Disease name:
Introduction:
Lung cancer occurs in the bronchial mucosa epithelium, also known as bronchial carcinoma. In the past 50 years, the incidence of lung cancer has been reported to increase significantly in many countries. Among male cancer patients, lung cancer has ranked first, and the incidence rate in women has also increased rapidly, accounting for the second or third place of common malignant tumors in women. The etiology of lung cancer is still not fully clear. A large amount of data indicates that long-term large amount of cigarette smoking is an important cause of lung cancer. For more than 40 cigarettes per day for many years, the incidence of lung squamous cell carcinoma and undifferentiated carcinoma is 4 to 10 times higher than that of non-smokers. The incidence of lung cancer in urban residents is higher than in rural areas, which may be related to air pollution and carcinogens in smoke. Therefore, it should promote non-smoking and strengthen urban environmental sanitation.
Cause:
(1) Causes of the disease
The high risk factors for lung cancer are:
1. Smoking In 1922, Hampeln found that smoking and inhaling dust can stimulate the bronchial epithelium to induce cancer. In 1924, Moller applied tar to the back of the rabbit and found that the incidence of lung cancer increased slightly. At present, smoking is considered to be the most basic risk factor for lung cancer. There are more than 3,000 kinds of chemicals in tobacco, and multi-chain aromatic hydrocarbon compounds (such as benzopyrene) have strong carcinogenic activity. Certain special enzymes that act on human tissues (especially lung tissue) produce mutations in cellular molecular structures (such as DNA) that may have mutations in K-ras.
2. Occupational and environmental exposures It is estimated that up to 15% of lung cancer patients have a history of environmental and occupational exposure, and there is sufficient evidence to confirm that the following nine industrial components increase the incidence of lung cancer: by-products of aluminum products, arsenic, asbestos, bis-chloromethyl ether, Chromium compound, coke oven, mustard gas, nickel-containing impurities, vinyl chloride. Long-term exposure to sputum, cadmium, silicon, formalin and other substances will also increase the incidence of lung cancer. In addition, air pollution, especially industrial waste gas, is a high risk factor for lung cancer.
3. Radiation uranium and fluorspar miners are exposed to inert gas helium, decaying uranium by-products, etc., which is significantly higher than other people's lung cancer, but people with ionizing radiation do not increase lung cancer.
4. Chronic infection of the lungs such astuberculosisIn patients with bronchiectasis, the bronchial epithelium may turn into a squamous epithelium during chronic infection, eventually causing cancer, but such cases are rare.
5. Intrinsic factors family, genetic and congenital factors as well as decreased immune function, metabolic, endocrine dysfunction, etc. may also be a high risk factor for lung cancer.
6. The incidence of lung cancer in developed countries is high, the city is higher than the rural areas, and the factory and mining areas are higher than the residential areas. The main reason is due to the industrial and transportation developed areas, oil, coal and internal combustion engines, and the burning of asphalt roads. It is related to the harmful substances such as benzopyrene carcinogenic hydrocarbons polluting the atmosphere. The survey materials indicated that the incidence of lung cancer was also increased in areas with high concentrations of benzopyrene in the atmosphere. Air pollution and cigarette smoking may promote each other's incidence of lung cancer and play a synergistic role.
(two) pathogenesis
There are four ways to transfer lung cancer:
1. Directly spread cancer grows, can block the bronchial lumen, and also expand into the extrapulmonary lung tissue. Tumors near the periphery of the lung can invade the pleura and chest wall, and tumors with a central or near mediastinum can invade the pleura and chest wall, and tumors with a central or near mediastinum can invade other organs. A huge tumor can cause central ischemic necrosis and form a cancerous cavity.
2. Hematogenous metastasis is a late manifestation of lung cancer. Cancer cells can be transferred to any part of the body after returning to the left heart with the pulmonary veins. The common metastatic sites are liver, brain, lung, bone system, adrenal gland, kidney and pancreas.
3. In the case of disseminated alveolar cell carcinoma in the bronchus, the cancer cells on the bronchioles and alveolar walls are easily detached; the cancer cells can diffuse through the bronchial tubes into adjacent lung tissues to form new cancerous foci.
4. Lymphatic drainage of the lymphatic metastasis has a certain regularity. The right upper lobe flows to the right hilar and right upper mediastinal lymph nodes. The middle lobe of the right lung flows to the lymph nodes of the middle and lower lobe summary area, the subcarinal and the right upper mediastinal lymph nodes. The right lower lobe leads to the middle and lower lobe summary area, the subtotal ligament, the lower lung ligament and the right upper mediastinal lymph node. The left upper lobe leads to the aortic arch (Bottallo) lymph node and the left anterior superior mediastinal lymph node. The left lower lobe lymph flow is in the upper and lower lobe summary area, under the bulge and across the mediastinum to the right superior mediastinal lymph node. For example, lymph node metastasis (N state) of lung cancer can be shown using the lymph node legend of Maoshof (Fig. 1).
symptom:
Most of the early asymptomatic, almost two-thirds of lung cancer patients are advanced at the time of presentation (stage III or IV), 95% of patients may have clinical findings, primary tumors, metastases, systemic symptoms or tumor accompanying symptoms However, the patient's first diagnosis.
The primary symptoms caused by primary tumors accounted for 27%. Symptoms were related to the location of the primary tumor. Central lung cancer was characterized by irritating dry cough, belching, recurrent pneumonia, hemoptysis or asthma, recurrent laryngeal nerve, and phrenic nerve compression. Symptoms or superior vena cava compression syndrome. Peripheral tumors are more common symptoms such as chest pain, hernia or pleural effusion. Large peripheral lesions, central necrosis, and voids eventually show similar lung abscesses, and the common symptoms of primary lung cancer are grouped.
Distal metastases account for 32% of the first symptoms, and common distant metastases are: lymph nodes, adrenal glands, liver, bone, lung, brain and chest wall, which produce some corresponding symptoms, indicating that lung cancer has reached advanced stage, such as: proximal mediastinum The tumor can invade the phrenic nerve, causing ipsilateral diaphragmatic paralysis, showing increased diaphragmatic position and abnormal respiratory movement under fluoroscopy; invading the ipsilateral recurrent laryngeal nerve, causing hoarseness, ipsilateral vocal cord paralysis and fixation in the median position; Vena cava, causing edema of the head and face and upper limbs, venous engorgement; invasion of the pleura. Causes a large amount of bloody effusion in the pleural cavity, aggravating the symptoms of shortness of breath, or directly invading the chest wall, causing severe chest pain; the upper tip of the lung cancer is at the entrance to the thoracic cavity, also known as the upper sulcus cancer, which can invade and compress the brachial plexus and neck. The sympathetic ganglia and the subclavian arteries and veins produce a series of special, cervical sympathetic ganglia and subclavian arteries and veins, which produce a series of unique symptoms, such as numbness and pain in the lateral upper limbs, which gradually increase the difficulty of tolerance; muscle and skin present Atrophic changes, upper extremity venous engorgement and edema; and ipsilateral ptosis, pupil dilation, eyeball invagination, facial sweatless neck and other cervical sympathetic syndrome.
10% to 20% of lung cancer patients with tumor-associated syndrome, the most common accompanying such symptoms are small cell lung cancer and squamous cell carcinoma, common tumor associated syndrome is: pulmonary osteoarthrosis syndrome (skull finger , bone and joint swelling and pain, periosteal hyperplasia, etc., SIADH (antidiuretic hormone secretion syndrome), hypercalcemia, etc., as well as Cushing syndrome,Myasthenia gravisOr male breast enlargement, etc., about 16% of patients with neuromuscular symptoms. Some patients have skin diseases such as:sclerodermaBlack acanthosis.
The clinical manifestations of lung cancer are closely related to the location and size of the cancer, whether it is oppressed, invasion of adjacent organs, and the presence or absence of metastasis. Cancer grows in larger bronchi, often with irritating cough. Increased cancer affects bronchial drainage, and there may be purulent sputum secondary to pulmonary infection. Another common symptom is blood stasis, usually with blood spots, bloodshot or intermittent hemoptysis in some sputum; some patients have important reference value even if they have blood or sputum once or twice. Some patients may have chest suffocation, shortness of breath, fever and chest pain due to large bronchial obstruction caused by the tumor.
When advanced lung cancer oppresses adjacent organs, tissues, or distant metastases, it can produce:
1 oppression or invasion of the phrenic nerve, causing ipsilateral diaphragmatic paralysis.
2 oppression or invasion of the recurrent laryngeal nerve, causing hoarseness in the vocal cords.
3 compression of the superior vena cava caused facial, neck, upper limb and upper chest vein engorgement, subcutaneous tissue edema, upper limb venous pressure increased.
4 invasion of the pleura, can cause pleural effusion, mostly bloody.
5 cancer invades the mediastinum and oppresses the esophagus, which can cause difficulty in swallowing.
6 Upper lobe top lung cancer, also known as Pancoast tumor or superior sulcus tumor, can invade and compress organs or tissues located in the upper thorax, such as the first rib, superior supraclavicular artery and vein, brachial plexus, cervical sympathetic nerve, etc. Chest pain, jugular vein or upper extremity venous engorgement, edema, arm pain and upper limb dyskinesia, ipsilateral upper eyelid ptosis, pupil dilation, eyeball invagination, facial sweatless neck and other cervical sympathetic syndrome.
A small number of lung cancers, due to the secretion of endocrine substances in cancer, clinically present non-metastatic systemic symptoms: such as bone and joint syndrome (skull, joint pain, periosteal hyperplasia, etc.), Cushing syndrome, myasthenia gravis, male breast enlargement Extrapulmonary symptoms such as multiple muscle neuralgia. These symptoms may disappear after removal of lung cancer.
diagnosis:
Only early diagnosis and early treatment can achieve better curative effect. Therefore, it is necessary to publicize the anti-cancer knowledge widely. For adults over 40 years of age, a chest X-ray survey should be performed once every six months. For those who have had suspicious symptoms such as chronic cough, blood stasis, and lung shadow, a series of detailed examinations should be performed to confirm the diagnosis. For nodules ≤5mm found in the census, it should be reviewed every 3 months; nodules of 6~10mm size should be percutaneous biopsy. If biopsy is not available, CT should be reviewed every 3 months; >1cm knot Section, should be biopsy.
Lung cancer is currently using the clinical staging of the TNM system published by the International Union Against Cancer in 1997.Non-small cell lung cancer. Small-cell lung cancer often uses a two-stage system: limited and extensive. The limitation is defined as: the lesion is confined to one side of the chest, with or without ipsilateral mediastinum or supraclavicular lymph node metastasis. It accounts for only 26% of small cell lung cancer. The broad type is defined as the extent to which the lesion exceeds the defined range.
Corresponding to one or more TNM indicators, there are four stages of tumor staging, the prognosis of stage I is the best, and the stage IV is the worst.
Identification
Typical lung cancer is easy to identify, but in some cases, lung cancer is easily confused with:
1. Tuberculosis, especially tuberculoma (ball), is sometimes difficult to distinguish from peripheral lung cancer. Pulmonary tuberculoma (ball) is more common in young patients under the age of 40. The course of disease is longer, and there is less blood in the sputum. There is less change in erythrocyte sedimentation rate. Tuberculosis is found in 16% to 28% of patients. The chest radiograph is mostly round, found in the tip or posterior segment of the upper lobe, the volume is small, generally not more than 5cm in diameter, the boundary is smooth, and the density is uneven, calcification is visible. In 16% to 32% of cases, the drainage bronchus is visible to the hilar, less Pleural shrinkage occurs, and the growth is slow. For example, there is a hollow in the center liquefaction, and the middle is thin and the inner edge is smooth. There are often scattered tuberculosis lesions around the tuberculoma (ball) called satellite foci. Peripheral lung cancer is more common in patients over 40 years old, and blood is more common in sputum, and 40% to 50% of cancer cells in sputum are positive. X-ray chest radiographs are often lobulated, with irregular edges, small burr and pleural shrinkage, and rapid growth. In some cases of chronic tuberculosis, lung cancer can occur on the basis of tuberculosis. Therefore, in adult patients with chronic tuberculosis, if abnormal lung shadows appear in the lungs, the hilar shadows increase or after regular anti-tuberculosis drugs are treated, the lesions do not increase and then increase. When you are old, you should suspect the possibility of lung cancer. Further sputum cytology and bronchoscopy should be performed and a thoracotomy should be performed if necessary.
2. Pulmonary inflammation In elderly patients with bronchial pneumonia, it is sometimes difficult to distinguish from obstructive pneumonia caused by lung cancer obstruction of the bronchi. Obstructive pneumonia often has a fan-shaped distribution according to the bronchial branches, while the general bronchopneumonia has irregular flaky shadows. However, if pneumonia has multiple episodes in the same site, it should be vigilant. It should be highly suspected of tumor blockage. The patient's sputum should be taken for cytological examination and fiber light-guided vascular examination. In some cases, pulmonary inflammation Absorption, when the remaining inflammation is wrapped by fibrous tissue to form nodules or inflammatory pseudotumors, it is difficult to distinguish from peripheral lung cancer. In suspicious cases, lobectomy should be performed to avoid delay in treatment.
3. Benign tumors of the lungs and benign tumors of the lungs such as structural tumors, chondromas, fibroids, etc. are rare, but they must be differentiated from peripheral lung cancer. Generally, benign tumors have a longer course and slower growth. Most of them have no symptoms. X-ray films often have round shadows, neat edges, no burrs, and no lobes. Bronchial adenoma is a low-grade malignant tumor, often occurring in younger women, mostly originating from the larger bronchial mucosa. Therefore, there are often pulmonary infections and hemoptysis caused by bronchial obstruction in the clinic. Ventiloscopy can often make a diagnosis.
4. Mediastinal malignant lymphoma (lymphosarcoma and Hodgkin's disease) Clinically, there are often symptoms such as cough and fever. X-ray films show a widening of the mediastinum and are lobulated, sometimes difficult to distinguish from central lung cancer. If there is swelling of the lymph nodes on the supraclavicular or axillary fossa, it is often clear that the biopsy is used for pathological sectioning. Lymphosarcoma is particularly sensitive to radiation therapy. For suspicious cases, low-dose radiation therapy can be tried. When the temperature reaches 5-7 Gy, the mass can be significantly reduced. This experimental treatment also contributes to the diagnosis of lymphosarcoma.
complication:
Most lung cancer patients who have had intra-thoracic regional dissemination have symptoms of chest pain, followed by hoarseness. Finally, it can lead to edema of the face and neck, and finally, lung cancer patients with regional spread almost have different degrees of shortness of breath.
However, some complications are often caused after lung cancer surgery, and its formation is closely related to the factors of the patient's body and the scope and mode of operation. Common postoperative complications and prevention methods are as follows:
(1) Respiratory complications: such as sputum retention, atelectasis, pneumonia, respiratory insufficiency, etc. Especially in the elderly and infirm, the original chronic bronchitis, emphysema, the incidence rate is higher. Because of wound pain after surgery, patients can not do effective cough, sputum retention caused by airway obstruction, atelectasis, respiratory insufficiency. Prevention is that the patient can fully understand and cooperate, and actively prepare for the operation. After the operation, encourage and urge him to take deep breathing and force cough to effectively drain the sputum. If necessary, nasal catheter suction or bronchoscopy suction is feasible. Patients with concurrent pneumonia should be actively anti-inflammatory treatment. When respiratory failure occurs, mechanically assisted breathing is often required.
(2) Postoperative hemothorax, empyema and bronchial pleural fistula: its incidence is very low. Hemorrhage after surgery is a serious complication. It must be treated urgently. If necessary, the chest should be stopped again to stop bleeding. During lung surgery, bronchial or pulmonary secretions contaminate the chest to the empyema. At this time, in addition to the selection of effective antibiotic treatment, timely and thorough thoracentesis is extremely important. Patients with poor results may consider closed drainage of the thoracic cavity. Postoperative bronchial stump cancer after pneumonectomy, hypoproteinemia and improper operation can cause poor healing of the bronchial stump or formation of fistula after surgery. The incidence of such complications has been greatly reduced in recent years.
(3) cardiovascular system complications: old and frail, intraoperative mediastinal and hilar traction, low potassium, hypoxia and hemorrhage often become the cause. Common cardiovascular complications include postoperative hypotension, arrhythmia, pericardial tamponade, and heart failure. For elderly patients, there are heart diseases before surgery, and those with low cardiac function should be strictly controlled. The operator pays attention to the operation. Keep the airway open and adequate oxygen supply after surgery, closely observe blood pressure and pulse changes, and timely replenish blood volume. After the operation, the infusion rate should be slow and balanced to prevent pulmonary edema from being induced too quickly and excessively. At the same time, for ECG monitoring, once an abnormality is found, it will be dealt with according to the condition. Geriatric patients are often accompanied by recessive coronary heart disease. The various stimuli of surgical trauma can promote acute exacerbation, but under the strict supervision and timely treatment of clinical experts, it can be turned into safety.
treatment:
First, Western medicine treatment
The treatment of lung cancer is divided into three categories:
Chemotherapy
Tumor chemotherapy has developed rapidly and has been widely used in the past two decades. The efficacy of chemotherapy for small cell lung cancer is relatively positive in early or late stage, and even a few reports of radical cure; it also has a certain effect on non-small cell lung cancer, but it is only palliative, and its role needs further improvement. In recent years, the role of chemotherapy in lung cancer is no longer limited to patients with advanced lung cancer who cannot be operated, but is often included as a comprehensive treatment for lung cancer. Chemotherapy will inhibit the bone marrow hematopoietic system, mainly the decline of white blood cells and platelets, combined with traditional Chinese medicine and immunotherapy.
(1) Chemotherapy of small cell lung cancer Due to the biological characteristics of small cell lung cancer, it is currently accepted that chemotherapy should be the first choice except for a small number of sufficient evidence that there is no intrathoracic lymph node metastasis.
1, the indication
(1) Patients with small cell lung cancer diagnosed by pathology or cytology;
(2) KS scores above 50 to 60 points;
(3) Those whose expected survival time is more than one month;
(4) Those aged ≤70 years old.
2. Contraindications
(1) Those who are old or weak or cachexia;
(2) Those with severe heart, liver and kidney function disorders;
(3) poor bone marrow function of white blood cells below 3 × 10 ^ 9 / L platelets below 80 × 10 ^ 9 / L (direct count);
(4) There are complications and infections, fever and bleeding tendency.
(B) chemotherapy for non-small cell lung cancer Although there are many effective drugs for non-small cell lung cancer, it is inefficient and rarely achieves complete remission.
1. Adaptation:
(1) Stage III patients who have been confirmed by pathology or cytology as squamous cell adenocarcinoma or large cell carcinoma but are inoperable, and those who have recurrence and metastasis after surgery or other stage III patients who are not suitable for surgery;
(2) Those who have undergone surgical exploration and pathological examination have the following conditions:
1 has a residual stove;
2 lymph node metastasis in the chest;
3 cancerous plugs in lymphatic vessels or thrombi;
4 poorly differentiated cancer;
(3) Patients with chest or pericardial effusion need local chemotherapy.
2. Contraindications: same small cell cancer.
Radiation Therapy
(1) Principle of treatment Radiotherapy is best for small cell carcinoma, followed by squamous cell carcinoma, and adenocarcinoma is the worst. However, small cell carcinoma is prone to metastasis, so large-area irregular irradiation is often used. The irradiation area should include the primary lesion, the bilateral mediastinal area of the mediastinum, and even the liver and brain. It should be supplemented with medication. Squamous cell carcinoma has moderate sensitivity to radiation, local lesions are mainly local invasion, and metastasis is relatively slow, so radical treatment is often used. Adenocarcinoma is less sensitive to radiation and is prone to hematogenous metastasis, so less radiation therapy is less common.
(2) There are many radiological complications and even some loss of function; for patients with advanced cancer, the effect of radiotherapy is not perfect. At the same time, the patient's constitution is poor, and the age is too large for radiotherapy.
(3) The indications for radiotherapy are divided into radical treatment, palliative treatment, preoperative radiotherapy, postoperative radiotherapy and intracavitary radiotherapy according to the purpose of treatment.
Radical treatment
(1) Early cases with surgical contraindications or refusal to perform surgery, or cases of IIIa whose lesions are limited to 150 cm;
(2) The heart, lung, liver and kidney function are basically normal, the white blood cell count of blood is greater than 3×10^9/L, and the hemoglobin is greater than 100g/L;
(3) KS ≥ 60 points should be carefully planned beforehand, strictly enforced, do not easily change the treatment plan, even if there is a radiation reaction should also aim to cure the tumor.
2. Palliative care: The purpose is very different. There are palliative treatments close to radical treatment to alleviate the suffering of patients, prolong life, and improve the quality of life. There are also palliative treatments such as pain, paralysis, coma, shortness of breath and bleeding that only relieve symptoms of advanced patients and even cause soothing effects. The number of exposures for palliative care can vary from several times to tens of times, depending on the circumstances and equipment conditions. However, the principle of not increasing the patient's pain must be used. If there is a large radiation reaction or a decrease in the KS score during treatment, the treatment plan may be modified as appropriate.
3. Preoperative radiotherapy: aims to improve the surgical resection rate and reduce the risk of tumor dissemination during surgery. For patients with estimated difficulty in surgical resection, high-dose and low-segment radiotherapy can be performed before surgery; if the tumor is huge or invasive, it is estimated. It is difficult to perform surgical resection and conventional separation radiotherapy can be used. The time from radiotherapy to surgery is generally about 50 days, and the maximum length is no more than three months.
4. Postoperative radiotherapy: used for preoperative underestimation, surgical resection of the tumor is not complete. The silver clip mark should be placed on the local residual stove so that it can be accurately positioned during radiotherapy.
5. Intracavitary short-range radiotherapy: suitable for cancerous lesions confined to the large bronchus, can be placed in the bronchial lesion by fiberoptic bronchoscopy using post-loading technique, with 192Ir for brachytherapy and external irradiation. Improve the treatment effect.
Surgical treatment of lung cancer
In addition to stage IIIb and IV, the treatment of lung cancer should be based on surgical treatment or surgical treatment. According to different stages and pathological types, comprehensive treatment of radiotherapy, chemotherapy and immunotherapy should be added.
Regarding the survival period after lung cancer surgery, the three-year survival rate is reported to be about 40% to 60% in China; the five-year survival rate is about 22% to 44%; the operative mortality rate is below 3%.
(a) surgical indications
Surgical treatment is generally available for the following conditions:
1. There are no distant metastasis, including parenchymal organs such as liver, brain, adrenal gland, bone, extrathoracic lymph nodes, etc.;
2. The cancerous tissue does not invade the proliferators, such as the aorta, superior vena cava, esophagus, and cancerous pleural fluid, to adjacent organs or tissues in the chest;
3. No serious cardiopulmonary function or short-term angina pectoris;
4. No severe liver and kidney disease and severe diabetes. Patients with the following conditions should generally be treated with caution or need further examination:
(1) Those with poor physical and pulmonary function;
(2) Small cell lung cancer should be treated with chemotherapy or radiotherapy in addition to stage I, and then it can be determined whether surgery can be performed;
(3) There are several suspicious metastases in the mediastinum in addition to the original lesion.
At present, the academic community has relaxed the indications for the surgical treatment of lung cancer. For some patients who invade the large blood vessels in the chest and the distant metastasis, as long as the physical conditions permit, some scholars also believe that surgery can be performed, and related exploration and the study.
(2) indications for thoracotomy
Anyone who has no surgical contraindications and is clearly diagnosed with lung cancer or who is highly suspected of having lung cancer may choose the procedure according to the specific circumstances. If the lesion is found to be beyond the resectable range, the primary cancer may still be resected. The original lesion should be removed. In order to reduce the operation, but in principle, no pneumonectomy is performed in order to assist other treatments after surgery.
(C) the choice of lung cancer surgery
According to the 1985 lung cancer international staging method for patients with stage III and III lung cancer, any surgery without contraindications can be treated with surgery. The principle of surgical resection is to completely remove the primary tumor and lymph nodes that may be metastasized in the thoracic cavity, and to preserve normal lung tissue as much as possible. Pneumonectomy should be cautious.
1. Local excision: refers to wedge-shaped cancer block resection and segmental resection, that is, for small volume of primary cancer, old and weak, weak lung function, or poor cancer differentiation, etc. ;
2. Lung lobectomy: For isolated peripheral lung cancer, limited lobectomy with no obvious lymphadenopathy in one lung lobe. If the cancer is involved in the two leaves or the middle bronchus, the upper middle or lower middle lobe may be resected;
3. Sleeve lobectomy: This procedure is mostly applied to the right upper lobe of the lung. If the cancer is located in the leaf bronchus and the leaf bronchial opening is involved, the sleeve lobectomy may be performed.
4. Total pneumonectomy: Pulmonary resection can be carefully considered when the lesion is extensively removed by the above method;
5. Carina resection and reconstruction: when the tumor exceeds the main bronchus involving the carina or tracheal wall but not more than 2 cm:
1 can be used for reconstruction of the carina or sleeve-type pneumonectomy;
2 If you still keep a leaf lung, try to keep it. The procedure can be based on the situation at the time.
(4) Surgical treatment of recurrent or recurrent lung cancer
1. Although the surgery can remove the cancer, but there are residual cancer, or regional lymph node metastasis, or the presence of tumor thrombosis in the blood vessels, etc., the probability of recurrence and metastasis is very high. Treatment of multiple primary lung cancer: The principle of treatment for multiple primary lung cancer patients is treated according to the second primary tumor.
2. Treatment of recurrent lung cancer: Recurrent lung cancer refers to a cancer that occurs within the scope of the original surgical scar or a recurrence of intrathoracic cancer associated with the primary tumor, called recurrent lung cancer. The principle of treatment should be based on the patient's cardiopulmonary function and whether it can be removed to determine the scope of surgery.
Second, Chinese medicine treatment
Lung cancer is divided according to Chinese medicine, and there are many types. Different types have corresponding treatment methods and prescriptions.
1. Lung cancer - qi and blood stasis
Symptoms: Cough is not smooth, chest tightness and suffocation, chest pain has a fixed place, such as a cone like a thorn, or blood stasis red, lips dark purple, dark tongue or freckle, thin fur, fine string or fine.
Governing Law: Activating blood circulation, qi stagnation.
Prescription: Taohong Siwutang is flavored. The party uses Siwutang to regulate blood circulation, and combines peach, safflower, paeonol, fragrant, and stagnation to promote collaterals and relieve pain. If repeated hemoptysis, bloody dark red plus Puhuang, 藕 、, 仙鹤草, 三七, 茜草根祛瘀 stop bleeding; stagnation of heat, dark injury, gas, see the days, dry tongue, add sand ginseng, Tianhua powder, habitat, Scrophulari , Zhimu and other heat-clearing Yin and Shengjin; less food, fatigue, shortness of breath plus jaundice, Codonopsis, Baizhu Yiqi and spleen.
2. Lung cancer - phlegm and dampness
Symptoms: cough, sputum, sputum, phlegm, sticky, white or yellow and white, chest tightness, chest pain, poor appetite, Shenpi fatigue, dark tongue, yellowish greasy or yellow thick greasy, pulse string slippery .
Governing Law: suffocating, spleen and dampness.
Prescription: Erchen Decoction and White Banxia Soup. The two Chen Tang Li Qi dry and phlegm, combined with the white Banxia soup to help the gas, wide chest and loose work. If you see chest swelling, cough and cough, you can add 葶苈 枣 泻 泻 肺 汤 以 以 以 以 以 泻 泻 泻 痰 痰 痰 痰 痰 痰 痰 痰 痰 痰 痰 痰 痰 痰 痰 痰 痰 痰 痰 痰 痰 痰 痰 痰 痰 痰 痰 痰Golden glutinous wheat roots, jaundice clearing heat and phlegm; chest pain is very, and the sputum is obvious, plus stagnation, Chuanxiong, Yanhusuo sputum pain; God tired stagnation, Jiaxi Codonopsis, Atractylodes, chicken Jinjian spleen and transport.
3. Lung cancer - Yin deficiency and heat
Symptoms: Cough without sputum or less sputum, or blood in sputum, even hemoptysis, chest pain, upset, low heat, night sweats, or hot, long time, not thirsty, thirsty, big knot, red tongue The tongue is thin yellow and the pulse is fine or large.
Governing Law: nourishing yin and clearing heat, detoxifying and dispersing.
Prescription: Shashen Maidong Decoction and Wuwei Disinfecting Drink. In the prescription, Radix Salviae Miltiorrhizae, Wangzhu, Ophiopogon japonicus, licorice, mulberry leaf, trichosanthin, raw lentils are used to nourish yin and heat; honeysuckle, wild chrysanthemum, dandelion, purple diced, and purple backed sunflower are clearing away heat and detoxifying. If you see hemoptysis, you can choose Addition of raw land, Rhizoma Imperatae, Agrimony, Alfalfa root, Shenshen Sanqiliangxue to stop bleeding; dry stool and sputum, peach kernel moist and dry laxative; low heat night sweats plus bone skin, Bai Wei, Schisandra Yuyin Clear and sweaty.
4. Lung cancer - Qi and Yin
Symptoms: less cough, or thin and sticky, cough low, shortness of breath, fatigue, pale, cheeky, spontaneous or night sweats, dry mouth, less drink, red or light tongue, pulse Weak.
Governing Law: Yiqi Yangyin.
Prescription: Shengmai drink. The party used the party to supplement the lungs, the wheat and the yin and the spleen, the schisandra to replenish the lungs and the three medicines, and the qi and nourish the yin and the qi.
Lung cancer qi deficiency symptoms are obvious to add jaundice, Taizishen, Baizhu and other benefits of Qi and lung spleen; partial yin deficiency plus northern sand ginseng, aspartame, Scrophulariaceae, lily and other nourishing Yin liquid; Less and sticky, plus Fritillaria, medlar, almonds, etc. If the lungs and kidneys are the same disease, the yin and yang are caused by the yin and yin, and the yang yang, the spleen, the spleen, the cistanche, the psoralen and the like can be added to warm the kidney yang. Among the above syndromes, if there is a superior vena cava compression syndrome, there are facial, upper chest blue edema, hoarseness, headache dizziness, difficulty breathing, and even serious symptoms of coma, severe cases can die in a short period of time. Chinese medicine treatment of lung cancer from the treatment of blood stasis, edema, blood circulation, diuresis and swelling can make some patients relieve. Commonly used prescriptions such as Tongqiao Huoxue Decoction, Wuling Powder, Wupiyin, Zhenwu Decoction, etc. If the symptoms of oppression are mild, the prescriptions for the treatment of prescriptions, such as medlar, swine fever, raw ephedra, motherwort, etc., can be used to clear the lungs and remove blood. In the long-term clinical research of lung cancer, some commonly used anti-cancer Chinese medicines have been screened, such as heat-clearing and detoxifying drugs: Houttuynia cordata, Solanum nigrum, Baiying, Hedyotis diffusa, Daqingye, Shuxiu, and Shandou. Root, dandelion, Nongjili, stone cypress, wild chrysanthemum, golden buckwheat, stone see wear, etc.; phlegm and stasis medicine: Prunella vulgaris, Pleurotus ostreatus, Fritillaria, Fritillaria, Radix Scutellariae, Poria, Fritillaria, Southern Star, Pinellia, Almond, Hundred, Aristolochia, Mountain Conch, Pelican, Shougong, Cognac, etc.; Blood-activating and hemostasis drugs: frankincense, myrrh, peach kernel, mantle, rhubarb, pangolin, trigonal, Qishu, Zelan, Shuihuazi, Clematis, comfrey, Yanhusuo, Yujin, Sumu, celandine, Xu Changqing, Lupifang, Sanqi, etc.; attacking water drinking drugs: scorpion, large戟, 芫花, Shanglu, psyllium, piglet, Alisma and so on.
prevention:
(1) Prohibition and Control of Smoking: The mechanism of smoking-induced lung cancer has been studied more clearly. Epidemiological data and a large number of animal experiments have fully proved that smoking is the main cause of lung cancer. The issue of smoking bans is discussed below.
1. You should ban smoking immediately.
2. The state should enact a strong law to promote tobacco containing carcinogens that cause lung cancer.
3. To reduce the harm of passive smoking.
(2) Reducing the hazards of industrial pollution: We should start from the following aspects.
1. Workers in dust-contaminated environments should wear masks or other protective masks to reduce the inhalation of harmful substances.
2. Improve the ventilation environment in the workplace and reduce the concentration of harmful substances in the air.
3. Transform the production process to reduce the production of harmful substances.
(3) Reducing environmental pollution: Air pollution is an important lung cancer factor. Among them, there are mainly 3,4-stupid, sulphur dioxide, nitrogen oxides and carbon monoxide. There are several aspects to reducing environmental pollution and measures:
1. Limit the development of urban motor vehicles, improve the combustion equipment of motor vehicles, and reduce the discharge of toxic gases.
2. Study harmless energy and gradually replace or eliminate those harmful energy sources.
3. Improve indoor ventilation equipment to reduce harmful substances in small environments.
(4) In terms of the spirit, it is necessary to keep the spirit happy and not to be unhappy for some small things.
(5) The diet should be rich in nutrition, vitamins A and D, and should eat more fresh vegetables and fruits.
What should be paid attention to during the recovery of lung cancer patients?
When lung cancer patients undergo surgical resection, radiation therapy or anti-cancer drugs for Chinese and Western medicine, after the condition has reached complete or partial remission, attention should be paid to the promotion of rehabilitation. The main thing should be:
(1) Smoking is completely prohibited. It’s not too late to quit.
(2) Qigong exercise, especially qigong to enhance respiratory function, in order to improve lung function.
(3) Always pay attention to the fresh air in the environment, and go to the natural environment to exercise or exercise.
(4) Do not go to public places where there are many people or air pollution to avoid external and respiratory infections.
(5) Eat less irritating foods and raw materials such as peppers, raw onions, and fats; eat more foods rich in vitamins A and C, and clear lungs and lungs such as carrots, grapes, and lilies. Shrimp, fried almonds, ginkgo, walnuts, asparagus, mangosteen, scallions, pears, etc.
(6) Adhere to the regular review and taking Chinese medicine for replenishing qi, clearing heat and fighting cancer for several years. If it is partial relief, the necessary comprehensive treatment of Chinese and Western medicine should be made under close observation by the doctor to achieve long-term relief.
Prevention and treatment of lung cancer
According to the pathogenesis of lung cancer, the following lung cancer prevention methods are proposed:
(1) Prohibition and control of smoking
(2) Control air pollution
(3) Occupational protection
(4) Prevention and treatment of chronic bronchitis, asthma, emphysema and tuberculosis.
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