I. Overview
Primary lung cancer (hereinafter referred to as lung cancer) is one of the most common malignant tumors in China. 2010 Health Statistical Yearbook shows that in 2005, the mortality rate of lung cancer accounted for the first place in the mortality rate of malignant tumors in China. In order to further standardize lung cancer diagnosis and treatment behavior in China, improve the level of lung cancer diagnosis and treatment in medical institutions, improve the prognosis of lung cancer patients, and guarantee medical quality and medical safety, this specification is formulated.
II. Diagnostic Techniques and Applications
(A) High-risk factors. People with smoking history and smoking index greater than 400 cigarettes/year, history of high-risk occupational exposure (e.g. exposure to asbestos) and family history of lung cancer, and those aged 45 years or above are the high-risk group of lung cancer.
(II) Clinical manifestations.
1. Lung cancer may have no obvious symptoms in the early stage. When the disease develops to a certain extent, the following symptoms often appear.
(1) Irritating dry cough.
(2) Blood in sputum or bloody sputum.
(3) Chest pain.
(4) Fever.
(5) Shortness of breath.
When the respiratory symptoms cannot be relieved by treatment for more than two weeks, especially blood in sputum or irritating dry cough, or the existing respiratory symptoms are aggravated, the possibility of lung cancer should be highly alerted.
2.When lung cancer invades surrounding tissues or metastases, the following symptoms may appear.
(1) Hoarseness when the cancer invades the recurrent laryngeal nerve.
(2) The cancer invades the superior vena cava, and the symptoms of superior vena cava obstruction syndrome such as facial and neck edema may appear.
(3) The cancer invades the pleura and causes pleural effusion, which is often bloody; a large amount of effusion can cause shortness of breath.
(4) The cancer invades the pleura and chest wall, which can cause continuous severe chest pain.
(5) Upper lobe apical lung cancer may invade and compress the organ tissues located at the entrance of the thorax, such as the first rib, subclavian artery and vein, brachial plexus nerve, cervical sympathetic nerve, etc., producing severe chest pain, upper limb venous anger, edema, arm pain and upper limb movement disorder, ipsilateral upper eye and face drooping, pupil narrowing, eye sunken, facial sweating and other cervical sympathetic syndrome manifestations.
(6) Recent neurological symptoms and signs such as headache, nausea, vertigo or blurred vision should be considered as possible brain metastases.
(7) Bone metastasis should be considered for persistent bone pain at fixed sites and elevated plasma alkaline phosphatase or blood calcium.
(8) Right upper abdominal pain, hepatomegaly, elevated alkaline phosphatase, glutamic transaminase, lactate dehydrogenase or bilirubin should be considered as possible liver metastases.
(9) Nodules may be palpated under the skin in case of subcutaneous metastasis.
(10) Hematogenous metastases to other organs may show corresponding symptoms of the metastatic organ.
(3) Physical examination.
(1) Most patients with lung cancer do not have obvious positive signs.
2.Patients present with extra-pulmonary signs of unknown cause and long duration, such as pestle and mortar fingers (toes), non-wandering pulmonary joint pain, male breast enlargement, skin tanning or dermatomyositis, ataxia, phlebitis, etc.
3.Patients with highly suspicious clinical manifestations of lung cancer, physical examination reveals vocal cord paralysis, superior vena cava obstruction syndrome, Horner’s sign, Pancoast’s syndrome, etc. suggesting the possibility of local invasion and metastasis.
4.Patients with highly suspicious clinical manifestations of lung cancer, hepatomegaly with nodules, subcutaneous nodules, enlarged lymph nodes in the supraclavicular fossa, etc. on physical examination suggest the possibility of distant metastasis.