I. Pathological types of lung cancer
The pathological type and stage of lung cancer are the basis for determining the treatment plan of lung cancer. Therefore, before treatment, the pathological type of lung cancer and its stage must be determined through various examinations and diagnostic tools, so that the treatment can be more targeted and effective.
The pathological types of lung cancer are often divided into two categories, one is non-small cell lung cancer and the other is small cell lung cancer. There are obvious differences between these two types of lung cancer in terms of microscopic manifestation, growth and spread rate, and response to different treatments.
1.Non-small cell lung cancer
Non-small cell lung cancer is the most common type of lung cancer, accounting for more than 80% of all lung cancers, and it usually grows and spreads more slowly than small cell lung cancer. As long as the diagnosis and treatment are timely, the survival rate can be good, for example, the 5-year survival rate of stage I patients can reach 60-80%. Non-small cell lung cancer can be subdivided into three subtypes: squamous carcinoma, adenocarcinoma and large cell undifferentiated carcinoma.
2.Small cell lung cancer
Small cell lung cancer is one of the more malignant types of lung cancer, which accounts for about 20% of all lung cancers and often has a 5-year survival rate of less than 10%. If left untreated, the survival period is often only 6-17 weeks. These cells are more sensitive to chemotherapy and radiotherapy, but even in early stage small cell lung cancer, the recurrence rate is very high.
Other types of lung cancer are less common, such as malignant mesothelioma, which is a cancer derived from the pleura, and its treatment is different from SCLC and NSCLC.
II. Staging of lung cancer
Staging is to fully understand the extent of lung cancer spread, which is very important for formulating treatment plan and judging prognosis. For example, a tumor in one stage is suitable for surgical resection treatment, while another stage may require combined chemotherapy or radiotherapy. Due to the different characteristics of tumors, the stages of non-small cell lung cancer and small cell lung cancer are also different.
1.Staging of non-small cell lung cancer
The most commonly used staging method for non-small cell lung cancer is the TNM staging method, which mainly considers the size and extent of lung cancer, the invasion of lymph nodes associated with lung cancer and the presence of distant organ metastasis.
Stage I: the tumor is confined to the lung and there is no lymph node metastasis, which belongs to the early stage of lung cancer and the prognosis is often better.
Stage II: tumor confined to the lung with paraneoplastic lymph node metastasis.
Stage III: the tumor is in the lung with metastasis in mediastinal lymph nodes or tumor cells in pleural fluid examination. Stage III is further divided into two types: the tumor spreads only to the ipsilateral lymph nodes becoming III-A, if the tumor spreads to the contralateral lymph nodes or supraclavicular lymph nodes called III-B.
Stage Iv: this stage belongs to the advanced stage of tumor, the tumor has spread to other organs outside the lung such as liver or bone.
2.Stage of small cell lung cancer
Small cell lung cancer can metastasize at an early stage due to its higher malignancy, therefore, small cell lung cancer is usually classified in another way as
(1) Confined small cell lung cancer: lung cancer is confined to one side of the chest and only invades one lobe and adjacent lymph nodes.
(2) Extensive small cell lung cancer: the cancer invades the opposite lobe of the lung or other organs.
C. What should you know before preparing for treatment?
After learning that you may have lung cancer, we recommend that you discuss it further with your doctor so that you can fully understand your condition and the next steps in your treatment plan so that you can be prepared for the upcoming treatment. There are various treatment options for lung cancer, and each person’s condition is different and treatment options are obviously different. There is no best treatment, only the most suitable one.
Before treatment starts, you can ask your doctor the following questions that will help you.
1.What type of lung cancer do I have?
2. Has my lung cancer spread?
3. What stage of lung cancer am I in? What does this mean for me?
4. What treatment plan do you recommend for me? Why?
5.Can I have surgery to remove the tumor?
6.Do I need radiation therapy or chemotherapy?
7. Do I need targeted therapy?
8.Are there any side effects of these treatments?
9.Is there any way to reduce these side effects?
10.What should I do before treatment?
11.What is the goal of the treatment?
12.How to evaluate the effect of my treatment?
13.Can I switch to another treatment plan if the treatment is not effective?
14.Can I stop the treatment in the middle of the treatment?
15.Will I be able to resume my daily activities?
16.Do I need regular follow-up?
17.Where can I or my family get more information?
18.Is there any clinical trial suitable for me?
Commonly used lung cancer treatment methods
The common treatment methods for lung cancer include surgery, chemotherapy, radiation therapy, targeted therapy, immunotherapy, Chinese medicine, and the combination of different treatment methods. The development of treatment plan needs to rely on the classification and stage of the tumor mentioned earlier.
Treatment of non-small cell lung cancer
1.Surgical treatment
According to the scope of lung cancer invasion and the stage of lung cancer, the surgical treatment of lung cancer is mainly divided into: wedge resection, lobectomy and total pneumonectomy. Wedge resection is mainly applicable to early stage of lung cancer, where the tumor invasion is very small or the lung function is poor, and only the lung tissues including the cancer are removed in a wedge shape. The advantages of this kind of surgery are: the damage to the lung is relatively small, the lung parenchyma can be preserved to the greatest extent, and the postoperative impact on the patient is relatively small. The normal left lung and the right lung are composed of 2 and 3 lobes respectively The so-called lobectomy is a lung cancer treatment surgery to remove the affected lobe of the lung when the lung cancer is confined to a single lobe. If the cancer reaches or is located in the main bronchus, then it is often necessary to remove the entire side of the lung and remove any lymph nodes that may have metastasized at the same time. This type of surgery is more extensive in terms of resection and has a greater impact on the patient.
With the rapid development of surgical techniques and anesthesia technology, most surgical treatments for lung cancer can be safely accomplished through minimally invasive surgery. At present, minimally invasive surgery for lung cancer, also known as thoracoscopic lobectomy, is regarded as a revolutionary breakthrough in thoracic surgery at the end of the 20th century and is the most widely used thoracoscopic surgery in minimally invasive thoracic surgery. The advantages of VATS include less trauma, protection of lung function, reduction of postoperative pain, faster postoperative recovery, shorter hospital stay, lower cost, and superiority over high-risk patients. The current evidence-based medical evidence shows that the efficacy of VATS for stage I peripheral NSCLC is not significantly different from that of conventional open-heart surgery. Therefore, the 2012 edition of the NCCN guidelines recommends that VATS is an acceptable and reasonable option for patients without anatomical or surgical contraindications, as long as it does not violate tumor treatment standards and principles of surgical resection of the chest.
Regardless of the surgical option or the extent of resection, the patient needs to be in good condition and have some tolerance for surgery. Sometimes surgery is combined with chemotherapy or radiotherapy, such as chemotherapy first, and then surgery after the tumor shrinks.
2.Chemotherapy
Chemotherapy is a treatment method that kills tumor cells by using chemical drugs. These drugs are usually administered intravenously (including intravenous infusion) or orally. Once these drugs enter the blood system they can enter all parts of the body. Chemotherapy drugs are all cytotoxic to some degree, but the mechanism of action of these drugs can vary, so doctors often combine multiple drugs to administer chemotherapy at the same time so that the effects of the different drugs can be synergistic. Depending on the stage of lung cancer and the classification of the tumor, the combination of drugs and the dosing regimen may vary.
The goal of chemotherapy is often to kill remaining tumor cells that may cause recurrence or spread outside of the lung with chemicals. Chemotherapy is usually administered in a cyclic fashion, usually at 21-28 day intervals, with 4-6 cycles of conventional chemotherapy. Sometimes, chemotherapy can be used as an adjunct to surgery and radiation therapy.
Since chemotherapy drugs are all cytotoxic to some extent, killing tumor cells while also reacting to normal tissue cells, most chemotherapy drugs have some side effects. It is also for this reason that chemotherapy may not be appropriate for some patients with poor health condition or elderly.
For non-small cell lung cancer (NSCLC), the commonly used chemotherapy drugs are cisplatin or carboplatin, and other combination drugs include: paclitaxel, doxorubicin, gemcitabine, pemetrexed, vincristine, irinotecan, etoposide, and vincristine.
In recent years, clinicians have become more and more flexible in the application of chemotherapy, which is no longer purely for postoperative prevention of recurrence and treatment of advanced lung cancer, but is increasingly applied before other treatments, such as surgery or radiotherapy, and is also called neoadjuvant chemotherapy by some scholars. At this time, chemotherapy can serve the following purposes: to reduce the stage, shrink the tumor to make surgical resection easier, improve the efficacy of radiotherapy, and kill potential cancer cells as early as possible. Chemotherapy before surgery or radiotherapy makes it easier for patients to tolerate the possible side effects of chemotherapy, and if chemotherapy is effective before surgery, the same chemotherapy regimen can be continued after surgery.
All chemotherapy drugs have side effects. Transient side effects (which can be recovered after stopping the drug) include loss of appetite, nausea, vomiting, and hair loss. Some chemotherapy drugs may also affect the function of bone marrow hematopoietic cells, resulting in a decrease in white blood cells and platelets in the blood. The decrease in the level of white blood cells makes the patient less able to fight germs and thus prone to various infections. However, as long as the prevention and treatment are proper, these side effects can be well controlled.
3.Radiotherapy
Radiotherapy is a treatment method that uses high-energy rays such as x-rays to kill tumor cells or relieve local symptoms. Radiation therapy can be carried out by shooting radiation externally into the body (called external irradiation) or by putting radioactive substances directly into the tumor site (called internal irradiation). External irradiation is the most common type of treatment for lung cancer radiation therapy. Usually radiotherapy can be applied to patients who are in very poor general condition and cannot tolerate surgical treatment or whose tumor has spread and cannot be operated. For some patients with advanced disease, radiation therapy can be used to relieve symptoms such as pain, bleeding, airway obstruction due to tumors, and to treat metastases such as bone metastases.
Radiation therapy usually requires a daily dose of radiation 5 days a week for 4-8 weeks, depending on the staging and stage of the tumor. The common side effects of radiotherapy are mainly discomfort caused by chest irradiation, including skin reaction, nausea, fatigue, painful swallowing, coughing, etc.
4.Targeted therapy
As the name implies, targeted therapy is a treatment method that targets the diseased area like a target for targeted destruction. Traditional chemotherapy is not targeted, after entering the body, chemotherapy drugs can not only kill tumor cells, but also normal cells, so the side effects are relatively large. Unlike targeted therapy, it is very targeted and usually targets substances that are unique to tumor cells or specifically needed for growth. Therefore, targeted therapy only works on tumor tissues, but not on normal cells, which is highly effective with minimal side effects and better tolerability. It is more suitable for patients who are in poor physical condition and cannot receive chemotherapy to consider receiving targeted therapy.
Currently, the main drugs used in targeted therapy for non-small cell lung cancer are Erlotinib (trade name Troche, Tarveva), Gefitinib (trade name Iressa), Ectinib (trade name Kemena), etc. The drugs take epidermal growth factor (EGFR), on which the growth of lung cancer tumor cells depends, as the target, and can block the effect of epidermal growth factor (EGFR), so as to inhibit the growth and division of tumor cells. It not only can significantly prolong the survival of patients, but also has fewer side effects, and can be used as first-line treatment for patients with mutations in EGFR. In addition, bevacizumab (commercial Avastin) and crizotinib have also been approved for targeted therapy of lung cancer abroad. It is believed that there will be more such options and more patients will benefit from them in the future.
Treatment of small cell lung cancer
Small cell lung cancer spreads very early, and in many cases, by the time it is detected, the swelling and pain have already spread throughout the body. For small cell lung cancer, the first treatment option is often chemotherapy, and in some cases, combined with radiotherapy, which is mainly aimed at cancer lesions in the lungs and metastatic sites. Recent studies have shown that surgery is more effective than radiation and chemotherapy alone for completely resectable small cell lung cancer. Supportive, alternative or complementary therapies.
Although how to remove or destroy the lung cancer cells is the most important treatment, how to better control symptoms, improve quality of life and guarantee that patients can continue these treatments is also very important. Therefore, please do not hesitate to tell your doctor about your symptoms and feelings when you experience discomfort and other symptoms during treatment. There are many ways to treat painful goods caused by tumors or adverse reactions caused by treatment. There are also many treatments that are not part of the regular treatment plan but can be useful to improve your symptoms or self-feeling, such as herbal treatment, acupuncture treatment or relaxation treatment like massage, you can also try some of them as long as you think they are helpful to you, but these treatments should not replace the regular treatment suggested by your doctor.
1.Maintenance treatment
Maintenance therapy after 4-6 cycles of chemotherapy for lung cancer has received wide attention in recent years, and a lot of clinical studies have shown that: maintenance therapy is useful for controlling tumor recurrence and progression, etc. At present, pemetrexed, gefitinib, erlotinib, docetaxel, gemcitabine and other drugs can be used for maintenance therapy.
2.Surgical treatment of non-small cell lung cancer with single distant metastasis
However, some clinical studies have found that for some single resectable distant metastases, if the primary lung foci are removed at the same time, the quality of survival and survival rate can be significantly improved, and the more definite ones are brain and kidney metastases.
V. Other factors you need to consider in the treatment
During the treatment process, you need to observe the changes in your condition, your response to treatment, and adverse reactions during the treatment process, and actively discuss with your doctor so that you can have a prediction of the whole process of common treatment methods, and play a foreseeable power, so that you can also take timely measures to prevent them, thus minimizing the impact of adverse reactions. It is also important to adopt a healthy lifestyle such as quitting smoking, a healthy diet, a regular routine and appropriate physical activity, all of which will help you resume your normal daily activities. Remember, you are the most important player in the treatment of your disease and learning to manage your disease will help you recover quickly.
New concept of lung cancer treatment
With the deepening understanding of lung cancer, there is now a great change in the concept, and experts at home and abroad agree that
1. Lung cancer is a systemic and chronic disease, so the purpose of lung cancer treatment has changed from radical cure to cure or control, and while emphasizing on prolonging life, more attention has been paid to improving the quality of survival, and the treatment has started to focus on the control of disease symptoms to reduce the pain of patients.
2.Surgery, chemotherapy, radiotherapy and any other means have certain limitations and cannot achieve the best results, emphasizing multidisciplinary comprehensive treatment.
3, emphasizing different treatment for different patients, that is, individualized treatment. Pathology, immunophenotype, molecular marker genes and proteins have become indicators to guide individualized treatment of lung cancer, thus “prescribing the right medicine” and improving the overall survival of patients.