Treatment of lung cancer must be phased treatment.Early treatment of lung cancer, lung cancer and advanced lung cancer treatment principles,
Treatment of lung cancer must be phased treatment.
Early treatment of lung cancer, lung cancer and advanced lung cancer treatment principles, treatment options and prognosis are not the same, so the treatment of lung cancer must be phased treatment. As the World Association of lung cancer lung cancer staging 7th introduced, we emphasize the doctor especially grassroots doctors must first stage of lung cancer after treatment of lung cancer, now in a new stage for stage I, II, III and IV, and I to III and I A, I B, in stage A, stage B, stage A, stage B, previously only stage I to III stage A patients can benefit by surgery. If you do not do the brain magnetic resonance imaging before surgery, do not do a bone scan, abdominal CT, have brain metastasis, bone metastasis, peritoneal metastasis, also do surgery, the patient will have to suffer a knife; on the contrary, if there is a history of trauma patients, but showed multiple metabolic bone by bone do not scan on the diagnosis of thoracic magnetic stage lung cancer, the patient will lose the chance of curative treatment, so clinicians must pay attention to the clinical stage and clinical stage do.
We advocate the use of a comprehensive approach, including surgery, chemotherapy, radiation therapy, and existing physical targeted therapies for the treatment of patients with lung cancer. Now, with the gradual application of minimally invasive surgery, especially the application of electronic thoracoscopy, more elderly people can safely receive surgical treatment. In addition, the new generation of chemotherapy drugs and adjuvant therapy for patients with lung cancer can be treated with dignity, dignified treatment.
Radiation therapy as Scud missiles like, or all, bring a lot of side effects to the patient, with the technology of precise radiotherapy under the guidance of PET-CT now, so that more can do surgery to local control is very good, especially in the last few years listed Iressa, the targeted drug clenbuterol Kai, to those patients not receiving chemotherapy or chemotherapy, treatment failure patients can survive and have a higher quality of life. In recent years, a number of physical targeted therapies, such as radiofrequency ablation, argon helium knife, particle knife, and so on, can bring more choices for patients who can not operate.
At present, the Ministry of health in the standardized diagnosis and treatment of lung cancer, lung cancer is engaged in related work emphasizes the doctor must do chest CT before operation, to do a bone scan except bone metastases, brain MRI except brain metastases, do abdominal ultrasound except peritoneal metastasis, except the metastasis after surgery, in order to enter the field of vision. Surgery also except stage A and stage B, the existing PET, TV mediastinoscopy and EBUS-TBNA, can check the mediastinal lymph node metastasis, no mediastinal lymph node metastasis for early lung cancer, the clinical benefit can be obtained by surgery.
For T staging, it should be emphasized that not all of the lung nodules are lung cancer, especially in elderly patients with pulmonary nodules lesions, it must be clear whether lung cancer. If a 80 year old patient with lung nodules misdiagnosed as lung cancer and surgery, the operation was found to be tuberculoma, and the patient was due to respiratory failure caused by surgery need rescue is not worth it. Therefore, it is very important for patients with advanced age, preoperative T staging and definitive diagnosis. At present, T staging can be done through the trachea puncture biopsy, but also through the CT guided percutaneous biopsy, but some parts of the risk of percutaneous puncture, need to pay attention to.
The two magnetic navigation bronchoscopy technology gives us more options, small nodules can get cells in diagnosis of bronchoscopy guide magnetic navigation, obtain pathological diagnosis, provide greater convenience for the diagnosis of lung cancer. Even if you can't do surgery, you need chemotherapy or radiation, you have to clear the diagnosis of lung cancer. Now, some hospitals in Guangzhou and Beijing Hospital of Zhong Nashan academician has been applied to bronchoscopy magnetic navigation of this technology, and the United States have hundreds of this instrument, we hope that the lung cancer center, Department of thoracic surgery and Department of respiratory medicine more, can the introduction and application of this technology, better for the early diagnosis of pulmonary nodules in the elderly patients preoperative.
In addition, I would like to emphasize the importance of N staging. If you already have a N2, especially the lymph node metastasis of N3, on the right side of the left lung cancer lymph node metastasis, lymph node metastasis of lung cancer on the right side of the left side of the operation, this case will not get good treatment effect and should adopt conservative treatment. Prior to the N stage what almost no good way, the accuracy rate of the traditional chest CT for lymph node staging diagnosis of less than 50%, the false negative rate is as high as 17%, and can now be used as mediastinoscopy, EBUS-TBNA and ultrasound esophagoscopy, especially EBUS. TBNA blind biopsy, lymph node biopsy TV mediastinoscopic lymph node biopsy and ultrasound endoscopy have certain limitations, there are some traumatic and unsafe sex, but EBUS ultrasound bronchoscopy guided biopsy of lymph node of lung associated lymph nodes were all accurate preoperative N staging diagnosis. This is indeed very grateful to these pharmaceutical companies, equipment companies in this regard to provide us with technical improvements and help. Conventional bronchoscopy with a capsule with a water sac can be accurately diagnosed before and after treatment. In fact, not only surgery, radiation therapy, respiratory medicine and oncology department needs accurate N staging, so I hope that further attention to the basic level of N doctors.
In 2006 the European lung cancer clinical guidelines in mediastinoscopic as the gold standard, the new research shows that EBUS-TBA provides more information for the diagnosis and staging, so in 2011, replaced by EBUS-TBA mediastinoscopic as the gold standard of clinical guidelines for non-small cell lung cancer in Europe, but the American NCCN and the guide of lung cancer in China or in mediastinoscopic as the gold standard.
At the same time, this knife is very important for the thoracic surgeon. Through thoracoscopy, mediastinoscopy in preoperative diagnosis can have no mediastinal lymph node metastasis, in addition, we are in operation, in addition to doing routine cleaning and lobectomy, mediastinal and hilar lymph nodes. At present many of the hospital, the Medical Center for mediastinal lymph node lymph node is 234 group and fifth group, sixth group and aortic dissection carina 789 groups have no problem, a serious problem is that many doctors are not considered intrapulmonary lymph nodes, the lung resection, twelve group, thirteen Group, fourteen groups of lymph nodes in lung, thoracic surgeons if not put these out to the lymph node pathology, pathology is not extra to do, what does that mean? You may think T1N0M0 patients, but in fact there have been N1 metastasis, stage II lung cancer and N1 metastasis after adjuvant therapy, so we hope also called for thoracic surgeons during surgery, in addition to intrapulmonary lymph node dissection of lymph node pathology, the doctor handed out for further pathological diagnosis. Department of thoracic surgery, Beijing, the most important member of the committee, the executive vice president of the Chinese Association of Department of thoracic surgery physicians, I often call on the meeting of thoracic surgeons must do these, grasp the pathological staging of lung cancer.