Core Tip: Lung cancer, according to the latest cancer surveillance released by Guangzhou CDC, ranks first in the incidence and mortality rate of malignant tumors in Guangzhou. However, for any patient who learns that he or she has lung cancer, he or she often asks, “Why is it found at an advanced stage?”, “Can’t it be found even if I have an X-ray every year?”, “Does it not need to be treated at an advanced stage? “Lung cancer, according to the latest cancer surveillance released by Guangzhou CDC, ranks first in the incidence and mortality rate of malignant tumors in Guangzhou. However, for any patient who learns that he or she has lung cancer, he or she often asks, “Why is it found at an advanced stage?”, “Can’t it be found even if I have an X-ray every year?”, “Does it not need treatment at an advanced stage? “…… Nowadays, many organizations will organize a physical examination once a year, one of which is chest X-ray, so why is lung cancer found in the middle and late stages? X-ray chest examination in medical checkups has a very high rate of missing diagnosis for early stage lung cancer. On an orthopantomogram, about 43% of the lung area overlaps with the heart, mediastinum, diaphragm and other tissues, making some early lung cancers difficult to detect. Chest radiographs also lack density contrast, and the detection rate of mediastinal lymph node metastases from lung cancer is low. In addition, even if a mass is found on chest X-ray, its exact location, nature and stage cannot be clarified. Since lung cancer is related to long-term smoking (including second-hand smoke), air pollution, decoration pollution and kitchen fume pollution, it is recommended that we should pay attention to two points: 1. Annual physical examination, if there is any problem in chest X-ray, or if there are suspicious symptoms but no problem is found in chest X-ray, further examination such as CT, fiberoptic bronchoscopy and percutaneous lung aspiration biopsy are needed for further confirmation; 2. This is because spiral CT has a very high resolution and can detect nodules smaller than 4 mm, and the radiation dose of low-dose spiral CT is significantly lower than conventional CT, which does not cause significant harm to human body. Why is it always late when detected? Lung cancer is difficult to detect because patients do not feel the symptoms in the early stage. If the tumor grows in the bronchial tubes, symptoms such as cough, blood in sputum and chest tightness may appear in the early stage of the disease. If lung cancer occurs in the periphery of the lung and close to the pleura, it will cause chest pain, chest tightness and other uncomfortable symptoms at an early stage and attract attention; however, if lung cancer occurs in the parenchymal part of the lung, far from the bronchus and the pleura, symptoms will appear only when the tumor metastasizes or local compression occurs, and patients are often alerted and discovered at a more advanced stage. Generally speaking, lung cancer has the following early symptoms – cough. If the tumor grows on the bronchopulmonary tissue, it may cause irritating cough. 1. Low fever. After the tumor blocks the bronchial tubes, there are often obstructive lung lobes present, and the degree varies from only low fever in mild cases to high fever in severe cases. 2.Chest distension and pain. Early stage lung cancer chest pain is mild, mainly manifested as boring pain or hidden pain, and the location is not certain. If the pain is persistent, it means that the cancer may involve the pleura. 3. Sputum and blood. There may be small amount of bleeding when capillaries are broken due to tumor, which is often mixed with sputum. Many lung cancer patients are found due to sputum and blood. Are lung shadows and small lung nodules lung cancer? After taking a CT, the most fearful thing is that it says “shadows in the lungs” or “small nodules found”, some people are very worried that it is lung cancer, but some people just let it go. To determine whether a small lung nodule is lung cancer or not, you need to be very experienced in clinical diagnosis, so you must ask a specialist to help you make a decision. However, in general, most of the small lung nodules below 4 mm are benign and patients need not worry too much; while for small lung nodules above 8 mm, continuous CT follow-up scans should be performed because the rate of malignant changes in this category is then dramatically increased. If “ground glass”-like nodules are found in the lungs during CT examination, it is likely to be a sign of early lung cancer. Shadows in the lungs are often found unintentionally during physical exams or related tests. He pointed out that the discovery of lung shadows should not be taken lightly, nor should it be overly nervous. Lung shadows are not equal to lung cancer, and the nature of the disease causing the shadows should be distinguished first. Generally speaking, besides lung cancer and congenital abnormalities of lung development, infectious diseases of the lung, including pneumonia, tuberculosis and bronchial dilatation, are also common diseases that manifest as “lung shadows. Initial identification is usually done by low-dose CT scan of the chest or bronchoscopy. Is there no cure for advanced stage? Lung cancer at different stages is treated differently. Early to mid-stage lung cancer can be cured through thoracic surgery, especially thoracoscopic minimally invasive surgery. For patients with suspected advanced lung cancer, thoracic surgeons usually adopt minimally invasive tissue biopsy methods, such as lung puncture, tracheoscopy, thoracoscopy, mediastinoscopy, bronchoscopic puncture biopsy under ultrasound guidance, magnetic navigation and other examination means to take lesion tissues for biopsy, which can make accurate pathological diagnosis and stage the lesion. Early diagnosis can lead to ease of treatment and prevent simple diseases from being delayed to complication. If treatment is delayed, problems that could have been solved by minimally invasive means will have to undergo open-heart surgery; those that could have been treated early with radical resection may be delayed to the point of total lung resection with enlarged lobes, or even to the point of relying on radiotherapy to maintain a short survival period. Surgery, radiotherapy and targeted therapy are still the main treatments for lung cancer. At present, in the field of chemotherapy, with the development and application of new generation of highly efficient and low toxicity chemotherapy drugs, chemotherapy is no longer as painful and unbearable as people traditionally think. With the development of science and technology, tumor has become a chronic disease that can be controlled, just like hypertension and diabetes, and can be controlled by medication for the purpose of life extension.