As our standard of living has improved and so has our health awareness, chest CT examinations are now commonplace, so that more and more cases of small lung nodules are being clinically detected. In the past, relying on chest X-rays, the lesions were only detected when they were large, and the lesions were often clearly characterized, making diagnosis relatively easy and treatment decisions clearer. Today, however, small pulmonary nodules are found to be on the increase, and it is not easy to make the right treatment decisions.
Let us first introduce four CT films of the chest of patients.
It is important to pay attention to lung physical examination and early detection of lung nodules Only regular physical examination (often once a year) can lead to early detection of small lung nodules, and almost all early imaging manifestations of lung cancer are small lung nodules.
It is well known that lung cancer is currently the number one cause of cancer death worldwide, and the incidence rate of lung cancer in China is 52/100,000, and the number is increasing by 05% every year.
Diagnosis of lung nodules
The first thing is to determine the nature of the “nodule”:
They may be early-stage lung cancer or benign lesions such as adenomatous hyperplasia, inflammatory pseudotumor or inflammatory lymph node hyperplasia, tuberculoma, sclerosing hemangioma, or malignant tumor. According to the literature, the malignancy rate of isolated lung nodules is 20%-40%; the malignancy rate of microscopic lung nodules less than 10mm is about 15%, especially the lung nodules with “ground glass”, the possibility of primary lung cancer is more than 90%; the possibility of lung cancer is more than 60% for lung nodules older than 45 years old. For lung nodules older than 45 years old, the likelihood of lung cancer is more than 60%, and lung lesions larger than 4 cm are not called lung nodules but lung masses, with a malignant ratio of more than 80%. This suggests that both doctors and patients must pay high attention to any lung nodules found, whether they are tiny or large.
If the diagnosis of lung nodules can be clearly identified as lung cancer, the decision of surgery should be made without hesitation.
However, what about the difficulty in confirming the diagnosis, and how should the decision be made? This is a complex issue.
Lung nodules do not exclude lung cancer, and early diagnosis is essential. This is where you need to be seen by an experienced specialist, preferably a thoracic surgeon, to get his opinion and advice.
Generally speaking, based on the patient’s age (>45 years old), gender, personal history (smoking), family history, clinical symptoms (cough, blood in sputum, hemoptysis), and imaging characteristics of the lesion, combined with their own personal experience, the thoracic surgeon will make a preliminary judgment of benign or malignant. If the possibility of benign is considered high, observation and regular review of chest CT are recommended to decide the measures and timing of treatment according to the morphological changes of the lesion. However, individual experience varies widely, and there are few lung cancers that delay treatment due to inappropriate advice from doctors. For example.
Case 1: A nodule less than 1 cm, but showing “hairy glass-like” changes, was diagnosed preoperatively as alveolar carcinoma and confirmed by surgery. The lung cancer was cured by early diagnosis and early surgery without radiotherapy or chemotherapy.
Case 2: A nodule larger than 3 cm was diagnosed as lung cancer and confirmed by surgery. The patient received effective treatment mainly by surgery, and the survival rate was improved.
Case 3 The nodule had been found untreated on the second CT review, and the opportunity for surgery was lost after 3 months, with a very unfortunate outcome: not good.
Case 4 The morphological manifestations of the nodule were both benign and malignant, and there were two opinions on the diagnosis: benign or malignant, and finally the surgery was confirmed to be malignant, without delaying the surgical treatment, and the estimated outcome was good.
Again, it is emphasized that individual physician experience varies widely, and there are few lung cancers for which treatment is delayed due to inappropriate physician recommendations. Therefore, we suggest that for lung nodules, it is generally better to “left rather than right”, which means that early surgical treatment should be emphasized to avoid delaying cancer diagnosis and treatment.
About surgery
People generally think that thoracic surgery is a major operation, but this concept is too old-fashioned. In fact, lobectomy, especially lung nodule resection, is now a very minimally invasive surgery.
Here we introduce to you one of the newest techniques in thoracic surgery – TV-assisted thoracoscopic surgery – the best choice for pulmonary nodule diagnosis and treatment.
Thoracoscopy has been hailed as one of the major breakthroughs in thoracic surgery in the last century and is a representative procedure of minimally invasive thoracic surgery. Thoracoscopic surgery (TV-assisted thoracoscopic surgery), considered the most significant advancement in thoracic surgery at the end of the 20th century, is the future direction of thoracic surgery.
TV thoracoscopic technique can locally remove intrapulmonary lesions through two to three small incisions in the chest wall of about 1 cm, and send rapid frozen pathology to determine the benignity and malignancy during the surgery. If the lesion is benign, the operation will be finished, which is very simple and equivalent to immediate relief for the patient; if it is malignant, further thoracoscopic lobectomy + lymph node dissection will be performed, which is less traumatic and effective, so that the benefit of early diagnosis of lung cancer is really put into practice. Thoracoscopic surgery has built a bridge from early diagnosis to early treatment for lung cancer patients, and is by far the best choice to solve the difficult problem of lung nodule diagnosis and treatment.
Let’s talk more about the causes of lung cancer and the effect of surgical treatment
I. Factors leading to lung cancer
There are many factors that lead to lung cancer: smoking, including second-hand smoke. Generally speaking, the risk of smoking 1 pack/day for 20 years is relatively increased. Second-hand smoke contains higher levels of chemicals (nitrite, benzo(a)pyrene) than mainstream smoke, and also contains some amount of nicotine. This is the reason for the current increase in lung cancer among various non-smokers, especially women. Therefore, you should take care of yourself and your family, stay away from cigarettes and do not create second-hand smoke.
Can lung cancer be cured?
Lung cancer can be cured, as long as it can be detected early, the effect is good. To diagnose early, we must pay attention to lung nodules, and to detect lung nodules at least once a year for physical examination. Even for mid-stage lung cancer, a more satisfactory result can be achieved through a comprehensive treatment mainly based on surgery. For advanced stage lung cancer (which accounts for most of them, 70%~80% of lung cancer patients lose the opportunity of surgery when they visit the clinic to make people regret and heartache), through the efforts of doctors, patients and family members, they can also have a satisfactory quality of life and prolonged survival by adopting individualized and humanized comprehensive treatment or targeted therapy with less side effects. With proper control, we will achieve satisfactory results with less toxic side effects of radiotherapy.
Here again, special emphasis should be placed on the lung nodules, as any indicator of benignity can be wrong – therefore, it is better to remove a benign lesion that does not need to be removed than to incorrectly treat a malignant isolated nodule in the lung as benign. And the surgeries are now minimally invasive.
III. Post-operative survival and recurrence rate of lung cancer
Without surgical treatment, the overall 5-year survival rate of lung cancer is less than 10%. The 5-year survival rate after surgery for early-stage lung cancer can reach 70-80%, while the 5-year survival rate after surgery for mid-stage lung cancer is about 30-40%. Surgery has significantly improved the 5-year survival rate of early and mid-stage lung cancer patients. The recurrence rate of early-stage lung cancer after radical surgery is about 10%. The recurrence rate after surgical treatment of mid-stage lung cancer is about 30%. However, lung cancer with local recurrence can be treated by surgery again. Therefore, patients with lung cancer after surgery must be reviewed regularly to help detect and treat tumor recurrence and metastasis as early as possible.
Let lung cancer get early detection and early surgery! Let lung cancer stay away from us!