Stills from "Get Out, Tumor King"
In the two years accompanied by the epidemic,
We are increasingly aware of the importance of good health and peace of mind.
In such an atmosphere,
"Patients' Families, Please Come" published in the second half of 2021
It has repeatedly aroused heated discussions and obtained a high score of 8.4 in Douban.
This is a book about cancer,
Against the backdrop of an average of 7.5 people diagnosed with cancer every minute,
People who have read it have said:
"It was so practical! Heavy and necessary. ”
"Not only the book of science, but also the book of care,
It is the book of methods and the book of courage. ”
According to the latest announcement of the National Cancer Center
Statistics on cancer incidence and mortality in China in 2015
The author of this book is Wang Xing,
Attending Physician of Thoracic Surgery, Shanghai First People's Hospital,
Do cancer-related science on the Internet for many years.
In the book, he offers a range of knowledge and advice:
Without bad habits, why do people also suffer from cancer?
Is genetic testing necessary?
Medical examination, which items are required?
After cancer, choose a specialist hospital or a general hospital?
Old drugs, or new drugs?
How to make the most of money?
When to give up?
Wang Xing was in the clinic
Not long ago, in the Shanghai First People's Hospital,
We met Dr. Wang and talked about cancer treatment
The questions and confusions that everyone wants to know the most.
In his opinion, in the face of disease,
The most important thing is to learn to face it with your family.
Whatever your dilemma,
We should all try to be as peaceful as possible and let ourselves live a little better.
Readme | Wang Xing
Edit | Yu Xuan edited | Ni Chujiao
I am Wang Xing, born in 1988, and am currently an attending physician in thoracic surgery. About seven or eight years ago, I started to do some consulting services for people on the internet platform. It was a platform to provide expert advice, some people talked about how to write public accounts, some people talked about how to wear makeup, and the topic I wrote at that time was called: What should I do if there are cancer patients at home? After asking questions, many people came to consult: when should I do low-dose CHEST CT? Often stomach pain, family members have a history of stomach cancer, do you want to do gastroscopy? What to do if the tumor marker is elevated when the blood is drawn... In school, I learned medical knowledge, in the hospital, I thought about the treatment method, and when I answered these questions one-on-one, I realized that most of those real dilemmas were isolated from the hospital walls and no one knew. From that point on, I decided to write a book that would give comprehensive professional advice and help to a family from the perspective of a doctor friend.
I live so healthy, why do I still get cancer?
"Why me?" This is the question I hear the most. In fact, cancer cells are part of our body, but it is a mutated cell that has infinite division ability, but loses the ability to differentiate. It can neither grow into eyes, skin, nor bones, it can only grow into two or four, grow into a tumor. Smoking and drinking alcohol can accelerate the process of cell damage, but the culprit of cancer is time. After hundreds of millions of copies, genes inevitably go wrong. Focus on wellness, just don't speed up the process. The incidence of cancer in normal people is about 3/1000 per year, and this number will increase with age, reaching the peak of incidence between 50 and 70 years old. So cancer is a probabilistic event, bad luck.
Stills of "Xiao Wei", the film tells
The story of a family of three whose lives were changed by their father's diagnosis of terminal liver cancer
Will there be an early warning of cancer? Most cancers do not have any symptoms in the early stages. Some family members will cry and say that Dad usually has nothing wrong with him, even coughing rarely, how is it advanced esophageal cancer? The esophagus is a duct organ that can be relaxed, in general, even if it is blocked by 30%-50%, the food can still pass through, there will be no symptoms; by the time the tumor grows a circle and causes obstruction, it is too late. Or maybe, the patient coughed up blood at home before coming to the hospital, a check, lung cancer advanced. Therefore, attention should be paid to unexplained weight loss, or if the stool turns black and bloody, occasionally alternating diarrhea, constipation, or long-term fever. In addition, when the frequency and intensity of any symptoms increase, such as cough, low back pain, fatigue and other symptoms become more and more serious, it is recommended to go to the hospital for a physical examination.
Is genetic testing necessary? Cancer is the result of a combination of environmental and genetic factors. If you are a patient undergoing cancer treatment, there are some special cancers, such as breast cancer, lymphoma, lung cancer, etc., targeted therapy is a very effective treatment. However, targeted therapy can only be effective if there is a target of corresponding genetic mutations on cancer cells, so genetic testing is necessary for these patients. People who are currently in good health can also use genetic testing to assess the risk of cancer. If the risk does not exceed 2-3 times normal, don't worry. However, if it is exceeded, it is necessary to increase the frequency and depth of the physical examination. If testing suggests that your risk of colon cancer is 5 times higher than normal, you'll need to have a colonoscopy every 5 years starting at age 45. If your family members are 45 years old and have colon cancer, you will need to start with a colonoscopy at age 35.
My mom doesn't smoke, so why does she get lung cancer? Over the years, we have found that more and more women have lung cancer patients, and they do not smoke, why is this? The first is the increase in life expectancy, which is the main reason. Secondly, second-hand smoke, the lungs of women who do not smoke, are more sensitive to harmful substances such as tar and nicotine. And they will attach to sofas and clothes, causing continuous damage to the human body. The third is kitchen fumes. A large number of data suggest that this may be an important reason for women's lung cancer. Kitchen fumes contain the products of food fried, which contain carcinogens. And many women often do not turn on the hood when cooking, because they have to take care of the children alone, and the loud noise of the hood will make them unable to hear the movement of the children. Fortunately, although women are suffering from lung cancer more and more, most people have adenocarcinoma, and most of them are early stages, and they will not return or metastasize after removal.
Specialist hospital or general hospital? Simply put, the departments of general hospitals are relatively comprehensive, and all diseases can be covered. Specialist hospitals are more comprehensive and resources are highly concentrated, for example, in cancer hospitals, oncology surgery, internal medicine, radiotherapy and traditional Chinese medicine are all together. But people are a whole, and they can't treat headaches and foot pains. Cancer patients with good physical condition can choose between two types of hospitals. If you have a special physical condition, have suffered from rheumatic immune diseases, kidney diseases, or even cancer patients who are pregnant, you should choose a general hospital. There are cardiovascular, internal medicine, rheumatology and immunology, respiratory, obstetrics and gynecology as a backing escort. If the tumor problem is very complex, the invasion is widespread, or the patient needs a series of comprehensive treatment, such as chemotherapy, radiotherapy, targeting, etc., the specialist hospital is the first choice.
The outpatient hall is always crowded
Local consultation or big city consultation? For many people, if you don't go to first-tier cities such as Beijing, Shanghai and Guangzhou, you will always feel regretful. In fact, in the field of tumors, the examination report can explain the problem most of the time. The patient's family can bring the patient's full set of information, including various reports, CT photos, pathology slices, etc. to the big city for consultation, without having to take the patient on the road. Especially in the past two years, affected by the epidemic, many people have stayed in the local area for treatment, so that the treatment level of some local hospitals has improved rapidly, so it is not necessary to go north to Guangzhou. In addition, we can choose a better articulation method, some surgeries may have to be done in the north, Shanghai and Guangzhou, but postoperative adjuvant chemotherapy or radiotherapy can be done in the hometown. Minimize the patient's rush to see a doctor, so as not to be physically and mentally tired and have other problems.
New drugs or old drugs?
Compared with old drugs, new drugs are relatively low in terms of cost performance. Because the newer the drug, the fewer people use it, the higher the unit price of the apportionment, but the effect does not necessarily increase with the increase in price, but the side effects may be more obvious. For example, immunotherapy, a relatively new therapy, may lead to 5%-10% of patients with serious immune myocardial damage, and even life-threatening. Elderly patients, especially those who have had previous cardiopulmonary and cerebral diseases, are not necessarily suitable for new drugs. You can care about the following questions: 1. How long does it take? Because some treatment plans are not the final plan, after several courses of treatment need to be combined with other therapies, do not wait for the money to run out, only to find that there is a second stage of treatment, need more money; 2. How good is the best treatment effect? Some regimens can only be maintained for 1-2 years; 3. What is the average treatment effect? Individual miracles occur from time to time, but do not take chances; 4. Ask the doctor to recommend some alternatives, so that when communicating with patients, you only need to do multiple choice questions, not judgment questions.
During open surgery (courtesy of Wang Xing)
Domestic medical treatment or overseas medical treatment? Overseas medical care is indeed the choice of many people. But is there a big difference between home and abroad? I have participated in the World Lung Cancer Congress for 5 consecutive years, and it can be clearly said that as of 2020, research from China accounts for 1/3 of the world's research, which is the most important voice in the world. From a world perspective, Chinese doctors are very good at surgery. For example, in the hospital where I am, the annual volume of thoracic surgery is more than 10,000, which is a very large base. If surgery is required, there is no need to go overseas. The most important reason for going to the United States for treatment is that some new drugs have just been developed and have not yet been listed in China, but in general, the effect of these new drugs is still unknown. Therefore, before going to overseas for treatment, it is necessary to consult the patient's opinion to avoid the regret of "death away from home". The most valuable point of overseas medical treatment is to obtain a "second diagnosis and treatment opinion", after getting the first diagnosis result, if there is any doubt, you can consult some overseas intermediaries and platforms. If the opinion is consistent with the original, there is no need to go abroad, and if there is no agreement, then consider going abroad.
Don't be impulsive, rationally choose the treatment plan "I am such a father/mother, must be cured." "That's the first reaction of most people. In fact, the front line of cancer treatment tends to be very long, and some patients have to go through chemotherapy for 2 months, then surgery, followed by radiation therapy for 2 months, which is by no means a problem that can be solved by raising a sum of money. Once, there was a patient with advanced lung cancer who could use targeted drugs. When I told his son that although the first generation of targeted drugs can be reimbursed and not expensive, the third generation of targeted drugs is slightly better, the young man was very excited, but he was silent when he heard that the cost was about thirty thousand a month.
After his father fell ill, he had already worked hard to earn money in the third shift, but it was only seven or eight thousand yuan a month, which was still too far from thirty thousand.
So, if you get cancer, do you have to sell your house for treatment? It is better to look at your family situation objectively and make rational decisions.
And from the doctor's point of view, many times the marginal utility of treatment is suddenly reduced, spending a lot of money and time, paying a high price, and can only increase the effective rate by 5%. I'll give you a formula:
Degree of medication = effect of the drug - complications - price - household debt
If the drug is 100% effective, it is 100 points; the complication rate is 10%, that is, 10 points; the price is 200,000 per year, to use 2 years, that is 40 points; the household debt is 800,000, that is, 80 points; the degree of medication = 100-10-40-80 = -30 points. A score below 0 means that from the long-term development of the family, it may not be suitable for investing such a large amount of money at the moment. As long as it is higher than 0 points, it means that the scheme is preferable and this medicine can be used.
Some people in developed countries can get cancer many times in their lives, while our citizens can usually only get 1 time. Because the medical examination rate and awareness in these countries are very high, many patients can be cured when they have the first cancer, so that they can get the opportunity to "get the second cancer". At present, the proportion of early-stage cancer patients in China does not exceed 15%, and the vast majority of patients are in advanced stages as soon as they are examined. Therefore, I recommend that people over 45 years old undergo a relatively comprehensive physical examination, here is a project reference: men: blood routine, fecal occult blood, thyroid ultrasound, chest CT (1-2 years), Helicobacter pylori blowing experiment (1-2 years), abdominal ultrasound, serum SPA, gastroscopy every 3-5 years after the age of 40, and colonoscopy every 5-10 years. Women: In addition to all the items of the above male physical examination, breast B ultrasound/molybdenum and palladium, women's molybdenum ultrasound, HPV examination and cervical brush (every 3-5 years) are added. HPV tests and cervical brushes do not need to be done every year, because the normal epithelial cells of the cervix, it takes 3-5 years for precancerous lesions to turn into cervical cancer, and it takes 2-5 years to develop cervical cancer, adding up to about 5-10 years, so it is enough to do it every 3 years.
Stills from "I Am Not a Medicine God"
Appropriate allocation of insurance, investment for health now everyone's awareness of insurance has increased. But how much should we spend on insurance? At present, 85% of Chinese cancer patients, once the disease is found, are usually stage 3 and stage 4, and the average treatment cost is 200,000-500,000. The greatest value of critical illness insurance is to provide a flexible compensation for major illness. Suppose you have cancer, at least in the 2-year recovery period, can not participate in too heavy work, can not be normal repayment, so the allocation of a 50-800,000 amount of serious illness insurance, equivalent to giving you medical treatment and living expenses are guaranteed. Medical insurance, on the other hand, is the solution to the problem of reimbursement as much as you spend at your own expense. Suppose a 30-year-old young man, spending 300 yuan a year in premiums, can leverage 1 million, if unfortunately get leukemia, to do bone marrow transplantation, whether it costs 600,000 or 700,000, medical insurance can help him / her full reimbursement, and then use serious illness insurance to compensate for life, will not be busy.
In any case, do what you can, do not recommend the brain to buy a very high amount of insurance, to leave yourself some leeway.
What are the dietary contraindications for cancer patients? Postoperative nutrition can be treated in stages. 1-4 days after surgery, it is mainly up to the doctor to deal with the problem of nutritional recovery. 4-7 days after the operation, people's digestive function gradually recovered, and began to follow the doctor's instructions for a simple diet and intake of nutrients. After 7 days after the operation, if all goes well with the recovery of the operation, you can start to gradually resume a normal diet. If the patient is undergoing gastrointestinal surgery, such as gastric surgery, esophageal surgery, and intestinal surgery, it is necessary to follow the steps of drinking water - clearing liquid food - liquid food - semi-liquid food - gradually eating normally. If it is a lung, thyroid, orthopedic, prostate, etc. that does not go through the digestive tract, it is possible to recover directly from a liquid diet.
"Need a big supplement" and "can't eat hair"? The so-called "postoperative injury, need to make up for it" and "hair must not be eaten", in fact, are not advisable. "Yuan Qi" refers to postoperative weakness, and we need more nutrition to help the wound recovery. Through daily natural foods, proteins, fats, carbohydrates (sugars), microorganisms and minerals, water, fiber, etc. can be obtained. Instead of letting the patient eat various supplements and miracle drugs, it is better to improve his appetite. The enjoyment and sensory stimulation that food brings us is irreplaceable as a tonic. At present, scientists have found many carcinogens, the World Health Organization divides them into Class I carcinogens (such as betel nut, moldy peanuts) and Class II carcinogens (evidence is not clear, such as barbecue food), etc., these foods we can try to avoid. As for the "hair" of the old people's mouth, most of them refer to lamb, pepper, seafood foods, most of which are nutrient-rich foods and have no miraculous effect on carcinogenicity.
In the corridor of the ward of Shanghai First People's Hospital
The little red couplet expresses a good wish for the patient
How do I survive my recovery? Some family members who are dedicated to caring for a patient will think that he/she is still unhappy after giving so much. One of the reasons is that you're doing too much to leave patients with the opportunity to provide value. Take myself as an example: In 2014, just three or four months before my wedding, my mother-in-law had stomach cancer. At first, we cared for her as a cancer patient, and after her surgery, we reached out and opened her mouth, but she always frowned. She is really happy, we asked her to help with the child, although the physical condition is not as good as before, but in the process of taking the child, found their own value, spirit and mentality are much better. I was also impressed by a lawyer. He was less than 40 years old, had lung cancer, and had surgery. He wanted to go back to work himself, and chose a post that was not as day-and-night as before. But as long as he is in the workplace, there will be pressure, and his family hopes that he will rest at home for a year or two, and then find a stable job in the system. He felt that if he did choose the second path, it would mean bowing to life, and if cancer did not defeat him in the end, he might regret his original decision.
As a friend, I was very adamant that he should continue with his original work. From a doctor's point of view, getting lung cancer has little to do with work. The relationship between stress, anxiety, staying up late and causing cancer is at least far less so than smoking and drinking alcohol at the level of evidence. Pressure should not be a reason for your veto. I will encourage cancer patients to resume their work as much as possible during the recovery period, because during this period, they are prone to continue to fall into a kind of fear, and whenever the wind blows, the first reaction is "am I relapsing", and every review requires a lot of determination. But if he returns to his daily routine and spends every day to the fullest, he has the strength to fight fear. If the disease can be cured well in a period of time, such as thyroid cancer, lymphoma and early stomach cancer, lung cancer, etc., it is recommended to try to let the unit reserve a position for you, such as communicating with the direct leader whether you can work from home.
When to give up? I once talked to a "winner in life", the uncle is in his early 50s, has advanced colon cancer, and accompanies his wife in her 20s. He said that the saddest thing is not that he has not spent all the money in his life, nor that he has married a young wife and been pointed out, he said that the most helpless thing is that he does not know where his end is. "It's as if I'm sitting in a small boat and I've been told that there's a waterfall ahead of me and that it's impossible to go ashore anymore, but I don't know how far this waterfall is, and if there's 10 seconds left, I'll look up at the sky and lie down until I close my eyes; if there's 10 hours left, I can eat a piece of bread first, don't go hungry, and think about my beloved girl." 」 When exactly to choose to give up, it is really too difficult! Cancer patients, especially advanced cancer patients, they do not accept their own death, depression, anger, anxiety, fear, are all the most normal reactions of human beings. We need to understand what the patient's wishes are. For example, they don't think that clothes to reach out and food to open their mouths are the best life, he thinks that the best life is to be able to go to the toilet.
As family members, we can gradually accept death in stages. The first is to give up the hope of cure and accept the reality of death within a few years; the second step is to abandon invasive symptomatic treatment and accept the reality of death within 1 year. When it comes to dying, the shorter the process, the better. One patient once said goodbye to active treatment, saying to his children, "I don't want to try the next option, let's use this money to travel." "Four elderly people, two children and 2 children, the family went to Japan for 10 days and left a moving group photo on the beach.
As Dr. Atul wrote: Accepting the mortality of the individual and clearly understanding the limitations and possibilities of medicine is a process, not an epiphany, and only by not trying to live longer can you live longer.