Excerpted from the interview of Health News by Director Su Zhiyong If a person or his family members go to the hospital for examination and find out that they may have malignant tumor, most of them will be very scared and confused: “Do I really have cancer?” “Is my tumor highly malignant?” “Which department should I go to?” “Who can help me choose the right treatment method?” This series of questions need patients and family members to face calmly. Today, we ask expert Director Su Zhiyong to take lung cancer as an example and talk about the issues that need to be noted in tumor diagnosis and treatment. Su Zhiyong of Cardiothoracic Surgery Department of Chifeng College Hospital After getting the preliminary diagnosis, patients have to confirm the diagnosis, choose the treatment plan and carry out step by step treatment. In the process of diagnosis and treatment, patients should ask themselves and doctors the following questions. Question 1: Do I really have lung cancer? In some hospitals, especially in primary hospitals, some doctors have limited level of reading chest CT and X-ray films and lack basic knowledge and ability to diagnose, differential diagnosis, evolution of lung cancer images and complications of advanced lung cancer. Many patients are misdiagnosed and some of them are confirmed to be benign lesions after surgery, instead some patients with suspected benign lesions before surgery are found to be malignant lesions after surgery. Therefore, if a problem is found in the lung, neither be overly alarmed nor ignore it, but calm down and go for further examination to confirm the diagnosis. Question 2 Is there an accurate pathological diagnosis and preoperative staging? The treatment for different stages of lung cancer is different. The closer the lung cancer is to the early stage, the more it can benefit from thoracic surgery. Thoracic surgeons can take minimally invasive tissue biopsy methods, such as lung puncture, tracheoscopy, thoracoscopy, mediastinoscopy, trans-ultrasound guided bronchoscopic puncture biopsy, magnetic navigation, etc., to take lesion tissues for biopsy, which can lead to accurate pathological diagnosis and staging of lesions. Early diagnosis can bring convenience in treatment and prevent simple diseases from dragging to complications. If treatment is delayed, problems that could have been solved by minimally invasive means will have to undergo open-heart surgery; what could have been done 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. Question 3: Have you gone through multidisciplinary consultation? Some general hospitals have established a multidisciplinary consultation system for lung cancer, which includes thoracic surgery, respiratory medicine, oncology, radiotherapy and interventional medicine, and the expert group will regularly consult with lung cancer patients to formulate scientific and reasonable treatment plans. Lung cancer patients will be staged before treatment, which avoids the practice of treating patients first by whichever department’s doctors receive them first, and minimizes the occurrence of irregularities such as blind treatment, excessive treatment, ineffective treatment, profit-driven treatment, accompanying treatment, even chemotherapy without pathology, and targeted treatment without basis and screening of sensitive drug tests. Question 4: Is my treatment plan an individualized treatment plan jointly developed by the expert group? Individualized treatment is a new model of lung cancer treatment in recent years, the essence of which is to select the appropriate beneficiary population and treatment method according to clinical stage, age, physical condition, underlying disease, etc. If the thoracic surgeon thinks it is inoperable during the consultation, the patient can be sent to chemotherapy in medical oncology, radiotherapy in radiotherapy, and also radiofrequency, particle, thermal perfusion, targeted and Chinese medicine. Especially, chemotherapy and targeted therapy should be mentioned. When choosing first- and second-line chemotherapy regimens for advanced lung cancer, four to six cycles of chemotherapy are generally administered with a platinum-containing two-drug regimen. Clinically, it has been found that the same chemotherapy regimen for the same gender and pathological type can have different therapeutic effects for different patients. Mutations in different genes make the effect of chemotherapy and targeted therapy of drugs very different. For example, a platinum-containing two-drug regimen with paclitaxel plus cisplatin is only 25% to 45% effective, meaning that at least 60% of patients do not benefit from a platinum-containing two-drug regimen. If a patient has low expression of the ERCC1 gene, then he may benefit from a platinum-containing chemotherapy regimen. Even though targeted drugs are now available, because it requires testing based on mutations in the EGFR gene to target the beneficiary population, and this mutation rate is 20% in Europe and 30% in China. This means that 70% to 80% of patients do not have EGFR mutations and they do not benefit from targeted therapy. Thoracic surgeons can obtain pathology through various methods such as lung puncture, thoracoscopy and mediastinoscopy, and then determine it through genetic testing. Those who do not have genetic mutation do not have to use targeted drugs and do not have to spend hundreds of thousands of dollars more on medical expenses. Question 5: Are some advertisements claiming to be able to cure tumors worth believing? Don’t believe the false and exaggerated advertisements about “traditional Chinese medicine” and “ancestral secret recipes”. If there were really such panacea and hermits, then China’s Nobel Prize would not be a blank. Of course, we do not reject the role of traditional medicine as an adjuvant treatment, but we must not give up the first-line treatment including surgery, radiotherapy and chemotherapy, and put the cart before the horse in seeking Chinese medicine treatment, which often delays the best treatment time.