1. Discovery
In May 2023, Ms. Song, 46, underwent a routine physical examination at a physical examination center, and a chest CT scan was added to this physical examination. Two days after the medical examination, Ms. Song received a call from the medical examination center, informing Ms. Song that there was a 19mm nodule in the upper lobe of her right lung, and asked Ms. Song if she had known about it.
Ms. Song had never had a CT scan of her lungs before, but she had taken a chest X-ray during a physical examination in 2021, and the physical examination report at that time suggested that there was a partial shadow in her lungs, which was presumed to be an aging scar left by tuberculosis in her early years, and advised Ms. Song to go to the hospital for a follow-up.
However, because no doctor specifically called Ms. Song to tell her that she must go to the hospital for a follow-up after the physical examination, Ms. Song thought that the matter was not a big deal, and she forgot about it in a blink of an eye. Then in 2022, Ms. Song was supposed to have a physical examination, but for various reasons, it was postponed for another year, and the final result was that a lung nodule was detected in 2023.
The medical examiner repeatedly instructed Ms. Song to go to a tertiary hospital or above as soon as possible on the phone, and she must register as an expert for a re-examination.
2. Seek medical attention
Ms. Song first hung up the expert number of a director in the thoracic surgery department of a hospital in northern Beijing, and after the director reviewed Ms. Song's CT film in the physical examination center, he asked Ms. Song if she had been vaccinated and whether she had been infected with the new crown. Ms. Song replied that she had received three shots of domestic vaccines and had also been infected with the new crown at the end of 2022.
Then the director said that it was necessary to rule out the possibility that these nodules were inflammation first, and prescribed Ms. Song anti-inflammatory drugs for more than a week on the spot, and instructed Ms. Song to go to the hospital for an enhanced CT examination two weeks after taking the anti-inflammatory drugs to see if there was any change in the nodules.
One month later, Ms. Song went to the hospital for contrast-enhanced CT, and the CT results showed that Ms. Song's right upper lobe nodule was about 21mm×11mm in size, and there was also a ground-glass nodule in the upper lobe of the left lung with a size of about 10mm×6mm. The doctor judged that both nodules had the possibility of lung cancer, and recommended that the largest nodule on the right side be directly surgically removed, and the left nodule should be temporarily left untreated.
Ms. Song decided to follow the doctor's advice, and the doctor immediately arranged surgery for Ms. Song.
3. Before surgery
Due to the shortage of hospital beds, Ms. Song waited for three weeks before being admitted to the hospital. After being hospitalized, Ms. Song underwent various examinations before the operation, and on the first morning, 11 tubes of blood were drawn on an empty stomach for blood tests. In addition to blood, Ms. Song also performed various ultrasound tests including limbs and head and resonance measurements.
Ms. Song later learned that if lung cancer metastasizes, it will first spread to the limbs and brain, and these tests are done to confirm whether lung cancer has metastasized to the brain and limbs.
After the examination, the day before the operation, the hospital asked the family to go to the hospital to sign the surgical consent form, and Ms. Song's husband went to the hospital to sign it. While signing, Ms. Song asked her attending doctor if it would be early because her tumor was probably less than 3cm.
The doctor replied that the stage of the tumor is not based on the size of the tumor, but depends on the components of the tumour and whether it has spread and other unknown factors. In other words, Ms. Song may also be in the middle stage and above after surgery.
Ms. Song was not calm, and asked her if the CT film she took could see if the tumor had spread? The doctor replied that CT scans could not tell whether it had spread, and that only after a quick test of a portion of the tumor specimen during the operation could it be determined whether it was benign or malignant, and whether it had spread.
The doctor said that the rapid test during the operation only takes a few minutes to get the results, and the accuracy rate is about 75% or more, and he will decide the scope of the operation according to the examination results. In the end, the doctor also told Ms. Song that he would have four surgeries tomorrow, each estimated to take about 4 hours, and that Ms. Song's surgery should be scheduled for the last one, which should start at about 7 p.m. The doctor told Ms. Song to prepare in advance, fasting from food and water after 10 p.m., and resting early.
Fourth, do surgery
Ms. Song slept all night in tension, and when she woke up the next morning, Ms. Song thought that her surgery should be scheduled for the evening, but she did not expect that at about 11 a.m., Ms. Song was called by the doctor to have surgery.
At that time, after Ms. Song entered the operating room, she felt very cold, lying naked under a layer of green surgical cloth and shivering from the cold. Fortunately, after a short time, Ms. Song was anesthetized and unconscious. When Ms. Song woke up, Ms. Song heard the doctor tell Ms. Song that the operation was done and asked Ms. Song how she felt.
Ms. Song still felt cold and shivered uncontrollably, and then Ms. Song fell asleep again, and when Ms. Song opened her eyes again, she found that she had returned to the bed in the ward, and it was already 6 o'clock in the evening.
Ms. Song's surgery lasted about 6 hours, two hours longer than the average, and the doctor later explained to Ms. Song that this was because the doctor entered Ms. Song's chest cavity and found that Ms. Song's lungs and pleura were glued together, so it was necessary to perform a pleural dissection for more than an hour before removing the lesion.
The doctor said that the original treatment plan was to do lung segment resection, but because Ms. Song's lung surface was covered with pleura, the pleura had to be removed after excision, and peeling off the pleura would cause a large area of trauma on the lung surface.
The doctor also said that although the wedge-shaped excision reduced the volume of the excision, Ms. Song was lucky that the doctor found no signs of spread at the edge of the excised specimen, and the cut was clean. Hearing what the doctor said, Ms. Song was very happy.
5. Postoperatively
Ms. Song recovered quickly after the operation, and when she got up the morning after the operation, Ms. Song ate a bowl of porridge and was able to walk around the hospital with the diversion bag. In addition, Ms. Song didn't feel how painful the wound was, but because she had a diversion on her body, she could only sleep on her back, and Ms. Song had a sore back when she slept.
Three days after the operation, Ms. Song's pathological test report came out, and she was diagnosed with invasive lung adenocarcinoma, about 85% of which were acinar and 15% adherent, with airway spread visible, no clear intravascular cancer thrombus and nerve invasion, no definite pleural invasion, no lymph node metastasis, and stage 1b.
Three weeks after the operation, Ms. Song's genetic test report also came out, and she was found to have an EFGR gene mutation, so she could take targeted drugs. The doctor recommended that Ms. Song take medication for adjuvant treatment for two years, because the pathological results showed that Ms. Song had a high risk factor for lung cancer recurrence due to airway spread.
The targeted drugs recommended by the doctor were icotinib and osimertinib for two years, and Ms. Song chose osimertinib after thinking about it, because although osimertinib is an imported drug, it cost 5,000 yuan a month for one box, but she only needs to take one medicine a day to choose it, which is a lot less troublesome.
After starting to take targeted drugs, Ms. Song went to the hospital every three months for follow-up examinations, including ultrasound examination and CT scan of the neck, adrenal glands, liver, gall bladder, pancreas, spleen and other parts. Ms. Song had no problem after several reexaminations, everything was normal, and even the 10mm nodule in the upper lobe of the left lung was ruled out malignant by the doctor.
Up to now, it has been more than a year since Ms. Song had undergone surgery, and it has been a year since she took targeted drugs. The reaction was paronychia on her hands, and the paronychia on Ms. Song's ten fingers came and went, but after about half a year of taking the medicine, the symptoms disappeared.
At present, Ms. Song's life is no different from before, and she is recovering well.