Lung cancer is the most threatening malignant tumor to human health and life, and it is the first cause of death due to malignant tumors, and its incidence and mortality are still increasing year by year. In recent years, certain progress has been made in the treatment of lung cancer in terms of surgery, radiotherapy, chemotherapy and molecular targeted drugs, etc. Currently, surgery is still the preferred treatment for lung cancer.
The 5-year survival rate after complete resection of early stage lung cancer can reach over 70%, but the 5-year survival rate of surgical treatment for middle and late stage lung cancer is only about 20%. Therefore, early detection, early diagnosis and early treatment are still the most effective measures to improve the cure rate and reduce the mortality rate of lung cancer at this stage.
Early detection is important
In recent years, with the development of imaging technology, especially spiral CT scanning technology, more small volume peripheral type lung nodules can be detected. Countries such as the United States, Japan, and Europe have begun to use low-dose spiral CT scans (LDCT) for early lung cancer screening studies.
The NLST is the first large study comparing low-dose spiral CT scans with X-ray chest radiographs for lung cancer screening. A total of 53,000 heavy smokers have been enrolled since it began in 2002. The study showed that low-dose CT screening resulted in a relative 20% reduction in lung cancer mortality and a significant 6.7% reduction in all-cause deaths. This is the first definitive randomized controlled trial with data showing that lung cancer screening can significantly reduce lung cancer mortality.
Annual low-dose spiral CT is recommended if you belong to the following groups at high risk for lung cancer: 1.? Live in an area with a high incidence of lung cancer and are over 50 years of age; 2.? Smoking index ≥ 20 pack-years (number of packs smoked per day × number of years of continuous smoking); 3.? Family history of tumor and related occupational carcinogenic factors, such as coal, iron ore, petroleum, chemical and other occupational carcinogenic factors.
If small nodules are found in the lungs during screening, the interval of follow-up should be decided according to the size of the nodules in the lungs. Lung cancer screening does not use the regular dose of CT, but low-dose spiral CT, which is 1/6 of the normal dose of radiation, that is, for 6 consecutive years, the radiation dose of low-dose spiral CT screening once a year is the same as the usual dose of a normal CT. Even according to the calculation of regular dose, once a few years to do chest CT should not have any impact on health.
Definitive diagnosis is important
Many patients and their family members seem to be extremely nervous once they are informed that they may have lung cancer. Some patients ask their doctors to start treatment immediately (e.g. request for immediate hospitalization, immediate surgery, etc.) before laboratory or instrument tests are done and the diagnosis is still unclear.
Some patients listen to rumors, expecting miracles to happen to them, and are easily deceived under the guise of “ancestral Chinese medicine”, “partial prescriptions”, “qigong masters”, etc. This is against This kind of behavior, which is against science, not only wastes the best time for treatment, but also leads to the tragic ending that people and money are empty in the end. In fact, there is no need to be overly nervous when you have lung cancer, as the treatment effect of lung cancer has radically improved compared with that of ten years ago.
Be sure to get a clear diagnosis. Once a lung lesion is found in physical examination or for other reasons (usually there are “nodules”, “masses”, “occupancy”, or “shadows” on the CT or X-ray diagnostic report), it is important to make a clear diagnosis. “Nodules are usually smaller masses), it is recommended to visit a thoracic surgeon first to determine if enhanced CT, bronchoscopy, etc. are also needed. In most cases, the doctor will be able to give a more definite diagnosis.
In recent years, with the improvement of examination means, especially the application of high-resolution CT, PET-CT and other equipment, more and more lung lesions can be detected, such as tiny nodules or hairy glass-like lesions in the lung, which were previously difficult to diagnose, now most of them can give a definite diagnosis. In some individual cases, it is difficult to clarify preoperatively, but if imaging shows lesions in the lung and lung cancer cannot be excluded, diagnostic surgical resection can be chosen, and intraoperative examination based on frozen pathology will clarify whether it is benign or malignant.
In some cases, the diagnosis of inflammation or tuberculosis is likely, and experimental treatment, such as anti-inflammatory and anti-tuberculosis treatment, can be chosen if puncture results are not available. After some time, the diagnosis is mostly clear when the results are reviewed.
Make treatment choice as soon as possible
There are many treatment methods for lung cancer, but the most important and effective ones are surgery, radiotherapy and chemotherapy. The first two are local treatment and chemotherapy is systemic treatment. Early stage lesions can be cured by surgery alone, while in most cases, a combination of surgery, radiotherapy or chemotherapy is needed, which is clinically called comprehensive treatment.
Other treatments include interventional therapy, thermal therapy, radiofrequency ablation, cryotherapy, biological therapy, immunotherapy, Chinese medicine treatment, etc. Although they are also one of the treatments for lung cancer, they are all adjuvant treatments and can be chosen when the above three main treatments are ineffective or cannot be used.
Generally speaking, surgery is the first choice for lung cancer treatment because among different treatment methods, surgery has the most definite effect and is the most likely means to cure lung cancer completely. However, the indications for surgery must be chosen well. Lung cancer is clinically divided into four stages (indicated by I, II, III and IV), and stage I-II lung cancer is the best indication for surgical treatment. Stage III is further divided into stage IIIA and stage IIIB.
Some patients with stage IIIA can choose to have surgery first and then undergo radiotherapy or chemotherapy after surgery (the clinical term for radiotherapy or chemotherapy after surgery is adjuvant therapy); some need radiotherapy or chemotherapy first (the clinical term for neoadjuvant therapy), and then choose surgery after the lesion shrinks, decreases in stage or progresses in disease is controlled. Numerous studies have shown that the efficacy of neoadjuvant treatment (i.e. radiotherapy followed by surgery) is significantly better than that of surgery alone.
For lung cancer after stage IIIB, surgery is generally not allowed in principle, except for the purpose of definite diagnosis (e.g. pathological confirmation through thoracoscopic biopsy or gene mutation detection, probing the pleura for metastasis, etc.), because it is difficult to completely remove the tumor at this time, and sometimes even aggravate the disease progression. Stage IIIB lung cancer or above can only be treated with systemic chemotherapy due to severe local invasion or distant metastasis. In recent years, targeted therapy has developed rapidly and is an effective choice for advanced patients with genetic mutations.
In addition, whether to choose surgery for lung cancer depends on the pathological histological type, which is usually divided into small cell lung cancer and non-small cell lung cancer (including squamous carcinoma, adenocarcinoma, large cell carcinoma, sarcoma, sarcomatoid carcinoma, etc.). Small cell lung cancer, which is very prone to lymphatic and bloodstream metastasis, is highly sensitive to chemotherapy and radiotherapy.
Therefore, once small cell lung cancer is diagnosed, chemotherapy, radiotherapy or radiotherapy is preferred, and some patients may have better results if radiotherapy is followed by surgical resection. If surgery alone is performed, even if the lesion is completely resected, the patient may still fail treatment due to distant metastases (e.g. brain metastases, bone metastases).