Patient: Description of condition (onset, main symptoms, hospital visited, etc.): Male, 63 years old, long history of smoking, pharyngitis, chronic bronchitis, large pulmonary alveoli. On November 17, he was diagnosed with lung cancer by CT-enhanced CT during a physical examination at a hospital unit in Hangzhou. The rest of the physical examination items including chest X-ray, blood biochemistry, carcinoembryonic antigen, etc. were not different. Last year’s physical examination CT only showed large pulmonary alveoli and no lesions around the main airways. After consulting with the radiology and respiratory departments of ZJII and ZJI, there was a suspicion of tracheal cancer. Since the lesion is on the outer wall of the main trachea, the biopsy cannot be taken by fibrinoscopy, and since the lesion is between the main trachea, esophagus and veins, surgery is risky. Currently, thoracoscopic surgery is recommended to remove it. All doctors say that this location is difficult to operate and it may be difficult to take the lesion. I would like to know: 1. What is the worst case scenario if the lesion cannot be removed? 2. Will the trachea, esophagus, and veins be injured due to the bad location? Or more serious accidents may occur. 3.What will be the prognosis of surgery? Hospital thoracic surgery: Imaging (CT) considers tracheal tumor or lung cancer invading the outer wall of trachea, but the degree and length of tracheal invasion is not clear, so it is recommended to improve the chest CT 3D imaging. If biopsy is needed to clarify the pathology, EBUS or TBLB is recommended for puncture. Thoracoscopic surgery is not recommended for the time being. Patient: Hello doctor! Thank you for your reply. I don’t understand the 2 puncture methods you suggested and I will get to know them as soon as possible. I would like to ask for further advice 1, the doctor said we have already delayed for a month and cannot delay any longer, but I want to do some other tests which may be delayed again for some time, will this lead to very dangerous consequences. 2, if I can’t confirm whether it is benign or malignant, do I still need surgery to remove it? Patient: Hello doctor! I regret that I didn’t listen to you. Due to the fear of cancer, I had the surgery and was discharged from the hospital (4 days after the surgery), and before the surgery, I had a cranial scan, fibrinoscopy, gastroscopy, esophagogram, ultrasound, etc. All of them were normal. The section shows two solid areas 2.3×2CM,2X1.2CM, showing epithelioid cells aggregated into nests, part of the area with necrosis. Diagnosis: granulomatous inflammation (right lung) (tuberculosis is the first consideration) At the time of discharge, I was prescribed only the hospital’s own phlegm and cough drops, and the doctor said that I did not need to take any medicine or treatment. My concern now is: 1, since it is inflammatory and tuberculosis, will opening the surgery stimulate its malignant change? 2. Do I need no treatment for tuberculosis? I would like to ask you to continue to give me some guidance, thank you! Hospital Thoracic Surgery: Surgery will not change the nature of the disease, nor will there be an effect on its benign and malignant transformation. If it is tuberculosis, standardized anti-tuberculosis treatment is required. Patient: Hello, doctor! Thank you for your reply, I feel much more at ease. As you are a pulmonary specialist, I would like to ask you again. Although it is not lung cancer this time, my doctor told me that it is slow-onset lung when I was discharged from the hospital, and the prognosis is worse than cancer. The prognosis is worse than cancer, because cancer can be treated with radiotherapy or surgery, but COPD is untreatable, not only untreatable, but also progressive, which means that patients can only wait for death passively. Please help me to check the test results, and I have one point that I can’t figure out, since the bronchial tubes are clear in the upper and lower left and right bronchial tubes in the fibrinoscopy, where is the obstruction to slow lung? Pulmonary function tests: decreased spirometry and expiratory volume, decreased first second expiratory volume, decreased first second rate, decreased expiratory flow-volume curve, increased residual air volume, decreased carbon monoxide diffusion and alveolar carbon monoxide diffusion; conclusion: moderate obstructive ventilation dysfunction, moderately decreased carbon monoxide diffusion function. All airways were patent. Diagnosis: moderate chronic obstructive pulmonary disease. Is it possible that my condition is more serious? What should I do? I’m sorry for the many questions, please forgive me! Hospital Thoracic Surgery: Chronic obstructive pulmonary disease is short for chronic obstructive pulmonary emphysema and has nothing to do with the patency of the tracheobronchial tubes. The prognosis of chronic obstructive pulmonary disease is not good, but your current condition is not so serious that it should be compared with cancer, please go to the relevant medical institution for details and ask them to make a diagnosis based on your medical records. If the postoperative pathology is tuberculosis, you should go to a tuberculosis clinic for anti-tuberculosis treatment.