Contents 1 Pinyin 2 English reference 3 Disease classification 4 Disease overview 5 Disease description 6 Symptoms and signs 7 Cause of disease 8 Pathophysiology 9 Diagnostic examination 10 Treatment plan 10.1 Indications and contraindications for surgery 10.2 Intraoperative precautions 10.3 Postoperative treatment 10.4 Follow-up 11 Prognosis and prevention attached: 1 Acupoints for treating bronchial lung cancer 1 Pinyin
zhī qì guǎn fèi ái 2 English reference
lung bronchogenic carcinoma 3 Disease classification
Thoracic Surgery 4 Disease Overview
Bronchial lung cancer (lung cancer for short) is a malignant tumor that originates in the bronchial mucosa and alveoli. Lung cancer is one of the common malignant tumors in countries around the world. The incidence rate of lung cancer increases with age, and is more common in adults over 40 years old. The increase is particularly significant in those aged 50 to 60 years old, and is higher in men than in women. However, in recent years, the incidence rate of lung cancer has been shrinking in both sexes. The prognosis of this disease is very poor, about 80% of patients die within one year after diagnosis, and the median survival period is generally about 6 months. Smoking is one of the main causes of lung cancer, with 80% of lung cancers caused by smoking. 5 Disease Description
Bronchial lung cancer (lung cancer for short) is a malignant tumor that originates in the bronchial mucosa and alveoli. Lung cancer is one of the common malignant tumors in countries around the world. In recent decades, the incidence and mortality of lung cancer have increased sharply in various parts of the world, with the increase even more significant in industrialized developed countries. The incidence of male lung cancer has increased 40 times in the United Kingdom and 28 times in the United States, ranking first among male cancer deaths. first place. In Shanghai, China's largest industrial city, the number has increased nearly five times in the past 15 years and ranks second among common malignant tumors. Lung cancer ranks first among male malignant tumors in Beijing. The incidence rate of lung cancer increases with age, and is more common in adults over 40 years old. The increase is particularly significant in those aged 50 to 60 years old, and is higher in men than in women. However, in recent years, the incidence rate of lung cancer has been shrinking in both sexes. The prognosis of this disease is very poor, about 80% of patients die within one year after diagnosis, and the median survival period is generally about 6 months. Smoking is one of the main causes of lung cancer, with 80% of lung cancers caused by smoking. To this end, the World Health Organization has decided to hold an annual World No Tobacco Day event on May 31 each year.
6 Symptoms and Signs
Pay attention to the presence of cough (especially ***-induced choking cough), sputum production, bloody sputum, chest pain, hoarseness, and difficulty swallowing. Physical examination: ① Chest signs: Pay attention to whether there are masses, atelectasis, pneumonia or pleural effusion. ②Signs of metastatic disease: Whether there are supraclavicular and axillary lymph node enlargement, bone tenderness, liver enlargement and neurological signs. ③ Signs of compression or obstruction: Pay attention to inspiratory dyspnea and localized wheeze; vocal cord paralysis on one side (recurrent laryngeal nerve compression); Horner's sign on one side (cervical sympathetic nerve compression); head, neck, and The upper chest is swollen, the skin is blue, and the superficial veins are distended (superior vena cava obstruction). ④Other signs, such as clubbing of the fingers (toes), pulmonary hypertrophic osteoarthropathy, male genital development, Cushing's syndrome, and skin lesions. 7 Causes of the disease
The cause is not very clear. Pay attention to age, history of smoking and special exposure to radioactive substances. 8 Pathophysiology
The pathogenesis is not very clear. 9 Diagnostic examinations
1. Routine examinations
① Chest X-rays: including posteroanterior and lateral plain films, tomograms, bronchial oblique tomograms, and CT films . Pay attention to whether there is a hilar mass or thickening and enlargement of the hilar shadow; whether there are lobulated edge burrs in the lung field or mass shadows with vacuolation signs or eccentric cavities like erosion; whether there are diffuse nodular shadows in both lungs; Whether there is hilar or mediastinal lymph node enlargement, etc. Suspicious lesions should be reexamined shortly. ② Sputum cytology examination: The sputum needs to be fresh and coughed up forcefully, and it must be sent for testing several times in a row, especially after bronchoscopy. ③ Fiber bronchoscopy: including direct vision, scraping, brushing and direct biopsy for pathological examination. Those who are negative and have high suspicion of lung cancer can be reexamined.
2. Carry out the following examinations when necessary
① Magnetic resonance imaging (MRl): For the discovery of large vessel lesions surrounding the aortopulmonary window and small cancers in the superior pulmonary sulcus It is superior to CT in detecting lesions and recurrence of cancer after radiotherapy. ② Biopsy: lymph node, anterior scalene muscle lymph node biopsy, percutaneous, transthoracoscopy or thoracotomy biopsy for pathological examination. ③ Pleural biopsy: suitable for those with pleural effusion. ④ Angiography: Superior vena cava, pulmonary artery, bronchial artery angiography, digital subtraction angiography (DSA) if possible, the image will be clearer. ⑤Lung radionuclide scans: such as 99mTe and 113In perfusion lung scans, tumor-friendly 169ytterbium citrate and 67gallium citrate lung scans, 99mTeMIBI (methoxyisobutyric acid) lung and mediastinal scans, and 99mTe bone scans, etc. .
⑥Tumor marker detection: such as antigens (such as CEA) in serum and body fluids, monoclonal antibodies, polyclonal antibodies, enzymes (NSE, LDH, etc.), hormones (ACTH, ADH, etc.), biochemical metabolites (sialic acid, β Microglobulin, etc.) and other examinations have certain reference value for auxiliary diagnosis, estimating the condition, observing curative effect and predicting recurrence. 10 Treatment Plan 10.1 Indications and Contraindications for Surgery
1. Non-small cell lung cancer
Indications for surgery for non-small cell lung cancer:
(1)TNM Those with stage 0, I, or II lung cancer and good functions of important organs such as heart and lungs.
(2) T3 lung cancer that invades the chest wall (stage IIIa) without extensive mediastinal lymph node metastasis.
(3) T3 lung cancer involving the proximal bronchus (stage IIIa), without obvious hilar and mediastinal lymph node metastasis.
(4) N2 lung cancer confirmed during surgery.
(5) The following situations should be carefully considered, or surgery should be performed after adjuvant treatment: ① For superior lung sulcus tumors (Τ3), 30 to 40Gy of radiotherapy should be given first, and then extensive surgical resection is performed; ② Surgery For N2 lung cancer that has been previously confirmed, induction chemotherapy should be performed first, and then surgery is considered; ③In patients with stage IIIb malignant pleural effusion, when the pleural effusion is large, difficult to control, or has severe chest pain, thoracoscopy, pleural adhesion surgery, or thoracotomy pleural stripping can be considered ④T4 lung cancer only invades the carina, the tumor is small, and the patient has good cardiopulmonary function. Carina resection and airway reconstruction (sleeve pneumonectomy) can be carefully considered. T4 lung cancer involving the heart, aorta, superior vena cava, esophagus, vertebral body, etc. should first undergo adjuvant treatment to downgrade the TNM stage, and then determine whether surgical treatment is possible; ⑤ Patients with stage IV (M1) brain metastases, if the primary lung cancer It belongs to T1～2N0, and the brain metastasis is single. Brain surgery or brain gamma knife or X knife irradiation can be performed first, followed by lung resection, which can prolong life and improve life quality; ⑥ Stage IV (M1) patients with solitary adrenal metastasis, Surgical removal of the primary tumor and metastases has a better prognosis than conservative treatment such as chemotherapy alone.
Contraindications for surgery for non-small cell lung cancer:
(1) Stage N lung cancer, extensive distant metastasis.
(2) Obviously extensive N2 lung cancer, accompanied by superior vena cava obstruction syndrome.
(3) N3 lung cancer is not an absolute contraindication, but the effect is very poor.
(4) Superior sulcus tumor invades the mediastinum and neck (Τ4).
(5) Cachexia or extremely poor cardiopulmonary function.
2. Small cell lung cancer? Unlike non-small cell lung cancer, the treatment principle should be comprehensive treatment based on chemotherapy. Stage I and II small cell lung cancer should receive 2 to 3 courses of chemotherapy first, then consider surgery, and then continue chemotherapy after surgery. Stage III and IV small cell lung cancer are treated with chemotherapy and radiotherapy, and surgery is not considered. 10.2 Points to note during surgery
1. The choice of surgery for lung cancer should be based on the location and scope of tumor invasion and the patient’s cardiopulmonary function. The principle is to completely and cleanly remove the disease while preserving healthy lung tissue to the greatest extent possible.
2. Lobectomy is the first choice. However, some patients require bilobal or total pneumonectomy. Some patients can only undergo segmentectomy, wedge or local resection.
3. For central lung cancer, especially the elderly and those with poor cardiopulmonary function, tracheal and bronchoplasty pneumonectomy can be performed to preserve more healthy lung tissue.
4. Lymph nodes with hilar or mediastinal metastasis should be removed as much as possible during the operation.
5. The treatment of pulmonary blood vessels is generally performed outside the pericardium. If necessary, the pericardium can be opened for complete lung or lobectomy. 10.3 Postoperative treatment
1. Same as thoracotomy.
2. TNM pathological classification should be performed upon discharge to formulate further treatment plans and evaluate treatment effects. 10.4 Follow-up
Every 3 months in the first year after surgery, every 4 months in the second year, and every six months thereafter. 11 Prognosis and prevention
There is no special prevention method. Acupoints for treating bronchial lung cancer: The lymph node group in the trachea collects lymphatic drainage from both sides of the lungs and bronchi, and is the main site of lymph node metastasis from bronchial lung cancer. Therefore, when performing lung cancer resection... Kongzui
Kongzui point injection, 2ml per point, once a day, has a good effect in treating hemoptysis caused by bronchitis and lung cancer.
Generally, after the hemoptysis stops, treatment is continued for 7... Yufu Point