General Knowledge of Tumor Diagnosis and Treatment 1. Classification of Tumor: Commonly speaking, tumor is a local abnormal mass in the body, and according to the biological behavior of tumor, it is divided into two categories: benign and malignant. Benign tumors do not cause death unless they grow in important parts of the body, while malignant tumors are the first cause of death for both urban and rural residents in China. Common malignant tumors are cancer (from epithelial tissue) and sarcoma (from mesenchymal tissue). We mainly talk about malignant tumors today. 2.How to find tumors in early stage 1）Regular physical examination Annual physical examination: chest X-ray, abdominal and pelvic ultrasound, blood routine, urine routine, stool routine, liver and kidney function, tumor index. There are different monitoring methods for a particular tumor, which can be accessed at http://www.myzlzx.cn/ (the website of Department of Oncology, Mianyang Central Hospital). 2) Early diagnosis of tumor is a world problem, but any kind of disease will always show certain signals on the eve of its onset. If we understand these signals, we can grasp the law and characteristics of disease occurrence, and it is possible to detect and treat the disease at an early stage, so as to improve the cure rate. What are the common signals of cancer? (1) Nasal discharge with blood, nasal congestion, tinnitus, headache, especially one-sided migraine, are the danger signals of nasopharyngeal cancer. (2) Choking sensation when swallowing food is the first sign of esophageal cancer. (3) Irritating cough with prolonged cough or bloody sputum is often considered as an early sign of lung cancer. (4) Breast lumps Women who are over 40 years old should consider the possibility of breast cancer. (5) Abnormal vaginal bleeding If attention is drawn to it, early cervical cancer may be detected. (6) Blood in stool, hidden pain, abdominal distension, change in bowel habit, feeling of falling and blood in stool, and feeling lumps in abdomen should be considered as possibilities of rectal cancer and colorectal cancer. (7) Long-term unexplained fever or weight loss. Cancer of hematopoietic system. However, when all the above suspicious signals appear, you should neither be rash nor take it lightly. One should go to the hospital in time for consultation and necessary examination so as not to delay the condition and cause lifelong regret. The basic procedure of tumor diagnosis is to determine the location of the tumor according to the patient’s description, doctor’s examination, ultrasound, CT, chest radiographs, etc.; and then obtain the tumor tissue by means of nasopharyngeal fiberscope, fibreoptic bronchoscopy, gastroscope, enteroscopy, biopsy, and then send the tumor tissue to microscope for observation to confirm the diagnosis. In recent years, the emergence of PET/CT (PET CT: Positron Emission Computed Tomography) has made non-invasive diagnosis of tumors possible, for example, the accuracy rate of PET/CT for lung cancer diagnosis reaches 80%. 4. Overview of tumor treatment In 1999, WHO reported that 45% of malignant tumors in the world could be cured, of which 22% could be cured by surgery, 18% by radiotherapy, and 5% by chemotherapy; in 2008, the cure rate of tumors in the U.S. had already reached 66%, but the cure ratios of the three main treatments were similar to those in the world. The press conference of the 4th China Oncology Conference (2005) declared that not more than half of the patients in China have received standardized treatment. Due to the lack of standardized treatment, the five-year survival rate of China’s tumor patients is less than 25%, which is far below the global average. What is standardized treatment of tumor? Standardized treatment of tumor is comprehensive treatment, that is, according to the patient’s physical condition, pathological type of tumor, invasive range (staging) and development tendency, rationally and systematically applying the existing treatments in a comprehensive manner, aiming at increasing the cure rate and improving the patient’s quality of life substantially. Benefits of integrated treatment: United States: 80s: 50%, now: nearly 66%, three major means of treatment surgery, radiation therapy, chemotherapy, single treatment of the cure rate did not improve, the increase of 16% is mainly from the integrated treatment of tumors. Specifically look at gastric cancer: 550 patients, divided into two groups, a group of pure surgery, a group of surgery to receive radiotherapy and chemotherapy, observed for 5 years. Mean survival was 27 months in the surgery group and 36 months in the surgery receiving radiotherapy and chemotherapy, with a mean extension of 9 months. The recurrence rate was 64% in the surgery alone group and 43% in the surgery receiving radiotherapy and chemotherapy, a 21% reduction in the recurrence rate. So the benefits of comprehensive treatment are still great. 6.Comprehensive treatment in Mianyang Central Hospital Our hospital is a comprehensive hospital, and the main treatment means of tumor are available. Surgical treatment is mainly carried out in the department of surgery, and there are a lot of excellent surgical experts in our hospital, who are able to finish most of the tumor surgeries. Radiation therapy and chemotherapy are done in the Department of Oncology. The hospital attaches great importance to the comprehensive treatment of tumors and has set up the Center for Comprehensive Treatment of Tumors, which includes Head and Neck Tumor Group, Gynecological Tumor Group, Abdominal Tumor Group, and Thoracic Tumor Group. When a patient enters into the hospital and is diagnosed with a tumor, the surgical experts, radiotherapists, chemotherapists, imaging experts, and pathologists will decide on a treatment plan together and then it will be carried out by the relevant experts. In case of surgical treatment, the surgeon will ask our radiotherapist and chemotherapist to decide the postoperative treatment plan together after the surgical treatment. When an oncology patient comes to our hospital, he receives the service not from a certain department or a certain person, but from many specialists of the whole central hospital. Intra-departmental: After the patient enters the oncology department and completes the examination, all the doctors in our department will discuss and decide the treatment plan, such as the plan of chemotherapy, the target area of radiotherapy, and so on. Achievements: First of all, the patients are benefited, the cure rate of patients is improved and the survival period is prolonged, for example: nasopharyngeal carcinoma, 30 cases of nasopharyngeal carcinoma received comprehensive treatment in our department from 2002 to 2003, and there are still 15 cases surviving this year. It is because our integrated treatment is carried out well that in 2007, our Integrated Tumor Treatment Center became a key specialty under construction in Sichuan Province. 7. Radiation therapy Radiation therapy is the most widely used and effective anti-tumor therapy. 40% of the long-term survivors benefit from radiation therapy alone or significantly, and 70% of the tumor patients receive radiation therapy at different times in their disease course due to different reasons. At present, the five-year cure rate of nasopharyngeal cancer, laryngeal cancer, rectal cancer and other early-stage or stage I tumors after simple radiation therapy reaches more than 80-95%, and the five-year survival rate of nasopharyngeal cancer, cervical cancer, Hodgkin’s lymphoma, prostate cancer and other cancers of various stages can reach 40-50%. The relief rate of radiotherapy for persistent pain caused by bone metastases of malignant tumors can reach 80-90%, and the purpose of local control of tumors can be achieved to different degrees. The imported radiotherapy equipment of our department is the most advanced in Mianyang City, which can carry out X-knife, conformal knife and advanced conformal intensity adjustment technology, which improves the level of tumor treatment in our hospital to a new level. Previously, some of the patients whom we could not treat and had to go to Chengdu or Beijing for treatment can be treated very well in our department now. Chemotherapy The main role of chemotherapy in treating cancer is to prevent the proliferation, infiltration and metastasis of cancer cells until the cancer tissues are finally killed. Indications of chemotherapy: (1) Hematopoietic system malignant tumors that are sensitive to chemotherapy and can be completely controlled or even cured by chemotherapy, such as leukemia, multiple myeloma, malignant lymphoma and so on. (2) Certain solid tumors with good effect of chemotherapy, chorionic epithelial carcinoma, malignant hyperemesis gravidarum, germ cell tumor, ovarian cancer, small cell lung cancer, etc. (3) Adjuvant chemotherapy after surgical resection and local radiotherapy or before surgery for solid tumors, such as breast cancer, non-small cell lung cancer, gastric cancer, colorectal cancer, etc. (4) Combined with radiotherapy for radical treatment of some tumors: head and neck tumors: nasopharyngeal cancer, laryngeal cancer, oral cancer, etc.; chest tumors: esophageal cancer, lung cancer; abdominopelvic tumors: cervical cancer, rectal cancer, anal canal cancer. (5) Solid tumors with extensive or distant metastasis, which are not suitable for surgical resection and radiotherapy; solid tumors with recurrence or spreading after surgical resection or radiotherapy can be considered for palliative chemotherapy. (6) Cancer body cavity effusion, including thoracic cavity, pericardial cavity and abdominal cavity, can be treated with intracavitary injection of chemotherapeutic drugs, which can often control or disappear the effusion. Correctly treating the side effects of radiotherapy Due to the limitation of current technology, the three major means of tumor treatment, i.e. surgery, radiotherapy and chemotherapy, have certain side effects, but to cure a disease, especially to treat a tumor, it is necessary to pay a certain price at this stage. With the emergence of new drugs, the application of new radiotherapy equipment and technology, and the reduction of drug prices, even ordinary patients can enjoy new drugs (antiemetic drugs) and technology (intensity-modulation technology to protect the salivary glands) with fewer side effects. Of course, as an oncologist, I also hope to develop highly effective, low-toxic or non-toxic drugs. 10. Are there any highly effective, low-toxicity or non-toxic anti-tumor drugs currently available? Targeted therapy: Aiming at the molecular pathological abnormality of malignant tumors, it can inhibit and regulate the growth of tumor cells or inhibit the formation of neovascularization by blocking or closing the key growth factors, receptors or kinases in the process of tumorigenesis and development. Characteristics: precise efficacy on some tumors, small side effects, but expensive, the effect is related to the expression of specific molecules in the tumor, non-curative treatment, such as Erasmus treatment for non-small cell lung cancer, Gleevec treatment for gastrointestinal mesenchymal stromal tumors. 11. Should we tell the patients about their own conditions? Many people say that we should not tell the patient’s condition, but those who say this are not tumor patients, so we don’t know what the tumor patients think. Professor Jiang Yu of West China Hospital made a survey on 1023 tumor patients, 90.8% of early-stage tumor patients want to be told their condition (69.9% of their family members), and even in late-stage tumor patients, 60.5% want to be told their condition (34.4% of their family members), so most of the tumor patients want to be told their condition. 12. Vaccine for preventing cervical cancer Recommended by American Cancer Society Non-smoking Regular exercise Avoiding obesity Limiting alcohol consumption Eating plenty of fruits and vegetables Eating roughage, don’t eat refined carbohydrates and sugar Replacing red meats with fish, nuts and beans Preventing tumors by changing our lifestyles