On a bleak afternoon, outpatients flocked to the clinic.
Suddenly, a young woman hurriedly walked in outside the door, looking anxious, and before she sat down, she asked urgently, "Doctor, my recent physical examination found that there was a small nodule on the lung, is this lung cancer?" ”
This young woman's reaction is very common, today's [medical clinic], let's talk about what is a "lung nodule"?
In general, the inner lung ≤ 3 cm in diameter, the range is relatively limited, rounded, densely increased solid (solid) or sub-solid (surrounding cloud-like wrapped around the middle solid /cloud-like) lung shadow, can be called pulmonary nodules.
Some of the more common lung diseases, such as tuberculosis or infection, may also cause small nodules to appear.
However, after these common diseases are treated symptomatically, the nodules on the lungs will absorb or even dissipate, which does not belong to the lung nodules in our general sense.
Here, we mainly talk about this frightening lung nodule, which may be "lung cancer".
Solid lung nodules
Subsective lung nodules
(Courtesy of the doctor)
There is no clear or particularly clear reason to explain how lung nodules grow. But to say that it is a completely random event is not convincing.
Since the physical examination or CT test for early lung cancer screening is to look for high-risk nodules (lung cancer may be large or "good-looking" nodules), there is currently a relatively clear statement about who belongs to the high-risk group. That is to say, people with these "conditions" are more likely to grow nodules as "time bombs".
People ≥ 40 years of age with any of the following risk factors[1]:
(1) Heavy smokers, such as smoking one pack a day, smoking history for 20 consecutive years or more, or old smokers have suddenly woken up to quit smoking, but quit smoking time
(2) Have a history of environmental or high-risk occupational exposure (such as contacts of asbestos, beryllium, uranium, radon, etc.);
(3) Combined with some chronic lung diseases, such as the old slow branch, chronic obstructive pulmonary disease, diffuse pulmonary fibrosis or a history of tuberculosis;
(4) Those who have had other types of malignant tumors or have a family history of lung cancer.
Of course, in the actual implementation process, everyone can check according to their own situation. (For example, the limit of age is not very clear at present, of course, advanced age is more dangerous.) Many women do not smoke themselves, but they will be "poisoned" by second-hand smoke at home or in the workplace, which also needs to be taken into account. ）
As more research progresses, there may be slight changes in high-risk conditions, so you can follow the specific advice of your doctor in a respiratory clinic to develop your own test principles.
Is the lung nodule on physical examination "lung cancer"?
To answer this question, you can't just take a CT and find a doctor to see the film to make a conclusion. Through the film, at most, it can only tell you whether this nodule is "like" a bad thing.
If you must know if it is lung cancer (mostly early cancers), you can only take it out of the lungs (surgery or use a needle to insert a nodule to take a little tissue), and then ask the pathologist to see if there are any cancer cells under a microscope. But obviously, the vast majority of lung nodules do not need to be so tossed to clarify.
Because the small nodules that are eventually diagnosed as early-stage lung cancer are very few. American scholars spent nine years (2002-2011) examining and following up on high-risk groups and found that less than 4% of people ended up with lung cancer [2].
That is to say, more than 95% of the lung nodules are actually "good people" or "temporary good people", and there will be no harm in the short term.
In recent years, many cities in our country have also carried out early screening for lung cancer, and similar results have been obtained [3], so there is no need to panic too much about the detection of a lung nodule.
As mentioned earlier, since most of the lung nodules are benign, the hospital review of chest CT at a certain interval is currently the most common means.
Some nodules are just found when they are "kind eyebrows", a "harmless look of people and animals", but they may grow up slowly, "fierce" to the point where they need to be dealt with (this proportion is not high), but only regular follow-up can allow doctors to find problems at the first time, so as to deal with this "time bomb" as soon as possible.
The average time to come to the hospital for review depends on each person's specific situation (such as age, nodule size, whether smoking, whether there is a family history of lung cancer), so following the doctor's advice is the key, excessive anxiety or indifference is not advisable.
I hope that everyone will have a regular medical examination and live happily every day.
bibliography
Lung Cancer Group, Respiratory Diseases Branch of Chinese Medical Association. Expert Group of China Lung Cancer Prevention and Control Alliance. Expert Consensus on diagnosis and treatment of pulmonary nodules in China (2018 edition)[J]. Chinese Journal of Tuberculosis and Respiratory Disease, 2018, 41(10): 763-771.
[2] National Lung Screening Trial Research Team, Aberle DR, Adams AM, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 2011;365:395-409.
[3] Li N, Tan FW et al. One-off low-dose CT for lung cancer screening in China: a multicentre, population-based, prospective cohort study. Lancet Respir Med. March 08, 2022; DOI: https://doi.org/10.1016/S2213-2600(21)00560-9
Editors: Wei Luo, Zhang Jie, Wang Yan
Proofreading: Wu Yihe | Typesetting: Li Yongmin
Operation: Han Ningning | Coordinator: Zhao Yanan