"The first chest CT was done in the physical examination of the unit, and the first pulmonary nodule in my life was found. "It is said that the 'three-piece set' of nodules (pulmonary nodules, thyroid nodules, and breast nodules) is the standard for people in the workplace, and nodules are very common, so don't pay too much attention to them......, right?" At the end of the year and the beginning of the year, the hospitals ushered in a concentrated period of physical examinations, and many people were very anxious and nervous when they saw the word pulmonary nodules in the physical examination report, and some people thought that pulmonary nodules were becoming more and more common and did not care about it.
Recently, the news of a 29-year-old woman who had lung nodules before and was subsequently diagnosed with lung cancer has been on the hot search, which has made many people discuss the importance of early detection and treatment of pulmonary nodules. So, what is a pulmonary nodule? What should we do after a pulmonary nodule is detected? Focusing on the issues that everyone is concerned about, this reporter interviewed Professor Liu Jun, director of the Department of Radiology of the Second Xiangya Hospital of Central South University, and Zhao Wei, an associate researcher team.
The risk of malignancy of pulmonary nodules is directly proportional to size
"With the continuous advancement of medical imaging technology, especially the application of high-resolution CT, doctors are able to observe lung tissue in more detail, and small nodules that used to be one or two millimeters that were easy to hide can now be seen clearly. Zhao Wei introduced that with the improvement of health awareness, more and more people are aware of the importance of physical examination, and physical examination usually includes imaging examination of the lungs, so that the detection rate of pulmonary nodules gradually increases.
Pulmonary nodules are common not only in middle-aged and elderly people, but also in young people. According to the "2022 Annual Health Examination Big Data Blue Book", about 54% of the population has pulmonary nodules, and the prevalence of pulmonary nodules is gradually increasing with age.
What exactly is a pulmonary nodule? In fact, pulmonary nodule is not a disease name, but an imaging term. Pulmonary nodules are density-increasing lesions of ≤3 cm in diameter found on lung imaging, which are approximately round, oval, or irregular in shape, and may or may not be well-defined in the border. It can be a single shot or multiple shots. If it is > 3 cm in diameter, it cannot be called a nodule, but a lump.
There are two main types of pulmonary nodules: benign and malignant. Authoritative studies have shown that 95% of pulmonary nodules are benign, especially those less than 10 mm in diameter. The risk of cancer is less than 1% for small nodules less than 6 mm in diameter, between 0.5% and 2% for solid nodules 6 to 8 mm in diameter, and about 3% for nodules larger than 8 mm in diameter.
Most pulmonary nodules don't go away on their own
From the physical examination report, it can be found that there are three places in the human body that love to grow nodules, namely the lungs, thyroid gland and breast. Among them, the lungs inhale air from the outside and are in close contact with the outside world, and inflammation, tuberculosis, tumors, connective tissue diseases and pulmonary thromboembolism caused by infectious or non-infectious factors may be the main causes of pulmonary nodules.
Some lifestyle and environmental factors, such as smoking, air pollution, and occupational exposure, may also be associated with the incidence of lung disease, which indirectly affect the formation of lung nodules.
In the office, people often ask whether lung nodules will go away, and some lung nodules may go away on their own over a period of time, especially benign nodules caused by infection or inflammation. However, this is relatively rare, and most pulmonary nodules are stable and do not go away on their own. Therefore, regular follow-up is essential after the detection of a pulmonary nodule.
Zhao Wei said that if the examination finds lung nodules, there is no need to be overly alarmed, because most lung nodules are benign and there is no need to worry too much. Consultation with a clinician for a comprehensive evaluation is recommended. Your doctor will base your diagnosis and treatment plan on the size, shape, location and other characteristics of the nodule.
Be suspicious for such nodules on CT reports
CT reports are mainly classified according to the nature and characteristics of pulmonary nodules, which are generally divided into ground-glass nodules (including pure ground-glass nodules and mixed ground-glass nodules) and solid nodules, among which ground-glass nodules found by physical examination have a relatively high probability of malignancy and should be paid special attention to, because some of them are early-stage lung cancer.
According to Zhao Wei, ground-glass nodules generally need regular follow-up to determine their nature. Although ground-glass nodules have a relatively higher probability of malignancy than solid nodules, most ground-glass nodules are inert and may not change much at long-term follow-up. At the same time, there are also inflammatory nodules that manifest as ground-glass nodules that may disappear with short-term follow-up. Therefore, there is no need to be overly anxious about the discovery of ground-glass nodules, and it is sufficient to consult a professional doctor for evaluation.
To determine whether a lung nodule is benign or malignant, a series of examinations and evaluations are usually required, including: (1) Imaging examination: CT scan is the most commonly used imaging examination, which can provide information about the size, shape, marginal characteristics, density and other information of the nodule. PET-CT scans can also provide information about the activity of nodules, X-ray is preferred for detailed observation of nodules, and MRI examination is of certain value in differentiating benign and malignant nodules. (2) Pathological examination: Histopathological examination after needle biopsy or surgical resection is the gold standard for judging the nature of nodules. (3) Clinical evaluation: The doctor will consider the patient's tumor history, smoking history, symptoms and other information to help judge the nature of the nodule.
For different types of lung nodules, the doctor's treatment plan will be different. Most benign nodules do not require treatment, and regular follow-up visits are performed to monitor changes in the nodules. Some nodules may require surgery or other treatments, depending on the type of nodule and the patient's medical history.
Typically, these nodules tend to be observed progressively: 1. the nodules are small with a diameter of less than 6 mm, 2. the nodules are regular in morphology with smooth margins, 3. they have low risk factors and the patient has no or short smoking history, and 4. the nodules have typical benign features on imaging.
Treatment of malignant nodules usually includes surgical resection, ablation therapy, radiotherapy, chemotherapy, targeted therapy, etc., and the specific treatment plan will depend on the type and stage of the cancer, the overall health of the patient, and other factors.
Why do some women get lung cancer without smoking?
It is said that smoking is easy to get lung cancer, why do some people smoke all their lives without getting lung cancer, while some women do not smoke but also get lung cancer? In this regard, Liu Jun explained that smoking is one of the main risk factors for lung cancer. However, the incidence of lung cancer is not only caused by smoking, but also related to genetics, occupational exposure, exposure to carcinogens, lifestyle, immune system and other factors. Some non-smoking lung cancer patients may be related to second-hand smoke, kitchen fume inhalation, etc.
In addition, not all lung cancers present as lung nodules, and the manifestations of lung cancer will vary depending on the type and individual differences. Some lung cancers do not necessarily manifest as lung nodules, such as scar cancer, pneumonic lung cancer, cystic lung cancer, etc.
Early screening is targeted at people at risk, including smokers or former smokers, people with a family history of genetic disease, people with long-term exposure to carcinogens, patients with previous lung cancer or other related cancers, older adults, and individuals with chronic respiratory diseases (such as chronic obstructive pulmonary disease) or immune system disorders.
At the same time, by grading the risk degree of the target population, it is clinically recommended to perform low-dose CT examination for the high-risk group. Enrollment criteria for the high-risk group included ≥ people aged 50 years and people with a smoking history of ≥ 20 packs/year.
The main cause of pulmonary nodules
Infection and inflammation
scar tissue
tumor
Genetic factors
Environmental exposure
age, etc
Can pulmonary nodules be prevented?
There is no specific way to completely prevent the appearance of lung nodules, but the following measures can reduce the risk of developing lung nodules
Quit smoking or avoid smoking
Establish a healthy lifestyle
Avoid inhalation of harmful substances
Regular medical check-ups
These factors may increase the risk of malignant transformation of pulmonary nodules
1. Smoking
2. Long-term exposure to harmful substances
3. Familial inheritance
4. Patients with other chronic lung diseases, such as chronic obstructive pulmonary disease and tuberculosis, may be more prone to malignant transformation
Source: Changsha Evening News