Malignant tumor of the upper lobe of the lung



OVERVIEW

Definition

Malignant tumors of the upper lobes of the lungs are malignant tumors that occur in the upper lobe of the left lung or the upper lobe of the right lung.

It mainly includes primary lung upper lobe malignant tumors and secondary lung upper lobe malignant tumors.

Primary lung upper lobe malignant tumors refer to tumors such as carcinoma of lung epithelial origin and sarcoma of mesenchymal origin.

Secondary lung upper lobe malignant tumors are metastatic tumors formed when malignant tumors originating in other parts of the body metastasize to the upper lobe of the lung.

Large cell carcinoma occurs mostly in the upper lobes of the lung.

Relatively speaking, ground-glass nodules in the upper lobes of the lungs are more likely to be malignant.

This entry focuses on primary carcinomas and sarcomas; for the rest, read Metastatic Lung Cancer.

Staging

Histologic staging is based on the 2021 edition of the World Health Organization (WHO) criteria for histologic staging of lung tumors [1-2]. Pathologic features, treatment, and prognosis differ between subtypes.

Squamous cell carcinoma

Abbreviated as squamous carcinoma, it is an epithelial malignancy that shows keratinization and/or intercellular bridges, or expresses markers of squamous cell differentiation.

Adenocarcinoma

Adenocarcinomas include minimally invasive adenocarcinomas, invasive non-mucinous adenocarcinomas, invasive mucinous adenocarcinomas, colloid adenocarcinomas, fetal-type adenocarcinomas, and intestinal-type adenocarcinomas.

Infiltration refers to a growth pattern in which cancer cells directly invade and grow into the surrounding normal tissues and organs and have no clear boundary with them, which is a characteristic of malignant tumors.

Adenosquamous carcinoma

Refers to a tumor that contains both adenocarcinoma and squamous carcinoma components, with each component accounting for ≥10% of all tumors.

Neuroendocrine tumor

Includes neuroendocrine tumors and neuroendocrine carcinomas. Neuroendocrine tumors include low-grade typical carcinoid tumors and intermediate-grade atypical carcinoid tumors; neuroendocrine carcinomas include small-cell lung carcinomas and large-cell neuroendocrine carcinomas.

Large cell carcinoma

Large cell carcinoma is a type of undifferentiated non-small cell carcinoma and is a diagnosis of exclusion. This means that the diagnosis of large cell carcinoma is made after other pathologic types have been ruled out.

Sarcomatoid carcinoma

Sarcomatoid carcinoma includes pleomorphic carcinoma, carcinosarcoma, and pneumoblastoma.

Lung sarcoma

A group of malignant tumors occurring mainly in the mesenchymal tissues of the lungs, including many different histologic types, such as fibrosarcoma, smooth muscle sarcoma, rhabdomyosarcoma, and liposarcoma.

Morbidity

There are no specific data on the incidence of malignant tumors of the upper lobes of the lung. Reference can be made to the overall incidence of lung cancer.

Lung cancer mostly occurs after the age of 40, with the peak age of incidence between 70 and 79 years old, more male patients than female, and the incidence rate of urban residents is higher than that of rural areas.

In 2016, there were 828,000 new cases of lung cancer in China throughout the year, of which 55.0 million were men and 278,000 were women.

In the same year, China’s annual lung cancer deaths were 657,000 cases, of which 455,000 were male and 207,000 were female [3].

[Special reminder] As the data from the National Tumor Registry is generally relatively lagging behind, the data released in the latest report in 2022 is the National Tumor Registry collecting and summarizing the registration information of the National Tumor Registry in 2016.

Etiology

The etiology of malignant tumors of the upper lobe of the lung is currently unknown and may be related to smoking, air pollution, genetics, and other factors.

Causes

Malignant tumors of the upper lobes of the lungs develop from the same causes as lung malignancies, while the exact etiology of the latter is currently unknown.

Risk factors

The following factors significantly increase the risk of developing lung malignancy and are called high risk factors for lung malignancy.

Smoking

Smoking significantly increases the risk of developing lung malignant tumors, and some studies have shown that the risk of morbidity and mortality in smokers is higher than that in nonsmokers; at the same time, there is a positive correlation between the dose of smoking and the risk of developing lung cancer [4].

Passive smoking, i.e., secondhand smoke, also leads to an increased risk of lung malignant tumors.

Air pollution

The incidence and mortality rates of lung malignant tumors are higher in large cities and industrial areas, which are mainly closely related to the pollution of air by exhaust gases or dust emitted from transportation or industry. It has been shown that the incidence of pulmonary malignant tumors is positively correlated with the concentration of 3,4-benzo(a)pyrene in the air [5].

Occupational factors

Those who are chronically exposed to highly carcinogenic substances such as radon, arsenic, beryllium, chromium, cadmium and their compounds have a high risk of developing lung malignant tumors; asbestos, silica and soot are also clear carcinogens [6-8].

Genetic factors

Individuals with first-degree relatives such as parents, children, and siblings diagnosed with lung malignancy are at significantly higher risk of developing malignant tumors, and heritable susceptibility loci may be present in those with a family history of lung malignancy [9-10].

Chronic lung diseases

Patients with chronic lung diseases such as chronic obstructive pulmonary disease, tuberculosis, and pulmonary fibrosis have a higher incidence of pulmonary malignancies than the healthy population.

Symptoms.

Symptoms of malignant tumors of the upper lobes of the lung are basically the same as those of lung malignant tumors.

Lung malignant tumors usually have no obvious symptoms in the early stages, and symptoms appear only after the disease has progressed to a certain stage and vary from person to person.

It should be noted that any untreated respiratory symptoms for more than two weeks, especially bloody sputum, dry cough, or repeated occurrence of pneumonia in the same area, or changes in the original respiratory symptoms, etc., should be alerted to the possibility of lung malignant tumors.

Some patients with lung malignant tumors may consult the doctor because of some atypical first symptoms, such as hoarseness, thickening of fingers like pestle, edema of head and neck or even both upper limbs.

Common symptoms

Cough, sputum

Cough is the most common symptom in patients with lung malignant tumors, and more than half of the patients have cough at the time of consultation.

It is mostly irritating dry cough without sputum, or a little white mucus sputum.

Hemoptysis

Hemoptysis is the most suggestive symptom of lung malignancy and is present in about 25% to 40% of patients.

It is usually characterized by blood in sputum, hemoptysis is rare.

Dyspnea

About 10% of patients with lung malignant tumors have dyspnea as the first symptom.

It mostly manifests as chest tightness, shortness of breath, and some patients may also have chest pain.

Fever

It can be caused by necrosis of tumor tissue or secondary pneumonia such as obstructive pneumonia.

Fever is characterized by recurrent episodes, sometimes good, sometimes bad, and difficult to cure.

Intermittent moderate or low fever is common, and high fever may be present when combined with infection.

Weight loss and fatigue

Lung malignancy may cause excessive consumption and loss of appetite, leading to fatigue and weight loss.

Wheezing

It is a harsh sound made when inhaling.

If the tumor is located in the large airways, especially if it is located in the main bronchus, it can often cause symptoms of limited wheezing.

Distant metastatic symptoms

Metastatic symptoms are symptoms caused by distant metastasis of the tumor. The most common lung malignant tumor is brain metastasis, followed by bone metastasis, liver metastasis and so on.

Brain metastasis

Early stage may be asymptomatic.

Central nervous system symptoms are common:

Sometimes accompanied by mental status changes.

Bone metastasis

Commonly found in the ribs, spine, pelvis and long bones.

They may be asymptomatic in the early stages, but may be associated with localized pain and tenderness in the later stages.

If the spinal metastasis compresses or invades the spinal cord, it may lead to incontinence or paraplegia.

Liver metastasis

Hepatomegaly and pain in the liver area may occur.

Liver enzymes such as aspartate aminotransferase (AST) or elevated bilirubin may be present.

Lymph node metastasis

Lymph node metastasis occurs in the hilar lymph nodes first, and then in the mediastinal and supraclavicular lymph nodes along the lymphatic return pathway.

The enlarged superficial lymph nodes are hard and can be fused into clusters, and are not accompanied by pressure pain.

Other

Lung malignant tumors may metastasize to various parts of the body, resulting in different clinical signs, such as subcutaneous nodules, skin ulcers and abdominal pain.

Malignant disease can be seen in patients with advanced cancer, which manifests as extreme wasting, weakness and generalized exhaustion.

Seek medical attention

With symptoms such as unexplained cough, sputum, chest tightness, chest pain and dyspnea, it is recommended to organize relevant information and go to respiratory medicine. Thoracic Surgery and other departments for consultation.

Department of Medicine

Respiratory Medicine

When symptoms such as unexplained cough, sputum, chest tightness, chest pain, dyspnea, etc. occur, it is recommended to go to the Department of Respiratory Medicine promptly.

Thoracic Surgery

Thoracic Surgery may also be consulted if nodules or space-occupying lesions are found in the lungs on chest imaging and malignant tumors in the upper lobes of the lungs are suspected or diagnosed.

Oncology

Oncology may also be consulted if the diagnosis of malignant tumor of the upper lobe of the lung is confirmed and anti-tumor treatment such as surgery, pre-operative or post-operative adjuvant radiotherapy, etc. is required.

Preparation for medical treatment

Consultation: Registration, Preparation of documents, Frequently Asked Questions

Tips for medical treatment

It is recommended that you choose clothes that are easy to put on and take off before going to the doctor so that the doctor can conduct the relevant physical examination.

Avoid wearing shirts with buttons, blouses with sequins, dresses with zipper buttons and other metal clothing.

It is recommended to be accompanied by a family member.

Preparation Checklist

Pay particular attention to the time of onset of symptoms, special manifestations, etc.

Any recent unexplained cough, sputum, chest tightness, hemoptysis, etc.?

Any recent unexplained fever, chest pain, dyspnea, etc.?

Any recent unexplained loss of appetite or weight loss?

Do you have a history of long-term smoking or exposure to second-hand smoke?

Any history of occupational exposure to asbestos, silica, radon, beryllium, chromium, cadmium, nickel, silica, soot and coal smoke?

Any history of chronic obstructive pulmonary disease (COPD)?

Any previous family history of pulmonary malignancy or similar tumors?

Test results in the last six months, which can be carried to the doctor’s office

Laboratory tests: blood test, liver and kidney function, coagulation function, tumor markers.

Imaging examination: X-ray chest film, chest CT, magnetic resonance (MRI), ultrasound, ECT, PET-CT.

Pathologic examination: sputum or pleural fluid exfoliative cytology, CT-guided lung puncture biopsy, bronchoscopic biopsy.

Diagnosis

Malignant tumors of the upper lobe of the lungs are mainly diagnosed initially based on medical history, clinical manifestations, laboratory tests and imaging tests, and ultimately require pathological examination to confirm the diagnosis.

Diagnosis is based on

Medical history

Patients may have the following medical history, but a history of the following is not always associated with upper lobe malignant tumor:

A past history of chronic smoking.

A past history of chronic obstructive pulmonary disease.

Past history of occupational exposure to asbestos, silica, radon, beryllium, chromium, cadmium, nickel, silica, soot, and coal soot.

Past family history of associated tumors.

Clinical manifestations

Symptoms

Early symptoms are not obvious, and clinical manifestations such as cough, hemoptysis, chest tightness, chest pain, dyspnea, fever, bone pain, headache, nausea, and vomiting may occur in the middle and late stages.

Physical signs

Most patients with early-stage upper lobe lung malignant tumors have no obvious associated positive signs.

They may show extrapulmonary signs of unknown cause and prolonged duration, such as pestle-like fingers/toes, male breast development, dark skin or dermatomyositis, and phlebitis.

In patients with clinical manifestations highly suspicious for malignant tumors in the upper lobes of the lungs, physical examination reveals vocal cord paralysis, superior vena cava obstruction syndrome, Horner’s syndrome, etc. suggesting the possibility of local invasion and metastasis.

In patients whose clinical manifestations are highly suspicious of malignant tumor of the upper lobe of the lung, physical examination reveals hepatomegaly with nodules, subcutaneous nodules, and enlarged lymph nodes in the supraclavicular fossa, suggesting the possibility of distant metastasis.

Laboratory Tests

Neuron-specific enolase (NSE) and gastrin-releasing peptide precursor (ProGRP) are ideal indicators to assist in the diagnosis of small cell lung cancer. Elevated levels of both can assist in supporting the diagnosis of small cell lung cancer.ProGRP positively correlates with the stage of small cell lung cancer and can be used to differentiate small cell lung cancer from benign lung disease.

Elevated levels of carcinoembryonic antigen (CEA) and squamous epithelial cell carcinoma antigen (SCC) can help in the diagnosis of non-small cell lung cancer.

It is recommended to test the tumor markers before the first diagnosis and the beginning of treatment, and dynamically monitor their changes after the beginning of treatment, which can play a role in monitoring the efficacy of the tumor and judging the prognosis.

Judgment of therapeutic efficacy: if one of the above tumor markers is elevated before treatment and decreases after treatment, it suggests that the therapeutic efficacy is better.

Follow-up monitoring: If one of the above tumor markers is found to be elevated in the course of follow-up, it suggests that there may be signs of recurrence, and it is recommended to consult a doctor for timely investigation.

Imaging

It is the basic examination of chest, usually including chest front and side view films, which are mostly used for routine examination in hospital or postoperative review of chest.

Tumor foci in the upper lobes of the lungs can be seen on X-ray.

It can effectively detect early malignant tumors in the upper lobes of the lungs and clarify the location and extent of involvement.

Enhanced CT can also help to detect the blood vessels and hilar and mediastinal lymph nodes with or without enlargement, and more accurately make clinical staging and evaluation of therapeutic efficacy, which is the main means of clinical imaging at present.

Bone scan is a routine examination for determining bone metastasis of lung malignant tumors and is the first choice for screening bone metastasis. When suspected bone metastasis is detected by bone scanning examination, further MRI examination can be performed for confirmation.

Chest MRI:

MRI of other parts:

PET-CT is one of the best methods for diagnosis, staging and restaging, surgical evaluation, radiotherapy target area outlining, efficacy and prognosis assessment.

The sensitivity for the diagnosis of brain and meningeal metastases is relatively poor, and cranial magnetic resonance is recommended for those who have the condition.

Ultrasonography of malignant tumors in the upper lobe of the lung is mainly used to observe the presence or absence of metastases to supraclavicular lymph nodes, liver, adrenal glands, kidneys, and other sites and organs, and to provide information for tumor staging.

Ultrasound-guided puncture can be used to perform puncture biopsy of subpleural lung tumors, supraclavicular lymph nodes, and metastases in parenchymal organs, and obtain specimens for histological examination.

Histopathologic examination

Sputum cytology is one of the simplest and most convenient noninvasive diagnostic methods, but it has some false-positive and false-negative possibilities and is more difficult to differentiate.

Thoracentesis can be used to obtain pleural fluid for cytologic examination to clarify pathology and for staging.

CT- or ultrasound-guided transthoracic puncture is one of the preferred methods for the diagnosis of peripheral upper lobe lung malignancies.

Bronchoscopy can help to visualize about 1/3 of the proximal bronchial mucosa, and histological or cytological sampling by biopsy, brushing, and lavage can be performed for further pathological examination to clarify the diagnosis.

Staging

The staging of malignant tumors in the upper lobe of the lung helps to reasonably formulate treatment plans, correctly evaluate the efficacy and judge the prognosis.

TNM staging

The staging criteria for malignant tumors in the upper lobe of the lung refer to the 8th edition of lung cancer staging criteria jointly formulated by the International Union Against Cancer (UICC) and the American Joint Committee on Cancer (AJCC), which is mainly based on the three elements of T, N, and M. The staging criteria for malignant tumors in the upper lobe of the lung are as follows

T: represents the extent of the primary tumor, mainly referring to the size of the primary tumor foci and the degree of extravasation.

N: represents the situation of regional lymph node metastasis, including the number of metastases and regional extent.

M: represents distant metastasis.

Special reminder: T, N, M will be followed by Arabic numerals, the larger the number, the more serious.

According to different TNM stages, the overall stage of the patient is finally determined, which is indicated by stages I, II, III and IV. For details, please refer to Lung Cancer.

Differential Diagnosis

The differential diagnosis of malignant tumors of the upper lobe of the lung is firstly the differentiation between different pathological stages, and secondly the differentiation from other diseases of the lung.

Tuberculosis

Similarities: both have clinical symptoms such as cough, hemoptysis, fever, malaise, emaciation and pleural effusion.

Differences: Tumor markers of pulmonary tuberculosis will not be abnormally elevated, and cavities and corn-like lesions can be seen on chest CT, while malignant tumors are mostly solid space-occupying lesions.

Lung abscess

Similarity: Clinical symptoms include fever, cough, sputum and fatigue.

Differences: lung abscess has a rapid onset, obvious toxic symptoms, thick-walled cavities with fluid planes inside on chest radiographs, and tumor markers will not be abnormally elevated; whereas malignant tumors do not have obvious toxic symptoms and tumor markers are elevated.

Benign tumors of lung

Benign tumors of the upper lobe of the lung commonly include misshapen tumors, chondrosarcomas, fibromas, etc., which are mostly asymptomatic clinically.

Similarities: they have similar occupational manifestations with lung cancer on imaging.

Differences: There are different features on imaging, and some of them need pathologic examination to be identified.

Treatment

Aim of treatment: For early-stage patients, we should strive to cure and improve the clinical long-term survival rate; for middle- and late-stage patients, the main purpose is to alleviate clinical symptoms, improve the quality of life and prolong the survival time.

Treatment principle: adopt the principle of combining multidisciplinary comprehensive treatment with individualized treatment. Multidisciplinary comprehensive treatment mode should be adopted according to the patient’s physical condition, pathological and histological types of tumors, molecular typing and developmental tendency, and surgery, radiotherapy, chemotherapy, targeting and immunotherapy should be reasonably applied.

Surgery

Surgery is the first choice of treatment and the only possible way to achieve clinical cure. According to the size of incision and trauma, it is categorized into conventional open-heart surgery, small-incision open-heart surgery and minimally invasive thoracoscopic surgery.

Open Chest Surgery

There are mainly incisions into the chest via posterior lateral incision and small chest incision.

The advantage is that it can visually expose the diseased lung tissue and facilitate lobectomy and systematic lymph node dissection.

The disadvantage is that the surgery is very traumatic and the postoperative recovery is slow.

Thoracoscopic surgery

Advantages: small surgical incision, less trauma, less loss of lung function, less pain, fast recovery and good results, has become the main method of thoracic surgery.

Disadvantages: Some complicated surgeries and emergencies during surgery require higher skills of the operator. At present, it is mainly suitable for earlier peripheral lesions, or elderly patients whose lung function does not tolerate open surgery.

Radiotherapy

Radiation therapy is also an important clinical treatment. Especially for patients in clinical stages I and II, radiotherapy can be chosen if they are unable or unwilling to undergo surgery for various reasons. It includes radical radiotherapy, palliative radiotherapy and comprehensive radiotherapy.

Radiotherapy

The purpose is to eliminate the primary lesion and its regional metastatic lymph nodes.

It is suitable for patients with good physical status (KPS score ≥70), including early, unresectable locally advanced patients who cannot be operated for various reasons.

Palliative radiotherapy

The aim is to inhibit tumor growth, reduce patients’ pain as much as possible, and improve patients’ quality of life.

It is applicable to tumor reduction therapy and pain relief therapy for advanced primary and metastatic foci.

Comprehensive radiotherapy

Adjuvant radiotherapy: applicable to patients with preoperative radiotherapy, postoperative positive margins or multiple metastases in regional lymph nodes. Positive margin means that after surgical resection of the tumor, cancer cells can be detected at the resection margin, indicating that the tumor has not been completely removed.

Prophylactic radiotherapy: mainly refers to prophylactic whole brain radiotherapy for small cell lung cancer that has reached complete remission after chemotherapy and radical radiotherapy.

Synchronized radiotherapy: Synchronized radiotherapy is recommended for inoperable stage IIIA and IIIB patients.

Drug therapy

Drug therapy includes chemotherapy, targeted therapy and immunotherapy.

Chemotherapy

Chemotherapy, short for chemotherapy, is a systemic treatment that utilizes cytotoxic drugs to destroy cancer cells. It is divided into neoadjuvant chemotherapy, adjuvant chemotherapy and palliative chemotherapy according to the purpose of treatment.

Adjuvant chemotherapy can be used in early stage, neoadjuvant chemotherapy, adjuvant chemotherapy or simultaneous radiotherapy in locally advanced stage, and palliative chemotherapy in advanced stage.

Commonly used first-line chemotherapy regimens include: vincristine + cisplatin/carboplatin, paclitaxel + cisplatin/carboplatin, gemcitabine + cisplatin/carboplatin, docetaxel + cisplatin/carboplatin, and pemetrexed (non-squamous) + cisplatin/carboplatin.

Adjuvant chemotherapy was administered after surgery for limited stage small cell lung cancer.

Extensive stage small cell lung cancer is treated with chemotherapy-based comprehensive treatment, and the commonly used first-line chemotherapy regimens are: etoposide + cisplatin/carboplatin, irinotecan + cisplatin/carboplatin.

Targeted therapy

Generally, it is recommended to obtain tumor tissues for driver gene mutation detection, and only patients with positive driver genes can implement targeted therapy. Take the common driver genes of lung cancer as an example to illustrate.

For patients with positive epidermal growth factor receptor (EGFR) gene mutation, EGFR-tyrosinase inhibitor (TKI) therapy can be chosen, and there are currently three generations of drugs.

The first generation is represented by gefitinib, erlotinib, and erlotinib; the second generation is represented by afatinib and daclotinib; and the third generation is represented by ositinib, amitinib, and vorametinib.

For ALK fusion gene positive drugs, currently divided into three generations.

The first generation represents the drug crizotinib; the second generation represents the drugs alectinib, enzatinib, and buclatinib; and the third generation represents the drug loratinib.

Currently the research against ROS1 enzyme-specific inhibitors is not successful, while ALK kinase inhibitors have the potential to inhibit ROS1 kinase activity, and ALK inhibitors are mainly applied at present.

Immunotherapy

The current immunotherapy mainly applies immune checkpoint inhibitors, and the common ones are PD-1 inhibitors, such as pabolizumab, navulizumab, sindilizumab, tirilizumab, and karelizumab; and PD-L1 inhibitors, such as dovaricizumab, atirilizumab, and sugilizumab.

Currently, it is mostly used in advanced and locally advanced non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC), either as a single agent or in combination with other treatment modalities, and more clinical indications are being explored.

Prognosis

There is no information on the overall cure rate and prognosis of upper lobe lung malignancies, refer to the data related to lung cancer.The 5-year survival rate for patients with stage I non-small cell lung cancer is about 75%.

Cure

Taking non-small cell lung cancer and small cell lung cancer, which are common clinical malignant tumors in the upper lobe of the lung, as an example, the 5-year survival rate is used to evaluate the cure situation. There are significant differences in the 5-year survival rates of lung cancer patients with different stages and pathologic types, as follows [11]:

Non-small cell lung cancer

The 5-year survival rate of stage I patients is about 75%.

The 5-year survival rate of stage II patients is about 55%.

Stage III 5-year survival rate is about 20%.

Stage IV 5-year survival rate is approximately 5%.

Small cell lung cancer

The 5-year survival rate for stage I patients is about 45%.

Stage II patients have a 5-year survival rate of about 25%.

The 5-year survival rate for stage III is about 8%.

The 5-year survival rate for stage IV is about 3%.

[Special Reminder

The overall survival time of cancer patients can be roughly predicted by the 5-year survival rate, which refers to the proportion of patients whose tumors survive for more than 5 years after various comprehensive treatments. the probability of recurrence after 5 years is very low, and it can generally be regarded as a clinical cure.

Statistical data such as the 5-year survival rate are for clinical studies only and do not represent an individual’s specific survival period.

Survival should be analyzed in the light of the stage of the disease, physical condition, and whether the patient has received standardized treatment and regular follow-up, etc. Consultation with the physician is recommended.

Prognostic factors

Prognostic factors are factors that have an impact on the overall survival and quality of life of patients.

Important prognostic factors for malignant tumors of the upper lobe of the lung include the clinicopathologic stage of the tumor, histologic type, patient’s physical fitness, and treatment.

Generally speaking, patients with low malignancy of histologic type, early pathological staging, early standardized treatment, and good personal physical fitness before the onset of disease have a relatively good prognosis.

Daily

The following recommendations for patients and families with malignant tumors of the upper lobe of the lung can also be referred to by the general population, especially for prevention and screening.

Daily management

Dietary management

Have a balanced diet rich in vegetables, fruits and whole grains, reduce excessive sugar and fatty foods, and eliminate alcohol intake.

High protein diet, mainly eat some fish, chicken and eggs. High protein diet can increase the patient’s metabolism and increase the patient’s nutrition. At the same time, eat less red meat food, such as pork, beef, lamb and so on.

Eat more vegetables and fruits, and eat less spicy, stimulating and fried food.

Life management

Pay attention to rest, regular work and rest, avoid labor and cold.

To quit smoking and drinking, as well as maintain a good, optimistic mindset and moderate exercise.

Psychological support

After diagnosis, patients may develop a sense of fear, and may be afraid of pain, abandonment and death, etc. Family members should pay attention to listening to the patient’s heart, improving the patient’s psychological tolerance and relieving anxiety.

Encourage the patient’s family to give support so that the patient can face the treatment positively with a good mindset.

During and after treatment, family members are advised to encourage the patient to do work and household chores that are within his/her ability to reintegrate into his/her social role.

Disease monitoring

During the treatment, pay attention to monitoring possible adverse reactions, such as nausea, vomiting, hair loss, anemia, bleeding, loss of appetite, fatigue, fever and other symptoms, and consult the doctor in time once there are obvious abnormalities.

Follow-up review

Malignant tumors of the upper lobe of the lung need to be reviewed regularly after treatment. The purpose of review is to monitor the efficacy of treatment and early detection of tumor recurrence and metastasis.

Year 1~2: review once every 3 months, including medical history, physical examination, chest CT, abdominal ultrasound, tumor markers, etc., and review the head magnetic resonance every half a year, and perform bone ECT examination as appropriate.

Year 2~5: 1 review every 6 months, the review items include medical history, physical examination, chest CT, tumor markers, 1 annual review of head MRI, ECT, etc., and bone ECT examination as appropriate.

After 5 years: review once a year, review items as above [11].

Prevention

There is no definitive prevention strategy for malignant tumors of the upper lobes of the lung. The following measures may help to reduce the incidence of malignant tumors of the upper lobes of the lungs, although they cannot completely prevent the disease from occurring.

Daily prevention

Adherence to smoking and alcohol cessation: Do not smoke, stay away from passive smoking, and avoid any form of alcohol intake.

Take occupational protection: avoid exposure to carcinogens such as asbestos, chromium and nickel.

Avoid air pollution: Avoid indoor pollution, such as heating by open fire and exposure to oil fumes.

Outdoor personal protection: avoid going out and exercising when the atmosphere is severely polluted, and if necessary, wear an anti-haze mask.

Timely and standardized treatment: Patients with chronic obstructive pulmonary disease or diffuse pulmonary fibrosis should standardize their treatment.

Healthy lifestyle: Try to have a regular routine, moderate exercise, weight control and balanced nutrition.

Regular screening

Cigarette smoking, passive smoking, people with COPD, and people with a history of occupational exposure for more than 1 year can be considered high-risk groups.

Low-dose spiral CT screening is recommended for high-risk groups.

The recommended interval for screening is 1 year, and those with normal annual screening are recommended to continue screening every 1 to 2 years.