Lung Cancer
Lung cancer in China is mainly distributed in northeast, north and east China coastal areas, and its incidence and mortality rate is higher in urban than rural areas, ranking first among urban malignant tumors. The incidence and mortality rate of lung cancer is rapidly increasing, which is a worldwide trend. Lung cancer accounts for the first place of common malignant tumors in men and the second three places of common malignant tumors in women in many developed countries. Smoking, passive smoking, environmental pollution, especially atmospheric pollution, have a close relationship with lung cancer.
Pathological classification of lung cancer.
Small cell carcinoma
Non-small cell carcinoma: squamous carcinoma, adenocarcinoma, large cell carcinoma
Clinical manifestations of lung cancer.
The most common intrapulmonary symptoms according to the frequency of occurrence are: ① Cough, mostly dry cough, without or with little sputum, accounting for 67% to 87% of various symptoms. Cough as the first symptom accounts for 55%-68.4% of all cases. Hemoptysis, which occurred in 31.6% to 58.5% of cases, was mostly intermittent, with blood in the sputum or blood spots, and hemoptysis was rare. Blood in sputum is a major reason for patients to seek medical attention. (iii) Chest pain accounts for 34.2% to 62% of cases, mostly vague, and starts with this symptom in 24% of cases. If the pain is severe one should consider the possibility of pleural implantation rib invasion, etc. Shortness of breath, which occurs in 10% to 50% of cases, starts with shortness of breath in about 6.6% of patients. The cause is early blockage of the bronchus by a mass causing atelectasis of the lung segment or lobe, which may be relieved by short-term adaptation. If the shortness of breath is severe, it may indicate an accumulation of fluid in the chest or pericardial cavity, compression of the trachea or bullae, or extensive pulmonary metastases, and the disease is advanced. ⑤ Fever, which occurs in 6.6% to 39% of cases, starts in 21.2% of cases. The fever is often low. The reason is that the tumor obstructs the bronchus causing distal segment, lobe or even whole lung atelectasis. If secondary infection occurs, the fever may also be unrelenting.
Patients with lung cancer have severe chest pain, hoarseness, superior vena cava compression syndrome, painful paralysis due to invasion of brachial plexus nerve, sympathetic nerve and phrenic nerve, dysphagia due to compression of esophagus, pericardial tamponade, severe bone pain, headache, pain in liver area, etc., which are all symptoms of advanced stage.
Diagnosis of lung cancer
1.Imaging diagnosis is the most common means to diagnose lung cancer, and its positive detection rate can be over 90%. It includes fluoroscopy, plain film, body layer, chest computer-aided body layer (CT), magnetic resonance imaging (MRI), bronchography and other methods.
The early X-ray manifestations of cancer include: ① isolated spherical shadow or irregular small infiltrate; ② unilateral poor ventilation during deep inspiration under fluoroscopy and mild shift of mediastinum to the affected side; ③ limited emphysema during expiratory phase; ④ mediastinal oscillation during deep breathing; ⑤ if lung cancer progresses to block segment or lobe bronchus, the distal gas of blockage will be gradually absorbed and segmental atelectasis will appear, which will form pneumonia or Pulmonary abscess will be formed if this distal part is infected. In addition to a clearer view of the shape, density, location, hilar and mediastinal lymph node enlargement of the mass, plain body radiographs can also reveal the blockage, stenosis, external pressure, and intraductal masses of larger bronchioles (above the lung segment).
More advanced lung cancer can be seen as: huge mass nodules in the lung fields or hilum, lobar in shape, generally uniform in density, with burrs at the edges and sometimes liquefied in the center, appearing as thick-walled, eccentric, and unevenly lined cavities. When the mass blocks the lobe or the total bronchus, there is lobar or whole lung atelectasis, and a large amount of pleural fluid is seen when the pleura is involved, and rib destruction is seen when the chest wall is invaded.
2, fiberoptic bronchoscopy Positive detection rate of 60% to 80%, the examination pay attention to the degree of vocal cord activation, the shape and mobility of the bulge and all levels (generally up to 4-5 levels) of bronchial orifice changes such as swelling, stenosis, ulceration, etc., and smear cytology, bite biopsy, local irrigation, etc.. This examination, which is generally more complete, has also been reported to be complicated by bleeding after 9% to 29% of biopsies.
Other tests: including sputum exfoliation cytology, percutaneous lung puncture, mediastinoscopy, magnetic resonance imaging, etc.
Treatment of lung cancer.
Surgical treatment has been recognized as the first choice for lung cancer treatment, and radical resection is so far the only treatment that has the potential to cure lung cancer patients and thus restore their normal life. According to the analysis of the effect of surgical treatment accumulated over the years, the following are the indications for lung cancer surgery.
1. Non-small cell lung cancer with clinical stage I, II and IIIA, that is, when the T grade is not >3 and the tumor only invades the diaphragm, chest wall, pleura, pericardium, near the rongeur with whole lung atelectasis. The upper limit of lymph node is N2, when there is metastasis in the ipsilateral mediastinum, but not yet expanded to more distant places. M is 0, when there is no distant metastasis yet.
2. The indications for small cell lung cancer require more come that the staging is limited to stage I and II. As for N2 lesions that are established at the beginning of surgery, if radical resection can still be achieved, surgical efforts should not be abandoned. One point of adjuvant chemotherapy after surgery for small cell lung cancer.
3. If there is no cytopathological evidence of intrapulmonary shadows, and the possibility of cancer is greater than benign lesions according to medical history, physical examination and imaging, patients should be persuaded to undergo surgical exploration, and if the nature is still uncertain after open-heart macroscopy, rapid pathological or cytological examination can be performed. Our opinion is that a more aggressive attitude should be taken towards intrapulmonary masses with uncertain diagnosis and early surgical investigation. Intraoperative rapid examination can provide a reliable basis for the exact diagnosis and the extent of surgical resection. In the case of benign lesions, a reliable basis for local excisional coverage is provided. The patient’s mind is not only worried about the disease, but also about the patient’s mind.
Although the stage of disease is late, T reaches grade 4, N reaches grade 3, or even M is 1 (such as isolated brain metastases), palliative surgery can be performed in order to reduce the symptoms of uncontrollable pulmonary co-inflammatory hyperthermia or pulmonary atelectasis that affects the gas exchange function and produces hypoxia.
Contraindications to surgery
The indications for lung cancer surgery have been described above, and the contraindications for surgery are, in short, those beyond the above indications, such as various T4 tumors that have invaded the mediastinum and have nodules in the heart, large blood vessels, trachea, esophagus, vertebrae, bulge or the same lobe, or have malignant pleural fluid. There has been distant metastasis to the liver, bone brain, adrenal glands, etc., when M is 1. The patient has more serious comorbidities such as severe chronic lung infection, emphysema, hypoventilation, cardiac insufficiency, heart failure, history of angina pectoris attack and or myocardial infarction within 3 months, cerebrovascular accident within 3 months, etc.
Benign tumors of the lung
These diseases mainly include inflammatory pseudotumor, pulmonary malignant tumor, pulmonary smooth muscle tumor, intrapulmonary teratoma, pulmonary hemangioma and pulmonary fibroma. These diseases usually have no special symptoms, and some patients even have no clinical symptoms for life. They are only noticed by patients when they are found during physical examination or when the tumor increases and produces pressure symptoms.