Lung cancer is the malignant tumor with the highest incidence and mortality rate, and it is the number one tumor killer of human beings. What is lung cancer? Lung cancer is a malignant tumor growing in the mucosal epithelium of the bronchial tubes. Bronchus is a tubular structure and the lumen is covered with a layer of epithelium, which becomes malignant and grows into nodules. Lung cancer is a modern disease, and according to the literature, there were only 200 cases of lung cancer with clear pathological diagnosis in the early 20th century.
There are two major factors leading to the increase of lung cancer, mainly tobacco and air pollution. Tobacco was introduced into Europe from the Indians and was first consumed by the upper class. With industrial production, the cost of cigarettes was greatly reduced and made available to the general public, so lung cancer rose parabolic in Europe from 1920-1930. China is also more than half a century behind the West in this regard, and smoking only became popular in China in the 1970s, but the incidence of lung cancer in China gradually increased by the 1980s.
Why do you get lung cancer?
We know that the causative factors of lung cancer are external and internal. The internal factors originate from the patient’s own factors, i.e. genetic factors (genetic susceptibility) that lead to a natural predisposition to lung cancer, which is determined by genes. This is why the same three smokers, one has the disease, two may not or passive smokers get lung cancer, while smokers do not get lung cancer. The second is the external causes, one is lifestyle habits, smoking, diet, etc. Second is the living environment, air pollution, indoor pollution, etc.
The third is occupational factors. We all know that 20 years ago the highest incidence of lung cancer in China was in the city of Jialao, Yunnan Province, because there were tin mines there.
Nowadays, the most important concern is smoking, and the relationship between smoking and lung cancer is very clear. Professor Miller suggested in the late 1920s that smoking was associated with lung cancer. So it is clear that smoking is the cause of lung cancer, clearer than any other factor. But if we know the cause, why can’t we treat it? It is because of the complexity of carcinogenic factors. After taking a puff of cigarette, we don’t know how many carcinogens are in it, it may be several, dozens or even 200, and there are compound effects.
Therefore, the more complex a disease is, the worse the treatment effect is. How much does smoking really have to do with lung cancer? In terms of smoking types, cigarettes have the highest risk factor, while cigars and pipes have a smaller risk factor, not that they have a lower risk factor, but cigarettes are two or three times more dangerous than cigars and pipes. The more you smoke, the more dangerous it is, and the longer you smoke, the more dangerous it is. The younger you start smoking, the higher the chance of getting cancer, so you must quit smoking.
About whether lung cancer is hereditary and contagious?
Lung cancer does have genetic correlation, but lung cancer is not a genetic disease, but only a susceptibility factor. Therefore, even if you have a family history of the disease, you will not easily get lung cancer as long as you do not smoke and are not exposed to pollution factors. Meanwhile, lung cancer is not an infectious disease and will not be transmitted through contact or kissing. Because it is very difficult for tumor to enter other people’s body, even if it does, other people’s immune system can kill it, so don’t discriminate against lung cancer patients.
We know that there are two major types of lung cancer, one is non-small cell lung cancer and the other is small cell lung cancer. 80% of lung cancers requiring surgery are non-small cell lung cancers, and 20% are small cell lung cancers, which are mainly treated with chemotherapy. Staging is very closely related to the outcome. There is a big difference in five-year survival rate from early to late stage, so the earlier the detection and the earlier the treatment, the better the five-year survival rate. Therefore, the earlier the detection and treatment, the better the five-year survival rate.
Why is lung cancer very difficult to treat?
Because of metastasis! One is lymphatic tract metastasis, another is hematogenous metastasis, and the other is implantation metastasis: for example, cancer cells are shed to the pleural cavity, resulting in implantation metastasis.
The most common symptom of lung cancer is asymptomatic. Once patients notice chest tightness and chest pain and then go to see a doctor, 80% of them are already in advanced stage. The lung symptoms are like cough, mostly paroxysmal dry cough. Hemoptysis is not a big mouthful of blood, but blood in sputum, which is the most common. Chest pain is the late stage manifestation of tumor. We know that the sensory nerves in the lung are not developed, so only when the tumor invades the pleura or grows to a large piece will there be chest pain.
In addition, there is also weakness and other sensations. Extra-pulmonary symptoms, pestle fingers and toes, hypertrophy of bone joints, many people treat it as joint disease. Paraneoplastic syndrome of lung cancer is not a manifestation of advanced lung cancer, nor is it a metastatic symptom. If the tumor inside the lung is removed, the painful bone and joint swelling and pestle finger will be significantly improved within a week, and the life expectancy is not greatly affected.
Diagnosis of lung cancer, how to exclude and confirm lung cancer as soon as possible?
First of all, let’s look at the reasons for lung cancer patients to visit the doctor. There are two major reasons, one is having obvious symptoms, coughing and hemoptysis, 80% of patients with obvious symptoms are in advanced stage. The second one is found by physical examination. Most of the lung cancers found by physical examination are early stage and patients have no symptoms. Disease physical examination, due to other diseases or preoperative examination.
Small nodules must not be ignored. In the past, it was difficult to detect small nodules in ordinary chest films, especially those less than 1 cm in diameter or less than 2 cm in diameter and located close to the septum. The development of modern imaging technology has brought benefits to mankind and small nodules can be detected. Small nodules have two major dangers. First, once a small nodule in the lung is isolated or solid, more than 60% or 70% of them are malignant.
Even larger tumors grow from small nodules. Therefore, according to domestic and international experience, most nodules in the lung are malignant, and 70% to 80% of them are lung cancer. In case of lung cancer, small nodules left untreated will lead to metastasis. The characteristic of lung cancer is that metastasis is early, especially adenocarcinoma. Secondly, small nodules bring mental stress to people. When patients with small nodules go to the hospital, they suspect that they may be malignant, which puts a lot of psychological pressure on patients and their families.
Many people can’t stand the torture mentally and must be cut off when they have a small nodule in their lungs. So small nodules must be closely observed and treated rationally, making timely treatment if necessary.
Routine examination, X-ray imaging: frontal and lateral chest films, chest CT, etc. MRI is not a routine method, it is not the best for lung and only applicable to few cases. the biggest role of PET-CT is to see if there is metastasis in other parts of the body, it has no advantage for the analysis of tumor itself. For example, it is not cost-effective to do PET examinations for simple glassy shadows, but PET can look for metastases in other parts of the body.
Fiberoptic bronchoscopy is the most accurate non-invasive diagnosis. The medical doctor only needs to clarify the diagnosis, but the surgeon needs to do the surgery to clarify the appropriate place to cut. It depends on which bronchus is invaded by the tumor and which part is cut off. To exclude small tumors that may be present in the airway, we have a case where a small tumor grew around the lung, only to have a fiberoptic bronchoscopy to find another small native tumor in the tracheal lumen. Painless bronchoscopy is a combination of local surface anesthesia and intravenous anesthesia.
Electronic fluorescence tracheoscopy, which is six times more sensitive than normal white light tracheoscopy, can detect some in situ cancers. You can look at the film for comparison. Many patients who have no problems with chest X-ray or CT can be detected by electronic fluorescence tracheoscopy. If the patient is a high-risk group and sputum cells find cancer but how can’t be detected, electronic fluorescence tracheoscopy can be done.
There is also puncture biopsy. Puncture is controversial and should not be used as a preoperative diagnostic item, but can be used as a diagnostic item. If the patient is going to have surgery, it is better not to do puncture, because puncture can bring many problems, which may cause pneumothorax, hemothorax, or even implantation and metastasis, etc. Puncture is not advocated for patients who can have surgery, and if not, just to confirm the diagnosis can be used.
There are many methods of puncture, electronic ultrasound tracheoscopy (EBUS), which is the most advanced minimally invasive diagnosis available. For example, it is not known if this patient’s lymph nodes are metastatic. If they are metastatic, chemotherapy should be followed by surgery, and if they are not metastatic, surgery should be followed by chemotherapy, but they grow outside the trachea and there is no way to biopsy. Now EBUS puncture goes in and can be performed with real-time ultrasound image monitoring. All puncture movements are guided by ultrasound, so it is very accurate and does not penetrate other vessels, so the success rate is very high.
How to treat lung cancer?
Lung cancer treatment: surgical resection, which is suitable for most of the early stage. So far surgical resection is the only means that has definite evidence to prove that lung cancer can be cured, no other treatment has evidence to prove that lung cancer can be cured. Chemotherapy is suitable for most advanced stage patients or post-operative adjuvant chemotherapy. Radiotherapy is indicated for locally advanced or palliative, adjuvant therapy. Immunotherapy, the method of enhancing the immunity of the body.
Chinese herbal medicine treatment whose efficacy needs to be further confirmed and quantified. There is also supportive therapy, symptomatic treatment, poor nutrition, infusion of nutrient solution to improve the quality of life, sometimes supportive therapy can allow the patient to live with the tumor for a longer period of time. There are other treatments, but when choosing them, we should remember that surgery should be performed if it is possible in the early stage.
For lung cancer, the main methods of surgery include lobectomy, bilobectomy, bronchial sleeve resection, pneumonectomy with rongeuroplasty and so on. The traditional way is to make an incision about 30 cm long, and there is also a minimally invasive incision, about 10 cm, but the ribs are stretched very much and the postoperative pain is obvious.
There is also a thoracoscopic incision. The reason why the first two methods cut the mouth wide or pull it wide open is to let the surgeon see the operation area, while thoracoscopy is to show the operation area through a mirror, and the surgeon looks at the high-definition TV to do the operation, which is equivalent to putting the surgeon’s eyeball in the chest, so that he can see more clearly. Let me show you a film for comparison.
This patient has grown a ground glass, one centimeter, to show you how the procedure is done thoracoscopically. This is a small nodule in the lung, and it was cut down in 5 minutes, with less than 5 ml of bleeding. The vascular handling is completely different from the past, and it’s a revolutionary change with more beautiful cuts and less bleeding than in the past. This is clearer than even an open chest, because the high definition display is clearer than any doctor’s eyes, the only drawback is that it is expensive.
The lobectomy takes about an hour, bleeds one or two hundred milliliters, and the patient can get out of bed the day after the operation. The resected lesion is contained in a specimen bag and isolated from the chest cavity so that no implantation or metastasis can occur. Lymph node clearance can be done very cleanly because the image can be magnified 6 to 20 times. In the past, when dealing with a blood vessel, a ligature was tied and sewn and then cut, but now it is all solved in 3 seconds, which is the change brought by modern technology to surgery.
Comprehensive treatment includes surgery followed by chemotherapy, or radiotherapy followed by chemotherapy followed by surgery. How exactly, according to the judgment of the doctor. There are also different plans for different individual cases, so it is still necessary to develop a plan according to individual cases. Targeted therapy is a great progress in lung cancer treatment. However, at present, it is still a surgical-based comprehensive treatment.