Editor's note: The 30th National Cancer Prevention and Treatment Publicity Week and China Anti-Cancer Day Science Popularization Campaign will be held nationwide from April 15 to 21, 2024, with the theme of "CACA Guidelines, I Know You".
On this occasion, the "4.15 Topic" was planned in the "Health Lounge" column of "Yiyuehui" to popularize the knowledge of cancer diagnosis and treatment in the form of celebrity views and popular science short videos, so as to promote the construction of the whole process management system of "prevention, screening, diagnosis and treatment" of tumors, improve the early diagnosis rate and cure rate of tumors, practice the national strategy of "Healthy China", and help the cause of cancer prevention and control.
In this issue of [Health Lounge-4.15 Topic], Dr. Meng Di and Professor Hu Jian from the First Affiliated Hospital of Zhejiang University School of Medicine are invited to popularize the relevant knowledge of "Lung Cancer You Don't Know"!
Interviewees
Hu Jian
The First Affiliated Hospital of Zhejiang University School of Medicine
American Association for Thoracic Surgery（美国AATS）委员
The 4th "Famous Doctor of the Country"
Qiushi Distinguished Expert of Zhejiang University
"13th Five-Year Plan" and "14th Five-Year Plan" National Key R&D Program Project Chief and Project Leader
Deputy head of the Lung Cancer Group of the Thoracic and Cardiovascular Surgery Branch of the Chinese Medical Association
Member of the Standing Committee of the Thoracic Surgeon Branch of the Chinese Medical Doctor Association
Director of China Association for the Promotion of International Exchange in Health Care/Vice Chairman of Thoracic Surgery Branch/Vice Chairman of Lung Cancer Prevention and Treatment Branch
Director of China Medical Education Association/Vice Chairman of Lung Cancer Medical Education Committee/Vice Chairman of Thoracic Surgery Professional Committee
Member of the Standing Committee of the Cancer Prevention and Treatment Science Popularization Committee of the Chinese Anti-Cancer Association
Evaluation expert of the Medical Device Technical Evaluation Center of the State Food and Drug Administration
Founding Chairman of Thoracic Surgery Branch of Zhejiang Medical Association
President of the Thoracic Surgeon Branch of Zhejiang Medical Doctor Association
Chairman of the Lung Cancer Prevention and Control Committee of Zhejiang Preventive Medicine Association
Vice Chairman of the Esophageal Cancer Professional Committee of Zhejiang Anti-Cancer Association
Mendy
Attending physician of the First Affiliated Hospital of Zhejiang University School of Medicine
He graduated from Zhejiang University School of Medicine in 2016
Cancer, also known as malignancy, is a chilling topic. With the improvement of economic life and medical standards, cancer appears more and more frequently in people's lives, and from time to time I hear that people around me are suffering from cancer or die as a result, which makes people talk about "cancer" discoloration. According to the latest report on the disease burden of malignant tumors in China released by the National Cancer Center, there will be 4,824,700 new cases of malignant tumors in mainland China in 2022, and the global standardized incidence rate is 201.61/100,000, of which males are higher than females (209.61/100,000 vs. 197.03/100,000), and the incidence of cancer is still rising.
In the latest global cancer burden data for 2022 released by the World Health Organization's International Agency for Research on Cancer (IARC).
Among them, lung cancer ranks first in the incidence and mortality of malignant tumors in China. In 2022, there were 1,060,600 new cases of lung cancer and 733,300 deaths in mainland China, accounting for about 28% of all cancer deaths.
Fear of cancer often comes from the unknown. In fact, the progress of modern medicine has greatly deepened our understanding of cancer and changed our understanding of cancer:
Cancer occurs in everyone's body all the time;
Cancer is a long process of accumulation and development;
Cancer, which is a "side effect" of longevity;
Cancer doesn't have to be dead or alive;
……
Let's take lung cancer as an example to introduce to you - lung cancer that you don't know.
1
Symptoms and early screening for lung cancer
Lung cancer you know: When it comes to the symptoms of lung cancer, many people will think: long-term cough, chest tightness and shortness of breath, chest pain, weight loss, blood in the sputum, and even hemoptysis...... This is also a typical symptom described in medical textbooks.
Lung cancer you don't know: There are no obvious symptoms of early-stage lung cancer, and it can only be detected through regular physical examinations, and surgical treatment has a high cure rate!
Like all cancers, lung cancer has no obvious symptoms in its early stages. If you wait until symptoms such as chest pain and hemoptysis appear, more than 70% of them have developed to advanced lung cancer. This is also the origin of why people often said that "lung cancer is found to be advanced", and the root cause is the lack of regular physical examination and awareness of early screening of high-risk groups of lung cancer.
In medicine, the "5-year survival rate" is often used as an indicator of the treatment effect of malignant tumors, that is, the survival data of the patients who have been treated are followed up for up to 5 years. According to the literature, the treatment effect of early-stage lung cancer is significantly better than that of middle-to-advanced lung cancer: for early-stage lung cancer < 1cm, the 5-year survival rate reaches more than 92%, while that of advanced lung cancer is less than 5%!
Screening for lung cancer
At present, the world's major authoritative guidelines recommend low-dose spiral CT as the main method for lung cancer screening. It not only clearly sees early lung lesions, avoiding omissions, but also minimizes damage caused by CT radiation. In the Guidelines for Clinical Diagnosis and Treatment of Lung Cancer of the Chinese Medical Association (2023 Edition), it is recommended that lung cancer screening be carried out ≥ people aged 45 years old, and it is recommended to continue screening every 1~2 years for people with normal annual physical examination results. According to statistics, low-dose spiral CT of the lungs once a year can reduce the lung cancer mortality rate by 20% in high-risk groups of lung cancer.
People at high risk of lung cancer
On the basis of the age of ≥ 45, people with one of the following risk factors are at high risk: history of smoking, second-hand smoke or environmental oil smoke inhalation, occupational carcinogen exposure, personal tumor history, family history of lung cancer in first- and second-degree relatives, and history of chronic lung diseases. See the following figure for details:
Of course, low-dose spiral CT is not perfect, for example, there are certain limitations in the diagnosis and differentiation of central lung cancer and solid nodules. Therefore, thoracic surgeons are also constantly researching more accurate screening methods, including the use of non-inductive fiber bronchoscopy to screen for central lung cancer, and the screening of early lung cancer through peripheral blood circulating tumor cells (CTC) and tumor circulating DNA (ctDNA). Maybe one day in the future, we can really realize the "blood screening for cancer".
2
Surgical treatment of lung cancer
Lung cancer as you know: Lung cancer surgery must be removed as much as possible, of course, the larger the incision, the better, and the more incision the better.
What you don't know about lung cancer: Minimally invasive surgery has long become the mainstream, single-port surgery, da Vinci robotic surgery, natural orifice surgery...... From minimally invasive incision to minimally invasive excision, the concept of surgical treatment has been updated and changed, so that lung cancer treatment can achieve better results with less trauma.
Surgery is the treatment of choice for resectable lung cancer. Different from the early stage of development, lung cancer surgery has developed from the outdated concept of "being able to cut as much as possible" to the new era of lung cancer surgery concept of "being able to cut as little as possible", and has entered an era of comprehensive minimally invasive surgery.
From minimally invasive incision, to minimally invasive organs, to comprehensive minimally invasive, the development of lung cancer surgery has always followed the central principle of taking patient benefits as the core, constantly advancing with the times, pioneering and innovating in terms of surgical instruments, surgical methods, surgical effects and other aspects, and actively practicing the concept of rapid recovery surgery, gradually transforming the original traumatic and long-recovery thoracic surgery into minimally invasive and day surgery.
3
Comprehensive treatment for lung cancer
Lung cancer as you know it: The prognosis for advanced lung cancer is very poor, and once diagnosed, it is equivalent to a death sentence.
What you don't know about lung cancer: The development of medicine is making it possible to manage lung cancer as a chronic disease, that is, like chronic diseases such as hypertension and diabetes, the development of lung cancer is controlled through drugs and other means, so that patients can survive with cancer and live longer and have a better quality of life.
Advanced lung cancer is desperate, but with the development of medical technology, the "resurrection from the dead" in the ancient people's mouth is no longer a rare case today.
In addition to the well-known surgery, chemotherapy and radiotherapy, there are also interventional treatments such as radiofrequency ablation and radioactive seed implantation, and precision drug therapy such as targeted therapy and immunotherapy has created a new situation in lung cancer treatment.
Advanced lung cancer often requires systemic tumor treatment, and traditional chemotherapy is the main treatment, but chemotherapy drugs themselves cannot distinguish the "good or bad" of cells, and have a killing effect on growing cells, which is the main reason for the obvious side effects of chemotherapy, and it is also the root cause of many patients who are difficult to tolerate or even refuse treatment.
So, can drugs recognize and precisely kill cancer cells? Targeted therapy and immunotherapy are among the outstanding representatives.
Targeted therapy
First of all, targeted therapy works on the principle of interrupting the key steps in the proliferation process of lung cancer cells through specially developed small molecule drugs, thereby preventing the further development of lung cancer. Because it is only effective against certain types of lung cancer with specific gene mutations, it is as accurate as shooting at a target, so it is called targeted therapy. Common gene mutations such as EGFR, ALK, ROS1, MET and other genes are currently available with mature targeted drugs. At the same time, it is precisely because of its "precision" that it is necessary to conduct genetic testing on tumor tissues to determine the type of mutation before treatment, otherwise the wrong choice will lead to ineffective treatment and delay the treatment time.
Immunotherapy
Immunotherapy, represented by PD-1/PD-L1 inhibitors, is one of the most important advances in the treatment of lung cancer in recent years, and has shown great potential in the treatment of advanced lung cancer, benefiting many patients and renewing them. Unlike targeted therapy, PD-1/PD-L1 inhibitors do not directly target tumor cells, but kill tumor cells by reactivating and mobilizing the body's own immune system to restore the body's normal anti-tumor immune response.
In patients with advanced lung cancer, the combination of immunotherapy + chemotherapy has been fully clinically validated and has entered the first-line treatment camp. In patients with locally advanced lung cancer, through comprehensive treatment modes such as neoadjuvant immunotherapy + chemotherapy, surgical treatment, and postoperative immunomaintenance therapy, the tumor of some patients can even be completely relied, and there is no trace of lung cancer cells even in the specimens resected by surgery. This kind of "resurrection" treatment effect is like the dawn of dawn, which surprises us and makes us full of challenges: how to get more lung cancer patients to get the same treatment effect? This is a difficult problem that lung cancer experts are constantly studying and breaking through.
Just like all diseases, early screening, early diagnosis and early treatment are the keys to cancer cure; the rapid development of comprehensive treatment has made middle and advanced tumors no longer terrible; and the whole life cycle management of cancer patients and the management of chronic cancer diseases have been promoted, so that patients can live longer and better! Cancer is also becoming a disease that everyone needs to face, whether it is family, friends or themselves. Only by looking at this problem scientifically and rationally and arming ourselves with popular science knowledge can we achieve the ultimate victory in the protracted battle against cancer!
Typography: Sticky holes
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