Ms. Chen was in the emergency room due to cough and right chest pain, but he had not healed. He was in the outpatient clinic again. The chest X-ray showed hydrops in the leukoplasia. The doctor suspected that "the case was not simple" and arranged for hospitalization. It was finally confirmed that it was the fourth stage of lung cancer. "She is so young and doesn't smoke, how could she be like this?" the medical staff sighed. The day of lung cancer was diagnosed, it happened to be Ms. Chen’s birthday.
Lung cancer is a relatively malignant tumor, and it is mostly asymptomatic in the early stage. Most patients are already in the late stage when they are diagnosed and cannot be eradicated through surgery. Although the drug has certain therapeutic effects, long-term survival is still not easy to achieve. "Find out effective screening tools and early diagnosis are the key to survival." In the past, chest X-rays and sputum examinations were unable to achieve the goal of reducing mortality and were not suitable as lung cancer screening tools.
In recent years, low-dose computed tomography (LDCT) has been regarded as an early detection of lung examinations, which can reduce lung cancer mortality rate by 20% and overall mortality rate by 6.7%. "Compared with breast photography, 465 to 601 people can save a woman's life, and low-dose computer tomography can save a life if it is screened for 320 people. It can be seen that low-dose computer tomography is worth promoting."
Most lung cancer patients do not smoke. How to identify high-risk groups for lung cancer among non-smokers to undergo screening? Due to the lack of sufficient clinical evidence, European and American societies recommend that non-smokers not undergo lung cancer screening.
1‧People with a family history of lung cancer can undergo low-dose computer tomography as a screening for lung cancer, but its effectiveness has not yet been confirmed.
2‧People with a history of lung cancer, radon exposure and specific occupational exposure can consult a doctor and consider undergoing lung cancer screening.
3‧People without risk factors currently have no evidence to support lung cancer screening.
4‧People with severe diseases or cannot receive treatment for radical cancer are not recommended for lung cancer screening.
5‧Screen of low-dose computerized tomography lung cancer should be carried out in medical institutions that have experience in low-dose computerized tomography screening and have multiple specialized lung cancer diagnosis and treatment.
6‧Smoking patients should quit smoking early. Low-dose computerized tomography screening cannot prevent lung cancer.
7‧Ages between 55 and 74 years old and have a history of smoking for more than 30 packs (i.e., smoking 1 pack per day for more than 30 years; or two packs per day for more than 15 years; or 3 packs per day for more than 10 years, etc.), and are still smoking or quitting smoking for more than 15 years, evidence shows that low-dose computerized tomography can be accepted to screen for lung cancer.
Many places are promoting low-dose computer faults, but screening is the same thing, what about subsequent tracking, nodules and processing, and complete evaluation? is currently lacking. Now most people only mention the benefits of low-dose computer tomography screening, but rarely mention its risks and psychological impact on patients when screening abnormalities
html. More than 0 doctors pointed out that although there is currently no evidence to support that non-high-risk groups should undergo lung cancer screening, if you are worried about cancer, you can afford it economically and it is okay to do it. However, it is recommended to know more about it before deciding to do screening:1. Fake alarms exceed 90%, causing psychological stress
The estimated positive rate of lung cancer screening for low-dose computer tomography (finally confirmed as lung cancer) is estimated to be only about 6.4%. In other words, up to 93% of people receive a "fake alarm" and are finally diagnosed with cancer (i.e., false positive).
"This makes many people suffer from psychological pressure of uncertain results, spending time, spending money, and even undergoing unnecessary invasive sections 3 or surgery. The wound is painful after surgery, which seriously affects lifestyle and daily life. This is rarely discussed and paid attention to." Some patients also seek medical treatment everywhere and ask for second opinions.
smoking rate is low, and women have a lower smoking rate. At present, the main risk factors for lung cancer are not yet confirmed. It is not suitable to imitate the United States for large-scale screening. Otherwise, the positive rate will be lower and the false positive rate will be higher, which will lose the significance of screening.
2. Overdiagnosis may lead to overtreatment of
"In the XXXX lung cancer screening cases in this hospital, XX early lung cancer was found" What does these numbers mean?
"How many early lung cancer can be found is not the point.To produce benefits and significance, lung cancer screening must be able to reduce the mortality rate and overall mortality rate. In other words, the detection rate of early lung cancer does not represent the effectiveness of screening. Therefore, in the absence of sufficient evidence, it is not recommended that the general public undergo lung cancer screening. As for whether to extend lung cancer screening to medium- and low-risk groups in the future, more rigorous clinical research and longer-term tracking results are needed to decide, and we cannot only look at small-scale descriptive statistics and short-term data."
The so-called early cancers are found in the low-dose computer faults of the lungs. A considerable proportion are slow-growing carcinoma in situ 4 or micro-invasive cancers, rather than life-threatening highly invasive cancers. Although these lesions are also called lung cancer, they may only be fatal for decades, and they will not even change throughout their lives.
If these lesions occur in people who are relatively old or have serious diseases, the patient may die from other diseases before these lesions cause harm. Therefore, these lesions do not require immediate surgery or treatment. Whether they are removed or even diagnosed will not affect their life expectancy. This situation is called "overdiagnosis". It also has the same phenomenon in breast cancer, thyroid cancer or prostate cancer screening, but the proportion accounts for different.
The problem is how to determine whether the lesions detected are low or high invasive? Is it safe to not deal with, just track and wait? How high is the risk of patients undergoing invasive examinations or surgical resection? "This requires professional knowledge and analysis and judgment."
But some doctors may be worried about medical disputes, and the patient also feels relieved to take it off, so the knife is cut. "Does this overdiagnosis cause overtreatment?"
A study in the United States earlier found that using low-dose computer tomography to screen for lung cancer, the amount of early cancers increased by 3 times compared to using chest X-ray screening, and the subsequent surgeries increased by 10 times, but there was no significant difference in the mortality rate of lung cancer. "The number of surgeries has increased so much. How many people have died from surgery or comorbidities? These numbers are often hidden. In fact, sectional examinations and surgery have risks and may cause comorbidities. Do patients know before entering the operating room?"
3. Continuous screening and tracking, the radiation risk is difficult to estimate
Yu Zhongren said that the radiation volume of low-dose computer faults is one-seventh to one-quarter of the traditional computer faults, and with the development of technology, it has decreased year by year, but it is still equivalent to the radiation volume of 8 to 10 chest X-rays.
Moreover, once an abnormality is found, it may be necessary to continue to track and repeatedly scan the fault. "How often should I take it? Half a year, one year or more? How long does it take to track it to be safe? Whether radiation exposure increases the risk of certain cancers (such as blood cancer, thyroid cancer, etc.) is currently unknown."
people have accumulated the risk of malignant tumors caused by radiation exposure in their lifetime. "If screening and tracking continues, the balance between the risk of radiation and the benefits obtained by screening must be carefully evaluated."
4. The processing and tracking after screening is the focus
. It is easy to do screening. How to explain, handle and track the abnormality after finding it is the focus.
Many diseases (mostly infectious diseases, such as tuberculosis, herpes virus, measles virus, chickenpox virus) will leave traces of inflammation in the lungs and form nodules. When abnormal nodules appear in low-dose computer tomography images, most of them are not cancer and there is no need to worry too much.
Doctors will recommend patients to track, sections for pathological tests or direct surgery based on the size and shape of the nodules. Most image abnormalities will shrink or maintain their original size after a period of time, and finally prove to be benign, that is, the aforementioned pseudo-positive.
"Generally speaking, nodules with no parenchymal parts within 1 to 2 cm can be observed. There is no need to immediately diagnose or operate the section. The low-dose computer fault is tracked again according to the size of about 3 to 6 months. If there is no change, it will be tracked once a year. If the growth exceeds 20% or the parenchymal parts may become invasive, then the section diagnosis or surgical removal will be considered based on the risk."
However, each doctor follows different guidelines, and the standards for processing nodules and the frequency of tracking are also different. It must be corrected at any time based on the latest research evidence and treatment guidelines.
But even if the nodules are small, the doctor judges that "now" is benign or non-invasive, and some people are still worried that they can't sleep. "Everyone has different feelings about risks." Usually correct knowledge and education can alleviate the patient's anxiety. When the doctor tells the patient, "There is a nodule in your lungs. There is currently more than 90% chance of being benign. There is no need to deal with or operate. Just follow it up. If there is a change in the nodule, it is safe to deal with it." Most people may be acceptable, but there are still a certain proportion of people who cannot accept coexisting with the nodule and insist on surgical removal, even if it is benign, it is still willing to do so.
"If it has seriously affected the patient's mental state or daily life, and the patient's physical condition is in good condition and the operation risk is not high, most doctors should still choose to perform surgery, diagnose and treat it at the same time." You should explain to the patient: the risk of surgery may be greater than the risk of the nodule becoming highly malignant and fatal in the short term. Let the patient think clearly before making a decision.
Smoking is the most clear risk factor for lung cancer. However, many lung cancer patients do not smoke, which is very different from Europe and the United States. Currently, some risk factors (such as second-hand smoke, family history, cooking smoke, exposure to carcinogenic environment, and once suffering from lung diseases such as tuberculosis) are highly related to lung cancer. But it is still unclear who or how old they start screening to have higher benefits.
Item is aimed at 12,000 people over 55 who do not smoke but have lung cancer risk factors. They use low-dose computerized tomography for lung screening. They hope that in the future, they can establish a risk prediction model for people who do not smoke, and evaluate the cost-effectiveness of low-dose computerized tomography. The mystery of not smoking but suffering from lung cancer has the opportunity to solve it.
Before using low-dose computer tomography to screen for lung cancer, learn more about it
Advantages of
can reduce the lung cancer mortality and overall mortality rate of high-risk groups (mainly severe smokers).
This screening usually allows early lung cancer to be found when there are no symptoms, and it is usually not early stage when there are symptoms.
The lung cancer found through this screening usually has a smaller range of surgery and less resection of lung tissue.
risk:
has high pseudo-positiveness, and most of the found are benign nodules, not tumors. The patient suffers psychological stress and unnecessary surgery.
Overdiagnosis may cause overtreatment. Carcinoma in situ or microinvasive cancers that grow slowly and may not affect lifespan are also removed, and the risks of surgery and complications may be ignored.
lacks a complete tracking and evaluation plan. Continuous screening and tracking, the radiation risk is difficult to estimate.
1, briary water accumulation
briary membrane is the two layers of serous membrane between the lungs and the chest wall. Under normal circumstances, there will be a little briary fluid as a lubricant for lung expansion and shrinkage. If the liquid increases abnormally, it will cause water accumulation in the rib membrane. Possible causes include: heart failure, renal failure, infection or tumor, etc.
2, high-risk group
The high-risk group in this study refers to those aged 55 to 74, who have a smoking history of more than 30 packs (i.e., smoking 1 pack a day for more than 30 years; or two packs a day for more than 15 years; or 3 packs a day for more than 10 years), and have quit smoking for more than 15 years.
3, section
Patients need to pass through the skin through bronchoscope with small forceps, or local anesthesia with a section needle under the guidance of the image to reach the lesion, and after cutting part of the tissue, they will be sent to the pathological test for whether it is malignant. After the examination, a small number of patients may develop complications such as pneumothorax (gas in the lungs leak out of the lungs, but are still in the chest cavity), coughing up blood, infection and other complications.
4, carcinoma in situ
Cancer cells are limited to epithelial tissue and have not invaded downward. They may be completely cured after appropriate treatment, and the prognosis is much better than invasive cancer.
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