Su Zhiyong
Director of Thoracic Surgery, Affiliated Hospital of Chifeng College Chief Physician
Ministry of Health, China
Member of the Thoracic Surgery Branch of the Chinese Physicians Association
Su Zhiyong, Director of the Cardiothoracic Surgery Department, Chifeng Affiliated Hospital, Capital Medical University Lung Cancer Treatment Center, Chifeng
Due to the lack of medical knowledge of lung cancer patients and the exaggerated propaganda of medical advertisements, lung cancer patients are caught in a maze of complicated paths in treatment, and they are unable to know which department is more reasonable for treatment, so they do not know how to consult a doctor and do not know the treatment process. Now we summarize the five steps of the process for lung cancer patients to remember before consultation.
Step 1: First of all, you have to ask the question – am I really suffering from lung cancer?
In fact, especially in primary hospitals, many disciplines and doctors engaged in lung cancer treatment do not know how to read chest CT and X-ray films, lack basic knowledge and ability to deal with diagnosis, differential diagnosis, lung cancer imaging evolution and advanced lung cancer complications, and do not have effective diagnosis methods. “In fact, some patients are clinically confirmed to have benign lesions after surgery, while some patients with suspected benign lesions before surgery are confirmed to have malignant lesions after surgery. In fact, some patients with preoperative suspected benign lesions are confirmed to be malignant after surgery, and there is a clinical phenomenon that physicians carry out radiotherapy based on imaging diagnosis alone.
Step 2: Actively seek pathological diagnosis–does my disease have an accurate pathological diagnosis and preoperative staging?
Lung cancer treatment methods are different for different stages. The closer to the early stage of lung cancer, the more benefits can be obtained through thoracic surgery, due to the rich and accurate experience in chest reading accumulated from the mastery of chest anatomy, preoperative and postoperative image comparison, and years of experience in direct vision surgery, the thoracic surgeons can master various advanced treatment methods and adopt more comfortable, bold and minimally invasive methods compared with other departments. Tissue biopsy methods, such as lung puncture, tracheoscopy, thoracoscopy, mediastinoscopy, bronchoscopy biopsy under ultrasound guidance EBUS-TBN, magnetic navigation and other means of examination, more early to unveil the mystery of the disease, to avoid the early lesions such as: isolated pulmonary nodules (SPN), pulmonary glassy changes (GGO) and other abnormal shadows in the lung to take – try, wait, see, defer the treatment, staged The tragedy of “look at you see the tumor quietly changing”! Making simple chest diseases dragged to complication, which could be solved by minimally invasive means, delayed to the necessity of open-heart surgery, and lung cancer patients who could have been resected radically at an early stage, delayed to the enlargement of the lung lobes for total lung resection, even to the point of relying on radiotherapy to maintain a short survival period.
Step 3: Has the multidisciplinary consultation after staging?
It is also urgent to establish a multidisciplinary consultation system for lung cancer in general hospitals, which includes thoracic surgery, respiratory medicine, oncology, radiotherapy and interventional medicine, and the expert group will regularly consult with lung cancer patients in the whole hospital to jointly formulate scientific and reasonable treatment plans. The purpose of the multidisciplinary consultation system is to avoid irregularities such as blind treatment, excessive treatment, ineffective treatment, interest-driven treatment, accompanying treatment, even chemotherapy without pathology, targeted treatment without basis and screening of sensitive drug testing.
Step 4: Is my treatment plan an individualized treatment plan jointly developed by the expert group?
Individualized treatment is a new model of lung cancer treatment in recent years, the essence of which is to select the appropriate beneficiary group and treatment method according to clinical stage, age, physical condition, underlying disease, etc. If thoracic surgery is not operable in the first consultation, we can go to chemotherapy in medical oncology, radiotherapy in radiotherapy, and also radiofrequency, particle, thermal perfusion, targeted, Chinese medicine, etc., especially chemotherapy and targeted therapy should be mentioned. When choosing first- and second-line chemotherapy regimens for advanced lung cancer, 4-6 cycles of chemotherapy are generally administered with platinum-containing two-drug regimens. Clinically, it has been found that the same chemotherapy regimen for the same gender and pathological type can have different therapeutic effects for different patients. Mutations in different genes make the effect of chemotherapy and targeted therapy of drugs very different, for example, a platinum-containing two-drug regimen with paclitaxel plus cisplatin is only 25% to 45% effective, meaning that at least 60% of patients do not benefit from a platinum-containing two-drug regimen. Even with targeted drugs like Erysal and Troche, which require EGFR-based mutations to target the benefit population, the mutation rate is only 20% in Europe and 30% in China, and 70% of patients without EGFR mutations do not benefit from targeted therapy. and do not benefit from targeted therapy. In contrast, thoracic surgeons can take the pathology through lung puncture, thoracoscopy, mediastinoscopy and other methods, and avoid the ineffective waste of hundreds of thousands of dollars for patients by not about a thousand dollars of genetic testing.
Step 5: Don’t believe the false exaggerated propaganda of advertisements for Chinese herbal medicine and ancestral secret recipes. If there really was such a panacea world hermit, then China’s Nobel Prize in medicine would not be a blank! Of course, we do not reject the role of traditional medicine as an adjuvant treatment, do not give up the first-line treatment including surgery radiotherapy and put the cart before the horse to seek Chinese medicine treatment to delay the best treatment time!