Lung Cancer | Complete Guide with Causes, Symptoms, Diagnosis and Treatment with Prevention Guideline

Lung Cancer as known is one of the most malignant lung tumors with the fastest growth in morbidity and mortality and the greatest threat to population health and life. Basically, it’s caused by the uncontrolled growth of lung tissue cells. Without proper treatment from the initial stage, the tumor cells will be transferred to nearby tissues and affected to other parts of the body.

The fact of lung cancer

In the past 50 years, the incidence and mortality of lung cancer have been significantly increased in many countries. The incidence and mortality of lung cancer in males accounted for the first place among all malignant tumors. The incidence rate of females ranked second and the mortality rate ranked second. The etiology of lung cancer is still not fully clear.

A large amount of data indicates that long-term large-scale smoking has a very close relationship with the occurrence of lung cancer. Previous studies have shown that the probability of lung cancer in a long-term large number of smokers is 10 to 20 times that of non-smokers. The younger the age of smoking, the higher the risk of lung cancer. In addition, smoking not only directly affects the health of the person, but also adversely affects the health of the surrounding population, resulting in a significant increase in the prevalence of lung cancer in passive smokers. The incidence of lung cancer among urban residents is higher than that in rural areas, which may be related to urban air pollution and carcinogens in smoke. Therefore, it should promote non-smoking and strengthen urban environmental sanitation.

Table of Contents: Fact of lung cancer Cause of lung cancer Disseminated metastasis of lung cancer Clinical manifestations Local symptoms of lung cancer Systemic symptoms of lung cancer Extrapulmonary symptoms of lung cancer Checkup Diagnosis Treatment for lung cancer Prevention

Basic Information about Lung Cancer:

The Nickname: Bronchitic lung cancer.
The English name: Lung cancer.
Visiting department: Oncology, thoracic surgery
Multiple groups: Smokers, people with chronic lung disease, those who are exposed to gas and asphalt, and those who receive excessive radiation.
Common causes: Smoking, occupational exposure, environmental pollution, tuberculosis, chronic inflammation of the lungs, family history, etc.
Common symptoms: Cough (including hemoptysis), blood in the sputum, low fever, chest pain, nausea and vomiting, shortness of breath, and weight loss.

What are the causes of lung cancer?

The Main causes of lung cancer are the below:

1. Smoking:

Smoking is currently considered to be the most important risk factor for lung cancer. There are more than 3,000 chemicals in tobacco, among which multi-chain aromatic hydrocarbons (such as benzopyrene) and nitrosamines have strong carcinogenic activity. Poly-chain aromatic hydrocarbons and nitrosamines can cause DNA damage in bronchial epithelial cells through various mechanisms, which inactivates oncogenes (such as Ras gene) and tumor suppressor genes (such as p53, FHIT genes, etc.), thereby causing cells. Transform and eventually become cancerous.

2. Occupational and environmental contact:

Lung cancer is the most important type of occupational cancer. It is estimated that about 10% of lung cancer patients have a history of environmental and occupational exposure. The following nine occupational environmental carcinogens have been shown to increase the incidence of lung cancer: by-products of aluminum products, arsenic, asbestos, bis-chloromethyl ether, chromium compounds, coke ovens, mustard gas, nickel-containing impurities, vinyl chloride. Long-term exposure to sputum, cadmium, silicon, formalin, and other substances will also increase the incidence of lung cancer, air pollution, especially industrial waste gas can cause lung cancer. Back to Top

3. Ionizing radiation:

The lungs are organs that are more sensitive to radiation. The initial evidence of lung cancer caused by ionizing radiation comes from the Schneeberg-Joakim mine, where the concentration of strontium and its daughters in the air is high, and most of the bronchial small cell carcinoma is induced. In the United States, it has been reported that 70% to 80% of miners who mine radioactive ore die from radiation-induced occupational lung cancer, mainly squamous cell carcinoma. From the beginning of contact to the onset time is 10 to 45 years, the average time is 25 years, and the average age of onset is 38 years old. When the accumulation of sputum and its daughters exceeds 120 working level days (WLM), the incidence begins to increase, while over 1800WLM, the incidence increases by 20 to 30 times. Exposure of mice to the gases and dust of these mines can induce lung tumors. The number of people suffering from lung cancer among Japanese atomic bomb survivors has increased significantly. In a lifetime follow-up of the Hiroshima atomic bomb survivors, Beebe found that survivors who were less than 1400 m from the heartbreaker were significantly more likely to die from lung cancer than those who died from 1400 to 1900 m and 2000 m.

4. Chronic infection of the lungs:

For patients such as tuberculosis and bronchitis, the bronchial epithelium may become squamous and cause cancer in the process of chronic infection, but it is rare.

5. Genetic factors:

Family aggregation, genetic susceptibility, decreased immune function, metabolic and endocrine dysfunction, etc. may also be It plays an important role in the occurrence of lung cancer. Many studies have shown that genetic factors may play an important role in people and/or individuals who are susceptible to environmental carcinogens.

6. Air pollution:

The incidence of lung cancer in developed countries is high, mainly due to the pollution of pollutants such as benzopyrene carcinogenic hydrocarbons produced by burning oil and coal and internal combustion engines in the industrial and transportation areas. Air pollution and smoking may promote each other's incidence of lung cancer and play a synergistic role.

Dissemination and metastasis of lung cancer:

Back to Top

1. Direct diffusion:

Tumors close to the periphery of the lung can invade the visceral pleura, and the cancer cells fall into the pleural cavity, forming a plant-like metastasis. Tumors with a central or near mediastinal surface can invade the pleural, chest wall, and mediastinal organs of the visceral wall.

2. Hematogenous transfer:

After the cancer cells return to the left heart with the pulmonary veins, they can be transferred to any part of the body. The common metastatic sites are the liver, brain, lung, skeletal system, adrenal gland, pancreas, and other organs.

3. Lymphatic metastasis:

Lymphatic metastasis is the most common metastatic pathway for lung cancer. Cancer cells pass through the lymphatic vessels around the bronchus and pulmonary vessels, first invading adjacent lung segments or lymph nodes around the bronchi, then reaching the hilar or subcarinal lymph nodes, then invading the mediastinum and paratracheal lymph nodes, and finally involving the supraclavicular or cervical lymph nodes.

Clinical manifestation:

The clinical manifestations of lung cancer are complex. The presence or absence of symptoms and signs, as well as the presence or absence of symptoms and signs, depends on the location of the tumor, the type of pathology, the presence or absence of metastasis, and the presence or absence of complications, and the differences in patient response and tolerability. Early symptoms of lung cancer are often mild, and may even be uncomfortable. Symptoms of central lung cancer appear early and severe, and symptoms of peripheral lung cancer appear late and light, even asymptomatic, often found during the physical examination. The symptoms of lung cancer are broadly divided into local symptoms, systemic symptoms, extrapulmonary symptoms, infiltration, and metastatic symptoms.

Symptoms of lung cancer

There are three categories of symptoms of lung cancer mentioned below such as a. Local symptoms, b. Systemic symptoms and c. Extrapulmonary symptoms.

(a) Local symptoms:

Local symptoms refer to symptoms caused by the tumor itself stimulating, occluding, infiltrating, and compressing tissue during local growth.

1. Cough:

cough is the most common symptom, with a cough as the first symptom, accounting for 35% to 75%. A cough caused by lung cancer may be associated with changes in bronchial mucus secretion, obstructive pneumonia, pleural invasion, atelectasis, and other intrathoracic complications. When the tumor grows in the bronchial mucosa above the segment with a large diameter and sensitivity to external stimulation, it can produce a cough caused by foreign body-like stimulation. The typical manifestation is a paroxysmal irritating dry cough. Generally, cough medicine is often difficult to control. When the tumor grows in the thin bronchial mucosa below the segment, the cough is not obvious, and there is no cough. Patients with smoking or chronic bronchitis, such as increased cough, frequency conversion, and cough properties such as high-pitched metal tone, especially in the elderly, should be highly alert to the possibility of lung cancer.

2. Blood or hemoptysis in the sputum:

Blood or hemoptysis in the sputum is also a common symptom of lung cancer, which accounts for about 30% of the first symptoms. Due to the rich blood supply of the tumor tissue, the texture is brittle, and the blood vessels rupture and cause bleeding during a cough. The hemoptysis may also be caused by local necrosis or vasculitis. Lung cancer hemoptysis is characterized by intermittent or persistent, repeated small amount of sputum with bloodshot, or a small amount of hemoptysis, occasionally due to large blood vessel rupture, large cavity formation, or tumor rupture into the bronchial and pulmonary vessels leading to uncontrollable large Hemoptysis. Back to Top

3. Chest pain:

About 25% of patients with chest pain as the first symptom. Often manifested as irregular or dull pain in the chest. In most cases, peripheral lung cancer invades the parietal pleura or chest wall, causing sharp and intermittent pleural pain, and if it continues to develop, it will evolve into constant pain. Mild chest discomfort, which is difficult to locate, is sometimes associated with central lung cancer invading the mediastinum or involving the blood vessels and peribronchial nerves, while 25% of patients with malignant pleural effusion complain of dull chest pain. Chest pain that persists sharply and violently and is not easily controlled by drugs often suggests a widespread pleural or chest wall invasion. Persistent pain in the shoulder or chest and back suggests a tumor invasion in the proximal mediastinum of the medial lobe.

4. Chest tightness, shortness of breath:

About 10% of patients have this as the first symptom, which is more common in central lung cancer, especially in patients with poor lung function. Causes of dyspnea mainly include: 1 advanced lung cancer, extensive mediastinal lymph node metastasis, compression of the trachea, carina or main bronchus, may anxiety, and even suffocation symptoms. 2 When a large amount of pleural effusion compresses the lung tissue and severely shifts the mediastinum, or when there is pericardial effusion, chest tightness, shortness of breath, and difficulty in breathing may occur, but the symptoms may be relieved after pumping. 3 diffuse bronchioloalveolar carcinoma and bronchial disseminated adenocarcinoma, reducing respiratory area, gas diffusion dysfunction, leading to severe ventilatory / blood flow ratio imbalance, causing dyspnea gradually worsening, often accompanied by cyanosis. 4 Others: including obstructive pneumonia. Atelectasis, lymphangitis, tumor microembolization, upper airway obstruction, spontaneous pneumothorax, and chronic lung disease such as COPD.

5. Sound hoarseness:

5% to 18% of lung cancer patients with hoarseness as the first complaint, usually accompanied by a cough. Vocal sputum generally suggests a direct mediastinal invasion or lymph node enlargement involving the ipsilateral recurrent laryngeal nerve leading to left vocal cord paralysis. Vocal cord paralysis can also cause upper airway obstruction to varying degrees

(b) Systemic symptoms:

1. Fever:

The first symptom is 20% to 30%. There are two causes of fever caused by lung cancer. One is an inflammatory fever. When a central lung cancer tumor grows, it often blocks the segment or bronchial opening, causing obstructive pneumonia or atelectasis in the corresponding lung or lung segment, but more fever. At around 38 °C, rarely exceeding 39 °C, antibiotic treatment may work, and the shadow may be absorbed, but due to poor secretion drainage, and often repeated attacks, about 1/3 of patients can repeatedly develop pneumonia in the same site in a short time. Peripheral lung cancer is often caused by inflammation in the late stage due to tumor compression caused by adjacent lung tissue. The second is cancerous fever, which is caused by the absorption of tumor necrotic tissue by the body. This kind of fever and anti-inflammatory drugs are ineffective, and hormones or steroids have certain curative effects.

2. Weight loss and cachexia:

Late lung cancer due to infection, pain caused by loss of appetite, tumor growth, and toxins caused by increased consumption, as well as increased levels of cytokines such as TNF and Leptin in the body, can cause severe weight loss, anemia, and cachexia. Back to Top

(c) Extra pulmonary symptoms:

Due to certain special active substances (including hormones, antigens, enzymes, etc.) produced by lung cancer, patients may develop one or more extrapulmonary symptoms, often before other symptoms, and may subside or appear with the growth and decline of the tumor. Clinically, pulmonary-derived osteoarthritis is more common.

1. Pulmonary osteoarthritis:

Clinically, the main manifestations are clubbing (toe), periosteal hyperplasia of the long bone, new bone formation, swelling of the affected joints, pain, and tenderness. The long bones are ribs, humerus, and metacarpal bones, and the joints are more common with large joints such as knees, ankles, and wrists. The incidence of clubbing and toe is about 29%, mainly found in squamous cell carcinoma; the incidence of proliferative osteoarthrosis is 1% to 10%, mainly found in adenocarcinoma, which is rarely seen in small cell carcinoma. The exact cause is not fully understood and may be related to estrogen, growth hormone, or neurological function. After surgical removal of cancer, it can be relieved or resolved, and recurrence can occur.

2. Tumor-associated ectopic hormone secretion syndrome:

About 10% of patients can develop such symptoms and can appear as a first symptom. Some patients have no clinical symptoms but can detect one or several elevated plasma ectopic hormones. These symptoms are more common in small-cell lung cancer.

1. Ectopic adrenocorticotropic hormone (ACTH) secretion syndrome The plasma cortisol is increased due to the secretion of ACTH or adrenocorticotropic hormone-releasing factor active substances in the tumor. The clinical symptoms are similar to those of Cushing's syndrome. They may have progressive muscle weakness, peripheral edema, hypertension, diabetes, hypokalemic alkalosis, etc., which are characterized by rapid progression of the disease and serious mental disorders. Skin pigmentation, while centripetal obesity, multi-blood, and purple lines are not obvious. This syndrome is more common in lung adenocarcinoma and small-cell lung cancer.


2. Ectopic gonadotropin secretion syndrome due to tumor autonomy secretion of LH and HCG and stimulating the secretion of glandular steroids. It is characterized by bilateral or unilateral mammary gland development, which can occur in various cell types of lung cancer, and is more common in undifferentiated carcinoma and small cell carcinoma. Occasionally, the penis is abnormally erect, in addition to the abnormal secretion of hormones, it may also be caused by penile vascular embolization.


3. Ectopic parathyroid hormone secretion syndrome is caused by the secretion of parathyroid hormone or a bone-dissolving substance (polypeptide) by the tumor. Clinically, it is characterized by high blood calcium and low blood phosphorus. The symptoms include loss of appetite, nausea, vomiting, abdominal pain, polydipsia, weight loss, tachycardia, arrhythmia, irritability, and confusion. More common in squamous cell carcinoma.


4. Ectopic insulin secretion syndrome Clinical manifestations of subacute hypoglycemia syndrome, such as mental disorders, hallucinations, headaches, and so on. The reason may be related to the large consumption of glucose by the tumor, the secretion of humoral substances similar to insulin activity, or the secretion of insulin-releasing polypeptides.


5. Carcinoid syndrome is caused by the secretion of serotonin by the tumor. It is characterized by bronchospasm, skin flushing, paroxysmal tachycardia, and watery diarrhea. More common in adenocarcinoma and oat cell cancer.


6. Neuro-muscle syndrome (Eaton-Lambert syndrome) is caused by tumor secretion of arrow toxic substances. It is characterized by voluntary muscle weakness and extreme fatigue. More common in small-cell undifferentiated cancer. Other peripheral neuropathy, spinal root ganglion cells, neurodegeneration, subacute cerebellar degeneration, cortical degeneration, polymyositis, etc., may have acromegaly weakness, dizziness, nystagmus, ataxia, difficulty walking and dementia.


7. Ectopic growth hormone syndrome manifested as hypertrophic osteoarthritis more common in adenocarcinoma and undifferentiated cancer.


8. Antidiuretic hormone abnormality syndrome is caused by the secretion of a large amount of ADH or a polypeptide substance having an antidiuretic effect. Its main clinical features are hyponatremia, accompanied by the low osmotic pressure of serum and extracellular fluid (admission continuous gravity greater l most osmotic plasma pressure renal specific than urine 1.200), and water intoxication. More common in small-cell lung cancer.

Back to Top

3. Other performance:

1. Skin lesions Acanthosis nigricans and dermatitis are more common in adenocarcinoma. Skin pigmentation is caused by the secretion of melanocyte-stimulating hormone (MSH), which is more common in small-cell carcinoma. Others have scleroderma, palmoplantar hyperkeratosis, and so on.


2. Cardiovascular system All types of lung cancer can have abnormal blood coagulation mechanisms, and there are migratory venous thrombosis, phlebitis, and non-bacterial embolic endocarditis, which can occur several months before the diagnosis of lung cancer.


3. The hematology system may have chronic anemia, purpura, erythrocytosis, and leukemia-like reactions. It may be caused by decreased iron absorption, shortened life span of erythropoiesis, and capillary oozing anemia. In addition, DIC can occur in lung cancer of various cell types, which may be related to the release of procoagulant factors by tumors. Patients with lung squamous cell carcinoma may be accompanied by purpura.


4. Symptoms of invasion and metastasis:
1. Lymph node metastasis: The most common are mediastinal lymph nodes and supraclavicular lymph nodes, mostly on the ipsilateral side of the lesion, a few can be on the contralateral side, mostly hard, single or multiple nodules, and sometimes can be the first complaint of the first visit. Swelling of the paratracheal or subcarinal lymph nodes can compress the airway and cause chest tightness. Anxious or even suffocating. Pressing the esophagus can cause difficulty swallowing.


2. Pleural invasion and metastasis: The pleura is a common site of invasion and metastasis of lung cancer, including direct invasion and implantable metastasis. The clinical manifestations vary with the presence or absence of pleural effusions and pleural effusions. In addition to direct invasion and metastasis, the causes of pleural fluid include lymph node obstruction concomitant obstructive pneumonia, and atelectasis. Common symptoms include difficulty breathing, cough, chest tightness, and chest pain, etc., and there are no symptoms at all; when the examination is performed, the intercostal space is full, the intercostal space is widened, the breath sound is reduced, the speech is reduced, the percussion is actually sounded, the mediastinum is displaced, etc. The pleural effusion may be serious or bloody, mostly exudate. The characteristic of malignant pleural effusion is that the growth rate is fast and bloody. Very rare lung cancer can occur spontaneous pneumothorax, the mechanism is a direct invasion of the pleura and rupture of obstructive emphysema, more common in squamous cell carcinoma, with poor prognosis.


3. Superior Vena Cava Syndrome (SVCS: Direct tumor invasion or mediastinal lymph node metastasis oppression of the superior vena cava, or embolization in the lumen, causing it to stenosis or occlusion, resulting in blood flow obstruction, a series of symptoms and signs, such as headache, facial edema, cervical and thoracic varicose veins, increased pressure Difficulty breathing, coughing, chest pain, and difficulty swallowing, often fainting or dizziness when bending over. The anterior and upper abdominal veins can be compensated for varicose veins, reflecting the time of obstruction of the superior vena cava and the anatomical location of the obstruction. Symptoms and signs of superior vena cava obstruction are related to its location. If one side of the unknown vein is blocked, the blood flow to the head and neck can be returned to the heart through the contralateral unnamed vein, and the clinical symptoms are mild. If the superior vena cava obstruction occurs below the entrance to the azygous vein, in addition to the above-mentioned vein dilation, there is still abdominal venous engorgement, and blood flows into the inferior vena cava in this way. If the occlusion develops rapidly, cerebral edema can occur with headaches, lethargy, irritation, and changes in consciousness.


4. Kidney transfer: About 35% of patients who died of lung cancer found kidney metastasis, which is also the most common metastatic site in patients who died within 1 month after surgical resection of lung cancer. Most kidney metastases have no clinical symptoms and can sometimes manifest as low back pain and renal insufficiency.


5. Digestive tract transfer: Liver metastasis can be manifested as loss of appetite, pain in the liver area, sometimes accompanied by nausea, serum γ-GT is often positive, AKP is progressively increased, liver enlargement, the hard and nodular sensation can be found. Small-cell lung cancer is prone to pancreatic metastasis and may present with pancreatic inflammation or obstructive jaundice. Lung cancer of various cell types can be transferred to the liver, gastrointestinal tract, adrenal gland, and retroperitoneal lymph nodes. It is clinically asymptomatic and often found during physical examination.


6. Bone transfer: Common sites of bone metastasis of lung cancer include ribs, vertebrae, humerus, femur, etc., but the ipsilateral ribs and vertebrae are more common, showing local pain and fixed point tenderness and pain. Spinal metastases can compress the spinal canal causing obstruction or compression symptoms. Joint involvement can cause fluid accumulation in the joint cavity, and cancer can be detected by a puncture.


7. Central nervous system symptoms:
1. The incidence of brain, meninges, and spinal cord metastases is about 10%, and the symptoms may vary depending on the site of metastasis. Common symptoms are increased intracranial pressure, such as headache, nausea, vomiting, and changes in mental status. Uncommon symptoms include seizures, cranial nerve involvement, hemiplegia, ataxia, aphasia, and sudden fainting. Meningeal metastasis is not as common as brain metastases and often occurs in patients with small-cell lung cancer, and its symptoms are similar to brain metastases.
2. Encephalopathy and cerebellar cortical degeneration The main manifestations of encephalopathy are dementia, psychosis, and organic disease. Cerebellar cortical degeneration is characterized by acute or sub-acute limb dysfunction, difficulty in limb movement, tremor movement, difficulty in pronunciation, dizziness, etc. It has been reported that the above symptoms can be alleviated after tumor resection.
8. Heart invasion and metastasis: It is not uncommon for lung cancer to involve the heart, especially in central lung cancer. Tumors can invade the heart by direct spread, or they can be spread retrogradely in the lymphatics. The draining lymphatics that block the heart cause pericardial effusion. Those who develop slower can be asymptomatic or only have pain in the anterior region, rib arch, or upper abdomen. Those with faster development may have typical symptoms of pericardial tamponades, such as urgency, palpitations, venous engorgement of the neck and face, enlargement of the heart, low heart sounds, hepatomegaly, and ascites.


9. Peripheral nervous system symptoms: The cancer is compressed or invaded by the cervical sympathetic nerve, causing Horner's syndrome, which is characterized by narrowing of the pupil of the diseased side, sagging of the upper eyelid, invagination of the eyeball and no sweat on the face. Brachial plexus compression is caused by compression or invasion of the brachial plexus manifested as ipsilateral upper limb burning-like radiation pain, local paresthesia, and nutritional atrophy. When the tumor invades the phrenic nerve, it can be approved for diaphragmatic paralysis, chest tightness, shortness of breath, and contralateral movement of the diaphragm can be seen under fluoroscopy. When oppressing or invading the recurrent laryngeal nerve, it can cause hoarseness in the vocal cords. Pulmonary tip tumors (upper sulcus tumors) invade the neck 8 and thoracic 1 nerves, brachial plexus, sympathetic ganglia, and adjacent ribs, causing severe shoulder-arm pain, paresthesia, flaking or weakness of one arm, muscle atrophy, the Pancoast syndrome.
Back to Top

Checkup:

1. X-ray inspection:

X-ray examination can be used to understand the location and size of lung cancer and may see local emphysema due to bronchial obstruction, atelectasis or invasive lesions in the vicinity of the lesion or inflammation of the lungs.

2. Bronchoscopy:

The bronchoscope can directly observe the lesions of the endobronchial and luminal lumens. Tumor tissue can be taken for pathological examination, or bronchial secretions can be taken for cytological examination to confirm the diagnosis and determine the histological type.

3. Cytological examination:

Sputum cytology is a simple and effective method for the screening and diagnosis of lung cancer. Most patients with primary lung cancer can find shed cancer cells in sputum. The positive rate of sputum cytology in central lung cancer can reach 70% to 90%, and the positive rate of peripheral lung cancer sputum detection is only about 50%.

4. Thoracotomy:

Pulmonary mass cannot be confirmed by various examinations and short-term diagnostic treatment. If the possibility of lung cancer cannot be excluded, it should be used for thoracotomy. This avoids delays in the disease and causes lung cancer patients to lose the opportunity for early treatment.

5. ECT check:

ECT bone imaging can detect bone metastases earlier. X-ray films and bone imaging have positive findings. For example, if the osteogenesis reaction is stationary and the metabolism is inactive, the bone imaging is negative and the X-ray film is positive. The two complement each other, which can improve the diagnosis rate. It should be noted that the false positive rate of ECT bone imaging for the diagnosis of bone metastasis of lung cancer can reach 20% to 30%. Therefore, the positive ECT bone imaging needs to be the MRI scan of the bone in the positive area.

6. Mediastinoscopy:

Mediastinoscopy is mainly used in patients with mediastinal lymph node metastasis, not suitable for surgical treatment, and other methods can not obtain a pathological diagnosis. Mediastinoscopy should be performed under general anesthesia. A transverse incision was made in the concave part of the sternum, and the soft tissue before the neck was bluntly separated to reach the anterior space of the trachea. The anterior channel of the trachea was bluntly released, and the observation mirror slowly passed through the inferior artery to observe the paratracheal, tracheobronchial angle, and bulge. The enlarged lymph nodes in the site were dissected by special biopsy forceps to obtain lymph node tissue for pathological examination.
The diagnosis of primary bronchogenic carcinoma includes symptoms, signs, imaging findings, and sputum cancer screening. Back to Top

Diagnosis:

Diagnosis is based on clinical signs, signs, imaging studies, and histopathological examinations. The early diagnosis of lung cancer is of great significance. Only when it is diagnosed and treated in the early stage of the disease can it achieve a better curative effect?

1. Lung cancer lacks typical symptoms in the early stage. For people over 40 years of age, chest X-ray screening should be performed regularly. Patients with primary or metastatic symptoms of lung cancer should be examined for chest X-ray or chest CT in time. If the lungs have a shadow of the tumor, the diagnosis of lung cancer should be considered first. Further examination should be performed and the diagnosis should be confirmed by histopathological examination.

Differential Diagnosis:

Typical lung cancer is easy to identify, but in some cases, lung cancer is easily confused with:

1. Tuberculosis

Tuberculosis, especially tuberculoma (ball) should be differentiated from peripheral lung cancer. Tuberculoma (ball) is more common in young patients, with a longer course of disease, less blood in the sputum, and tuberculosis in the sputum. The imaging is mostly round, found in the tip or the back of the upper blade, the volume is small, the diameter is not more than 5cm, the boundary is smooth, the density is uneven and the calcification is visible. There are often scattered tuberculosis lesions around the tuberculoma (ball) called satellite foci. Peripheral lung cancer is more common in patients over 40 years old, with more blood in the sputum, and 40% to 50% of cancer cells in the sputum. X-ray chest radiographs are often lobulated, with irregular edges, small burrs and pleural shrinkage, and rapid growth. In some cases of chronic tuberculosis, lung cancer can occur based on tuberculosis, and further sputum cytology and bronchoscopy must be performed, and if necessary, thoracotomy should be performed.

2. Pulmonary infection

Pulmonary infections are sometimes difficult to distinguish from obstructive pneumonia caused by lung cancer obstructing the bronchi. However, if pneumonia has multiple episodes in the same site, it should be vigilant. It should be highly suspected of tumor blockage. The patient's sputum should be taken for cytological examination and fiber light-guided vascular examination. In some cases, pulmonary inflammation Absorption, when the remaining inflammation is wrapped by fibrous tissue to form nodules or inflammatory pseudotumors, it is difficult to distinguish from peripheral lung cancer and thoracoscopic exploration should be performed for suspicious cases.

3. Benign tumors of the lungs

Benign lung tumors: such as structural tumors, chondromas, fibroids, etc. are rare but must be differentiated from peripheral lung cancer, benign tumors have a longer course, most clinically asymptomatic, X-ray film often round Block shadow, neat edges, no burrs, no lobes. Bronchial adenoma is a low-grade malignant tumor that often occurs in young women. Therefore, there are often pulmonary infections and hemoptysis in the clinic. Diagnosis can often be made by fiberoptic bronchoscopy.

4. Mediastinal malignant lymphoma (lymphosarcoma and Hodgkin's disease)

Clinically, there are often symptoms such as cough and fever. Imaging studies show that the mediastinum is widened and lobulated, and sometimes it is difficult to distinguish it from central lung cancer. If there is swelling of the lymph nodes on the supraclavicular or axillary fossa, a biopsy should be made for a clear diagnosis. Lymphosarcoma is particularly sensitive to radiation therapy, and small doses of radiation therapy can be tried in suspicious cases, which can significantly reduce the mass. This experimental treatment contributes to the diagnosis of lymphosarcoma.

Treatment for Lung Cancer:

Back to Top (a) Chemotherapy
Chemotherapy is the main treatment for lung cancer, and more than 90% of lung cancer need chemotherapy. The efficacy of chemotherapy for small cell lung cancer is relatively positive in both early and late stages, and even about 1% of early small cell lung cancer is cured by chemotherapy. Chemotherapy is also the main method for the treatment of non-small cell lung cancer. The tumor remission rate of chemotherapy for non-small cell lung cancer is 40% to 50%. Chemotherapy generally does not cure non-small cell lung cancer, only prolonging patient survival and improving quality of life. Chemotherapy is divided into therapeutic chemotherapy and adjuvant chemotherapy. Chemotherapy requires different chemotherapy drugs and different chemotherapy regimens depending on the type of lung cancer histology. In addition to killing tumor cells, chemotherapy also damages normal human cells, so chemotherapy needs to be carried out under the guidance of an oncologist. In recent years, the role of chemotherapy in lung cancer is no longer limited to patients with advanced lung cancer who cannot be operated on but is often included as a comprehensive treatment for lung cancer. Chemotherapy inhibits the bone marrow hematopoietic system, mainly the decline of white blood cells and platelets, and can be treated with granulocyte colony-stimulating factor and platelet-stimulating factor. Chemotherapy is divided into therapeutic chemotherapy and adjuvant chemotherapy.

(b) Radiation Therapy

1. Principle of treatment
Radiotherapy is the best for small-cell lung cancer, followed by squamous cell carcinoma and adenocarcinoma. The radiotherapy field of lung cancer should include the primary compartment and the mediastinal area of ​​lymph node metastasis. At the same time, it should be supplemented with medical treatment. Squamous cell carcinoma has moderate sensitivity to radiation, local lesions are mainly local invasion, and metastasis is relatively slow, so radical treatment is often used. Adenocarcinoma is less sensitive to radiation and is prone to hematogenous metastasis, so radiation therapy is less common. Radiotherapy is a topical treatment that often requires combination chemotherapy. The combination of radiotherapy and chemotherapy can be based on the patient's condition, taking concurrent chemoradiotherapy or alternating radiotherapy.

2. Classification of Radiotherapy

The purpose of treatment, it is divided into radical treatment, palliative treatment, preoperative neoadjuvant radiotherapy, postoperative adjuvant radiotherapy, and intracavitary radiotherapy.

3. The complications of Radiotherapy

Complications of lung cancer radiotherapy include radiation pneumonitis, radiation esophagitis, radiation pulmonary fibrosis, and radiation-induced myelitis. There is a positive correlation between the above-mentioned radiotherapy-related complications and the dose of radiotherapy, and there are also individual differences.

(c) Surgical treatment of lung cancer

Surgical treatment is the first and most important treatment for lung cancer and the only treatment that can cure lung cancer. The purpose of surgical treatment of lung cancer is to:
Completely remove the primary lesion of lung cancer and metastasis of lymph nodes to achieve clinical cure; Excision of the vast majority of tumors, creating favorable conditions for other treatments, namely cytoreductive surgery;

Reduction surgery: suitable for a small number of patients, such as refractory pleural cavity and pericardial effusion, through the removal of pleural and pericardial implant nodules, resection of part of the pericardium and pleura, cure or relieve clinical symptoms caused by pericardial and pleural effusion, prolong Life or improve the quality of life. The reduction surgery requires simultaneous local and systemic chemotherapy. Surgical treatment often requires adjuvant chemotherapy or radiotherapy before or after surgery to improve the cure rate of patients and the survival rate of patients. The five-year survival rate for surgical treatment of lung cancer is 30% to 44%; the mortality rate for surgical treatment is 1% to 2%. Back to Top

1. Indications for surgery

Surgical treatment of lung cancer is mainly suitable for early and middle stage (I～II) lung cancer, stage IIIa lung cancer, and partial selective stage IIIb lung cancer with one tumor on one side.

(1) Stage I and II lung cancer;
(2) Stage IIIa non-small cell lung cancer;
(3) Part of the IIIb stage non-small cell lung cancer with lesions confined to one side of the thoracic cavity;
(4) Patients with stage IIIa and part IIIb lung cancer who have been degraded by neoadjuvant chemotherapy before surgery;
(5) Non-small cell lung cancer with solitary metastasis (ie, intracranial, adrenal, or liver), if the primary tumor and metastases are suitable for surgical treatment, no surgical contraindications, and can reach the primary tumor and Completely removed metastalung cancer, tumor invasion of the pericardium, large blood vessels, diaphragm, tracheal carina, through various examinations to rule out distant or/and micro-metastasis, lesion limitations, patients without physiological surgery contraindications, can achieve the complete removal of tumor invaded tissue and organs.

2. Surgical contraindications

(1) Stage IV lung cancer with extensive metastasis
(2) accompanied by multiple groups of mediastinal lymph node metastases, especially those with invasive mediastinal lymph node metastasis;
(3) Stage IIIb lung cancer with contralateral hilar or mediastinal lymph node metastasis;
(4) Patients with severe visceral insufficiency who cannot tolerate surgery;
(5) Those who have a bleeding disorder and cannot correct it.

3. Choice of surgical procedures for lung cancer

The principle of surgical resection is to completely remove the primary tumor and lymph nodes that may metastasize in the thoracic cavity and to preserve normal lung tissue as much as possible. Pneumonectomy should be cautious.

(1) Pulmonary wedge and partial resection refers to the resection of wedge-shaped cancer and partial resection of the lung. It is mainly suitable for early-stage lung cancer with small volume, old and weak, poor lung function, or low cancer differentiation.

(2) Segmentectomy is the resection of the anatomical segment. It is mainly suitable for elderly patients with isolated solitary lung cancer with poor cardiopulmonary function or partial central lung cancer with localized lesions located at the root of lung cancer;

(3) lobectomy lobectomy is suitable for lung cancer confined to a peripheral and partial central lung cancer in a lobe. Central lung cancer must ensure that there is no cancer residue in the bronchial stump. If the lung cancer involves the two leaves or the middle bronchus, the upper middle or lower middle lobe can be resected;

(4) Bronchial sleeve-shaped lobectomy This procedure is mainly suitable for central lung cancer in which the lung cancer is located in the bronchus of the lung or the opening of the middle bronchus. The advantage of this procedure is that it achieves complete resection of lung cancer and preserves healthy lung tissue;

(5) Bronchial pulmonary artery sleeve-shaped lobectomy The surgical procedure is mainly suitable for central lung cancer in which the lung cancer is located in the bronchial or intermediate bronchial opening of the lung, and the lung cancer is simultaneously invaded. In addition to the need for bronchial resection, surgery requires simultaneous resection and reconstruction of the pulmonary trunk. The advantage of this procedure is that it achieves complete resection of lung cancer and preserves healthy lung tissue;

(6) tracheal carinal resection and reconstruction of the tumor more than the main bronchus involving the carina or tracheal wall but not more than 2cm, can be used for tracheal carinal resection or sleeve-type pneumonectomy if a leaf lobe is retained, Stress strives to preserve tracheal carinal resection and reconstruction of the lobes.

(7) Pneumonectomy Pneumonectomy refers to one side of the whole lung, that is, right or left pneumonectomy, which is mainly suitable for cardiopulmonary function, extensive lesions, and younger age, not suitable for lung lobe or sleeve. Lung cancer with lobectomy. The incidence of complications and mortality in pneumonectomy is higher. The long-term survival rate and quality of life of patients are not as good as lobectomy. Therefore, surgical indications should be strictly controlled.

4. Surgical treatment of recurrent lung cancer

Recurrent lung cancer includes recurrence of local residual cancer after surgery and second primary lung cancer with new lungs. For the recurrence of residual cancer in the bronchial stump, reoperation should be sought for bronchial sleeve formation to remove residual cancer.

For the second primary lung cancer that occurs after complete resection of lung cancer, as long as the lung cancer is suitable for surgical treatment, the patient's visceral function can tolerate re-surgical treatment, and there are no surgical problems, then the chest should be considered. Surgical resection of recurrent lung cancer. Back to Top

Prevention:

Lung cancer is preventable and controllable. Previous studies have shown that the incidence and mortality of lung cancer have decreased significantly in recent years after the West has passed the tobacco control and environmental protection. Prevention of lung cancer can be divided into three levels of prevention, primary prevention is the cause of intervention; secondary prevention is the screening and early diagnosis of lung cancer, reaching the early diagnosis and treatment of lung cancer; tertiary prevention is rehabilitation prevention.

Primary prevention:

1. Prohibit and control smoking
Foreign studies have shown that smoking cessation can significantly reduce the incidence of lung cancer, and the earlier the cessation of smoking cessation, the more obvious the incidence of lung cancer. Therefore, smoking cessation is the most effective way to prevent lung cancer.

2. Protect the environment

The existing research proves that the exposure doses of air pollution, sedimentation index, smoke index, and benzopyrene are positively correlated with the incidence of lung cancer. Protecting the environment and reducing air pollution are important measures to reduce the incidence of lung cancer.

3. Prevention of occupational factors

Many occupational carcinogens have been recognized for increasing the incidence of lung cancer, and reducing exposure to occupational carcinogens can reduce the incidence of lung cancer.

4. Scientific diet

Increasing the diet of vegetables, fruits, etc. can prevent lung cancer

Reference

1.
Individualized treatment options should be used for patients with lung cancer. Encyclopedia of famous doctors network. 2012-11-28[reference date 2014-01-03]
2.
Is lung cancer contagious? Encyclopedia of famous doctors network. 2011-11-18[reference date 2014-01-03]
3.
Why should lung cancer be treated after staging? Encyclopedia of famous doctors network. 2011-01-18[reference date 2014-01-03]

---

We hope, dear reader, to share your suggestions, your comments, and your thoughts. We take care of everything you send to us and will have the most interest to our editorial board. Thanks for your cooperation.
Copyright: Modern Herbalife
Not to be reproduced without the permission of Modern Herbalife.