Malignant tumor has been the top ten cause of death in China for many years, and lung cancer is the malignant tumor with the highest mortality. Moreover, in recent years, many celebrities have developed lung cancer even if they don't smoke, so people have an inexplicable fear of lung cancer, and the prevention and treatment of lung cancer has therefore become an important topic.
Lung cancer is a malignant tumor with high mortality, but different lung cancer cell types, treatment methods and drugs are very different. Radical surgery is the only chance for early lung cancer! Zhong Fucai, director of the Chest Department of New Taipei Tucheng Hospital (Chang Gung Memorial System), said that the correct diagnosis and staging of lung cancer is the most fundamental and important basis for the correct treatment of lung cancer. Let's take a look at the doctor's analysis.
Non-smoking female lung adenocarcinoma patients were followed up for more than 5 years after correct diagnosis and treatment.
46-year-old Ms. T came to the clinic for more than a month because of chronic cough, with abnormal shadow of left lung lobe and enlarged mediastinal lymph nodes. The most likely diagnosis is pulmonary adenoma with lymphatic metastasis. The following picture shows a case in which a mass was found in the left lung lobe on chest radiograph (as shown by the red arrow in Figure D). After the location of the mass in the left lung lobe is determined by chest computed tomography (as shown by the red arrow in Figure A), it is sectioned under the guidance of bronchoscope ultrasound (as shown by the red arrow in Figure C)? At the same time, chest computed tomography (as shown by the blue arrow in Figure A) and whole-body positron emission tomography (as shown by the blue arrow in Figure B) showed suspected paratracheal lymph node metastasis, which was treated by bronchoscopic mediastinal ultrasound and fine needle aspiration. (as shown by the blue arrow in Figure E) Get enough samples, and finally the pathological report proves that it is lymphatic metastasis of lung adenocarcinoma, complete the correct diagnosis and staging, and choose the correct treatment plan!
▲ Bronchoscopy-Diagnostic Staging Tool Diagram of Lung Cancer
How to correctly diagnose and stage lung cancer?
Malignant tumor has been the top ten cause of death in China for many years, and lung cancer is the malignant tumor with the highest mortality. Moreover, in recent years, many celebrities have developed lung cancer even if they don't smoke, so people have an inexplicable fear of lung cancer, and the prevention and treatment of lung cancer has therefore become an important topic.
Correct diagnosis and staging of lung cancer is the most fundamental and important basis for correct treatment of lung cancer. In addition to tumor size and organ invasion, the most important clinical staging of lung cancer is mediastinal lymph node staging. Usually, patients will first complete the clinical imaging diagnosis stage, that is, chest computed tomography and whole body positron emission tomography. However, depending solely on clinical images, it is impossible to correctly distinguish some inflammatory lesions from lymphatic metastasis caused by tumors. Accurate tumor diagnosis and lymph node staging can be obtained by ultrasonic sampling through bronchoscope. Bronchoscopic mediastinal ultrasound and fine needle aspiration provide the choice of mediastinal lymph nodes, which have less invasion and damage to normal tissues, but have higher accuracy. After fasting for 6-8 hours, local anesthesia and mild to moderate deep sedation can be completed in about 1 hour.
1. Diagnosis and staging of lung cancer
The first step is image diagnosis, usually a "chest X-ray". Abnormal shadow has been found in chest X-ray, and the nature and position of chest X-ray shadow are further confirmed by ordinary chest computed tomography. After the location and size of lung tumor are determined by chest CT, the next step is pathological diagnosis, which is called "biopsy".
Many patients will feel fear and even rejection when they hear that their lungs need to be sectioned. However, biopsy is the only way to obtain pathological diagnosis. So far, mild and moderate low-invasive sedation has improved the discomfort of examination. According to the size and location of the tumor, (1) bronchoscopy section, (2) image section, such as "chest ultrasound" or "computed tomography guided section", (3) surgical section, etc. Each has its own advantages and disadvantages, but it needs to be discussed with the doctor.
2. Bronchoscopic ultrasound
Bronchus has many branches in the lung, and computed tomography can only show the approximate location of the tumor. When the bronchus is sectioned, the lung tumor can be located by bronchoscopic ultrasound, and it can be sectioned correctly and effectively to correctly diagnose the lung tumor (as shown by the red arrow in Figure C).
3. Endoscopic mediastinal ultrasound and fine needle aspiration (EBUS-TBNA: transmediastinal ultrasound aspiration).
In the past, the staging accuracy of mediastinal and pulmonary lymph nodes was not good, while "surgical thoracoscope" or "mediastinoscopy" had high accuracy, but it required general anesthesia and tracheal intubation, which was traumatic. Therefore, "bronchoscopic mediastinal ultrasound and fine needle aspiration" provides a minimally invasive way and is a choice for correct staging of mediastinal lymph nodes. The ultrasonic probe at the front end of bronchoscope can diagnose the lesions of parabronchial lymph nodes, and enough samples can be obtained by bronchoscope mediastinal ultrasound and fine needle aspiration (as shown by the blue arrow in Figure E), and cytological or pathological staging can be obtained by sampling, which is most conducive to the correct staging of mediastinal lymph nodes and the opportunity of surgical resection of lung cancer. It also provides a high diagnostic rate and low invasive examination for mediastinal lymph node recurrence after surgical treatment. After fasting for 6-8 hours, the patient can be sedated by local anesthesia for about 1 hour, and can eat after 1 hour.
4. Drug therapy of lung adenocarcinoma
How to treat lung adenocarcinoma? According to the pathological tissue and staging results, the treatment method is decided. Patients with early lung cancer can be cured by surgery, and some patients must undergo preoperative dominant therapy or postoperative adjuvant therapy, such as chemotherapy, immunotherapy and radiotherapy.
If locally advanced lung cancer cannot be operated but has not metastasized, the patient can also receive chemotherapy and radiotherapy and consider the consolidation treatment of immunotherapy. We can also analyze the genetic variation of tumor and the patient's physical condition according to the pathological cell type, and choose targeted therapy, chemotherapy or radiotherapy. However, most patients with advanced lung adenocarcinoma have special gene mutations (EGFR, ALK, ROS 1, etc. ), about 55% of which are epidermal growth factor (EGFR) mutations, EGFR targeted drugs have also developed to the third generation, and medical insurance has been opened for payment. The non-deterioration survival time of EGFR target drugs used in the first line is about 9- 19 months, and the overall survival time is about 2 1-38 months. Doctors can choose appropriate drug treatment according to the type of gene mutation of patients.
People should pay attention to their health and avoid risk factors as much as possible. For high-risk groups, such as people with family history of lung cancer and smokers, low-dose chest computed tomography (LDCT) screening can also be considered, especially to detect lung nodules smaller than 1 cm, so as to increase the early detection rate of lung cancer. If there is any abnormality, you should seek medical advice as soon as possible so as to find and treat it as soon as possible.
Source: Health Care Network.