Lung cancer is the “king of cancers”, with a high degree of malignancy and the highest global incidence and mortality rate of all types of malignant tumors. Its causes include smoking, occupational and environmental exposures (long-term exposure to aluminum by-products, arsenic, asbestos, etc.), radioactive elements: uranium and fluorite miners exposed to inert radon gas, decaying uranium by-products, etc., chronic lung infections? such as patients with tuberculosis, bronchiectasis, etc. Intrinsic factors: family, genetic and congenital factors as well as reduced immune function, metabolic and endocrine dysfunction may also be high risk factors for lung cancer.
Lung cancer is growing rapidly in China, rising by 465% in the past 30 years. The proportion of smoking-related squamous carcinoma is decreasing, while the incidence of adenocarcinoma related to environmental pollution is increasing exponentially. Analyzing the reasons for the high incidence of lung cancer, the spearhead points directly to tobacco and environmental pollution. It is reported that the correlation between lung cancer and tobacco is 85% to 90%, and five years ago, the lung squamous carcinoma closely related to smoking accounted for 35% to 40% of lung cancer, but in recent years, the incidence of lung adenocarcinoma in China has increased exponentially, surpassing lung squamous carcinoma as a common type. And the rising incidence of lung adenocarcinoma is mainly influenced by environmental pollution.
So some people say on the Internet that the results of air monitoring are converted into how many high-tar cigarettes are smoked a day in the city: Lijiang 1, Beijing 21, Guangzhou 25, Shanghai 9, Nanjing 9, Changsha 13, Chengdu 12, Wuhan 13. It seems that people are more concerned about air pollution, so let’s talk about the recent hot PM2.5. The first thing is that PM10, which is ≤10 microns in diameter, can enter the human respiratory system of particles.
It is not difficult to understand that PM2.5 refers to atmospheric particles with a diameter less than or equal to 2.5 microns, also known as lung-accessible particulate matter. Its diameter is less than 1/20 of the thickness of a human hair, and it is obviously easier to inhale than PM10.
Compared with coarser atmospheric particles, PM2.5 is small in size, rich in a large number of toxic and harmful substances and has a long residence time and long transport distance in the atmosphere, so it has a greater impact on human health and the quality of the atmosphere, and particles ≤ 2.5 microns in diameter are the most harmful to humans because they can directly enter the alveoli. Scientists use PM2.5 to indicate the content of such particles per cubic meter of air, and the higher the value, the more serious the air pollution.
So how is PM2.5 linked to lung disease and even lung cancer? Wu Tui, former chief expert of Guangdong Meteorological Bureau, found a significant correlation between hazy weather and lung cancer mortality through statistics: 7-8 years after the occurrence of severe hazy weather, the mortality rate of lung cancer increased significantly. Previously it was widely believed that smoking was the number one killer of lung cancer.
However, while the smoking rate in Guangzhou has been decreasing over the past 30 years, the mortality rate of lung cancer has increased significantly. Accordingly, Guangzhou only had 1-2 days of hazy days per year in the 1960s, which later increased to 100-200 days per year. 2005 data showed that 60% of lung cancer patients in Guangzhou at that time did not have a history of smoking, and 2003-2005 was the worst time of hazy weather in Guangzhou. However, he was also careful to point out that only a lagged association between increased PM2.5 concentrations and lung cancer mortality has been found, but further research by epidemiologists, toxicologists and biochemists is needed to determine whether that equates.
Professor Pan Xiaochuan of the School of Public Health, Peking University School of Medicine, has done research on the health effects of PM2.5 in recent years and found that increased PM2.5 concentrations have a significant impact on emergency visits for cardiovascular and respiratory diseases. between 2004 and 2006, he had set up several observation sites on the Peking University campus and found that when the daily average PM2.5 concentration increased, about 4 km away There was also an increase in the number of emergency cardiovascular patients at Peking University Third Hospital.
He said: PM2.5 has an effect on the lungs first after inhalation, stimulating the airways to contract, making people feel short of breath for a short period of time and have difficulty breathing. It can have systemic effects after absorption into the blood. The specific hazard is determined by the toxic chemicals adsorbed on its surface. The International Agency for Research on Cancer (IARC), at its meeting in Lyon, has identified atmospheric pollution as a carcinogen, which is also recognized by experts. In fact, specifically, atmospheric particulate matter, also known as PM2.5, is a confirmed human carcinogen.
Experts in Jiangsu province also said that although the cause of cancer has not been fully elucidated, “PM2.5 causes cancer” is theoretically reasonable, and the first one is lung cancer, PM2.5 in the air is only equivalent to 1/20th of the thickness of a hair, which will precipitate in the lungs and damage the epithelial cells of the alveoli and is difficult to remove. At the same time, PM2.5 adsorbs many harmful gases, heavy metals and carcinogens, and these toxic substances will be deposited in the alveoli with PM2.5, which will directly produce toxic effects, and the incidence of lung cancer will increase with long-term exposure to PM2.5.
A new finding published in the new issue of The Lancet Oncology on the 10th shows that the Danish Cancer Society Research Center and other institutions have summarized and analyzed the information from 17 studies related to “the impact of urban air pollution on people’s health” and found that if the PM2.5 content increases by 5 micrograms per cubic meter of air, people’s risk of lung cancer increases by 18%. An increase of 10 micrograms of PM10 is associated with a 22% increase in lung cancer risk.
Therefore, from these research results and data, the increase of environmental pollution, especially the long-term concentration of PM2.5 and PM10, is harmful to the development of lung cancer, but is it that we people can only sit back and wait for death? First of all, under the influence of air pollution and other factors, the incidence of lung cancer is increasing, and while we are all concerned about haze pollution, we must not forget that smoking is still the main killer of lung cancer.
At least compared to changing air pollution, quitting smoking is within our own control and can be done now. Secondly, to reduce the harm of environmental pollution, we should first reduce industrial emissions and automobile exhaust, strengthen greening and reduce dust from urban construction sites, and citizens should avoid outdoor activities in polluted weather when PM2.5 increases. After talking about these external factors, the most important thing is to raise our own awareness of prevention and to have standardized medical checkups to understand lung cancer and to be well informed.
Lung cancer occurs in the bronchial mucosa epithelium and is divided into two main types, which are usually referred to as small cell lung cancer and non-small cell lung cancer; among them, about 80% of lung cancer patients are non-small cell lung cancer. Non-small cell lung cancer is further divided into: adenocarcinoma, squamous carcinoma, fine bronchoalveolar cell carcinoma, large cell carcinoma, etc. Almost 2/3 of lung cancer patients are already in advanced stage (stage III or IV) when they are diagnosed. 95% of patients can have clinical examination results, and primary tumor, metastasis, systemic symptoms or tumor accompanying symptoms can be the first symptoms of patients.
What kind of symptoms should people be alert to lung cancer? The symptoms related to lung cancer are neither typical nor specific, and none of them is exclusive to lung cancer. For example, hemoptysis: hemoptysis is one of the early symptoms of lung cancer, and patients should seek medical consultation as soon as such a symptom occurs. Hemoptysis of lung cancer is characterized by sudden coughing of blood or blood in sputum in middle-aged and elderly people, or repeated “pneumonia” with spitting of bloody sputum in some cases. There are also male female breasts: if male breasts appear to be raised like female breasts, this may be a sign of lung cancer.
If a man’s breast is enlarged on one or both sides like a woman’s, he should go to the hospital immediately for lung cancer examination and early detection of the disease for treatment. Arthritis: It is mainly manifested as wandering arthritis symptoms, burning pain in elbow, knee, wrist, ankle, and metacarpal joints, impaired movement, and possible periosteal hyperplasia of elbow and fibula, which is called rheumatoid arthritis-like arthritis, which may also be a complication of lung cancer. For example, progressive peripheral weakness and loss of appetite may occur, and in case of aggravation, symptoms such as difficulty walking and difficulty getting up from bed may occur.
According to experts’ statistics, 85% of lung cancer patients have suffered from peripheral myositis, and it appears before the typical symptoms of lung cancer. Mortar and pestle finger: it can also be called drumming finger, which is also one of the early symptoms of lung cancer, mainly manifested as hypertrophy of the first joint of fingers and toes, protrusion and curvature of nails, often accompanied by painful symptoms, foreign reports show that 21% of early lung cancer is accompanied by crickety finger, and most of them disappear after lung cancer surgery …… In fact, many symptoms other than this may be related to lung cancer In fact, many other symptoms may be related to lung cancer, such as irritating cough, blood in sputum, chest tightness, chest pain, weakness, weight loss without obvious reasons, hoarseness with shortness of breath without obvious reasons; obvious swelling on one side of the neck; small eye fissure, drooping eyelid and narrow pupil on one side of the eye, etc. Sometimes, they may also appear when the lung symptoms are not obvious, in any case, it is important to be alert.
Therefore, men over 40 years old who have been smoking for a long time, women who have been exposed to second-hand smoke for a long time, and those who have lung cancer in their family should be alert to the occurrence of lung cancer. In addition to those who have these symptoms, regular medical checkups for other people are also indispensable. Adults over the age of forty should have a chest X-ray or CT examination at least once a year, and if lung shadows are found, they should seek consultation with a thoracic surgeon for early diagnosis and treatment.
As for the high-risk group mentioned earlier, it is recommended to have a medical checkup every six months, preferably with a chest CT examination. Once a suspicious lung lesion is found, you should seek consultation with an experienced thoracic surgeon as soon as possible to further clarify the diagnosis and have received timely and effective treatment.
What should be done if lesions are found? The treatment methods of lung cancer include surgery, chemotherapy, radiotherapy, targeted therapy, biological therapy, traditional Chinese medicine therapy, etc. In recent years, comprehensive treatment is preferred, which is not a disorderly and arbitrary combination of these methods, but a comprehensive and rational judgment based on the clinical characteristics, tumor stage and molecular biological characteristics of different lung cancer patients, so as to formulate an optimal The best treatment strategy should be formulated for patients based on the clinical characteristics, tumor stage and molecular biology of different lung cancer patients.
Early detection and early treatment of lung cancer for surgery can achieve better therapeutic effect for most of early stage patients; for locally advanced stage, the therapeutic effect can be largely improved; even for advanced stage patients, some of them can benefit from surgery to relieve symptoms to a great extent when necessary. Some studies have shown that through early surgery, the 5-year survival rate of patients with early stage lung cancer is over 70%.
Lung cancer surgery mainly includes local resection, lobectomy, sleeve lobectomy, total pneumonectomy, rongectomy and reconstruction. The resection should preserve as much normal lung tissue as possible on the basis of complete removal of the primary focus and lymph nodes with potential metastasis in the chest cavity.
In recent years, the use of thoracoscopic surgery has given patients a better choice, as this procedure is less invasive with smaller incisions, less painful and easier to recover from, and also reduces postoperative acute reactions and faster recovery of lung function compared to traditional surgery. For those patients with advanced disease who are unable to undergo surgery, radiotherapy, biology and Chinese medicine can be used to prolong life. Therefore, early detection and surgery is the first choice to cure lung cancer.
In conclusion, prevention of lung cancer is crucial, and the most important thing is regular medical checkups to raise our own awareness of prevention, early prevention, early detection and early treatment, so as to maintain a healthy body in today’s “10-faced haze”.