lesions cannot be detected without adequate pretreatment examination. Accurate clinical staging helps doctors to formulate scientific and reasonable treatment plans for lung cancer patients, so that those lung cancer patients with distant metastases who should not undergo surgery can avoid the pain of open-heart surgery, and those who originally do not have metastases can receive timely and scientific surgical treatment. At present, the commonly used staging examinations include: CT chest examination, which is one of the best imaging examinations for lung cancer patients; it can detect hidden lesions in the chest, help qualitative diagnosis and accurate staging; it is also an examination that must be performed before choosing a treatment plan. Magnetic resonance imaging (MRI) examination, MRI is better than chest CT for lesions in special areas such as apical lung, diaphragmatic surface and hilar vascular areas, but it should not be used as a routine examination for lung cancer patients. When brain metastases are suspected in lung cancer patients, cranial enhanced MRI is the “gold standard”. In addition, a new imaging technology —–PET-CT has emerged in recent years, which can also be used as an important examination before lung cancer treatment. Its features include accurate and flexible response to abnormal metabolism and perfusion of tumors, and detection of some lesions that are not easily detected; the accuracy rate of differentiating benign and malignant tumors reaches 90%, and compared with CT, it can be more accurate in clinical staging of tumors and detecting whether tumors are metastatic or not; it is conducive to early detection of tumor recurrence, etc. In the United States, it is a mandatory staging test for lung cancer patients before formulating treatment plans, but in China, due to economic and medical insurance factors, it has not been listed as a mandatory test for lung cancer. The commonly used clinical staging method for lung cancer is mainly the international TNM staging, where T represents the size of tumor, N represents whether there are lymph node metastasis, and M represents the distant metastasis. Patients in stage I-II are mainly patients with tumor confined to the chest cavity, without lymph nodes and distant metastases, and the main treatment method is surgical resection, some patients need to supplement with chemotherapy. Stage IV patients are those who have developed distant metastases, and for these patients, the main treatment is internal medicine, i.e. chemotherapy and targeted therapy. Therefore, accurate staging is the prerequisite for correct treatment plan. 4. First consultation —- is the key to patient’s efficacy. First consultation is the process of seeking medical treatment for the first time after the patient learns that he/she has cancer or may have cancer. It is directly related to the correctness of treatment plan and the effectiveness of treatment. As far as the current medical level is concerned, there are mainly the following treatment methods for lung cancer: surgical resection, radiation therapy (radiotherapy), chemotherapy (chemotherapy), immunotherapy and traditional Chinese medicine, each of which has certain indications and periods of adaptation. Generally speaking, early stage lung cancer should be surgically resected as much as possible, the earlier the effect, the better and the more thorough the treatment, the less likely to recur. For those who cannot be operated temporarily, other treatment measures can be taken first to create conditions for surgery. However, for patients with middle and late stage lung cancer, who are no longer able to undergo surgery, chemotherapy or chemotherapy combined with radiotherapy should be started as early as possible. As for immunotherapy and Chinese herbal medicine, they are easily accepted by patients because of their small side effects, but in view of the current level of efficacy, they cannot be the first choice of tumor treatment and can only be used as auxiliary measures to other treatments. With the development of science, medical subspecialties have become more and more detailed, even if a doctor is capable, it is impossible to cure all diseases, not to mention that malignant tumors are complex, with many complications and very complicated types of diseases. The clinical experience of the treating physician has an important influence on the formulation of the treatment plan of the patient. Lung cancer has become a difficult problem in cancer treatment due to its intractability and high mortality rate, therefore, it has become a hot spot in cancer treatment and research. Every year, many new clinical trials related to lung cancer are reported and new drug indications are introduced, therefore, the guidelines for lung cancer treatment are updated every year and the treatment concept of lung cancer is constantly updated. If the treating physicians cannot keep abreast of the latest progress in their specialty, it is impossible to formulate the best treatment plan for patients. In addition, the equipment condition of the hospital will also have an impact on the treatment of lung cancer. If there is no good equipment to ensure the accuracy of detection, the diagnosis and staging of lung cancer will be inaccurate, which will affect the formulation of treatment plan. Only by following the principle of “standardization, individualization and humanization” during the first consultation can we lay a solid foundation for the first step of treatment. 5. Good psychological state —- escorts the implementation of treatment Modern medicine has proved that the mental state has a great influence on the treatment of patients, and patients with good psychological state can achieve significantly better treatment than those with good psychological state. The therapeutic effect is obviously much better than those with a poor psychological state. Patients who are waiting for death because of ignorance, blind fear and mental breakdown can have two very different treatment effects compared with those who fully understand the disease and cooperate with treatment with confidence, the latter being more beneficial to cancer treatment and recovery. Many family members of lung cancer patients try to conceal their disease by all means after receiving the diagnosis and do not tell the patients any information, which results in the patients not caring about their disease and not cooperating with the treatment. Some family members, in order to keep the patient completely unaware, simply do not live in oncology specialists, which results in irregular treatment plans and untimely treatment of toxic side effects of chemotherapy, leading to patients’ resistance to treatment and poor treatment results. Of course, it is not true that all lung cancer patients should be informed truthfully, when facing some patients with extremely poor psychological quality, it is necessary to conceal the disease appropriately. When informing patients of their condition, we must follow scientific and objective principles, firstly, gain patients’ trust, eliminate unnecessary tension, and avoid the formation of pressure on patients’ minds by the surrounding tension. The patient’s family should show a positive attitude towards treatment and influence the patient with your positive attitude. Send positive signals to the patient: the disease can be controlled, but you must cooperate with the treatment. The patient has the right to know the condition and the right to choose his own treatment, which is more humane and the patient is more cooperative, so that the treatment will be more effective. Close and harmonious family relationship and positive and meticulous affectionate care are powerful “drugs” to help patients overcome cancer. Patients and family members should communicate more with doctors during the treatment process, so that they can have a good understanding of the results, possible risks and toxic side effects of treatment, so that they can respond calmly when problems arise in the treatment process. Lung cancer treatment usually requires multiple courses of treatment, and some advanced patients may need to be hospitalized repeatedly, and it is inevitable that the disease will recur during treatment. Only when family members, doctors and patients work together under the premise of overcoming cancer can the best results be achieved, and one of these three is indispensable. Last but not least, the treatment of lung cancer must be scientific, standardized and sensible, and we should choose regular medical institutions and believe in rigorous scientifically verified methods, not hearsay, and not to blindly believe in “ancestral secret recipes”, which will waste money and miss valuable treatment time.