With the development of society, the deterioration of people’s living environment and natural environment has led to the frequent occurrence of many diseases to a certain extent. At present, lung cancer has become the most dangerous malignant tumor to human health and life in the world today, with an incidence rate of 61.4/100,000, and about 600,000 people die from lung cancer every year, and the incidence rate is still on the rising trend.
In October 2008, the national tumor registration work and academic annual meeting showed that the incidence rate of malignant tumor in five districts of Lanzhou city is the highest in Xigu District, 208.5/100,000, and the lowest in An Ning District, 150.5/100,000, while in the rising trend of various types of cancer, lung cancer has increased by 337.98%, tripling the previous data and ranking first in all types of cancer. There is an alarming data: the rising trend of cancer mortality in Gansu Province is even more obvious, 56.02% higher than the national average mortality rate, of which the incidence of lung cancer is the highest in the country, while the average urban than rural areas is about 20% higher.
1.What is the relationship between smoking and lung cancer, and is passive smoking harmful?
The causes of lung cancer are many, but the most important one is smoking. The risk of lung cancer caused by smoking is related to the amount of smoking, the number of years of smoking, the type of smoking, and the age of starting to smoke. The incidence of lung cancer among smokers is 8-20 times higher than that of non-smokers. If you smoke 10-20 cigarettes a day, the incidence of lung cancer is 15%; if you smoke 21-40 cigarettes a day, the incidence of lung cancer is 28%; if you smoke more than 40 cigarettes a day, the incidence of lung cancer is as high as 68%. If you stop smoking for 1 year, the risk of lung cancer is still 94.4%; if you stop smoking for 2-3 years, it is 85.2%; if you stop smoking for 4-9 years, it is 56.1%; if you stop smoking for 10-15 years, it is 39.3% Even if you stop smoking for 16 years, the incidence of lung cancer is still 5.3%.
The International Anti-Cancer Research Center (IARC) has conducted a comprehensive study and analysis based on epidemiological findings from around the world in recent years and identified tobacco as a definite human carcinogen. The increased incidence of lung cancer in passive smoking has received widespread attention. It has been found that although passive smokers inhale the side streams of cigarette combustion, because there is less air passing through the side streams, the combustion is incomplete and the temperature is lower, which is suitable for the formation of carcinogenic polycyclic aromatic hydrocarbons, so the content is higher than that of the central stream, so the harm suffered by inhaling the side streams is more obvious.
2.Is there any gender and age difference in the occurrence of lung cancer? Can it be inherited or transmitted?
In almost all countries and regions, the incidence and mortality rate of lung cancer in men are higher than that in women. However, in recent years, the incidence rate of lung cancer in women has increased faster than that in men. This may be related to the increase of female smokers. In addition, lung cancer in women is mainly adenocarcinoma, and according to our survey, it is closely related to small environmental pollution in the kitchen (fuel, oil smoke, etc.). The incidence of lung cancer increases with age, but it is rare before the age of 30 and increases gradually after the age of 40. The mortality rate generally peaks at age 65 or 70. However, as the smoking population becomes younger, the tendency to develop lung cancer under the age of 30 should be guarded. Lung cancer has been studied for nearly a century, but there is no definite evidence that lung cancer is hereditary.
However, if you have a family member with cancer (including lung cancer) and you are a long-term heavy smoker, you should be vigilant. Lung cancer occurs when certain cells become cancerous due to genetic factors and certain environmental factors, and these cancerous cells continue to multiply and grow to become tumors. Therefore, it is impossible for lung cancer to be transmitted from one person to another in any form.
3.What are the symptoms of lung cancer that can be easily ignored or delayed?
The most common ones are fever and cough, which are easily misdiagnosed as “cold”. When chest X-ray or chest X-ray is accompanied by faint shadow, it is easy to be misdiagnosed as “pneumonia”. If conventional treatment is ineffective, or if “pneumonia” occurs repeatedly in the same area within a short period of time, we should be vigilant except lung cancer. Chest CT, deep sputum cytology or fiberoptic bronchoscopy should be performed if necessary. Pulmonary shadow is often misdiagnosed as “tuberculosis” and anti-tuberculosis treatment is used without any examination to exclude “tuberculosis”, resulting in delayed diagnosis and treatment with serious consequences.
Lung cancer occurring in the apical part of the lung is often accompanied by symptoms such as shoulder pain or limitation of upper limb movement due to invasion or compression of the surrounding tissues, which is easily misdiagnosed as “frozen shoulder” and delays the diagnosis and treatment.
Gradually worsening chest tightness, shortness of breath, inability to lie down, chest physical examination or imaging examination shows pleural effusion, which is easily misdiagnosed as “tuberculous pleurisy” when the fluid extraction is non-bloody. In this case, the pleural fluid should be pumped for cancer cells and tumor markers, and chest CT should be performed after pumping as much as possible to show the lesions in the lungs hidden by the pleural fluid. If it is suspicious, further examination should be conducted in a specialized hospital.
Pain in the lower back, radiating to the buttocks, the outer side of the lower limbs, or even the outer side of the calf or foot, and worsening with coughing, stool and other actions that increase abdominal pressure, is easily misdiagnosed as “sciatica”, but cancer pain is characterized by gradual worsening or worsening at night, and is mostly one-sided.
Other cases, such as cancerous osteoarthropathy, are easily misdiagnosed as “rheumatic” or “rheumatoid” arthritis because they are often accompanied by joint deformation. Therefore, in case of appeal, if conventional treatment is not effective, you should consult a large general hospital or a specialized hospital to exclude lung cancer.
If a lump appears on the neck, especially on the clavicle, and increases in size within a short period of time, the patient should immediately consult a major general hospital, and if cancer is suspected, the patient should immediately consult a specialized oncology hospital for further examination. Please do not receive “anti-tuberculosis” treatment or anti-tumor “test” treatment without any evidence.
4.What tests should be done when lung cancer is suspected?
The diagnosis of lung cancer cannot be confirmed only by symptoms such as cough, hemoptysis and chest pain. If you have the above-mentioned suspicious symptoms, you should immediately consult a specialized oncology hospital or a large general hospital. After a comprehensive physical examination and obtaining valuable positive signs, doctors should also conduct chest imaging examinations, including chest X-ray and CT. If lung cancer is suspected, bronchoscopy, biopsy of lesions or metastases, mediastinoscopy or thoracoscopy and/or sputum cytology should be performed to confirm the diagnosis, and the correct treatment method should also be performed after staging examination to clarify the stage. Sometimes an early lesion that appears to be resectable, such as a peripheral type 1-3 cm in diameter, is detected after staging as an asymptomatic advanced (stage IV) lesion with metastases elsewhere in the brain or bone. The treatment methods are very different.
5.Surgical treatment and comprehensive treatment of lung cancer
Surgery is still the preferred treatment for tumors and the most effective treatment for localized early-stage tumors. However, even after surgery alone, many patients eventually die of recurrence and metastasis, even if stage I non-small cell lung cancer is surgically resected, about 30% still die of distant metastasis and/or recurrence 5 years later.
Radiotherapy is an effective treatment to control unresectable local lesions, but it cannot solve the problem of metastasis or recurrence; chemotherapy, i.e., killing tumor cells in various parts of the patient’s body directly or indirectly by various drugs, is less effective than radiotherapy for local lesions where the tumor load is often large; biological therapy, especially monoclonal antibody therapy with clear targets of anti-gene products, is more effective than radiotherapy for certain tumors such as advanced breast cancer, non-small cell lung cancer, and non-small cell lung cancer. Biological therapy, especially monoclonal antibody therapy with anti-gene products with clear targets, has unique advantages in mobilizing the body’s anti-tumor ability and alleviating the side effects of other treatments, but the effect of direct tumor control is generally poor, and is an effective adjuvant therapy.
According to the advantages and disadvantages of various treatments mentioned above, the concept of comprehensive treatment has been gradually developed in the treatment of solid tumors including lung cancer. In other words, according to the patient’s physical condition, pathological type of tumor, the scope of invasion (disease) and development trend, various existing treatments are applied in a planned and rational manner, in order to improve the efficacy and quality of life as much as possible. Currently, the treatment of various tumors, including lung cancer, is in the era of comprehensive treatment, and no single treatment can replace the mode of comprehensive treatment. Generally, surgical resection is the main treatment for early stage (I and II), while postoperative adjuvant treatment includes palliative radiotherapy or interventional therapy for certain metastases according to specific conditions.
How to combine the local treatment means such as surgery, radiotherapy, interventional therapy and heat therapy with the systemic treatment such as chemotherapy, biotherapy, targeted therapy, gene therapy and traditional Chinese medicine to achieve the best therapeutic effect is an extremely complicated issue and a hot issue for oncologists to research and explore.
6.Will surgery spread the tumor instead, and can we operate again if the tumor recurs after surgery?
Surgery is the main treatment for early stage lung cancer, and its purpose is to completely remove the primary tumor and local metastatic lymph nodes in the lung. Due to the operation process of surgery, some malignant cells may be detached, or metastasis or local planting metastasis may occur along the veins or lymphatic vessels, or tumor cells already existed in the small veins around the tumor before surgery, which are all factors of tumor metastasis and recurrence. Gentle surgical operation or postoperative adjuvant therapy can generally reduce the risk of tumor spread and metastasis. The problem of tumor cancer surgery for recurrence after surgery depends on the recurrence foci or metastasis. If it is an isolated metastasis in the lung, no metastasis elsewhere in the body and no contraindication to surgery. Then it can be resected surgically again.