According to the survey on the causes of death of urban and rural residents in China in recent years, malignant tumors have surpassed cardiovascular diseases to take the first place, while lung cancer takes the first place among malignant tumors, and its incidence rate and mortality rate are also rising rapidly, thus it can be said that lung cancer has become the first killer of people’s health!
Lung cancer is a cancer that grows in the bronchial epithelium or alveolar epithelium, mostly occurring in the bronchial epithelium first. The epithelial cells of the tumor grow abnormally and proliferate indefinitely, and can spread to the surrounding areas or even the whole body. When lung cancer is detected, 80% of patients are already in advanced stage, and the efficacy is extremely poor, while the 5-year survival rate of early stage patients can reach over 70%. Popularizing lung cancer knowledge, regular screening, early detection, early diagnosis and early treatment are effective means to improve the survival rate.
Isolated lung nodule refers to a single parenchymal lung lesion less than 3cm in diameter without pulmonary atelectasis or hilar lymph node enlargement on imaging, which is a major manifestation of early lung cancer. With the development of imaging, especially the development and wide application of low-dose spiral CT, the detection rate of isolated lung nodules has increased significantly. How to detect early cancer nodules and provide timely surgical intervention is the key to improve the outcome!
Who should have regular low-dose spiral CT scan?
1.Age ≥ 45 years old, those who smoke 400 cigarettes per year or more than 20 cigarettes per day or long-term passive smokers.
2, people with chronic cough that is persistent, shortness of breath, asthma/ wheezing
3, those with persistent chest pain or persistent site symptoms, such as bone pain
4.Persons with cough with blood and hoarseness
5. those with a history of previous lung disease (e.g. tuberculosis)
6, those with recurrent episodes of bronchitis or pneumonia
7. persons with unexplained loss of appetite or weight loss
8.People with a history of lung cancer in their immediate family.
9.Other risk factors include: those with a history of exposure to hazardous substances such as radon or asbestos.
What are the symptoms of early stage lung cancer?
1.Cough, hemoptysis, fever, chest pain, chest tightness, shortness of breath or weakness may be present. About 45% of the cases have cough as the first symptom. Hemoptysis as the first symptom accounts for 20%.
2.Changes in symptoms of chronic lung disease: When lung cancer is complicated, its symptoms will be changed, such as repeated blood in sputum, choking cough, and continuous worsening of chest pain.
3.Extrapulmonary manifestations: pestle and mortar fingers (toes), osteoarthrosis, dermatomyositis, myasthenia gravis syndrome, endocrine disorders, may appear earlier than respiratory symptoms, thus providing clues for early diagnosis.
What should I do after finding a small pulmonary nodule?
Accurate and timely clarification of the diagnosis of pulmonary nodules, especially the differential diagnosis of benign and malignant, is a difficult task for clinicians. Early detection of cancerous nodules and timely surgical intervention are the keys to improve the outcome!
Once a small lung nodule is found, it should be seen in a regular hospital immediately. Doctors usually make a preliminary judgment based on the imaging characteristics and medical history, and if it is new, regular anti-inflammatory treatment will be given for 1-2 weeks, and then X-ray examination will be repeated to exclude inflammation, and sometimes tuberculosis examination, sputum for tumor cells and blood-related tumor indexes will be performed at the same time.
When lung cancer cannot be excluded by the above methods, PET-CT examination is feasible if available (at own expense, about 7000 RMB). It can reflect the abnormal metabolism and perfusion of tumor, protein synthesis, DNA replication, and metabolic kinetics of anti-cancer drugs in a flexible and accurate way.
It is specifically applied to the following situations.
1, differential diagnosis of intrapulmonary lesions.
2.Judgment of lung malignancy, especially the extent of lung cancer, local invasion, lymph node metastasis, which is of great help in clinical staging.
3.It is more helpful in determining the residual or recurrence of fibrous scar lesions formed after lung cancer treatment, such as surgery and radiotherapy.
4.Monitoring the effect of treatment. However, PET, like other imaging examinations, is not 100% accurate.
Pathological diagnosis is the “gold standard” of lung cancer diagnosis. When the diagnosis cannot be confirmed by non-invasive examination, invasive examination is needed, usually fiberoptic bronchoscopy is the first step, and about 70% of lung cancers can be detected by fiberoptic bronchoscopy to obtain specimens for histological or cytological examination. In general, puncture is not recommended for diagnosis because the lung must move up and down constantly with breathing, especially for small lung lesions, it is more difficult to accurately locate puncture for diagnosis, and if the puncture is negative, it is likely that the lesion is not reached and there is a risk of tumor implantation.
Still fail to confirm the diagnosis, unless the clinical diagnosis of benign may be large, regular follow-up is possible, once there is progress, surgery should be performed immediately, but there is a risk of delayed treatment. Otherwise, surgery should be considered. In the past, surgical treatment of thoracic tumor was mainly performed through one of the standard postero-lateral incision, antero-lateral incision, median incision and Hirschsprung’s incision which transects the sternum. The surgery incision is large, and the soft tissues and nerves of the chest wall are easily damaged. With the change of medical model to “bio-social-psychological” model, and the development of natural science (electronic imaging equipment, imaging, remote operation machinery, etc.) and medical level of thoracic surgery (isolated single lung ventilation anesthesia technology, manual suture ligation surgical technology, etc.), the development of thoracic surgery is gradually formed. The development of minimally invasive thoracic surgery, mainly including thoracoscopic surgery, mediastinoscopic surgery, and small incision surgery with preserved pectoral muscle, has gradually emerged. Minimally invasive thoracic surgery includes thoracoscopic surgery, mediastinoscopic surgery, and small incisions to preserve the chest muscle. Minimally invasive thoracic surgery minimizes the trauma and damage to the patient’s body and systems in all aspects of the perioperative period, while treating the chest lesion as thoroughly as a traditional open chest. Minimally invasive thoracic surgery incisions are smaller than traditional thoracic surgery incisions, but not in the sense of “small incisions” or even “no incisions”, but in the sense that the overall damage to the heart, lung, liver, kidney function and the nervous and motor systems is significantly reduced.
The latest concept of lung cancer treatment
With the deepening understanding of lung cancer, there are two changes in the concept, and experts at home and abroad agree that: 1. Lung cancer is a systemic and chronic disease, so the purpose of lung cancer treatment has changed from radical treatment to cure or control, and the emphasis is on prolonging life while improving the quality of survival. chemotherapy, radiotherapy and any other means have certain limitations and cannot achieve the best results, emphasizing multidisciplinary comprehensive treatment, emphasizing different treatment for different patients, that is, individualized treatment.
Expert advice.
1. Not all lung tumors can be treated with minimally invasive surgery, there are many chest tumors that must be treated with conventional surgery to achieve satisfactory results.
2. Minimally invasive surgery generally requires more special surgical instruments and is more expensive, while its efficacy is similar to that of conventional surgery, so it should be considered carefully according to your own economic condition.
As a thoracoscopic surgeon, the primary and necessary condition is to have solid basic skills in open-heart surgery and to be a qualified thoracic surgeon who can independently carry out routine thoracic surgery. Secondly, they should master the basic knowledge and basic skills of thoracoscopic surgery and be trained in a formal training center in order to carry out thoracoscopic surgery correctly. Due to the limitations of the level of understanding and technical conditions and other issues, the development of TV thoracoscopic surgery in China is still very unbalanced and the overall level is still relatively backward, so it is best to go to a regular hospital for thoracoscopic surgery.