There are two types of treatment, one is local treatment and the other is systemic treatment. Local treatment is further divided into two types, the first is surgery. Generally speaking, about 20-30% of lung cancer patients can be treated surgically. There are two attitudes: one is that they want to open up quickly; the other is that they do not want to open up. Many patients say I don’t want to have surgery or chemotherapy, I want to do what I want. It depends on the condition. If you can operate and you don’t, it is definitely unfavorable and it is an opportunity. If you can’t operate and you insist on surgery, the prognosis will be much worse. Because the treatment itself is localized, you can’t use a solution that is not localized; if it is a systemic lesion and you use surgery, it increases the chance of trauma and spread. So, this is something we need to understand.
Whether or not to operate one has to be based on the disease in terms of being confined to the chest and lungs and not spreading. Secondly, it is early and intermediate stage without distant metastasis. Early and mid-stage, the range is still relatively large, early and mid-stage can be operated, as long as there is no distant metastasis. Thirdly, it depends on how the operation is performed. People may shiver with fear when they hear about surgery. In fact, surgery is not as stressful as it was 20 years ago, and thoracic surgery has basically passed now. Usually lobectomy is performed, if the tumor grows in the lung, the tumor will not be removed from the lung. Our lung is divided into five lobes, the left is the second lobe and the right is the third lobe, just like the leaves of a tree, so we call it the right three and the left two. Cut off the one lobe that has lung cancer. When we cut an organ, like a leaf, we should not over-traumatize the anatomical area and take down the tumor along that lobe. This is commonly called “lobectomy” to remove the tumor more thoroughly. In addition, the intrathoracic lymph nodes should be removed. There are several directions of invasion, especially the intrathoracic lymph nodes. This lymph node is in the middle of two lungs, if the tumor cells are hidden in it, it will have the chance to expand if it is not removed.
People often ask me another question: Should I use chemotherapy? As soon as I see his file, I say, “Sorry, I can’t give you a decision because it doesn’t say whether the lymph nodes are taken or not. If the lymph nodes are not taken, of course, you still need chemotherapy, so you must get these data of the lymph nodes. Because the lymph nodes also have sites where they grow and run at one stop, so usually the lymph nodes along the stops have to be removed. This works a little better. The total number of patients who can undergo surgery is 20-30%. It is important to note that some patients with intermediate to advanced disease can seek surgery after radiotherapy and chemotherapy. What we have to strive for is shrinkage, improvement or apparent stabilization before the surgeon can prescribe. That’s why we often need medical and surgical departments to work together, not just one.
Chemotherapy is called preoperative chemotherapy, and the new formulation is called neoadjuvant chemotherapy. It is only suitable for mid to late stage, but usually early stage does not need chemotherapy. In addition, there is radiotherapy, chemoradiotherapy and then surgery. One problem is that it is more traumatic, and chemotherapy and radiotherapy are needed to minimize the lesion and kill the tumor cells to the minimum, and the lymph nodes on the side are also included, and then sent to open surgery, but this time cannot be too long. If more than three months after radiotherapy, you can’t open it, it’s full of tumor, the surgeon can’t open it for you. You must buy time and never let the tumor breathe and stop for two months before opening. Doctors attach great importance to the recovery of the patient at this time when dealing with it. If the patient cannot recover, he cannot operate. So in between, you need to cooperate, and attack and defend, and the patient has to do what the doctor says. Grasp the time, reach the goal step by step, and then do the surgery. Not just open surgery alone.
In the last ten years, we have made another progress. Why do doctors say, you should have chemotherapy first, and then surgery after chemotherapy. Many patients say, “Whatever, just prescribe it to me. After you prescribe it, then chemotherapy. Chemotherapy after opening is not the same as chemotherapy before opening. After opening, the surgery has to bleed and squeeze. The doctor’s hand always has to go in and then turn around, turning around is not too good for the tumor, it is unstable and can easily cause accidents. We oncologists turn less and pay attention to it. Oncologists are required to have the concept of tumor-free, and oncologists are aware of it. We oncologists all know what surgeons should do.
The second type of local treatment is radiation therapy. Radiotherapy is harmful to the tumor and to the human body. Firstly, dizziness and weakness when illuminated, but not all people. Secondly, the most important point is painful swallowing because the light cannot avoid the esophagus. Third, there is radiation pneumonia during or after radiation. But you don’t have to worry, this is a symptom that happens during radiation. Nowadays, there are many ways to try to reduce the range of the light exposure to just include the tumor. The radiation range is too small and the cancer will spread as usual. Put it clean, but the normal tissue on the side has to be traumatized. This is the disadvantage of radiotherapy, the enemy is not distinguished from me. Nowadays, radiotherapy is a rotational type. In the past, the light was very rigid, it was illuminated in the front and also in the back, which was more traumatic layer by layer. This layer may include a lot of normal lung tissue, but nowadays radiotherapy is administered from different angles and at different levels. The radiotherapist’s skill is very important, he has to design the plan, exactly according to the appearance of the tumor, exactly in that range. Therefore, there are various disciplines that should be linked together, which we call multidisciplinary. What is the reaction to the radiation, the bone marrow suppression? It also causes poor appetite, weakness, darkening of the skin, and many patients have a thick tongue. After the radiation, most of them can recover.
At this time, you can also use Chinese herbal medicine to help you improve your body immunity. But the treatment must be clear which is the main. Radiation therapy, as I mentioned earlier, has toxic side effects, but also has its advantages. By the way, many people come to ask me, I found lung cancer, people say use gamma knife. I’ll start by saying that I’m not an expert in radiation. But through consultation with the radiotherapy department, I know that this gamma knife can not just go on. You must first ask the radiotherapy doctor to explain clearly, think you can use the gamma knife to do, “gamma” after not “put”. Generally speaking, the gamma knife measurement is difficult to feel accurate, and is localized. This I said before, you gamma knife after the gamma, and then come back to me to see, I said oops, you should first light, gamma also can not penetrate, how to do it, can only be sent back again. The measurement of radiotherapy is very strict. So there should be a plan before treatment. I think foreigners are better, he knows what the doctor said he will do. Then he will also ask the reasoning, to understand whether radiation therapy or surgery or chemotherapy should be the main focus. For example, chemotherapy reduces the reaction, diet and rest should be paid attention to. The same goes for radiation therapy. Like this, you can get the best treatment.
Systemic treatment of lung cancer
1.Chemotherapy: Chemotherapy damages tumor cells, and its scope of action includes cancer cells in local lymphatic tracts and blood channels, which is a more mature systemic treatment drug. Chemotherapy is developing rapidly and its toxic side effects are getting smaller and smaller. In the 1970s, patients had a hard time with chemotherapy. In the morning, they were given cisplatin, and in the afternoon, the nurse was unlucky to carry a basin, and this one vomited before the other one started to vomit. Now it’s better, because there are anti-emetic drugs. The white blood cell drop was also very strong before. The white blood cells dropped to 3,000 or 2,000, and you had to worry about fever, infection, and dizziness. These reactions have improved significantly since the 1980s and are well tolerated. The principle of chemotherapy drugs is to fight poison with poison, the disadvantage is also the enemy is not distinguished from me, there are adverse effects on normal cells. Some people ask why the toxic reactions, mainly blood, gastrointestinal tract, but also hair loss, nerves, etc.? The reason is that all cells that grow vigorously are sensitive to chemotherapy drugs.
You can’t eat greasy food. We don’t talk much about avoiding food in Western medicine, but Chinese medicine does. I listen to the TCM doctors. I heard the TCM doctor say that yellow fish should not be eaten, so I told my patients not to eat yellow fish. Some Chinese doctors say that chicken should not be eaten, I said how can that be, I still rely on nutrition here. Of course you think that people do not eat, I suspect, then you do not eat. But if this can not eat, that can not eat, where does the nutrition come from.
Nutrition should be ensured, protein should be there, but not in excess, desperately eating snapper, should be anything to eat, fruit should also be eaten.
The role of chemotherapy drugs should also be talked about, its role is to kill tumor cells. The scope of action includes the local lymphatic tract, as well as the lesions in the lungs and the cancer cells in the blood tract. Why do we need chemotherapy? It can kill the tumor cells in the blood tract and lymphatic tract. These cancer cells are placed there and may metastasize in the future. But chemotherapy drugs are limited and toxic to achieve that therapeutic effect, and people can’t take it. Chemotherapeutic drugs are still in development, and new drugs appear generation after generation, and currently it is the third generation of new drugs that can kill cancer cells and also reduce side effects. Prevention with a better effect, that is, the cancer cells have not been found to metastasize. It is up to the doctor to decide whether to use chemotherapy or not. This treatment is one of the most mature of all systemic treatments. However, it has adverse effects on normal cells, including hair loss, which will grow out after chemotherapy is stopped. The hair that grows out will be fuller than the original, some are curly, so that it will not destroy your hair quality.
2.Bio-targeted (point) therapy drugs, inhibit the targets that replace the proliferation and differentiation of cancer cells, such as tyrosinase inhibitors of epithelial growth factor receptors, monoclonal antibodies, etc.
Tumors have many genes and proteins, many switches and many lines, just like electric lights, the lines do not light up even if they do not work, and the switches do not light up even if they do not work. The cell has a switch and a circuit. If the switches and circuits are broken, the cells will not grow. Of course, they will continue to grow, but the growth is limited, and they will stop growing when they reach a certain level. But tumor cells will grow like crazy without limit, so we need to find a way to turn off the switch and circuit. Biologically targeted therapies work at a certain point to turn off the switch of cell growth and disconnect the line of growth. The focus is on epithelial cells, which are found in the liver, stomach and intestines. But I also tell you not to think that biologically targeted therapies are effective in treating lung cancer. It is only better for some of the lung cancers (female, non-smoking, adenocarcinoma), not all of them. Therefore, you must listen to your doctor.
3.Chinese herbal medicine and evidence-based treatment is better. According to your tongue, pulse and then examination. The registration queue is inconvenient and now there are some compound prescriptions. Chinese herbal medicine has drifted across the ocean and applied for passports to go out like we did. Since last year there have been two herbal medicines prepared abroad for new drug use. One is Connexion, and the other is Green Valley Shuang Ling Gu Ben Ben San. Of course there are many, many new drugs to go over in the future. The development of TCM is very promising.
Multidisciplinary treatment of lung cancer
1.Post-operative adjuvant chemotherapy: it is beneficial to reduce distant metastasis, 3-4 chemotherapy cycles after surgery.
2.Pre-operative treatment of middle and late stage lung cancer: including chemotherapy radiotherapy, the purpose is to reduce the scope of lesions, including primary foci and intrathoracic lymph nodes, and strive for conditions for surgery.
3.The combination of chemotherapy and radiotherapy for middle and advanced lung cancer: chemotherapy can play a sensitizing role of radiotherapy, increase the tumor-killing effect of radiotherapy and reduce the chance of distant metastasis.
4.Late stage lung cancer reduction therapy: including chemotherapy radiotherapy such as brain metastasis and bone metastasis. In late stage, we try to prolong patients’ life and improve the quality of life. It includes chemotherapy, radiotherapy and biological therapy.
Rehabilitation of lung cancer
Purpose: to improve the quality of life and physical ability, reduce pain, improve symptoms and prolong survival.
When a patient has a tumor, the first thing he thinks about is himself, whether his family thinks about him or not, whether society thinks about him or not. Tumor patients will think why I have this disease and that I am inferior to others. Family members including the society should treat the patient as a normal person to guide him and never make the patient too nervous.
A few notes: therapeutic: post-operative chemotherapy radiotherapy, radiotherapy after chemotherapy distant metastases of local treatment.
Physical: moderate physical exercise after surgery, such as upper limb activities, walking, etc. Excessive physical exercise is not recommended.
Psychological: personal feeling, relaxed psychology, reading social, political and news, correct attitude towards the professional reading of the disease suffered, with the main focus on science.
Diet: nutrition is the main focus, lighter diet, avoid “picky eating”.
Social care: including moderate comfort from family and friends, care, not pity.
Patient’s attitude: accept the physician’s treatment recommendations, combined with individual characteristics.
In short, actively accept the treatment, adjust the psychological state, the drug is targeted, not repeatedly into the drug, respect the facts.