Tumor is called the "king of all diseases". It is a genetic disease. In medicine, it has biological characteristics such as abnormal cell differentiation and proliferation, loss of growth control, infiltration and metastasis. Its occurrence is a multi-factor, multi-step complex process, which is divided into three processes: carcinogenesis, cancer promotion, and evolution. In layman's terms, it is an uncontrolled growth of tissue cells, just like the underworld organizations in the human body continue to grow and develop, and branches are also set up in different places. Z3z
Decades ago, there was a jingle about cancer, "Nine out of ten cancers are buried, and one is not cancer." This means that the level of diagnosis and treatment at that time was very low, and there was no treatment for tumors. It was nothing more than the best supportive treatment. The patient was given painkillers if it hurts, and some nutrient solution was given to the lack of nutrients. In fact, there is no way to cure cancer. Cancer rarely escapes the fate of death.
And in recent years, we can see that the continuous advancement of medical research and the continuous improvement of the level of medical technology can enable more and more cancer patients not only to survive, but also to survive very well. Face this "all diseases" Wang" We can say loudly today that cancer is no longer equal to death.
Next, Dr. Tian will explain the "lung cancer" through a case.
Recently, Dr. Tian received a 54-year-old patient with " lung adenocarcinoma ".
Mr. Tang is 54 years old this year. He has been engaged in decoration all year round. During the decoration process, he will inevitably inhale a lot of dust and some decoration materials will release a lot of ammonia. About half a year ago, Mr. Tang had a cough and it gradually got worse. Later, there was sputum expectoration, with bloodshot eyes in the sputum.
In the local hospital, a chest CT examination revealed a lung mass, and there were also many lymph nodes and enlargements in the mediastinum. It was considered lung cancer with multiple lymph node metastases. So I did a fiberoptic bronchoscopy examination, took a biopsy, and the final pathological diagnosis was "lung adenocarcinoma". The local hospital believes that there have been multiple lymph node metastases in the mediastinum, which is not suitable for surgical treatment. So the patient came to Shenzhen and found Dr. Tian.
Dr. Tian said: According to the patient's condition, is indeed not suitable for surgery. For inoperable lung adenocarcinoma, genetic testing must be done first. Because the biopsy tissue taken by the patient's bronchoscopy was too small, the patient was advised to draw blood for genetic testing. Fortunately, the results show that the patient has a deletion mutation in exon 19 of the EGDR gene (see the figure below). For patients with this mutation, the targeting drug can be used for treatment, and the effect will be better.
Unveil the mystery of lung adenocarcinoma, what causes it?
Lung adenocarcinoma is a relatively common pathological subtype of lung cancer, which belongs to non-small cell carcinoma. It is derived from glandular epithelial cells and germinal cells in the peripheral lung tissue. It can occur in various levels of bronchus, but it is mainly small bronchus. 3/4 of the patients occur in the periphery, so peripheral masses are the most common. It currently accounts for more than 40% of lung cancers, and this proportion is getting higher and higher.
A large number of medical data indicate that: the risk factors for lung cancer include smoking (second-hand smoke), asbestos, radon, arsenic, ionizing radiation, coal vapors, coal-tar pitch, dichloromethyl ether (chloromethyl), rubber products , Nickel, etc. There are many toxic particles in the air. After being inhaled by the human body, they will attach to the cilia of the lungs, which will hinder the ventilation function of the lungs. Many harmful substances are formed in the lungs, which will eventually lead to the occurrence of lung cancer. What are the clinical manifestations of
lung adenocarcinoma?
Lung adenocarcinoma can occur in both men and women. It is more common in women and has nothing to do with smoking. There are no special symptoms in the early stage of lung adenocarcinoma, because it is mostly located in the periphery, similar to the symptoms of general respiratory diseases, mostly dry cough, Chest pain, low fever, shortness of breath are the main symptoms.
should pay attention to some hidden symptoms of lung cancer in the early stage. Some patients will also have extrapulmonary manifestations, such as bone and joint swelling, pain, shoulder and back pain, hoarseness and other symptoms, and even the clinical manifestations of lung adenocarcinoma metastasis to the brain. Appears in the primary lesion.
The late symptoms of lung adenocarcinoma will vary according to the patient’s physique.. There is also a special situation. Although the primary lung lesions are small, some patients can have more extensive metastases. Therefore, a small primary disease does not necessarily mean that it is an early stage. Pain is a relatively common symptom of advanced lung cancer. Most lung cancer patients who have developed regional dissemination in the chest have chest pain. If the tumor invades the right side of the mediastinum and compresses the superior vena cava, the jugular vein will expand due to poor return, and it will also cause edema of the face and neck. Shortness of breath and pleural effusion are also symptoms of advanced lung cancer.
rely on which link to make the correct diagnosis of lung adenocarcinoma:
lung cancer diagnosis is based on the following aspects: First, the clinical manifestations. Most patients with lung cancer have cough, sputum, bloodshot sputum, and hemoptysis in severe cases. , Asthma, difficulty breathing. Followed by the test results: lung adenocarcinoma often has elevated carcinoembryonic antigen (CEA) and sugar chain antigen CA199. CT examination can reveal a lung mass. Finally, the diagnosis must be confirmed by pathological diagnosis, which can be diagnosed by obtaining specimens through fiberoptic bronchoscopy or percutaneous lung biopsy for pathological examination.
Some lung adenocarcinomas have relatively small lesions and are close to the periphery, which cannot be seen by fiberoptic bronchoscopy, and specimens cannot be obtained. At this time, you can consider percutaneous lung puncture to obtain pathology under CT guidance. But in this case, the needle path needs to pass through normal lung tissue. If the patient has emphysema or poor lung elasticity, pneumothorax symptoms may occur after surgery.
Dr. Tian said: currently has a relatively advanced electromagnetic navigation technology in clinical practice, which is equivalent to our satellite. Through the electromagnetic navigator, we can know where the lesion is in the lungs. Even if it is a small lesion, it will accurately guide us to the past, and then take out a biopsy for a clear diagnosis.
How will we treat patients with lung adenocarcinoma? Z18z
1. Surgical treatment
For patients who can be operated on, surgery is still the preferred treatment for lung adenocarcinoma, which can achieve complete tumor removal, reduce tumor metastasis and recurrence, and can simultaneously Perform pathological diagnosis and TNM staging, and guide comprehensive postoperative treatment. The standard method is lobectomy and mediastinal lymph node dissection. Chemotherapy is the main and auxiliary treatment for lung adenocarcinoma.
2. radiotherapy
radiotherapy is a treatment method that uses radiation to kill tumors and is a local treatment method. It can be used alone or in combination with other therapies. In recent years, radiotherapy has also made great progress, such as the trial of intensity modulated radiotherapy, proton therapy and so on.
3. Drug treatment
Lung cancer drug treatment has also undergone rapid changes in recent years. In the first 10 years of the 21st century, the targeted therapy of lung cancer has made great progress. Many targeted drugs have been used in clinical applications and have achieved great success. Immediately after the second 10 years, we entered the era of immunotherapy for lung cancer. Immunotherapy drugs represented by PD1 monoclonal antibody and PD-L11 monoclonal antibody greatly improved the treatment effect of lung cancer. It has been gradually promoted and applied clinically.
Dr. Tian pointed out: The lung adenocarcinoma that Mr. Tang suffered from is a type of lung adenocarcinoma called EGFR mutant. EGFR plays an important role in the reproduction and growth of tumor cells. The abnormal activation of EGFR is also closely related to angiogenesis, tumor invasion and metastasis, tumor resistance to chemotherapy and prognosis. Such patients have better curative effect with molecular targeted drugs, relatively long survival time, and better treatment effect.
In recent years, the diagnosis and treatment of lung adenocarcinoma have made considerable progress, and the efficacy has also been greatly improved. I believe that with the joint efforts of all parties, the diagnosis and treatment of lung adenocarcinoma will reach a higher level.
