Is lung cancer really that terrible?
Lung cancer has become the malignant tumor with the highest incidence and mortality rate in the world, and the number of lung cancer deaths in China is 600,000 every year. The incidence and mortality rate of lung cancer is the only malignant tumor that has increased significantly year by year for 60 consecutive years, accounting for about 1/4 of the annual deaths from malignant tumors in China. from the 1990s to the beginning of the 21st century, the incidence rate of lung cancer has increased more in both urban and rural areas, with the incidence rate of lung cancer in rural areas increasing by nearly 30% and that in urban areas by nearly 50%. The incidence of lung cancer in women was 120,000 in 2000 and 170,000 new cases in 2005, while in men it increased from 260,000 to 330,000. Lung cancer has become the top four causes of death from malignant tumors in China’s urban population. In the past, the rising incidence of lung cancer was mainly seen in men, but now there is a dramatic increase in female patients, which may be related to the changing pattern of tobacco use. The ratio of men to women has decreased from 8:1 to 2:1, and patients who have access to surgery account for only 15-20% of the total number of lung cancer patients seen.
Who is at risk for lung cancer?
Who are the high-risk groups for lung cancer? For example, if one of the parents has lung cancer in the immediate family, the risk of lung cancer in children is higher, which means that there is a genetic predisposition.
In addition, environmental factors, staying away from tobacco is the most important factor in lung cancer prevention, including second-hand smoke, which is a key issue in the increasing incidence of lung cancer in women.
For example, teachers used to inhale a lot of chalk dust when they were writing on the board, which has an impact. In addition, Chinese frying and cooking fumes contain carcinogenic substances, all of which are related to the development of lung cancer.
How can early detection be achieved?
70% of lung cancer is already in advanced stage when first diagnosed.
Several reasons.
First, there are few clinical symptoms in the early stage of lung cancer, which are very similar to other benign respiratory diseases, such as cough (about 70% of lung cancer patients complain of cough, and irritating cough is the most common symptom.) ), shortness of breath, chest tightness, coughing with blood (about 50% of patients have blood in their sputum or small blood clots), these are both symptoms of lung cancer, but some other diseases, such as tuberculosis, chronic obstructive pulmonary disease, emphysema, even colds and lower respiratory tract infections, may cause similar symptoms, so they are easily overlooked.
Secondly, the health insurance system, health awareness and health science education in our country are lagging behind those in developed countries, so not many high-risk people go to hospitals for health checkups.
There are more and more means for early diagnosis of lung cancer, and one of the most important points is that we should have health awareness and be alert to the high incidence of lung cancer, especially the high-risk groups should go for regular health checkups.
Studies have proven that LDCT can detect more lung cancers and more resectable early-stage lung cancers by CT screening than the previous application of chest X-ray plus sputum cytology, but it is still controversial whether increasing the detection rate of early-stage lung cancer patients can reduce the mortality rate of lung cancer. Therefore, we would like to remind you that for those who are at high risk (e.g. long-term smokers) or older than 40 years old, it is better to have a low-dose spiral CT of the chest if you go for a medical checkup, as CT is currently the best imaging tool for early diagnosis of lung cancer. Of course, positron emission tomography (PET-CT), if available, may be more helpful for early diagnosis. What is the recommended age for these types of high-risk groups for lung cancer to have these examinations? We recommend that those over 40 years old should have a more standardized medical checkup once a year.
Under what circumstances should surgery be performed?
Clinically speaking, patients with stage I and stage II non-small cell lung cancer are suitable for surgery. When we refer to the ability to operate, in most cases we mean the ability to benefit the patient. Stage I and II patients can definitely benefit the patient. For stage III patients, we have to sit down and discuss, even if we want to do surgery, we have to see if we want to do systemic therapy first, if we want to add systemic therapy or targeted therapy or some other therapies after surgery, so as to give patients a good design, which is different from whether the surgeon’s skill is good or not, and whether he can cut it down or not. Nowadays, our surgeons do not simply look at whether the tumor can be cut down or not, but whether the tumor can be removed to improve the quality of life and prolong the survival of the patient. This is the criterion for us to judge whether to operate or not. This is precisely what patients do not understand, and what some surgeons do not understand or are not willing to explain to patients.
Is open heart surgery scary?
When it comes to lung cancer surgery, many people ask, “Does it require an open chest? Do you have to cut a long, big incision from the front to the back? It seems like a rib has to be sawed off, it’s horrible.” That’s what most people used to think. However, compared with the previous traditional techniques of opening the chest and cutting a large incision, there are more and more means to treat lung cancer nowadays, and the level is getting higher and higher. Modern thoracoscopic techniques have become very mature, with minimal trauma to the patient, quick recovery and aesthetics. Simply put, it is to make two openings in the chest wall, one for sticking the thoracoscope in for illumination and the other for sticking the instruments in for operation and cutting off the lesion. The largest opening is typically 5 to 8 cm.” Compared with the previously feared open-chest surgery, minimally invasive surgery can be discharged from the hospital in almost 7 or 8 days, causing less damage to the patient and less pain, not to mention leaving big scars.
What is the treatment effect of lung cancer in the current stage of clinical practice?
The 5-year survival rate for stage I lung cancer is reported to be 70% in the literature, and for stage II lung cancer, it can reach about 50% at 5 years. Some studies have reported that for advanced non-small cell lung cancer with EGFR gene mutation, the median survival time for treatment with ERSA is about two years, while the median survival time for general chemotherapy is only 8-10 months, and the survival time for chemotherapy combined with anti-tumor vascular drugs is about one year. Therefore it is certainly helpful to give some genetic analysis to patients before treatment and then decide the treatment plan (we call it individualized treatment) to improve the efficacy and prolong the survival. Oncologists around the world are currently working in this direction.
What do lung cancer patients need to pay attention to in their review?
Patients within two years after surgery must be reviewed every three months. After two years, the review time will be extended to once every six months, and for patients after five years, a health checkup every year is sufficient.
What is the content of the review? In the first three months of surgery, a small checkup is to take a chest X-ray and check the patient’s liver function and kidney function. In the second trimester, the patient will be given a major checkup, including the very important chest CT to see how the lungs are doing, and other necessary tests for metastasis-prone areas, such as bone scan, etc.
For patients with more advanced lung cancer, after the completion of standard treatment, what will be checked every three months? Chest CT, abdominal ultrasound/ or CT, neck lymph node examination, and brain CT or brain MRI, and bone scan once every six months.