Treatment In the field of treatment, there is a “hundred flowers blooming, a hundred schools of thought”. As a result, patients are overwhelmed and often rely on missteps and fate. Medical treatment is marketed and inevitably integrated into financial interests. Thus it emerged that whoever first receives a lung cancer patient is given priority for treatment. Internal medicine doctors often observe some intrapulmonary lesions, especially those with atypical manifestations, and treat them with “anti-inflammatory” treatment, which may take months. Some patients with lung cancer progress during this process, and by the time they realize that it may be lung cancer or are diagnosed by sputum cytology or bronchoscopy, they may have lost their chance for radical treatment. Tuberculosis specialists may diagnose tuberculosis and treat it for months and months with anti-TB treatment, but when it is not effective and lung cancer is suspected, the possibility of complete cure is also lost. Some internal medicine and radiologists believe that as long as there are enlarged lymph nodes in the hilum or mediastinum, there is metastasis, which leads to misinformation and gives up surgical treatment. It is not known that enlarged lymph nodes in the hilum and mediastinum do not necessarily mean metastasis. Clinically, there are enlarged lymph nodes with large diameter, but the pathological diagnosis is only reactive enlargement, not metastasis. Even if they are metastases, they are still indications for surgery and can be removed together with lung tissue during surgery, which can also achieve the purpose of radical treatment. Therefore, enlarged lymph nodes in the hilum and mediastinum should never be considered as a contraindication to surgery! One should consult the thoracic surgeon and listen to the opinion of the thoracic surgeon. The first thing that comes to the mind of oncologists is chemotherapy, and if patients who are able to operate receive chemotherapy first, that is, the so-called “neoadjuvant therapy” which has been very popular for a while in the past few years, is actually preoperative chemotherapy. Due to the toxic side effects of chemotherapy, if not controlled properly, the whole body condition may deteriorate to the extent that it cannot bear the blow of surgery, and as a result, the most important treatment for lung cancer is lost and the chance of cure is lost. Therefore, preoperative chemotherapy is not recommended for patients who are not obviously “locally advanced”. Radiation therapy is a local treatment and can be considered for patients who are unable to undergo surgery or cannot afford surgery. But it should not be optional. For those who can operate, surgery should be given priority. Radiotherapy equipment is expensive and certainly needs to recover the investment as soon as possible. A famous radiotherapy-oriented hospital in China once treated all benign diseases as malignant, which resulted in a medical accident. In conclusion, lung cancer should be treated mainly by surgery and comprehensive treatment, therefore, it is important to know who is first and who is second, which should be multidisciplinary cooperation, but because of the interest, it is difficult to do so, and it often hits the hands of whoever is treated first. This is the last thing that should happen and should be avoided as much as possible. The first choice of treatment for lung cancer is surgery, a principle recognized worldwide. Small cell lung cancer is an exception, because it is highly malignant and tends to be a systemic disease, which can metastasize widely and distantly at an early stage. Therefore, as long as the diagnosis of small cell lung cancer is confirmed before surgery, chemotherapy must be given first. Many small cell lung cancers are very sensitive to chemotherapy, and even the lesions can disappear completely. However, studies have shown that even in patients with complete disappearance, local recurrence can occur quickly once chemotherapy is stopped. Therefore, it is advocated that the diseased lung lobes should be removed even if they disappear completely. For other lung cancers, such as squamous carcinoma and adenocarcinoma, surgery is the first choice. Removal of the primary and intrathoracic lesions, combined with other comprehensive treatments, is the only hope for complete eradication. Imagine how difficult it should be to completely “cure” a huge solid tumor by drugs (whether Western or Chinese, genetic or immunological)! The toxicity of systemic drugs can be imagined. There is no shortage of patients who have died from “chemotherapy” in clinical practice. I have seen many cases in my life, some are senior cadres, some are scientists, some are soldiers, and some are college students. Chemotherapy was not completely stopped until death. There was a major officer in his forties, who asked the most famous experts in China to come up with a chemotherapy regimen, and the chemotherapy got so bad that his neck couldn’t support his head, and the whole person was dripping and jangling, and he couldn’t even sit down. I explained the condition to the family and said that no matter whose plan it was, no more chemotherapy could be given in this state. The family finally agreed to stop the chemotherapy. I told the doctor in charge that this patient could not be treated, and that he would die if he was treated again! And we must not make this money! The doctor stopped the treatment. But the next day I walked past his ward and saw that the chemotherapy drugs were still being dripped, and when I asked, I found out that the patient was adamant that he wanted to continue with this last chemotherapy treatment, and said that he had passed all 99 levels, so if he didn’t use the drugs for the last time, he would have given up all his work. I was speechless. The next day, the ward was empty and he left. It is said that chemotherapy is a double-edged sword, so mastering the balance of treatment and toxic side effects is a sign of a doctor’s maturity. Surgery must not be the only means. Because lung cancer, like other malignant tumors, may have local recurrence and distant metastasis in the future no matter how cleanly it is cut. Therefore, comprehensive treatment should be given. Chemotherapy is an important part. After surgery, the patient, no longer has tumor load, therefore, the dosage of chemotherapy drugs should be more reasonable. To date, the dosage of chemotherapy drugs based on body weight and body surface area are based on patients without surgery. There is no standard chemotherapy drug dosage for post-surgical patients worldwide. Therefore, it is all in the hands of the physician. Such patients do not rely on high doses of drugs to “cure” the tumor, but rather a systemic drug to prevent recurrence and metastasis. It is like in the battlefield, large regiments and bunker strongholds have been cleared, so it is not necessary to use a group of troops to clean up the stragglers. Otherwise, if the surgery is done well, the patient will be completely defeated by chemotherapy in the end. It is not what you want and it is not worth the loss. Immunotherapy has very few side effects and can theoretically enhance the patient’s immunity and reduce the chance of recurrence and metastasis, so it can be used as an adjuvant treatment. However, its therapeutic effect is also not obvious, and there is little hope to rely on it to cure the tumor. Other treatment methods, such as radioactive particle implantation, is actually a kind of internal radiation, using special equipment to place radioactive particles into the tumor, either through skin puncture or through surgery. Local treatment is effective, and mastering the indications and distributing the particles evenly is the key to achieve local eradication. Then radiofrequency treatment, which can also be performed through percutaneous or surgical incision, has good local treatment effect. Patients who are inoperable or cannot be removed surgically can consider a combination of these two methods in surgery to avoid needless exploratory surgery (simple switch). As for such as gene therapy, targeted therapy, etc., all have certain indications, but compared with surgery and radiotherapy, only a few patients with fairly good economic conditions, choose to use. All of them are not very mature yet and are under continuous exploration. In conclusion, the first treatment means for lung cancer is surgery. Pre-operative and post-operative radiotherapy and drug chemotherapy can be applied in combination according to different conditions. Immunotherapy can be used for both. Radioactive particle placement or radiofrequency therapy can be chosen in some cases.