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[1] Wang Yilun, Zhang Yaojing, Shi Hongcan.Research progress on diagnosis and treatment strategies of multiple primary lung cancer[J/OL].Chinese Journal of Clinical Thoracic and Cardiovascular Surgery,1-7[2024-04-17].http://kns.cnki.net/kcms/detail/51.1492.R.20240409.1041.042.html.
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Asbestos, I don't know how much you know about it, presumably friends born in the 80s must have seen asbestos tiles when they were children. As a natural mineral resource, asbestos has good fireproof, heat insulation, moisture-proof functions, and is often made into fire blankets, drainage pipes and heat insulation boards and so on for various fields, especially in northwest China, with a large number of natural asbestos deposits, and most of the local buildings use asbestos as a building material. But what many people don't know is that the dust of asbestos fibers can have an irreversible blow to the human body and even eventually lead to lung cancer!
2015 is the 8th year that Zhang Xu has been working hard alone in Dongguan. Waking up in his own house has always been Zhang Xu's wish. Finally, in August of this year, Zhang Xu saved enough for a down payment and bought a rough house. After paying the down payment, the money for renovation is very tight. So Zhang Xu didn't look for a professional decoration company, he bought decoration materials through various channels, hired a few workers, and started working.
On the morning of March 12, 2018, Zhang Xu woke up in his room as usual, looking at the pouring rain outside the window, and the closed windows and doors of the room completely cut him off from the hustle and bustle of the outside world, and his heart was filled with great satisfaction. But the good times didn't last long, Zhang Xu felt that something was wrong with his body, and recently he always felt that his right chest was tingling for a while, but the heart grew on the left, and it would not be a heart attack, so Zhang Xu felt that there was no need to make a big fuss, so he left it behind.
But after a month, Zhang Xu felt that the tingling pain in his chest became more and more frequent, and when he went to work, he needed to stop what he was doing and breathe heavily every once in a while to relieve himself. Zhang Xu went to a small clinic near the factory to take a chest X-ray, and the results showed that there was a patchy shadow in the right lung, and B-ultrasound showed that there was a 400ml effusion in the right chest cavity.
The pleura of the human body is a double-layer structure, the pleura covering the surface of the lungs is called the visceral pleura, and the pleura covering the surface of the thoracic cavity is called the parietal pleura, and a small gap will be formed between the two layers of pleura, that is, the pleural cavity, and the normal human body will secrete about 100ml of pleural fluid every day to act as a lubricating fluid in the pleural cavity to prevent pain caused by direct contact and friction between the two pleuras with the ups and downs of the pleural cavity during breathing.
When there is a lesion in the lungs, it causes the pleural fluid to be produced too quickly or absorbed too slowly, and the amount of fluid in the pleural cavity accumulates to a certain extent, resulting in pleural effusion, commonly known as pleural effusion. When the amount of pleural fluid reaches 500ml, the heart and lungs will be squeezed, and the patient will have symptoms such as palpitations and difficulty breathing. Pleural effusion can be caused by a variety of conditions, such as tuberculous pleurisy, which stimulates the pleura to produce inflammation and secrete more pleural effusion, causing symptoms of chest pain.
The doctor at the clinic suggested that Zhang Xu go to a big hospital to check the chest CT and puncture to explore the nature of the pleural fluid, but Zhang Xu thought of the usual difficult appearance of the manager, and he still had a fixed monthly mortgage to repay, so he asked the doctor to prescribe some medicine for him first, and the doctor prescribed rifampicin anti-tuberculosis and amikacin anti-infection to Zhang Xu according to the treatment method of tuberculous pleurisy.
Because tuberculosis is contagious, Zhang Xu applied for home office, and took medicine at home for two weeks, but the chest pain not only has not been relieved, but his physical condition has taken a sharp turn for the worse, Zhang Xu's breathing is becoming more and more difficult, and the cough in a row makes his chest more painful, and the chest pain is no longer limited to the right, as long as he takes a deep breath, the entire chest hurts uncontrollably.
Zhang Xu finally couldn't bear the pain and went to the Municipal People's Hospital for treatment, and the chest CT report showed that the right lung occupied a mass, the right pleural effusion, and the right hilum and mediastinal polyswollen lymph nodes, indicating a high possibility of malignancy. After hearing this, Zhang Xu asked the doctor in disbelief if the diagnosis was wrong, how could he get lung cancer even though he didn't smoke?
The doctor told Zhang Xu that although it is still necessary to take a pathological biopsy of the percutaneous lung to confirm the diagnosis, according to Zhang Xu's symptoms and examination report, it is very likely to be lung cancer, and the pleural fluid in the right lung is not an inflammatory pleural fluid formed by the inflammation stimulated by Mycobacterium tuberculosis, but a cancerous pleural fluid produced by the tumor compressing the lymphatic vessels and causing the obstruction of lymphatic return.
The doctor explained to Zhang Xu that it is not only smokers who are easy to get lung cancer, in addition to smoking, there are carcinogens in many places in life, in addition to the tar in cigarettes is a strong carcinogen, benzopyrene, arsenic oxide, nitric oxide and so on in industrial exhaust gas and automobile exhaust in the city are also carcinogens. There is also a group of people who are susceptible to various chemicals and dusts such as silica, and are also prone to lung cancer.
Hearing this, Zhang Xu suddenly reacted, when he chose decoration materials three years ago, in order to avoid mildew in the house caused by the hot and humid weather in Guangdong, he specially used asbestos in the wall to prevent moisture. Asbestos is a silicate mineral, and its main component is silica.
Lung disease occurs when asbestos fibers float in the air for a long time and are inhaled into the human body and deposited in the lungs. Silica dust accumulates in the lungs, which will damage the normal alveolar cells, the repair function of the lungs is abnormal, and the scars formed change the normal structure of the lung tissue, that is, irreversible fibrosis, and in the long run, the normal function of the lungs will be gradually lost, seriously affecting the respiratory function, and repeated inflammatory stimulation will lead to the occurrence of lung cancer.
Zhang Xu didn't expect that the house he wanted to buy was the culprit of his lung cancer, thinking of this, he couldn't help but feel sad, now the situation is that he can't go back to his home, and the doctor also sympathized with Zhang Xu's experience and sighed: "In fact, asbestos can't cause lung cancer in a day or two, as early as when there is a small range of fibrosis in the lungs, the body has given you three hints, but you don't notice it in time to drag it into lung ......cancer."
1. Cough
The early symptom of lung cancer is often coughing. Invasion of the trachea and bronchi by cancer cells causes the trachea to constrict and reflex cough, which is different from cough caused by respiratory infections and is often irritating and dry, with no or only a small amount of sputum. When the tumor completely blocks the trachea, the airflow cannot pass through, and in addition to the worsening of the cough, the coughing sound will become sharp and high-pitched, which is not easy to control with medication.
When the tumor tissue grows and the compressed blood vessel ruptures and bleeds, the patient may develop blood in the sputum or hemoptysis. When the amount of hemoptysis exceeds 500 ml/24 hours or the hemoptysis exceeds 200 ml (about the amount of one paper cup), it is considered massive hemoptysis and needs to be treated immediately, otherwise hemorrhagic shock will occur.
2. Difficulty breathing
Lung cancer patients have extremely poor lung function, which will lead to insufficient gas intake, often have symptoms of wheezing, chest tightness, and difficulty breathing. Clinically, a series of pulmonary function tests, including lung ventilation and pulmonary ventilation tests, will be performed on patients with lung disease to evaluate the lung function of patients.
However, there are three types of patients who are not suitable for pulmonary function test clinically, because the patient needs to blow hard during the examination, which may induce hemoptysis, so patients with hemoptysis in the near future cannot do it; the process of exertion will lead to changes in the pressure in the lungs, which will aggravate the severity of pneumothorax, so patients with pneumothorax are not recommended to do it; finally, patients with cardiopulmonary failure are not able to perform pulmonary function tests, and are not suitable for doing it.
III. Pleural effusion
Lung cancer patients are prone to infection in the lungs, which will stimulate the pleura to secrete more pleural fluid to form pleural effusion, and the insufficient nutrient intake and absorption of lung cancer patients will lead to a decrease in the concentration of albumin in the blood, a decrease in plasma colloidal osmotic pressure, and the barrier effect of the blood vessel wall will be weakened, the permeability of the blood vessel wall will increase, and the fluid in the blood vessel will more easily enter the pleural cavity to produce effusion.
When there is an abnormal increase in pleural effusion, it should be cooperated with the doctor to use anti-infective drugs to control the formation of pleural effusion, and when the pleural fluid volume reaches a moderate degree, that is, greater than 500ml, it is recommended to undergo thoracentesis and drainage as early as possible, if the effusion continues to increase, it will aggravate the symptoms of dyspnea. When patients with advanced lung cancer develop malignant pleural effusion, drugs cannot inhibit the growth of pleural effusion, and thoracentesis drainage is currently the only method that can alleviate the patient's symptoms.