Breast cancer, premature lung cancer... For 11 years, Ms. Huang, 63, has been battling malignant tumors. Thanks to the continuous improvement of treatment methods, her bilateral breast cancer and early cancer of her right lung were controlled in a timely manner at the First Affiliated Hospital of Jinan University.
Unfortunately, her review of chest CT this year found multiple nodules in both lungs, both of which were considered malignant. In order to be treated, she came to the Department of Thoracic Surgery of the First Affiliated Hospital of Jinan University again, and the deputy chief physician of the Department of Thoracic Surgery, Cai Songwang, carefully designed the surgical plan and successfully removed these small nodules that had evolved into clear lung adenocarcinoma in two stages.
Normal people's lungs are divided into 5 lobes, Ms. Huang's lung nodules are grown in the middle lobe of the right lung, the lower lobe of the right lung and the lower lobe of the left lung, all of which consider primary lung cancer and need to be surgically removed; and the patient had been partially removed from the upper lobe of the right lung 9 years ago due to squamous cell carcinoma of the upper lobe of the right lung, and the lung function was worse than that of normal people.
Due to the treatment of lung cancer 9 years ago, Ms. Huang's lobe has been removed, and the lung function is deviated. After the emergence of multiple lung nodules, if the surgery is performed on both lung nodules at the same time, the risk of surgery is higher, and the postoperative complications will increase, for the sake of safety, Cai Songwang decided to operate on both lung nodules in two parts, that is, to treat one side of the lung nodule first, and the other side of the lung nodule after three months.
Considering that the lower lobe of the left lung is nodules are large, have many solid components, and are close to the pleura, if not operated on as soon as possible, they may soon metastasize, so they need to be removed as soon as possible. At the same time, because the nodule is close to the outside of the lung, Cai Songwang's team chose to partially remove the lung tissue where the lung nodule is located under minimal trauma, and then quickly sent to the pathology department for frozen pathology. Due to the large size of this nodule, it is not excluded that there is metastasis of lymph nodes, in order to ensure the effect of surgery, the radical surgery for lung cancer of the lower lobe of the left lung is finally completed under minimal trauma. On the third day after the operation, Ms. Huang recovered and was discharged from the hospital.
After 3 months, Ms. Huang should go to the Thoracic Surgery Department again with the intention of minimally invasively resolving the nodules in the middle and lower lobes of the right lung. After the evaluation of Cai Songwang's team, Ms. Huang's lung function can not tolerate the radical lung cancer surgery, in order to obtain a better treatment effect at the same time, to minimize the loss of lung function, after full communication with Ms. Huang, it was decided to partially remove the middle lobe of the right lung under minimal trauma, perform accurate anatomical resection of the lung segment of the lower lobe of the right lung, the surgical process was smooth, the two nodules cut off were invasive lung adenocarcinoma, and the lymph nodes of the hilar mediastinum were dissected. On the 4th day after the operation, Ms. Huang recovered and was discharged from the hospital.
Cai Songwang said that the treatment of multiple lung nodules is a very difficult problem, and there is no very consistent standard opinion. The general principle is that relatively single lung nodules tend to be conservative; mainly focus on the main lesion; whether to deal with the intervention depends on the risk of the main lesion, if necessary intervention, take into account the secondary lesion, as much lung tissue as possible while treating the lesions that can be netly treated as much as possible. "If the lung nodules are high-risk nodules, like Ms. Huang's three nodules, ct lung nodules that show imaging features of lung cancer, surgery is currently the only most effective way to cure."
For smaller multiple, low-risk nodules, regular chest CT follow-up may be selected. For multiple lung nodules, it is crucial to find an experienced thoracic surgeon to develop an individualized treatment and follow-up plan.
Written by: Nandu reporter Wang Daobin correspondent Yang Pingshan Zhang Cancheng