What factors are related to the occurrence of lung cancer?
1.Smoking
Smoking is the primary reason for the progressive increase of lung cancer. Compared with non-smokers, the risk of lung cancer in smokers is 4-10 times higher on average and up to 10-25 times higher in heavy smokers. The younger you start smoking, the longer you smoke, and the more you smoke, the higher the incidence of lung cancer. Passive smoking or environmental smoking is also a cause of lung cancer. The incidence of lung cancer decreases progressively during the 2-15 year period after quitting smoking, after which the incidence is equivalent to that of lifelong nonsmokers.
2.Occupational carcinogenic factors
Occupational factors that have been identified to cause human lung cancer include asbestos, arsenic, coal tar, mustard gas, heating products of tobacco and radon and radon gas produced by the decay of radioactive substances such as uranium and radium, ionizing radiation and microwave radiation. These risk factors can increase the risk of lung cancer by 3 to 30 times. Asbestos is a recognized carcinogen, and the incidence of lung cancer increases significantly in those who are exposed to it, with a latent period of 20 years or more.
3.Air pollution
Indoor passive smoking, fuel combustion and cooking processes all produce carcinogens. Some data show that indoor coal use, exposure to soot or its incomplete combustion products are risk factors for lung cancer, especially for female adenocarcinoma. Oil fumes generated during cooking are also carcinogenic factors that cannot be ignored.
4.Ionizing radiation
Large amount of ionizing radiation can cause lung cancer, making the risk of lung cancer higher than that of ordinary people.
5.Diet and nutrition
Research shows that less consumption of vegetables and fruits containing β-carotene increases the risk of lung cancer. People with low serum beta carotene levels also have a higher risk of lung cancer.
6.Other predisposing factors
The American Cancer Society lists tuberculosis as one of the factors in the development of lung cancer. The risk of lung cancer in people with tuberculosis is 10 times higher than that of normal people.
7.Heredity and genetic changes.
What are the classifications of lung cancer?
I. Classification by site
1.Central type lung cancer
Lung cancer occurs in the segmental bronchi and main bronchi. It accounts for about 3/4 of lung cancer and is more common in squamous epithelial cell carcinoma and small cell lung cancer.
2.Peripheral type lung cancer
Lung cancer occurring below the segmental bronchus. It accounts for about 1/4, and is mostly seen in adenocarcinoma.
Classification by histopathology
1.Non-small cell lung cancer (NSCLC) includes
1.Squamous epithelial cell carcinoma
2.Adenocarcinoma: early invasion of blood vessels and lymphatic vessels, and metastasis often occurs before the primary tumor causes symptoms.
3.Large cell carcinoma and other types of lung cancer.
2.Small cell carcinoma includes oat cell type, intermediate cell type and compound oat cell type.
3.What are the clinical stages of lung cancer?
1.Stage 0
Also called carcinoma in situ, the tumor is confined to the primary location, without extra-pulmonary metastasis and without invasion of other tissues.
2.Stage I
It is also divided into stage IA and stage IB, with small tumor and no lymph node metastasis. Smaller tumors are stage IA and larger ones are stage IB.
3.Stage II
It can be divided into two types: stage IIA and stage IIB. stage IIA includes: i. slightly large tumor but no adjacent lymph node metastasis, ii. smaller tumor with peripheral lymph node metastasis. stage IIB refers to larger tumor with lymph node metastasis. Or large tumor with or without invasion of peripheral lung structures but without lymph node metastasis.
4.Stage III
It is divided into stage IIIA and stage IIIB. Many stage IIIA invade large blood vessels and mediastinal lymph node metastasis.
5.Stage IV
Distant metastasis occurs in lung cancer. This includes: cancer cells metastasizing to multiple parts of the contralateral lung, or fluid accumulation around the lung or heart, or metastasizing to other parts of the body through blood flow. The most common sites of lung cancer metastasis are brain, bone, liver and adrenal gland.
What are the clinical manifestations of lung cancer?
Clinical manifestation: It is closely related to the size, type, development stage, location, complications or metastasis of tumor. A small number of patients are only found during routine physical examination and chest impact examination. The rest of patients can show more or less symptoms and signs related to lung cancer, which are classified as primary tumor, intra-thoracic spread of lung, in addition to extra-pulmonary manifestations such as dermatomyositis, embolic phlebitis, non-bacterial embolic endocarditis, thrombocytopenic purpura and anemia according to the site.
V. What tests should be done for lung cancer.
1.Frontal and lateral X-ray chest film and CT are the most important examinations to detect tumor.
2.magnetic resonance imaging (MRI)
3.Single electron emission computed tomography (SPECT) is used for localization, characterization and diagnosis of bone metastasis.
4.Positron emission tomography (PET) has a high probability of diagnosing lung cancer and is sensitive to the detection of metastatic lesions.
5.Sputum exfoliative cytology examination
6.Fibrinoscopy: It is helpful for diagnosis, clarifying the scope of lesions, and specifying the indications and modes of surgery. The diagnostic rate of bronchial lesions visible by fibrinoscopy can reach 92% for brush examination and 93% for biopsy. Transbronchial lung biopsy (TBLB) can improve the diagnosis rate of peripheral lung cancer. For lesions larger than 4 cm in diameter, the diagnostic rate can reach 50% to 80%. However, for lesions less than 2 cm in diameter, the diagnosis rate is only about 20%. The cytological examination of lavage and brushings during fibrinoscopy also provides important help for diagnosis.
7. Fine needle cytology examination
8. Mediastinoscopy Useful for the diagnosis and staging of tumor
9. Thoracoscopy
10. Other cellular or pathological examinations
11. Open-chest lung biopsy
12. Tumor marker examination
What are the treatment options for lung cancer?
The decision is mainly based on the histology of the tumor. Non-small cell lung cancer can be limited and can be cured radically by surgery or radiotherapy, but the response to chemotherapy is worse than that of small cell lung cancer. Many lung cancers are metastatic by the time they are detected and rely mainly on a combination of chemotherapy or radiotherapy.
Lung cancer is a common malignant tumor nowadays, and its basic treatment principle is comprehensive treatment with surgery as the core. Surgery is the most effective and best prognosis treatment for lung cancer, and it is the only treatment method that may completely cure lung cancer. Surgery can completely remove the diseased tissues and lymph nodes that may be involved, and obtain accurate pathological diagnosis and staging through pathological test reports, which can guide the adjuvant treatment (radiotherapy, chemotherapy, etc.) after surgery to actively prolong the patient’s survival time and improve the quality of survival after surgery. For patients who fail chemotherapy or cannot receive chemotherapy, targeted therapy can be tried. Surgery is divided into: radical lung cancer resection, palliative surgical treatment.
VII. Preparations that patients need to do before surgery.
1. Respiratory training: the patient takes a sitting or semi-recumbent position, relaxes the whole body, inhales deeply, and then exhales slowly. Do this 30-50 times a day in the morning, afternoon and evening to increase lung ventilation.
2. Effective coughing: The patient takes a sitting position, relaxes the shoulders, leans forward, takes 2-3 deep breaths and then inhales as deeply as possible, holds the breath for 1 to 2 seconds, opens the mouth and throat at the same time, makes a maximum cough with the force of the chest and abdomen, and the coughing sound vibrates out from the chest. Practice three times a day before surgery, 20 to 30 consecutive strokes each time.
3, Quit smoking and alcohol: among them, quit smoking for at least 15 days, the risk of surgery and complications will be reduced.
4.Appropriate physical exercise, such as slow walking, walking, tai chi, etc.
5.Enhance nutrition: try to eat high-protein, easy-to-digest, vitamin-rich food, such as egg soup, steamed egg, lean meat cake, chicken soup, duck soup, fish, soy products, various meat porridge, fish porridge, vegetable porridge, etc., to improve the nutritional status and make the patient have a better physique for the surgery.
6.Improve relevant examination. To determine whether there are malnutrition, cardiovascular disease, pulmonary dysfunction, kidney disease, diabetes, coagulation disorder, etc. that affect the surgery, so that the doctor can deal with them in time.
VIII. Can lung cancer patients undergo minimally invasive surgery?
Minimally invasive surgery has become a major trend in lung cancer surgery. Towards minimally invasive to minimize patients’ pain, the use of TV thoracoscopic minimally invasive surgery technique for lung cancer has become a mature and routine treatment method. Minimally invasive surgery is to make several small holes of about 1.5cm in length in the chest, send camera lens and micro surgical instruments into the chest through the small holes respectively, easily find the lesion location under the TV screen, perform surgery on the lesion and completely remove all the diseased tissues to achieve the purpose of radical surgery, which is a new thoracic surgery method, TV thoracoscopic minimally invasive treatment technology.
Advantages of minimally invasive thoracoscopic surgery for lung cancer
1.Small trauma: The incision of thoracoscopic surgery is only about 1.5 cm, so the surgical trauma is small, which can significantly reduce the patient’s pain and surgical danger compared with the 30 cm incision of conventional surgery; with small trauma, there is less chance of infection; the small incision of thoracoscopic surgery can maintain and improve the patient’s quality of life with less damage to the lung function after surgery.
2, light pain: the small incision avoids the pulling open of the ribs and does not cut off the ribs, which reduces the pressure on the nerves and avoids the friction of the broken ends of the ribs, so the postoperative pain of patients is significantly reduced compared with the traditional incision.
3.Fast recovery: Because the small incision does not cut off the large muscles of the chest, does not cut off or open the ribs, and does not pull the scapula, the muscles and bones of the locomotor system are not traumatized, and the function of the shoulder joint activity is little affected and recovers quickly.
4.Beautiful incision: It is especially important for people who love beauty, that is, the incision will not be so obvious because it is too big.
5.Low overall cost: Due to minimally invasive surgery equipment and materials, the cost of surgery may be slightly higher than that of open-heart surgery, but the overall cost of minimally invasive surgery is not too high, or even lower than that of ordinary open-heart surgery because of short hospitalization time, fast recovery, less medication and fewer complications after surgery.
Comparison of minimally invasive surgery and traditional surgery
Minimally invasive surgery for lung cancer can achieve the same effect as open-chest surgery, or even better. The TV display during the operation greatly increases the surgeon’s “vision”, “field of view” and “line of sight”, so that the lesion can be clearly seen. The TV display during the operation greatly increases the surgeon’s “vision”, “field of view” and “line of sight”, so that the lesion can be clearly displayed on the TV and histopathological examination can be obtained.
XI. Which patients are suitable for minimally invasive surgery?
1.It has been the consensus and common practice of domestic and foreign thoracoscopic experts to give priority to thoracoscopic surgery for all early-stage lung cancer.
2.Most patients with mid-stage lung cancer can be completely and radically resected under minimally invasive thoracoscopic surgery.
3.Some advanced lung cancers are also within the scope of indications.
4.Surgical resection of metastatic lung cancer.
5.Almost all benign lung tumors.
6.Minimally invasive surgical treatment is of great significance, especially for the elderly and patients with poor lung function who can hardly accept traditional open-heart surgery.
XII. Advantages and strengths of our minimally invasive treatment
Traditional open-heart surgery is in fact a reflection of a hospital’s comprehensive strength, while thoracoscopic minimally invasive surgery has higher requirements for thoracic surgeons and the anesthesia and equipment of the hospital where it is performed. Therefore, at present, minimally invasive thoracoscopic surgery is mostly concentrated in large hospitals with high level. Our department takes the lead in carrying out minimally invasive thoracoscopic surgery in China, especially in Hubei Province, and is capable of performing various types of lung tumor surgery.
What are the preventive measures of lung cancer?
The occurrence and development of lung cancer is caused by a combination of factors: smoking, air pollution, occupational factors, chronic lung diseases (tuberculosis, silicosis, pneumoconiosis, etc.) and intrinsic factors (family genetics and endocrine dysfunction of immune function, etc.), so how to prevent it?
1, regular checkups: regular chest X-rays, chest CT examinations, etc., can be early detection of lesions, to buy sufficient time for further treatment.
2.Advocate smoking cessation: more than 80% of lung cancer cases are related to smoking, so tobacco control and smoking cessation is one of the key factors for lung cancer prevention.
3.Cultivate good living habits, avoid staying up late and overworking, regular diet and moderate exercise can improve body immunity and better resist the invasion of external harmful factors.
4, good at regulating life, work stress, peace of mind, maintain a good mood.
XIII. What tests should be done during the review?
1.Chest X-ray or chest CT: If there is any abnormality, chest CT should be done again, in order to detect possible intrapulmonary recurrence, metastasis, mediastinal lymph node metastasis or pleural invasion in time.
2.Tumor marker measurement: carcinoembryonic antigen (CEA) Neuron-specific enolase (NSE)
Cytokeratin 19 fragment (CYFRA21-1)
Squamous cell carcinoma-associated antigen (SCC)
3.Abdominal ultrasound: focus on liver, pancreas, spleen, kidney, adrenal gland and posterior peritoneum, if there is a possibility of metastasis, then perform enhanced abdominal CT.
4.Bone scan: If there is bone pain, especially if it is progressively increasing or accompanied by pressure pain, then there is a possibility of bone metastasis, and bone scan can be done first to understand the bone situation of the whole body, and then CT or MRI can be done to select important parts for further confirmation.
5.Fiber bronchoscopy: according to the condition, it can be used to observe the local tracheal condition under direct vision.
6.If there is persistent headache, vomiting or bilateral muscle strength inequality, intracranial metastasis may be considered, enhanced CT examination of the head is needed.
14.What ways can patients be reviewed?
1.Outpatient clinic: my specialist clinic time: every Monday afternoon, Wednesday afternoon, Thursday morning; location: Wuhan Tongji Hospital Outpatient Clinic, 5th floor, Outpatient Building.
2.Online follow-up: such as logging on my website, long-term online consultation, etc. Patients can come to the outpatient clinic for review according to the above review time, or they can review locally, and the examination results can be uploaded to my website:.