In April 2008, the Ministry of Health released the results of the third national survey on the causes of death: malignant tumors have become the first cause of death among urban residents in China, among which lung cancer has grown most rapidly, rising by 465% in the past 30 years, and has replaced liver cancer as the first cause of death from malignant tumors in China (accounting for 22.7% of all malignant tumor deaths).
With the dramatic increase in the number of smokers and passive smokers in China, along with the accelerated aging and industrialization of the population, the continuous increase in air and environmental pollution, as well as the improvement of people’s health awareness and the popularization of health checkups for the middle-aged and elderly, especially the modernization of medicine, which has improved the level of lung cancer diagnosis and treatment, many factors will certainly lead to a yearly increase in lung cancer incidence and mortality.
We frankly admit that nearly 70-80% of clinically diagnosed lung cancer patients are in the middle and late stages of lung cancer and have lost the best time for treatment, which is the main reason for the high mortality rate of lung cancer. However, lung cancer is not an incurable disease, and with early detection and comprehensive treatment, many early-stage lung cancers can achieve long-term survival. Even for localized mid- to late-stage non-small cell lung cancer, it can survive for a long time with cancer through minimally invasive surgery, new generation chemotherapy drugs, molecular targeting drugs and new physical therapy.
Tobacco control is an effective measure to prevent lung cancer and reduce its incidence
After decades of clinical research and a large number of demographic surveys, the causes of lung cancer have been recognized by scholars to be closely related to smoking and air pollution.
As early as the 1930s, the medical profession proposed the relationship between smoking and lung cancer. In the 1950s, British medical researchers conducted a large-scale study of more than 50,000 British male physicians, scientifically and epidemiologically, irrefutably confirming that smoking is the culprit of lung cancer.
Extensive demographic and epidemiological surveys have proven that smoking (including passive smoking) is the cause of 87% of lung cancers in men and 80% of lung cancers in women. The incidence of lung cancer in men is 8-20 times higher in long-term smokers than in non-smokers. In the United States and the United Kingdom, thanks to nearly 40 years of strict government tobacco control policies, the overall population smoking rate has declined each year. Today in the United States and the United Kingdom, lung cancer incidence and mortality rates have shown a downward trend. Although our country has made unremitting efforts to control tobacco and air pollution and reduce environmental carcinogenic factors, and has achieved significant results in some areas, there is still a considerable gap from developed countries.
As every citizen, what we can do to prevent lung cancer is to refuse tobacco and stay away from lung cancer, which is the easiest, most economical and most effective measure in primary prevention of lung cancer. We hope that smokers will be fully aware of the health hazards of tobacco, especially the close relationship with lung cancer, and quit tobacco as soon as possible under the guidance and help of doctors.
Screening can detect early lung cancer, and surgical resection can be clinically curable
As we all know, lung cancer is not easily detected at an early stage due to the lack of early symptoms. Once clinical symptoms such as irritating cough, blood in sputum or coughing up blood, chest pain, shortness of breath, etc. appear in hospital, it is often in the middle and late stages of localization. At present, only 20-30% of lung cancer patients who come to hospital with clinical symptoms are in the early stage (stage I and II), while the other 70-80% are in the late stage (stage III and IV), and the treatment effect is poor, which is a very disturbing reality. However, if early detection and early diagnosis can be achieved, most early stage lung cancers can be clinically cured through surgical procedures.
Since the 1950s, governments and scholars in various countries have been studying ways to detect lung cancer at an early stage and have also adopted the screening methods of annual sputum cytology and chest X-ray for specific groups of people, but after years of efforts and long follow-up observations, the results of sputum cytology and chest X-ray screening were unsatisfactory and failed to reduce the overall lung cancer mortality rate.
In recent years, with the advancement of medical imaging technology, the use of annual chest X-ray combined with low-dose spiral CT scan of the chest can help to detect early lung cancer in a timely manner. It is recommended that smokers who smoke more than 20 cigarettes per day and have smoked for more than 20 years should undergo annual chest X-ray (chest X-ray front and side) combined with low-dose spiral CT scan of the chest for early detection of lung diseases.
Timely surgical resection of early lung cancer detected by screening can clinically cure the majority of lung cancer patients, and the five- and ten-year survival rates also reach more than 85% and 50%. Adjuvant chemotherapy with a two-drug platinum-containing regimen for 4-6 cycles after surgery can also improve to better long-term survival in some highly selected benefit groups.
The reader needs to be informed that currently, thoracic surgery in many lung cancer centers in China has abandoned the traditional large-incision open-heart surgery and instead applied TV thoracoscopy-assisted small-incision minimally invasive surgical techniques to treat lung cancer, which have been popularized and promoted throughout the country. The tiny trauma of modern lung cancer surgery is not only the external aesthetic appearance of the wound, but also brings better quality of life to many young and middle-aged female lung cancer patients and senior lung cancer patients over 70 years old, and lays the foundation for possible postoperative adjuvant chemotherapy for non-small cell lung cancer.
III. Comprehensive treatment can effectively prolong the survival of patients with intermediate and advanced lung cancer
From the current treatment effect, surgery, radiotherapy and chemotherapy are still the main means of lung cancer treatment. We have awakened to the fact that clinical behaviors of relying solely on a single surgical knife, overemphasizing the omnipotence of drugs, and unreasonably exaggerating the effects of physical therapy cannot bring real clinical benefits to lung cancer patients. It is necessary to apply all existing effective treatments in a planned, scientific and rational manner according to the physical and mental conditions of lung cancer patients, the specific location, pathological type, invasion range (stage) and developmental tendency of the tumor, combined with changes in molecular biology, to achieve the best treatment effect at the most appropriate economic cost while maximizing the quality of life of patients. This is the definition of multidisciplinary comprehensive treatment for lung cancer that we have emphasized for many years.
Clinical staging before lung cancer surgery is crucial. Scientific and standardized staging examinations must be performed before surgery, such as cranial MRI to exclude cranial metastases, whole-body bone scan to exclude bone metastases, and abdominal ultrasound or abdominal CT to exclude abdominal organ metastases. These examinations are not only required by the clinical treatment routine of lung cancer in China, but also reimbursed by medical insurance departments at all levels. Lung cancer surgery must routinely clear all groups of mediastinal lymph nodes, which we call systemic lymph node clearance. Only by doing so can we obtain accurate pathological stages of lung cancer, which are commonly referred to as early, middle and late stage lung cancer by our people. These are crucial for us to guide and formulate the postoperative treatment plan. The postoperative chemotherapy and radiotherapy or not depend on the final pathological stage.
The progress of modern thoracic surgery technology and the rapid development of instrumental surgery and minimally invasive surgery, the clinical application of new generation chemotherapeutic drugs and modern radiotherapy equipment and techniques have laid a solid material foundation for the multidisciplinary comprehensive treatment of lung cancer. In particular, minimally invasive thoracic surgery techniques and radical lung cancer treatment by televised thoracoscopy have made it possible for more patients with low lung function and advanced lung cancer to receive surgical treatment, and most of them can be discharged from the hospital within one week after surgery. Third generation lung cancer chemotherapy drugs and new generation adjuvant drugs to address the toxic effects of chemotherapy have enabled those who require pre-surgical neoadjuvant chemotherapy and post-surgical adjuvant chemotherapy to be completed safely and in adequate doses, further improving long-term survival of lung cancer patients. The rapidly updated radiation therapy equipment and technology, guided by the new generation of 3D and 4D positioning system, locks the tumor target organs through conformal intensity modulated radiotherapy technology, and protects the surrounding healthy tissues and organs from damage to the maximum extent. In other words, the traditional three major treatments have undergone significant changes in recent years, and the organic combination of the three treatments has brought new hope to more patients with locally advanced non-small cell lung cancer. And all of this requires the communication and cooperation of discipline leaders. In recent years, many lung cancer treatment centers have been established across the country, gathering leaders in thoracic surgery, respiratory medicine, oncology and radiotherapy to jointly study and formulate regional lung cancer prevention and treatment strategies, research and formulate individualized multidisciplinary comprehensive treatment plans for each lung cancer patient, and fully and rationally apply new technologies and means in the field of tumor treatment in recent years as well as Chinese medicine with great Chinese characteristics to treat lung cancer.
4. Molecular targeted therapy turns lung cancer into a chronic disease
With the deepening understanding of tumor biology, medical doctors have found that molecularly targeted therapeutic drugs have become the highlight of the global non-small cell lung cancer treatment field. Molecular targeted therapy is a new biological treatment model that targets the links that may lead to cell carcinogenesis, such as cell signaling pathways, proto-oncogenes and oncogenes, cytokines and receptors, anti-tumor angiogenesis, suicide genes, etc., to reverse this malignant biological behavior at the molecular level, thus inhibiting the growth of tumor cells or even making them completely regress.
The statement of making lung cancer a chronic disease represents a shift in thinking about tumor treatment. The launch of two molecularly targeted drugs in China, ERSA and Troche, has transformed this ideal into a reality, with nearly 50,000 Chinese non-small cell lung cancer patients reaping the benefits of long-term survival from ERSA and Troche, two molecularly targeted drugs. Among them are many patients with advanced non-small cell lung cancer who were sentenced to death by many doctors, who have achieved miracles. In the past, the concept was that cancer cells had to be killed by various means such as radiation and chemotherapy. Now with molecular targeted therapy, it may not kill the tumor cells, but it can slow down their progress and buy more time, turning the treatment of advanced lung cancer patients into a relatively long and chronic process. To our surprise, molecularly targeted therapies have brought a boon to more Chinese women, non-smoking non-small cell lung cancer patients. It is thanks to these molecularly targeted drugs that many advanced non-small cell lung cancers are beginning to have one-, two- and three-year survival periods. Our emphasis now is on invoking the concept of chronic disease, which is to view lung cancer as a chronic disease, along with hypertension, coronary heart disease and diabetes.
In addition to their ability to inhibit cell proliferation, angiogenesis and metastasis, and promote apoptosis, targeted therapeutic agents can also exert immunological anti-tumor effects. It has been found that the combination of targeted therapeutic agents and cytotoxic drugs such as cisplatin and paclitaxel have synergistic anti-tumor effects, which not only prolong the overall survival of patients with advanced non-small cell lung cancer, but also reduce the possibility of tumor metastasis. New molecularly targeted therapies have not only been shown to prolong patient survival, but also significantly improve patients’ symptoms, such as reducing cough, dyspnea, and pain, and improving their quality of life.
However, early stage lung cancer should never be treated as a chronic disease, and radical resection must be performed when the tumor can be removed. Patients with early stage lung cancer who cannot tolerate surgery due to physical reasons can try CT-guided radiofrequency ablation, body stereotactic radiotherapy and other “physically targeted” methods. For advanced non-small cell lung cancer, effective molecular targeted drugs can allow many patients with advanced non-small cell lung cancer to live peacefully with them and still hope to eliminate them once they have a chance.
V. Conclusion
To solve the problem of early diagnosis and treatment of lung cancer, screening and health screening for high-risk groups is still a recommended and important tool to improve the clinical cure rate of early-stage lung cancer. Although lung cancer occupies the first place in cancer deaths, it has the most definite etiology among all kinds of cancers and is therefore included as one of the most preventable cancers. The most effective way to prevent lung cancer is to control smoking and stay away from air and environmental pollution as much as possible. For people at high risk of lung cancer (long-term heavy smokers and those exposed to certain occupations), annual lung cancer screening should be performed to detect lung cancer at a curable stage. Early stage lung cancer can be cured clinically through standardized surgery, and minimally invasive surgery gives early stage lung cancer patients a better quality of life. More and more patients with advanced non-small cell lung cancer have been able to obtain long-term survival from new generation of molecular targeted drugs.