Surgery is the preferred treatment for lung cancer patients after diagnosis, but even if radical lung cancer surgery is done, a large proportion of patients will still have recurrence and metastasis within a few years after surgery, which is also a special fear and worry of every lung cancer patient. After the lung cancer patients have undergone surgery, in order to reduce the probability of recurrence and metastasis, the following points need to be done.
1. Regular follow-up
It can be said that surgery is only the first step in the treatment of lung cancer, and even very early lung cancer still needs to be reviewed regularly every year. According to the 2021 edition of the Chinese Society of Clinical Oncology (CSCO) Non-small cell lung cancer diagnosis and treatment guidelines, the follow-up methods for lung cancer are: stage I to II. and after surgical resection of stage III.A NSCLS R0 or after SBRT treatment, patients with no clinical symptoms or stable symptoms, follow-up once in 6 months for the first 2 years after the end of treatment, 3 to 5 years, follow up once a year. Follow-up once a year for more than 5 years after the end of treatment. Follow-up items are: physical examination, chest scan CT± contrast scan, abdominal CT or ultrasound. If symptoms worsen or new-onset symptoms occur during this period, they should be followed up immediately. In fact, in clinical practice, for patients with a slightly higher probability of recurrence and metastasis, it is recommended to repeat the examination in the first 2 years, 3 to 4 months, 3 to 5 years, 6 months, and once a year after 5 years. The purpose of follow-up is not only to observe whether there is recurrence of metastasis in time, but also to detect whether a second primary cancer has occurred in time.
2. Standardized postoperative adjuvant therapy
In addition to carcinoma in situ, micro-invasive carcinoma and stage IA, which are very early-stage lung cancers, patients with lung cancer in other stages basically need postoperative adjuvant therapy after surgery. Postoperative adjuvant therapy modalities, including adjuvant chemotherapy, adjuvant targeted therapy, and adjuvant immunotherapy. According to guidelines, adjuvant chemotherapy should be given postoperatively in stage IB and in all patients with lung cancer above stage II who are at risk of recurrence. With the recommendation of adjuvant targeted therapy by the guidelines, for lung cancer patients with stage IB-IIIA, if there is an EGFR gene mutation, targeted therapy after chemotherapy can be considered for 2-3 years, and those with poor constitution can consider using only targeted therapy.
Postoperative immunopharmological adjuvant therapy is a recently approved treatment modality. On March 16, 2022, the State Drug Administration of the People's Republic of China officially approved the adjuvant adjunctive treatment of atenolizumab monotherapy in ≥1% of patients with tumor cell (TC) PD-L1 stains, surgical resection, and platinum-based chemotherapy stage II-IIIA non-small cell lung cancer (NSCLC). This is the first and only indication for postoperative adjuvant immunotherapy in China.
3. Proper exercise
Lung cancer patients have experienced the trauma of surgery, and their physique and lung function will decline, but don't treat yourself as a patient forever and do nothing. In fact, you can get out of bed the next day after surgery, you can do simple daily activities for 3-5 days, you can do some light housework activities in 1-2 weeks, start physical exercise after a month, and need to add some special pulmonary rehabilitation exercises, such as using a respiratory exerciser. For middle-aged and elderly people with poor physical strength, long-term exercise is required after surgery to restore exercise ability. Common exercise styles include: walking, jogging, tai chi, baduanjin, swimming, etc. In short, we must do what we can and take it step by step.
4. Pay attention to the details of life
It can be said that improving autoimmunity is the key to reducing recurrent metastasis. In addition to continuous exercise, it is necessary to abandon all preoperative bad habits, including smoking, drinking, staying up late, overworking, etc. to improve immunity. Pay attention to strengthening nutrition in daily life, and supplement high-quality protein foods after surgery. Pay attention to keep warm at the turn of the season, otherwise it is easy to induce lung infections due to colds. Influenza and pneumonia vaccines can be given before winter. Patients with too poor constitution can appropriately use drugs that improve immunity, such as ubenemex, thymus for injection, enteric-coated tablets of thymus peptides, ginseng capsules and so on.
5. Positive mindset
Mindset is one of the factors that determine the outcome of the disease, and a positive mindset can make people feel uplifted and play a positive role in reducing relapse and metastasis. Conversely, excessive anxiety and depression will affect appetite and sleep, and will reduce immune function. It can be seen that a peaceful attitude and correct treatment can prolong life and reduce the risk of recurrence.