1.Lung cancer is the most common primary malignant tumor of lung.
Most lung cancers originate from bronchial mucosa epithelium, so it is also called bronchial lung cancer. In the past 50 years, the incidence and death rate of lung cancer have increased rapidly in countries around the world, especially in industrialized countries.
2.Some people say that Chairman Mao lived to 83 and Uncle Deng lived to 89, is there a big relationship between lung cancer and smoking?
Smoking is the most important cause of lung cancer, and more than 90% of lung cancer is caused by active or passive smoking. The mortality rate of lung cancer in smokers is 4-8 times higher than that of non-smokers, and the earlier smoking starts, the longer the smoking time and the greater the amount of smoking, the higher the mortality rate of lung cancer.
3.Some people say that smoking leads to squamous or small cell cancer, while non-smoking leads to adenocarcinoma, which metastasizes quickly and is more difficult to treat, right?
In fact, the incidence spectrum of non-small cell cancer has changed and the incidence rate of adenocarcinoma has exceeded that of squamous cancer.
4.What are the early symptoms of lung cancer?
Early symptoms of lung cancer usually include cough, hemoptysis, chest and back pain, wheezing and unexplained fever, which are not typical. As we know, lung cancer is a malignant tumor that occurs in our respiratory organ, lung, so the symptoms are closely related to the location of its occurrence. Generally speaking, lung cancer is divided into central type lung cancer (bronchial lung cancer of segments and above) and peripheral type lung cancer (bronchial lung cancer of segments and below). Central type lung cancer generally has slightly earlier symptoms because it occurs in the main bronchial tubes, so cough, sputum and blood or chest discomfort appear earlier.
Generally, we diagnose it by bronchoscopy. Peripheral type may have changes in chest pain once the tumor accumulates to the pleura at the time of detection, and if it develops further, pleural lesions will appear and pleural effusion will be produced. Generally we diagnose through lung puncture.?
5.What are the high-risk groups of lung cancer?
At present, the first group is heavy smokers, and the second group has family history and immediate family history of malignant tumors, especially lung cancer, which means that the genetic resistance to anti-cancerous substances is relatively poor. In addition, those who have been exposed to occupational pollution, such as a workplace with radioactive contamination or chemical or physical workplaces that can cause cell damage, should also be examined regularly.
Therefore, if there is an irritating dry cough, coughing nature, of course, coughing are everyone will, to persist in dry cough, there are to be blood, this should be particularly worried, to go to the hospital for examination. Other chest pain or chest discomfort, if you are a heavy smoker and the several high-risk groups just described, you also need to be checked regularly. Early detection means regular physical examination, including chest fluoroscopy, blood tests and other corresponding tests. In this way, early lung cancer can be detected and treated in time.
6.How to detect lung cancer at an early stage?
There are three levels of early detection. Generally speaking, if a country wants to detect lung cancer at an early stage, the country should screen the high-risk groups, that is, the areas with high incidence of lung cancer, and the people with high incidence of lung cancer, which is the behavior of the country. We, as netizens, as ordinary people, should do this while the state is doing this work. First, people over 40 years old should insist on annual health checkups, which is the most important.
Annual health checkups, while emphasizing the importance of the chest frontal and lateral medical examination, some netizens said I also physical examination, after the physical examination, just do the chest X-ray, but also not. Secondly, only the frontal chest film, take a small film, also can not. Should also do the standard chest X-ray front and side, the conditions of the region, the conditions of the unit, the conditions of the population, but also recommended to do some low-dose spiral CT, the price and chest X-ray is about the same, accepting radiation is also very low.
Thirdly, we remind our heavy smokers, who smoke more than 20 cigarettes a day for more than 20 years, that these smokers are recommended to do medical checkups every six months, and in areas with conditions and people with insurance, it is recommended to do low-dose CT, and many centers include low-dose CT in normal medical checkups. We also do tumor marker-related tests are necessary. All in all, healthy people, smokers and residents with respiratory symptoms should be alert to the occurrence of lung cancer and should pay attention to health checkups and examinations in specialized hospitals.
7.How to diagnose lung cancer at an early stage? A netizen asked me about a relative who had blood in sputum and no problem in chest X-ray in a hospital, but lung cancer was found in CT after one month, how is it?
Early diagnosis of lung cancer mainly relies on the patient’s attention to early symptoms, in addition, it should be emphasized that there are hidden areas in chest X-ray, such as the tip of lung, supra-diaphragm, paraspinal, near the pleura of chest wall, behind the heart, mediastinum, etc. CT can distinguish the very small differences in density between various soft tissues, so that small peripheral nodular lesions that cannot be shown on ordinary chest X-ray can be diagnosed with fibrinoscopy or needle aspiration biopsy. The patient you mentioned is estimated to have a lesion located in the hidden area of the chest film. So it was missed.
8. Some users asked whether PET-CT can replace bronchoscopy or lung puncture as they heard that there is a kind of PET-CT, which can tell whether there is cancer or not once it is taken.
PET is a non-invasive, high-resolution imaging technique that measures the metabolic activity of a lesion by emitting positron radioactive tracer elements, and fluorescent [18F]-fluorodeoxyglucose (FDG) is usually chosen as the tracer. It is important in the diagnosis of isolated pulmonary nodules in the lung and in the staging of non-small cell lung cancer (NSCLC).
However, PET examination also has only 90% accuracy and is not a substitute for pathological diagnosis. Whereas lung cancer is a pathological diagnosis, we can only obtain pathology through bronchoscopy or lung puncture excision, so it cannot replace it. In addition, some families often think that bronchoscopy or lung puncture biopsy will cause tumor metastasis, which is proved to be wrong by evidence-based medicine.
9.How exactly should lung cancer be treated?
Surgery is preferred for early stage non-small cell lung cancer, supplemented by chemotherapy and radiotherapy; chemotherapy, chemotherapy + radiotherapy and molecular targeted therapy are chosen for advanced stage non-small cell lung cancer; chemotherapy, plus radiotherapy, supplemented by surgery if necessary, is the main treatment for small cell cancer. Whether a lung cancer patient can be operated depends on the patient’s stage and cardiopulmonary function status. However, we often encounter family members going to two extremes, one is to refuse surgery when it is clearly possible, saying that surgery will accelerate metastasis; the other is to insist on surgical treatment when the patient cannot be operated, who does not understand that palliative surgery does not prolong patient’s survival.
10.A netizen asked my relative who had small cell lung cancer and was hospitalized for chemotherapy, but it turned out that the chemotherapy drug was only a few hundred dollars, so was it not a good drug?
Small cell lung cancer is mainly treated with chemotherapy, and the current EP regimen is still the first-line classical treatment regimen, which is indeed just a few hundred dollars. I often tell patients and families that a penny drug is a good drug as long as it is symptomatic, and it is none of your business if a $10,000 drug is not symptomatic. Small cell lung cancer treatment progress in recent years is that for treatment that cannot tolerate EP regimen with IP regimen, ha, not address, is irinotecan + cisplatin.
In addition increasing the dose of chemotherapy drugs does not improve survival benefit, and in unselected patients, more than 6 courses of chemotherapy have not shown a survival benefit and may bring a reduction in quality of life. Most randomized trials have shown that extending the duration of chemotherapy does not improve survival. Therefore, the current duration of chemotherapy for small cell lung cancer SCLC ) is mostly chosen to be 4-6 courses. Topotecan has gradually become the standard second-line treatment option for sensitive recurrent SCLC.
11.Some people ask whether small cell lung cancer patients should be treated with prophylactic radiotherapy to prevent brain metastasis.
Brain metastasis is usually the only site of clinical recurrence after SCLC treatment reaches complete remission, so many experts recommend prophylactic brain irradiation (PCI). PCI reduces the incidence of brain metastases in patients in complete remission after induction chemotherapy, but it is still controversial because of its impact on survival.
12.Some people ask if it is true that chemotherapy can now be used for drug sensitivity testing.
Yes, with the advancement of molecular biology, we can now detect whether tumor cells are sensitive to platinum (ERCC1), gemcitabine or paclitaxel, and to pemetrexed (TS). This allows the selection of effective drugs and avoids blind empirical dosing. Thus individualized chemotherapy emerged. Current treatment choices for small cell lung cancer are increasingly tilted towards pathological staging with molecular biology, with pemetrexed being effective for adenocarcinoma and large cell carcinoma. Chemotherapy for squamous carcinoma is now mostly chosen from gemcitabine or paclitaxel.
13.Magic little pills change the treatment pattern of lung cancer?
The launch of the molecularly targeted drug ERSA, Troche and the efficacy achieved in the treatment of lung cancer is amazing. However, if the first-line treatment must be tested for EGFR and positive before it can be applied. Molecular targeted therapy is not applicable to all lung cancer patients and EGFR negative patients are more likely to benefit from chemotherapy.
However, in second-line therapy, molecular targeted therapy has achieved no less efficacy than second-line chemotherapy in unselected patients. The targeted drug crizotinib (crizotinib), currently in phase III clinical trials by Pfizer, can be used to treat patients who are resistant to existing molecularly targeted drugs, as long as they have ALK gene defects, with impressive efficacy. The objective remission rate was 63%, the longest remission duration reached 15 months, more than 90% of patients showed tumor shrinkage, and 72% of patients received treatment for 6 months after the disease has not progressed.
14.Some people asked that there is a way to starve the cancer cells for the treatment of lung cancer?
Yes, if we treat anti-lung cancer as a siege, we can either attack strongly or break its food and grass, cutting off the food and grass of lung cancer is to block the nutrient blood vessels of lung cancer. 12, 3 months, and 14, 2 months for adenocarcinoma.
And our own brand drug, Endo, from Nanjing Centrum Pharmaceuticals, as the first new vascular endothelial inhibitor lung cancer drug, inhibits tumor neovascularization, blocks tumor cell nutrient supply, and starves cancer cells. The effect of these drugs alone is not ideal, but they play the role of this 1+1>2.
15.Some netizens have heard that there are various “knives” other than open surgery for lung cancer treatment, how are they effective?
These “knives” are partly radiotherapy devices, such as radio wave knife, gamma knife and gyroscope knife. Radiofrequency knife, also known as stereotactic radiosurgery platform, is the latest global stereotactic radiosurgery equipment. It can treat tumors in all parts of the body and kill tumor tissues with only one to five irradiations. It is the only form of whole-body radiosurgery with no wound, no pain, no bleeding, no anesthesia and no recovery period, and patients can go home after surgery.
Gamma knife is a stereotactic radiotherapy system of gamma rays, a stereotactic radiosurgery device that integrates stereotactic technology and radiosurgery technology to treat mainly cranio-cerebral diseases. It is commonly used for patients with brain metastases from lung cancer. Gamma knife is very effective in treating benign intracranial tumors below 4 cm, but it is almost impossible to treat larger tumors. Radiofrequency knife has no such limitation, and there have been more successful treatment cases at home and abroad.
The gyroscope adopts the principle of aerospace gyroscope, in which the radioactive source cobalt 60 is mounted on two gyroscopic structures that rotate synchronously in vertical directions, rotating both autonomously and orthogonally, hence its name. It can treat primary or metastatic lung cancer. At present, radiofrequency knife is not covered by medical insurance, but the latter two can be reimbursed by medical insurance. Other “knives” are ablative treatments, such as argon helium knife and radiofrequency knife, which have certain therapeutic effects on peripheral lung cancer. Both radiotherapy and ablation therapy must be combined with chemotherapy to prolong patient’s survival.
16.Some netizens asked what are the common metastatic sites of lung cancer?
The common metastatic sites of lung cancer are brain, bone, liver, and adrenal gland. In the past, Wm26 and CCNU chemotherapy were used for brain metastasis, which were thought to be able to cross the blood-brain barrier, but now, because of the destruction of the blood-brain barrier by radiotherapy, chemotherapeutic drugs can easily enter brain tissue. It is the optimal combination for the treatment of NSCLC. In addition to radiotherapy, bisphosphonates are generally used in the treatment of bone metastases, and zoledronic acid is more commonly used in clinical practice now.
17.Some netizens asked how to treat advanced lung cancer with widespread metastasis and unbearable pain? Is morphine addictive?
Cancer pain is the main symptom in 70% of advanced cancer patients, and many patients and their families and even health care workers are afraid that taking opioid drugs will become addictive. This is a very misconception. The chance of addiction is less than 4 in 10,000 as long as they are used under the guidance of a physician and in a regulated manner. That is, for every 10,000 patients who use opioid painkillers on a long-term basis, there are less than four addicts.
In addition, it is now clearly emphasized that the use of dulcolax is not advocated for cancer patients with chronic pain. Since the 1980s, the World Health Organization has proposed a “three-step therapy” for the treatment of cancer pain. Mild pain: the first step NSAIDs are preferred, represented by aspirin; moderate pain: weak opioids, represented by codeine, can be combined with NSAIDs; severe pain: strong opioids, represented by morphine, combined with NSAIDs. At present, the use of fentanyl patch has brought improvement to the quality of survival of many cancer pain patients.
18.Some netizens asked how to take Chinese medicine without surgery and chemoradiation for lung cancer?
Nowadays, some patients and their families still have the misconception that western medical treatment will accelerate the death of patients. In fact, evidence-based medicine has long proven that chemotherapy is better than best supportive care, and the average patient survival is more than twice that of supportive care. Chinese medicine should play an adjuvant role in lung cancer treatment at present. During the interval between chemotherapy treatments, Chinese medicine can be used to help improve immunity. However, there is no evidence-based medical evidence that herbal treatment alone can provide survival benefit to patients.