Many people have the words "lung nodules" or "ground glass nodules" written on their reports when doing chest CT examinations, what are these nodules? Are they benign or malignant? How can I tell?
Some patients are nervous when they see a CT report showing lung nodules, especially ground glass nodules, because most patients think that a lung nodule is lung cancer. In fact, more than 90% of the nodules on the lungs, especially some small, solid nodules, are benign. To judge the benign or malicious nature of the nodules, it is first necessary to see these nodules clearly, that is, experienced specialists read the patient's high-definition, thin-layer chest scan data on the computer, called soft reading.
The so-called soft reading begins with high-definition, thin -- (1mm) digital films, as nodules are usually smaller, especially early pulmonary nodules. This has a huge amount of data, which requires patients to carve this data into a CD-ROM for easy soft reading. Anti-Cancer Butler - Kang Ai Butler, we fight cancer together, and curing cancer is not a dream. Only this kind of soft reading can show the relationship between the size, boundaries, density, and surrounding tissues of the lung nodules more clearly. Sometimes it is even necessary to perform special post-processing on the image of the nodule to facilitate the determination of the stereoscopic shape of the nodule and its relationship with the blood vessel. These subtle structures synthesize the patient's clinical information to help doctors judge the probability of malignancy of the nodule.
Of course, clinically, a chest CT examination can not completely determine whether the nodule is benign or malignant, and most clinicians will recommend follow-up of the lung nodule after the lung nodule is found. Based on the results of the patient's lung nodules, the next follow-up cycle is determined. For example, for a mixed terrazzo nodule, we recommend follow-up for 3-6 months; if it is a solid nodule smaller than 5 mm, it is usually recommended to follow up once a year.
If the lung nodule is examined physically, does the patient have to choose "one size fits all"? What tests and treatments do you need to do in the future?
In most cases, doctors may recommend surgical resection when a nodule with a high probability of malignancy is suspected or determined, or when clinical diagnosis is difficult and malignancy cannot be ruled out, and there are no contraindications to surgical resection.
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But in general, most lung nodules are benign, especially small ones. Therefore, if the lung nodule is examined physically, whether to choose surgical resection or not, you need to make a basic judgment first.
A friend once came to me with a CT report, and the film showed that the nodule was relatively large, with a long diameter of 15 mm. Second, its nodules are mixed-density nodules, and nodules of this density are most likely to be malignant. Third, the boundaries of the nodules are not very smooth and burrs. Fourth, there is the penetration of microvessels within the nodule. Fifth, the nodule has a certain connection with the pleura. Sixth, this nodule is located in the upper lobe of the lung, although this friend has no family history of tumors, but there are risk factors such as a long-term smoking history, so we predict that the probability of malignancy of this lung nodule is more than 90%, and we recommend that he operate as soon as possible. It was also confirmed that he was lung cancer.
There is also a friend who has two nodules in the lower and middle lobes of his right lung, which are 4 mm and 5 mm in size, respectively, with clear boundaries of solid nodules, near the subpleural. By asking for a medical history, it was learned that he had no family history of tumors, no history of smoking, and other risk factors. From the nature and shape of the nodule, we preliminarily judged that the probability of malignancy of the nodule was relatively low, so my suggestion to him was that he could do a follow-up from 6 months to a year.
From these two examples, we can see that the lung nodules that are examined do not have to be one-size-fits-all, and most patients will be like the second patient, and regular follow-up is recommended.
Therefore, because this nodule is not visible on the lungs, it can not be worried, the lung nodule needs to be surgically removed, and must be judged according to the clinical situation.
Low-dose spiral CT (LDCT) is the recommended lung cancer screening method in the current guidelines, which populations need lung cancer early screening? What is the difference between LDCT and general CT?
Which people need to do early screening for lung cancer is mainly related to the risk factors for lung cancer.
The high-risk group of lung cancer is first of all high-risk gender, and there will be more men than women. Mainly associated with men who may have more risk factors such as smoking. In recent years, the incidence of lung cancer in women has shown an upward trend, which is related to women's passive smoking and indoor pollution (cooking smoke).
The second is exposure to people with some risk factors, such as smokers, including active smokers and long-term passive smokers. There are also people who are exposed to special chemicals such as benzene, arsenic, etc., as well as radioactive substances.
The third had tumors, especially those with a family history of lung cancer. For example, parents, siblings have a history of tumors. If the patient has previously had a tumor in other parts, or has a chronic respiratory disease, such as chronic obstructive pulmonary disease, etc., it is also a high-risk group of lung cancer, and needs to be screened for lung cancer. The age of early lung cancer screening recommended by each national guideline varies, with some recommending over 40 years of age and some recommending over 50 years of age.
The so-called low-dose spiral CT refers to the reduction of the ordinary CT dose to achieve the purpose of reducing radiation. Low-dose spiral CT is judged from the clarity and effect of the image presentation, and our ordinary CT is not much different, but its X-ray load is much smaller than that of ordinary CT, and the harm to the patient is much smaller, so it is more suitable for lung cancer screening and follow-up.
In addition to smoking, the patient has a history of chronic diseases, such as COPD, or tuberculosis, can these causes lead to lung cancer?
The prevalence of lung cancer in smokers is dozens of times that of non-smokers, which is an indisputable fact that smoking is one of the most important risk factors for lung cancer.
In addition to active smoking, passive smoking is also closely related to the occurrence of lung cancer. In addition, smoke attaches to the smoker's body, hair, clothing, and moves with the smoker. If you smoke in a room, the smoke can attach to the walls of the room, tables, chairs, and objects. Even if the smoker leaves, the residual smoke can still be suspended in the air, adsorbed on walls, tables and chairs, and slowly released into the environment, forming a long-term harmful third-hand smoke.
The occurrence of lung cancer is a very complex process, in addition to smoking, there are some factors related to the occurrence of lung cancer. Including COPD, tuberculosis, etc., such as COPD is a chronic inflammation of the airways, and lung cancer has the same or similar risk factors. Anti-Cancer Butler - Kang Ai Butler, we fight cancer together, and curing cancer is not a dream. The gradual malignancy of squamous epithelial metaplasia of the airway mucosa is an important factor in the formation of lung cancer, so in recent years, many patients with COPD and lung cancer have been found in the clinic. Since COPD and lung cancer have a relatively similar pathogenesis basis, patients with COPD have a higher incidence of lung cancer than the average person.
Patients with chronic lung diseases such as tuberculosis usually leave scars in the lungs after the disease has healed, scars lead to local chronic inflammation, and some may undergo malignant transformation, which eventually leads to the development of lung cancer.
Cancer screening is the primary strategy to reduce lung cancer mortality, what is the current survival status of patients with early lung cancer? What treatment options are available?
No matter what kind of disease, especially for lung cancer, early detection, early diagnosis, and early treatment can significantly improve the prognosis of patients, and the survival time of patients will be greatly extended.
Existing studies have shown that early lung cancer, especially stage I lung cancer, has a 5-year survival rate of almost 100%, and in the advanced stage, the 5-year survival rate will drop significantly, about less than 30%.
The earlier, the more opportunities for patient treatment, the patient will have a longer survival period, better living conditions, therefore, early diagnosis and early treatment is a very important diagnosis and treatment strategy for lung cancer.
At present, the treatment of early lung cancer is still mainly based on surgery.
Is it correct to say that the later the stage of lung cancer means the shorter the survival time? What are the treatment options for patients with advanced lung cancer?
The later the stage, the more opportunities the tumor has to invade other sites. Advanced lung cancer may invade lymph nodes, blood vessels, and even metastasize to multiple parts of the body with blood flow, such as metastasis to the bone, liver, and even the brain. Tumors invade other sites and cause clinical symptoms, so the transition from diagnosis to treatment of advanced lung cancer is much more complicated than in the early stages.
Early lung cancer is mostly a local lesion, and local resection of surgery may be completely cured. For patients with advanced lung cancer, we must not only treat the primary tumor, but also consider the impact of metastasis on the function of the patient's organs, anti-cancer housekeeper - Kangai housekeeper, we fight cancer together, and curing cancer is not a dream. For example, a series of problems such as the effect of pleural effusion caused by metastasis on the respiratory function of patients, the effect of tumors metastasized to the liver on liver function, and the effect of brain metastases on nervous system function in patients with brain metastasis have made the treatment of tumors more complicated.
At present, the treatment methods available for advanced lung cancer have been diversified, and the traditional treatment methods of lung cancer include chemotherapy, radiotherapy, surgical treatment, traditional Chinese medicine treatment, etc. In recent years, targeted therapy, immunotherapy, anti-neovascular therapy and so on for lung cancer have made rapid progress. Among them, chemotherapy, targeted, immunology, and traditional Chinese medicine treatment are all systemic treatments, and surgery and radiotherapy are local treatments.
Different lung cancers, different tissue types, different molecular types, coupled with different stages, and patients with different backgrounds in the underlying disease make treatment very different. However, the current treatment of advanced lung cancer has improved significantly compared with the past, and we have entered the era of personalized treatment of lung cancer.
This article is transferred from the Lung Cancer Rehabilitation Circle (reprinted and shared by "Anti-Cancer Butler Website - Kangai Butler")
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