Regarding the examination of lung cancer, don't panic when you see these results.

For most on-the-job employees, the unit will organize a physical examination every year, one of which is to take a chest X-ray. The question is: Why do some patients diagnosed with lung cancer fail to detect lung cancer early? Professor Zhou Ming, director of the Third Department of Thoracic Surgery, Cancer Hospital affiliated to Guangzhou Medical University, said that X-ray chest film is of little significance for screening early lung cancer, and the gold standard for screening lung cancer is low-dose spiral CT.

X-ray chest film can't detect lung cancer early.

Mr. Wu, 48, was recently diagnosed with lung cancer. He took a chest X-ray in the physical examination of the unit six months ago, and found nothing unusual and didn't feel unwell. "The X-ray chest film in routine physical examination is of little significance for early screening of lung cancer. When lesions are found on chest radiographs, they are often large. " Zhou Ming said, "So that nearly 80% of lung cancer patients were discovered in the middle and late stages."

He explained that the missed diagnosis and misdiagnosis rate of chest X-ray screening for lung cancer is very high. On the chest film, about half of the lung area overlaps with the heart, mediastinum, diaphragm and other tissues, and some early lung cancer is difficult to find. Chest radiographs also lack density contrast, and the detection rate of mediastinal lymph node metastasis of lung cancer is low.

In addition, even if the tumor is found on the chest radiograph, its exact location, nature and staging are not clear. "Screening lung cancer with ground glass shadow nodules on chest radiographs will all be missed. If it is a small lung cancer with solid nodules, a considerable number of patients will be missed. Therefore, chest radiograph is not the best means to screen lung cancer. "

Lung cancer is a disease related to environmental factors and lifestyle, and its risk factors include smoking, environmental pollution, occupational exposure, chronic lung disease and past history of malignant tumor. Zhou Ming suggested that it is best for high-risk groups to do 1 low-dose spiral CT every year, and the markers of physical examination and blood test cannot be used as diagnostic criteria.

Small pulmonary nodules were found. Do you want to deal with them?

If small nodules are found in the lungs during CT examination, should they be treated? Zhou Ming explained that pulmonary nodules refer to some round soft tissue lesions with clear boundaries in lung parenchyma. For lesions less than 3 cm, they are clinically called nodules; For lesions larger than 3 cm, they are called masses; Less than 2 cm, called pulmonary nodules; For those smaller than 5 mm, they are called microscopic nodules.

We must attach great importance to finding ground glass shadow nodules in the lungs on CT. Zhou Ming introduced that in the lung parenchyma, some small nodules with slightly increased density, clouds or circles belong to a special type of pulmonary nodules. Some ground glass shadow nodules are actually very early lung cancer.

No matter what kind of small pulmonary nodules are, the size of the nodules is closely related to their benign and malignant. "Generally speaking, the malignant probability of a mass larger than 3 cm is very high, while a tiny nodule smaller than 5 mm is usually a benign lesion."

Zhou Ming said, "The doctor will make a comprehensive judgment based on the patient's medical history, symptoms and CT examination results." If the possibility of malignant tumor is considered high, the patient will be advised to have surgery as soon as possible. If benign lesions are considered or a clear judgment cannot be made at the moment, patients are often advised to have a CT examination every 3-6 months.

Can lung nodule follow-up delay the illness?

For some small pulmonary nodules whose nature is difficult to judge at the moment, there is often no good diagnosis method in clinic. PET-CT examination has no more favorable diagnostic results; Even if a biopsy is done, the diagnosis may not be confirmed. At this time, regular follow-up observation is often the best choice.

Some patients will worry: if it is malignant, will it delay the treatment time during regular follow-up?

Zhou Ming said that in fact, this kind of worry is completely unnecessary. For these undiagnosed ground glass shadow nodules below 65,438+0 cm, even if they are malignant, even if their diameter has more than doubled during regular follow-up, they still belong to very early lung cancer. Video-assisted thoracoscopic minimally invasive surgery can be used, and the patient can be discharged 2 ~ 3 days at the earliest after operation. The five-year survival rate of patients is still close to 100%. Moreover, these patients often do not need adjuvant radiotherapy and chemotherapy after surgery. In other words, an interval of three months to six months will not affect the long-term prognosis of patients. On the contrary, it can avoid some unnecessary surgical treatments and related risks.