This past November was the Global Lung Cancer Awareness Month. Currently, lung cancer is the number one cancer worldwide, and the number of deaths from lung cancer each year is higher than the total number of deaths from breast, prostate and bowel cancers. In China, although there are no clear statistics, the number of deaths due to lung cancer is comparable to that of traffic accidents. About 400,000 people are diagnosed with lung cancer each year in China, making it the country with the largest number of lung cancer patients in the world. Compared with other cancers, lung cancer is more like a “latent killer”. Most patients are diagnosed with lung cancer at an advanced stage, i.e. the cancer cells have spread to other parts of the body, and less than 5% of patients can live beyond 5 years if they receive treatment at this stage. If diagnosed at an early stage, nearly 70% of patients can survive for more than 5 years, and some of them even have the hope of being cured. However, there are still many misunderstandings about lung cancer among the general public.
Myth 1: Lung cancer is a disease of the elderly and young people are not allowed to have it. Smoking gets lung cancer, but non-smoking does not get lung cancer
Last month, our hospital diagnosed two cases of lung cancer in young people, one patient is 17 years old male and the other is 24 years old female, both of them are non-smokers. Some young people have a family history of cancer, and these young people have a special sensitivity to carcinogenic stimuli, creating the conditions for a younger cancer. Young people have a high level of cell division and reproduction and are vulnerable to attack by carcinogens. It is true that the history of smoking is a high incidence factor of lung cancer, but this does not mean that if you do not smoke, you will not get lung cancer. In recent years industrialization (chemical pollution) urbanization (car exhaust) has made air pollution serious, such as the current hazy weather, PM2.5 particles and other toxic substances inhalation, and even EBV infection, tuberculosis scars are often overlooked causes of the disease.
Myth 2: Lung discomfort does not require examination?
Chest pain, cough or blood in sputum are common symptoms of lung cancer or “basic symptoms”. In the early stage of lung cancer, chest pain and cough may not be so obvious, so many people do not take it seriously, thinking that it will be fine after a few days, or that it is inflammation and will be fine after taking some anti-inflammatory drugs. As a result, they do not go to the hospital for examination, resulting in many cases of “carelessness”. The central type of lung cancer cough is characterized by a high-pitched metallic sound. Alveolar cancer coughs up a lot of mucus sputum. According to some data, only 20% of the diagnosed lung cancer patients are in the early stage of the disease, while 80% of the patients have developed to the middle and late stage of the disease. In fact, if early examination, early diagnosis and early surgical treatment can be achieved, the 5-year tumor-free survival rate of lung cancer can reach 60% to 90%. Therefore, once suspicious symptoms appear in the lung, it is very necessary to go to hospital for timely diagnosis and treatment.
Myth 3: Surgery is not necessary for elderly lung cancer and advanced lung cancer?
In clinical practice, we often hear such statements as “the tumor is too big to be operated, and the patient will not live for a few days” or “the old man is too old and weak to be operated”. This actually involves the indications for lung cancer surgery. Indeed, not many patients have the chance to have surgery once lung cancer is diagnosed, mainly because there are too few lung cancers detected in early stage. Many lung cancers are already too large to be operated immediately when they are discovered; some are not large but have distant metastases. In fact, for patients who cannot undergo surgery immediately, chemotherapy can be used to shrink the tumor to achieve lower stage, and then seize the opportunity to perform radical resection. As with the treatment principles of many solid tumors, only by undergoing radical surgery can lung cancer patients have the possibility of long-term survival. Clinical experience shows that age is not a contraindication to lung cancer surgery, and even elderly people in their 80s can obtain good treatment results through surgery and comprehensive treatment.
Myth 4: There is no need to treat lung cancer in the middle and late stages?
Because some lung cancer patients are not treated in time, when they are diagnosed, the disease has already developed to the middle and late stages, and many of them have already involved the heart and large blood vessels. Therefore, some people think that since the disease has developed to the middle and late stage, it is the same whether to treat or not to treat. In fact, it is not. Statistics show that patients with advanced lung cancer can only survive for 3-4 months without treatment, but after comprehensive treatment such as surgery, the quality of survival is significantly improved, and some patients can even survive for 3-5 years. It can be seen that the outcome is very different between treatment and no treatment. Especially for those patients with non-small cell lung cancer, if there is no distant lymphatic metastasis and the lesion only invades the adjacent organs (such as heart, large blood vessels, esophagus, etc.), radical surgery of varying degrees can prolong life and improve the quality of survival to the greatest extent.
Myth 5: It’s okay to take a chest X-ray
Nowadays, many people have a chest X-ray project when they have a physical examination, thinking that a normal chest X-ray is fine. In fact, otherwise, from the perspective of a specialist, it is recommended that people over 40 years of age, it is best to do a CT physical examination once a year. Because the ordinary chest X-ray examination, the heart, muscles, bones, etc. are layered together from front to back, if the physician is not experienced enough, it is impossible to detect the lesion. The CT examination, similar to cutting a carrot, is a layer of performance, the results are more accurate and reliable.
Myth 6: Small lesion means early lung cancer
Many patients think that small lesions are early stage lung cancer when they have preliminary examinations. In fact, some lung cancers are more prone to metastasis, such as small cell lung cancer, adenocellular lung cancer, etc. The cancer cells can easily metastasize to many parts such as head, liver, bones, etc. Although the lesions are small, a large number of metastases occur, which is already middle to late stage lung cancer, called small lesions with large metastases, which is very dangerous. In contrast, squamous cell carcinoma is less metastatic. Therefore, the stage of lung cancer cannot be judged by the size of lesions.
Myth 7: Surgery is useless
Patients with lung cancer are most afraid of open-heart surgery, and sometimes they would rather choose chemotherapy than surgery, or even easily believe in the “theory of uselessness of surgery” and miss the best time for surgery. For early stage lung cancer, thoracic surgery is a recognized better measure, and the 5-year survival rate can reach about 70%. If surgery is abandoned, the 5-year survival rate may be only 5-10%. Many of the so-called knives nowadays are actually radiotherapy. For example, radio-wave knife, gamma knife, gyroscope knife. It is a means of treatment for advanced tumors or early stage patients who cannot tolerate surgery, and in no way they can replace surgery.
Misconception 8: Chinese and Western medicine are incompatible with each other
Some patients think that western medicine anti-tumor drugs are toxic and harmful to human body, while Chinese medicine has small side effects, thus rejecting western medicine. Some patients think that Chinese medicine treatment is purely ineffective and psychological comfort. In fact, people have misconceptions. They should cooperate with TCM on the basis of western medicine surgery and drug treatment to support and regulate body functions and immunity, which often have unexpected gains in treatment effect.
Myth 9: Never disclose the disease to patients?
As long as lung cancer is treated properly, it is possible for patients to achieve long-term survival or even cure. Experts suggest that, with the consent of patients’ families, if patients are given an open and honest account of their disease and told that lung cancer is curable, most patients can quickly calm down and face it positively after a short period of panic, pushing the treatment in a good direction. As for those patients who are kept in the dark, it is difficult to establish trust between doctors and patients, and patients either do not cooperate with treatment or speculate about their condition, which is a serious psychological problem and ultimately detrimental to treatment.
Myth 10: Is it necessary to have chemotherapy?
In fact, chemotherapy is an important part of comprehensive treatment for lung cancer, and has been proven to be better than the best supportive treatment for advanced lung cancer by evidence-based medicine. How effective it is depends on how it is used. The optimization of chemotherapy should be based on a comprehensive diagnosis. Some patients are found early enough to prefer surgery without chemotherapy at all; others need chemotherapy first to create an opportunity for surgery; and some patients need additional chemotherapy after surgery to consolidate the efficacy. The specific situation of patients varies, and the application and specific implementation plan of chemotherapy are diverse. With the development of molecular target diagnostic technology, through molecular typing of lung cancer, screening mutated lung cancer genes and selecting more effective chemotherapy drugs, the traditional so-called “tied chemotherapy”, which is nearly 70% ineffective, can be avoided to a certain extent, thus obtaining twice the effect with half the effort. The emergence of new targeted therapies in recent years has indeed provided clinicians with new options and ideas, but it should be emphasized that no drug should be deified. No single targeted drug can be suitable for all patients, and its application should follow a strict range of indications, i.e. patients must have “molecular targeted drug targets” in their bodies by molecular biology testing before the drug can work.