Today, lung cancer has become the number one cancer in the country, taking 626,000 lives each year. The first time a lung test is reported to be slightly abnormal, everyone often becomes nervous and at risk.
In recent years, the term “pulmonary nodule” has become a hot search term on major medical websites, and it is an imaging diagnosis in which a lung shadow less than 3 cm in diameter found on a chest X-ray or chest CT is called a pulmonary nodule, with those less than 1 cm in diameter called small pulmonary nodules and those less than 0.5 cm in diameter called micronodules. microscopic nodules.
As awareness of “early diagnosis and treatment” of cancer spreads and CT imaging technology improves, more and more lung nodules are being detected.
Foreign surveys show that the detection rate of pulmonary nodules in people aged 18-24 years is more than 1 per 1,000, and increases with age, with a detection rate of nearly 2% in people aged 55-64 years.
Taking into account factors such as air pollution and dietary habits, the prevalence of pulmonary nodules in our population is likely to be higher.
However, the mixed messages of good and bad have left the people confused as to what is the relationship between lung nodules and lung cancer? Do the dreaded lung nodules have to be eliminated? Today, let’s talk about 5 facts about lung nodules so that we can get a comprehensive and objective understanding of this clinical phenomenon.
If a lung nodule is found to be so worrying, does it have to be lung cancer?
The lung nodule is a lung cancer.
Fact: This worry is overwhelmingly superfluous.
Patients who get a “lung nodule” are not sure if they have lung cancer.
Patients are often very nervous and even anxious when they get a diagnosis of a “lung nodule,” but in the eyes of the doctor, it’s not that bad.
First, in terms of probability, the vast majority of lung nodules found for the first time are benign (inflammation, tuberculosis, scarring, lymph nodes, etc.), and less than 20% are likely to be malignant. Second, even in the case of lung cancer, the vast majority are in the early stages and with appropriate treatment will barely affect the patient’s normal life expectancy.
So, in terms of early diagnosis and treatment of cancer, the detection of a lung nodule is a fortunate event that overwhelmingly ends in a comedy, and excessive worry mostly proves to be superfluous in the end. At this moment, the more important thing is to find a good doctor who can use his expertise to help you turn a happy ending into a reality at minimal cost.
Is it easy to find lung cancer in lung nodules?
Fact: Ruling out lung cancer is a highly technical task.
One of the most important things to do after finding a lung nodule is to rule out lung cancer. However, most lung nodules are found incidentally on examination and are not accompanied by clinical symptoms. It is not easy to rule out lung cancer because there are no characteristic clinical signs and the nodules are small and do not have obvious imaging features.
▲(Lung nodule increased from 3mm to 6mm a year ago on low-dose spiral CT in a 62-year-old woman.)
Source: Early detection of lung cancer, F1000Res., 2016.5
There are 3 things that need to be accomplished in order to rule out lung cancer:
1 clarify whether you are at high risk for lung cancer
This is critical when your doctor is assessing the benignity of the nodule!
These high-risk factors include:the patient’s age, lifestyle habits, long-term environmental exposure, previous health status, and genetic information. For example, do you smoke or have you ever smoked? Is there a history of exposure to carcinogens (asbestos, radon, radium, etc.)? Have you ever had other cancers? Are there other lung diseases such as emphysema or pulmonary fibrosis? Have parents, brothers, and children ever had cancer?
It is important to note that being at high risk does not mean that a lung nodule is necessarily lung cancer, and being at low risk does not necessarily mean that it is not; it is really a matter of probability.
② Completion of a high-quality CT examination
Chest radiographs and low-quality CT are hardly adequate for diagnosis, and PET-CT, a functional test with high expectations, is only suitable for identifying larger, solid nodules. Currently, high-resolution CT (HRCT) combined with various imaging techniques provides the most comprehensive and accurate characterization of pulmonary nodules.
3 Most important is to find a team that is both specialized and experienced
This team needs to include thoracic surgeons, radiologists, and pulmonary physicians.
Given the shortage of healthcare resources in this country, which few patients have access to, it would be relatively more realistic to find an experienced surgeon at a larger medical center.
What should be done after a lung nodule is characterized?
Fact: Benign lesions should be left alone, and malignant should be promptly biopsied.
After thorough consideration of the degree of risk for cancer, the site of the tumor, and the CT presentation, the doctor will assess the risk of the lung nodule being lung cancer, and depending on the results of the assessment, the patient may receive the following treatment.
1 imaging is clearly benign or the lesion is less than 6 mm in diameter and does not require any further treatment
A portion of benign lesions have a very typical presentation on CT and the diagnosis can be confirmed by imaging alone, at which point a biopsy is not required.
As the quality of CT imaging has improved, many very small lung nodules have been detected. This subset of lung nodules is extremely unlikely to be lung cancer (<1%), and even if they are, they are mostly inert tumors that grow slowly, can live peacefully with the body for a long time, and do not necessarily need to be removed from the body.
There is a high probability that the lesion is lung cancer, and if the malignancy is estimated to be high, timely biopsy or surgery is needed to make a clear diagnosis
.
Some of the more malignant lung cancers have characteristic appearances on CT, such as larger size, more solid components, and active growth of tumors and blood vessels. Timely surgical biopsy in such cases can avoid the risk of tumor metastasis during the waiting process.
Does it have to be “just in time” to be surgically removed because it is difficult to characterize?
Facts: Follow up for a period of time and then operate when lung cancer is confirmed.
In the past, surgical resection was the preferred treatment for lung nodules, and the idea of “prompt and complete removal of the lesion” has been widely accepted by doctors and patients for some time.
But as the understanding of pulmonary nodules gradually improved, it became clear that a significant proportion of resected pulmonary nodules were benign or low-grade malignant lung cancer. Compared with patients who do not have surgery, surgical patients do not benefit in terms of survival from the resection of the lesion; rather, the removal of lung tissue often affects the patient’s quality of life or creates problems for possible future lung surgery.
As a result, the indications for surgery for pulmonary nodules are becoming more stringent, and more patients are waiting for a period of time before surgery or biopsy to repeat CT exams to improve diagnostic accuracy by observing changes in the nodule, known medically as “follow-up.
This is similar to how it is often wrong to judge a person based on the first meeting, but if you wait a while, the chance of being wrong is greatly reduced. The following are some of the more than a dozen combinations of follow-up plans that need to be developed by a medical professional, depending on the chances of a lung nodule being a lung cancer.
Should everyone diagnosed with lung cancer have surgery?
Fact: A high level individualized treatment plan is the answer that is right for you.
“Sometimes to heal, often to help, always to comfort.” A widely circulated interpretation of medicine from Dr. Trudeau’s epitaph.
We often say that maximizing the benefit to the patient is the central purpose of all medical practice. A qualified physician should evaluate the specific situation comprehensively and develop an individualized plan that is in the patient’s interest based on the level of disease awareness.
For example, in the same case of an early-stage lung cancer of 1.0 cm in diameter, the primary treatment goal for a 40-year-old patient is to remove the lesion in time to ensure a cure and return him to society as a healthy person.
When switched to an 80-year-old, the patient’s survival is hardly benefited by surgery, and the risk of complications and low lung function associated with surgery can affect quality of life in later life, when surgery is not an appropriate treatment option.
If you then switch to a successful person in their 50s who is facing the last hurrah of their career, closely monitoring the progression of the nodules and waiting 3 to 5 years to achieve their career dreams before surgery, there is still a good chance of cure.
In conclusion, you don’t need to worry too much after finding a lung nodule. Find a professional and experienced team with doctors whose expertise will help you get through this.
- Author: Wu Hao, Deputy Chief Physician of Thoracic Surgery, Peking University Shenzhen Hospital, M.D., Master’s Degree Supervisor; Standing Committee Member of the Guangdong Health Management Society for Thoracic Tumor and Lung Nodule Management, Member of the Thoracic Surgery Committee of Shenzhen Medical Association, Deputy Leader of the Minimally Invasive Group; has been engaged in clinical work of thoracic surgery for nearly 20 years, specializing in the application of thoracoscopy He specializes in the treatment of lung cancer, bronchiectasis, spontaneous pneumothorax, esophageal cancer, myasthenia gravis, mediastinal tumors, correction of funnel chest (Nuss surgery), hand sweating, etc. He studied under Professor Wang Jun, Director of Thoracic Surgery at Peking University People’s Hospital, who is the “first person to perform thoracoscopic surgery in China”.