With the progress of industrial economy, the incidence of lung cancer has been increasing year by year. In most developed countries, although the incidence of lung cancer has been decreasing year by year, it is still the first of male tumors and the second or third of female tumors. In the United States, lung cancer has the following characteristics: mortality is the first cause of death for all cancers (both male and female); only 12-15% of lung cancer patients can receive modern treatment options; and more than 90% of lung cancer patients are preventable. The principles of treatment in the field of lung cancer at home and abroad are
1. Diagnosis must precede treatment
There are many methods to obtain histological diagnosis, such as: bronchoscopy, mediastinoscopy, thoracoscopy, CT-guided puncture biopsy, etc., but sometimes the diagnosis still cannot be confirmed, while clinical and radiological evidence supports malignant disease, then repeated multiple examinations or exploratory surgery must be performed to confirm the diagnosis. PET examination can help to distinguish the nature of the lesion, but there are also false positives and false negatives.
2. Surgery is still the most effective treatment
Although this belief may not be confirmed in patients with advanced disease, the clinician must present evidence that the patient is not a candidate for surgery before surgery can be abandoned. The patient’s general condition should be able to tolerate surgery, and the decision to do surgery should be considered based on the patient’s specific situation.
3. Reduce perioperative complications and mortality
Clinicians know that every patient must undergo a preoperative examination to assess his or her tolerance for surgery prior to undergoing surgery. These tests usually include: clinical physical examination, pulmonary ventilation function, blood tests, etc. For borderline patients, lung perfusion scan should be used to more accurately assess lung function or endurance test and coronary angiography to assess cardiac function. Postoperative complications and mortality are related to the extent of lung resection and the age of the patient.
4. Selection of treatment plan based on staging
In addition to preoperative routine examination, more important is preoperative staging. Some people divide the staging examination of lung cancer into two parts: intrathoracic staging and extrathoracic staging.
5.Uncertainty of preoperative staging
During resection, the physician can understand the tumor scope more accurately and do the final intrathoracic staging to decide whether to remove the tumor. Intraoperative biopsy should include all lesions such as enlarged lymph nodes, dirty pleural nodes, wall pleural nodes, intrapulmonary nodes and primary foci as far as possible, and the principle is: all abnormalities found intraoperatively should have pathological diagnosis after surgery.
The accuracy of preoperative clinical staging is less than 50%, and 25% of patients preoperatively classified as non-N2 stage are diagnosed as N2 postoperatively. postoperative staging is not always equal to or higher than preoperative staging, and there are some cases where postoperative staging is lower than preoperative staging, which means that there may be some patients whose preoperative staging is wrongly too high, making the patients not operated when they should.
6.High risk factors of lung cancer
(1) Smoking
(2) Occupational and environmental exposure: It is estimated that up to 15% of lung cancer patients have a history of environmental and occupational exposure. There is sufficient evidence to confirm that the following nine industrial components increase the incidence of lung cancer: by-products of aluminum products, arsenic, asbestos, chromium compounds, coke ovens, mustard gas, impurities containing nickel, and vinyl chloride.
Long-term exposure to beryllium, cadmium, silicon, and formalin also increases the incidence of lung cancer. In addition, air pollution, especially industrial exhaust, are all high-risk factors for lung cancer.
(3) Radiation: Uranium and fluorite miners exposed to inert gas radon gas, decaying uranium by-products, etc. have significantly higher incidence of lung cancer than others, and it is currently believed that personnel exposed to ionizing radiation will not increase the incidence of lung cancer.
(4) 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.
7.Diseases related to lung cancer
(1) Head and neck cancer: The occurrence of head and neck cancer is also related to smoking, and its incidence of lung cancer is four times higher than that of the control group of smokers of the same age. A study in the United States showed that up to 50% of patients with head and neck cancer had primary lung cancer instead of metastatic lung cancer. Clinically, it is important to distinguish between primary and metastatic, as primary lung cancer associated with head and neck cancer may be resected and treated.
(2) Patients infected with human immunodeficiency virus can develop a variety of tumors, including: sarcomas, lymphomas, and neck tumors. It is still debated whether HIV-infected patients are equally susceptible to lung cancer.
(3) Non-malignant lung diseases: Some non-malignant lung diseases can also increase the incidence of lung cancer, especially adenocarcinoma of the lung. Chronic obstructive pulmonary disease is the most common of such diseases, and patients with emphysema have a higher risk of developing lung cancer than those who smoke without emphysema. Old tuberculosis has an increased risk of lung cancer at the site of its lesions, and fibrotic tissue at the site of tuberculosis lesions is directly related to scarring cancer. Sometimes TB can coexist with lung cancer, and the possibility of lung cancer should be highly suspected when the TB lesion suddenly becomes large and there is no evidence of TB recurrence.