A.Diagnosis basis
1.Lung cancer should be suspected if there is no symptom or sign, and the X-ray chest film reveals isolated nodules or masses in the lung, lobulated or with fine burrs, or if there are signs of bronchial obstruction confirmed by CT examination via tomography.
2.Males aged 40 years or older who are long-term smokers with irritating cough, accompanied by intermittent or persistent small amount of hemoptysis, and limited lesions in the lung found on chest radiograph, which are ineffective after active anti-inflammatory or anti-tuberculosis treatment (2~4 weeks) or the lesions tend to increase.
3.Segmental pneumonia develops into lobar atelectasis within 2~3 months, or lobar atelectasis develops into total pulmonary atelectasis within a short period of time, or a mass appears at the root of the atelectasis, especially a growing mass.
4.Persons who develop growing pleural fluid on one side without other causes within a short period of time, or multiple hemorrhagic pleural fluid on one side with simultaneous pulmonary atelectasis, should be verified by bronchoscopy.
5.Significant shortness of breath, cough, and corn-like or diffuse lesions on both sides of the X-ray chest film should exclude those with cornual tuberculosis, pulmonary metastatic carcinoma, pulmonary mycosis and other lesions.
6.Pulmonary mass shape is found in the chest with enlarged hilar or (and) mediastinal lymph nodes and symptoms of neurovascular compression such as superior vena cava obstruction and laryngeal recurrent nerve palsy, or with distant lymph node metastasis.
7. Those with clear diagnosis by cytological examination or biopsy.
B. Clinical staging staging The TNM staging of lung cancer by the International Union Against Cancer (UICC) in 1989 is as follows.
Primary tumor (T) staging.
TX: cancer cells were found in sputum, but no lesions were seen on X-ray or bronchoscopy; or re-treated patients with unmeasured size of primary foci.
T0: no evidence of primary tumor.
Tis: carcinoma in situ.
T1: tumor ≤3 cm, confined to the lung or within the visceral pleura, with no proximal involvement of the lobar bronchi on bronchoscopy; superficial tumor of any size confined to the bronchial wall spread only. If it extends beyond the lobar bronchi to reach the common bronchi, it is also classified as T1.
T2: tumor ≥3 cm, or tumor invading lobar bronchi but beyond 2 cm from the bulge; or tumor infiltrating the dirty pleura; obstructive pneumonia or atelectasis of the lung lobes, but not involving the whole lung.
T3: Tumor of any size directly involving the chest wall, diaphragm, mediastinal pleura, or pericardium, but not involving the heart, great vessels, trachea, esophagus, or vertebrae; or tumor in the trachea less than 2 cm from the ramus, but not involving the ramus; obstructive pneumonia or atelectasis of the whole lung.
T4: Tumor of any size involving the mediastinum or heart, large blood vessels, vertebral body, tracheal ramus or with malignant pleural fluid.
Lymph node metastasis (N) staging.
N0: No lymph node metastasis.
N1: Para-bronchial or ipsilateral hilar lymph node metastasis.
N2: ipsilateral mediastinal lymph node and subsurface lymph node metastasis.
N3: contralateral mediastinal lymph node and contralateral hilar lymph node metastasis; ipsilateral or contralateral oblique muscle or supraclavicular lymph node metastasis.
Distant metastasis (M) staging.
M0: No or no distant metastasis was found.
M1: with distant metastasis or with lymphatic metastasis in the neck.
The clinical staging is summarized according to the above primary and metastatic foci as follows.
Occult carcinoma: TX N0 M0.
Stage 0: Tis N0 M0.
Stage I: T1 N0 M0; T2N0 M0.
Stage II: T1 N1 M0; T2 N1 M0.
Stage IIIa: T3 N0~2 M0; T1~3 N2 M0.
Stage IIIb: any T, N3 M0; T4; any N, M0.
Stage IV: any T or N, M1.
The differential diagnosis often requires careful differentiation from other diseases before diagnosing lung cancer. The common diseases are as follows.
1, pulmonary tuberculosis.
2.Pulmonary hilar lymphatic tuberculosis.
3.Infiltrative pulmonary tuberculosis.
4.Cornular pulmonary tuberculosis.
5.Mediastinal tumor.
6.Bronchiectasis.
7, Isolated massive fibrous caseous tuberculosis.
8.Lung abscess.
9, Pneumonia.
10.Benign lung tumor.