Lung cancer-related knowledge Lung cancer is the most common primary lung malignant tumor, and the vast majority of lung cancer originated from bronchial mucosa epithelium, so it is also called bronchial lung cancer. In the past 50 years, the incidence and mortality of lung cancer have risen rapidly all over the world, especially in industrialized countries. Among men who died of cancer, lung cancer has ranked first. More than 40 years ago, most of the patients who underwent surgical treatment for lung diseases in China were tuberculosis, followed by pulmonary purulent infections such as bronchiectasis and lung abscess, and there were few cases of lung cancer. Directory [hidden] Etiological symptoms Early symptoms and late symptoms of lung cancer Extensive metastasis Symptoms and signs Lung cancer classification 1. Squamous cell carcinoma (squamous cell carcinoma): 2. Undifferentiated cancer 3. Adenocarcinoma 4. Diagnosis and examination of staging and metastasis complications of alveolar cell carcinoma and small cell lung cancer 1, X-ray examination 2, bronchoscopy 3, radionuclide examination 4. Cytological examination. Thoracotomy 6. ECT check 7. Mediastinoscopy treatment of lung cancer chemotherapy and radiotherapy 1. Radical surgical treatment of lung cancer (1) surgical indications (2) indications for thoracotomy (3) selection of lung cancer surgery (4) patients with recurrent or recurrent lung cancer should avoid eating and nursing methods. Kitchen fumes are more likely to cause lung cancer. Women with advanced lung cancer are more likely to have unique symptoms of TCM treatment. Home care of lung cancer patients should pay attention to three aspects: etiology, early symptoms, late symptoms of lung cancer and extensive metastasis of lung cancer. Classification of symptoms and signs of squamous cell carcinoma (also known as squamous cell carcinoma): 2. Undifferentiated cancer 3. Adenocarcinoma 4. Diagnosis and examination of staging and metastasis complications of alveolar cell carcinoma and small cell lung cancer 1, X-ray examination 2, bronchoscopy 3, radionuclide examination 4, cytology examination 5, thoracotomy 6. ECT check 7. Mediastinoscopy treatment of lung cancer chemotherapy and radiotherapy 1. Radical surgical treatment of lung cancer (1) Indications for surgery (2) Indications for thoracotomy (3) Selection of surgical methods for lung cancer (4) Patients with recurrent or recurrent lung cancer should avoid diet and nursing methods for health care and rehabilitation. Kitchen fumes are likely to cause lung cancer. Women are more likely to get lung cancer. The symptoms of advanced lung cancer are unique. Treatment of lung cancer patients with traditional Chinese medicine and home care should be paid attention to. Summarize that lung cancer occurs in bronchial mucosa epithelium, also known as bronchial lung cancer. Lung cancer generally refers to cancer in the lung parenchyma, and usually does not include mesothelioma originating from other pleura, or other malignant tumors such as carcinoid, malignant lymphoma, or tumors with metastasis from other sources. Therefore, lung cancer refers to malignant tumors from bronchi or bronchial epithelial cells, accounting for 90-95% of lung parenchymal malignant tumors. Lung cancer is the first cause of cancer death in the world at present. From 65438 to 0995, 600,000 people died of lung cancer in the world, and this number is increasing every year. The incidence of female lung cancer is especially on the rise. The onset age of this disease is mostly over 40 years old, and the peak age of onset is between 60 and 79 years old. The prevalence rate of male and female is 2.3: 1. Race, family history and smoking all affect the incidence of lung cancer. Lung cancer originates from bronchial mucosa epithelium and is confined to basement membrane, which is called carcinoma in situ. It can grow into bronchial cavity or/and adjacent lung tissue, and can spread through lymphatic blood circulation or bronchial metastasis. The growth rate, metastasis and spread of cancer are related to the histological type and differentiation degree of cancer. Lung cancer is more distributed in the right lung than in the left lung, and the upper lobe is more than the lower lobe. Cancer can develop from the main bronchi to the bronchioles. Lung cancer originating from the main bronchus and lobar bronchus and located near the hilum is called central lung cancer; Lung cancer originating from the lower part of the segmental bronchus and located in the peripheral part of the lung is called peripheral lung cancer. There are two basic types of lung cancer: small cell lung cancer 1) small cell lung cancer (SCLC) or oat cell cancer, and nearly 20% of lung cancer patients belong to this type; Small cell lung cancer has a short doubling time and rapid progress, and is often accompanied by endocrine abnormalities or carcinoid syndrome. Because the patient has early blood metastasis and is sensitive to radiotherapy and chemotherapy, the treatment of small cell lung cancer should be mainly systemic chemotherapy, combined with radiotherapy and surgery as the main treatment means. Comprehensive treatment is the key to the success of small cell lung cancer treatment. Non-small cell lung cancer 2) Non-small cell lung cancer (non-small cell lung cancer), about 80% of lung cancer patients belong to this type. This difference is very important because the treatment of these two types of lung cancer is completely different. Patients with small cell lung cancer are mainly treated with chemotherapy, and surgical treatment does not play a major role in this kind of lung cancer. On the other hand, surgical treatment is mainly suitable for patients with non-small cell lung cancer. [Edit this paragraph] Treatment methods The treatment methods of lung cancer can be divided into three categories: chemotherapy for lung cancer. In recent twenty years, tumor chemotherapy has developed rapidly and been widely used. Early or late chemotherapy for small cell lung cancer is effective, and there are even a few reports of radical treatment. It also has a certain curative effect on non-small cell lung cancer, but it only treats the symptoms rather than the root cause, and the effect needs to be further improved. In recent years, the role of chemotherapy in lung cancer is no longer limited to patients with inoperable advanced lung cancer, but is often included in the comprehensive treatment plan of lung cancer as systemic treatment. Chemotherapy can inhibit the decline of bone marrow hematopoietic system, mainly white blood cells and platelets, and the combination of traditional Chinese medicine and immunotherapy has a better effect. (1) Because of the biological characteristics of small cell lung cancer, except a few patients without intrathoracic lymph node metastasis, it is recognized that chemotherapy should be the first choice for patients with small cell lung cancer whose indications are (1) confirmed by pathology or cytology. (2) The 2)KS score is above 50 ~ 60; (three) the expected survival time is more than one month; (4) People under the age of 70. 2. contraindications (1) elderly people who are weak or cachexia; (2) Patients with severe liver, kidney and renal insufficiency; (3) Patients with bone marrow dysfunction whose white blood cells are less than 3× 10 9/L and platelets are less than 80× 10 9/L (direct count); (4) There are complications and infection, fever and bleeding tendency. (2) Chemotherapy for non-small cell lung cancer, although there are many effective drugs for non-small cell lung cancer, is inefficient and rarely achieves complete remission. 1. indications: (1) patients with squamous cell carcinoma, adenocarcinoma or large cell carcinoma diagnosed by pathology or cytology, patients with postoperative recurrence or metastasis or other reasons who are not suitable for operation; (2) After surgical exploration and pathological examination, the following conditions were found: ① residual lesions; ② Metastasis of thoracic lymph nodes; ③ There are tumor thrombus or thrombus in lymphatic vessels; ④ poorly differentiated carcinoma; (3) Patients with pleural or pericardial effusion need local chemotherapy. 2. Contraindications: Same as small cell carcinoma. Radiotherapy for lung cancer (I) Treatment principles Radiotherapy is the best for small cell carcinoma, followed by squamous cell carcinoma and adenocarcinoma. However, small cell carcinoma is easy to metastasize, so large-area random field irradiation is often used. The irradiation area should include the primary focus, supraclavicular region of bilateral mediastinum, and even liver and brain, supplemented by drug treatment. Squamous cell carcinoma is moderately sensitive to radiation, mainly local invasion and relatively slow metastasis, so radical treatment is often used. Adenocarcinoma is insensitive to radiation and easy to metastasize in blood, so radiotherapy alone is rarely used. (two) radiation complications are more, and even cause partial loss of function; For advanced cancer patients, the effect of radiotherapy is not perfect. At the same time, the patient's physique is poor and he is old, so he is not suitable for radiotherapy. (3) The indications of radiotherapy are divided into radical treatment, palliative treatment, preoperative radiotherapy, postoperative radiotherapy and intracavitary radiotherapy according to the purpose of treatment. 1. Radical treatment (1) for early cases with surgical contraindications or refusal to operate, or for IIIa cases with lesions limited to 150cm; (2) The heart, lung, liver and kidney functions are basically normal, the white blood cell count of hemogram is greater than 3× 10 9/L, and the hemoglobin is greater than100g/L; (3)KS≥60 points should be carefully planned in advance and strictly implemented, and the treatment plan should not be changed easily. Even if there is radiation reaction, the goal should be to eradicate the tumor. 2. Palliative care: Its purpose is very different. Palliative treatment close to radical treatment can alleviate patients' pain, prolong their lives and improve their quality of life; There are also some palliative treatments, such as pain, paralysis, coma, shortness of breath, bleeding, etc., which only relieve the symptoms of late patients and even cause comfort. The irradiation times of palliative care vary from several times to dozens, depending on the specific situation and equipment conditions. But it must be based on the principle of not increasing the pain of patients. When there is a large radiation reaction or the KS score decreases during the treatment, the treatment plan can be modified as appropriate. 3. Preoperative radiotherapy: aimed at improving the resection rate and reducing the risk of tumor spread during operation. For patients who have no difficulty in estimating the amount of surgical resection, preoperative radiotherapy can be given with large dose and less segmentation; If the tumor is huge or invasive, it is estimated that it is difficult to remove, and conventional radiotherapy can be used. The time from radiotherapy to surgery is generally about 50 days, and the longest is no more than three months. 4. Postoperative radiotherapy: used for cases with insufficient preoperative estimation and incomplete surgical resection of tumors. The silver clip marker should be placed at the local residual lesion so as to locate it accurately during radiotherapy. 5. Intracavitary brachytherapy: it is suitable for cancer focus confined to the big bronchus. The afterloading technique can be adopted, and the catheter can be placed at the bronchial focus through fiberoptic bronchoscope, and iridium (192Ir) brachytherapy combined with external irradiation can improve the therapeutic effect. Surgical treatment of lung cancer except Ⅲ B and Ⅳ stages, the treatment of lung cancer should be mainly surgical treatment or strive for surgical treatment, and the comprehensive treatment of radiotherapy, chemotherapy and immunotherapy should be added according to different stages and pathological tissue types. As for the survival rate after lung cancer surgery, it is reported in China that the three-year survival rate is about 40% ~ 60%; The five-year survival rate is about 22% ~ 44%. The operative mortality rate is less than 3%. (1) Patients with the following surgical indications can generally be treated by surgery: 1. No distant metastasis, including liver, brain, adrenal gland, bone, chest lymph nodes and other parenchymal organs. 2. Cancer tissue has not invaded and spread to adjacent organs or tissues in the chest, such as aorta, superior vena cava, esophagus and cancerous pleural effusion; 3. No serious cardiopulmonary dysfunction or angina pectoris in the near future; 4. No severe liver and kidney diseases and severe diabetes. Generally, patients with the following conditions should be operated with caution or need further examination and treatment: (1) elderly patients with poor cardiopulmonary function; (2) Except for stage I, small cell lung cancer should be treated with chemotherapy or radiotherapy before it can be treated surgically. (3)x-ray showed that there were many suspicious metastases in mediastinum besides the primary focus. At present, the academic evidence of surgical treatment of lung cancer has been relaxed. For some patients who have invaded the great vessels of the chest and have isolated metastasis in the distance, some scholars believe that surgery can be performed as long as the physical conditions permit, and relevant exploration and research have been carried out. (II) Indications for exploratory thoracotomy There are no surgical contraindications, and those who are definitely diagnosed with lung cancer or highly suspected of lung cancer can choose the surgical method according to the specific circumstances. If the lesion is found beyond the resectable range during operation, but the primary cancer can still be resected, the primary focus should be resected. This is called reduction surgery, but in principle, pneumonectomy is not performed after surgery to assist other treatments. (III) Selection of surgical methods for lung cancer According to the international staging method of lung cancer 1985, patients with stage I, II and III lung cancer can be treated surgically. The principle of surgical resection is: completely remove the primary focus and lymph nodes that may metastasize in the chest cavity, preserve normal lung tissue as much as possible, and be careful in total lung resection. 1. local resection: refers to wedge-shaped tumor resection and segmental resection of lung, that is, local resection of lung can be considered for small primary cancer with poor lung function or well-differentiated and low malignant cancer in the elderly and infirm; 2. Lobectomy: Solitary peripheral lung cancer, confined to one lobe, no obvious lymphadenopathy, feasible lobectomy. If the cancer involves two lobes or intermediate bronchi, it is feasible to remove the upper or lower middle lobe; 3. Sleeve lobectomy: This operation is mostly applied to lung cancer in the upper middle lobe of the right lung. If the cancer is located in the lobar bronchus and involves the opening of the lobar bronchus, sleeve lobectomy is feasible; 4. pneumonectomy: when the above methods can not widely remove the lesions, pneumonectomy can be carefully considered; 5. carina resection and reconstruction: when the lung tumor exceeds the main bronchus and involves carina or tracheal sidewall but not more than 2cm: ① carina resection and reconstruction or sleeve pneumonectomy can be performed; (2) If there are lungs, try to keep them. The operation can be decided according to the situation at that time. (4) Surgical treatment of recurrent or recurrent lung cancer 1. Although the tumor can be removed by surgery, there are still residual tumors, regional lymph node metastasis, or tumor thrombus in blood vessels, and the probability of recurrence and metastasis is very high. Management of multiple primary lung cancer: All patients diagnosed with multiple primary lung cancer should be treated according to the second primary focus. 2. Treatment of recurrent lung cancer: The so-called recurrent lung cancer refers to the recurrence of cancer focus in the scar of the original operation or the recurrence of cancer focus in the chest related to the primary focus, which is called recurrent lung cancer. The principle of management should be based on the patient's cardiopulmonary function and whether it can be resected to determine the scope of operation.