Are lung nodules lung cancer?

According to the “Global Cancer Statistics 2018” report published by the American Cancer Society’s official journal “Journal of Cancer for Clinicians”, lung cancer is still the global incidence rate (11.6%) and mortality rate (18.4%) of the first malignant tumor. At present, the number of people with lung nodules found in chest X-rays or CT examinations is gradually increasing every year. Once a lung nodule is detected, many people will associate it with lung cancer, so they worry that their lives are threatened. .

So, are lung nodules and lung cancer the same thing? What kind of relationship exists between them? Let’s talk about it today.

01

Pulmonary space-occupying lesions with a pulmonary nodule diameter ≤ 3cm

Pulmonary nodules are space-occupying lesions in the lungs. Defined according to its diameter, a round or irregular-shaped lesion with a diameter of ≤ 3 cm in the lung can be single or multiple, and we call it a pulmonary nodule.

A pulmonary nodule with a diameter of 0.5cm-1cm is a small pulmonary nodule, and a diameter greater than 3cm is called a mass .

According to CT imaging Pulmonary nodules can be divided into pure ground glass nodules, mixed ground glass nodules, and solid nodules. Pure ground glass nodules are like ground glass, showing cloudy shadows; solid nodules are shadows with relatively high density in the lung; mixed ground glass nodules, as the name suggests, contain both solid components and ground glass nodules. The glass component, usually the solid component is in the middle of the ground glass component, like a sun that is shining.

02

Lung nodules are not lung cancer

But there is a possibility of malignant transformation

When many people learn that they have lung nodules, they feel that they are not far from lung cancer, so they have negative emotions such as fear and worry. In fact, not all lung nodules are lung cancer, or to be precise, most lung nodules are not lung cancer, because the malignant proportion of lung nodules is very small.

Most of the pulmonary nodules are benign, but this does not mean that once diagnosed Nodules can be taken lightly. Because the pulmonary nodule itself has the possibility of malignant transformation. The larger the diameter of the nodule, the older the age, the irregular border, and the more high-risk factors combined, the higher the probability of malignant transformation.

Pleural indentation sign, drainage line sign, vascular cluster sign, burr sign, spinous process sign, lobulation sign CT image changes such as , vacuoles, and air bronchioles are all signs of malignant transformation of pulmonary nodules. Among them, the order of malignant transformation probability should be: mixed ground glass nodule > ground glass nodule > solid nodule.

However, the process of malignant transformation of pulmonary nodules takes a certain amount of time, and often undergoes pure grinding in form Glass, mixed ground glass nodules to solid components in different stages. This process allows us enough time to make an accurate treatment plan.

03

High risk factors for pulmonary nodule malignancy

< span>“Consensus of Chinese Experts on the Diagnosis and Treatment of Pulmonary Nodules 2018 Edition” defines the high-risk group of lung cancer as those aged ≥ 40 years and with any of the following risk factors:

①Smoking ≥ 20 packs/year (or 400 sticks/year), or once smoked ≥ 20 packs/year (or 400 sticks/year), time to quit smoking <15 years;

②History of environmental or high-risk occupational exposure (such as asbestos, Beryllium, uranium, radon and other contacts);

③COPD, Diffuse pulmonary fibrosis or previous history of tuberculosis;

④Patients with previous malignant tumors or family history of lung cancer.

04

Management of pulmonary nodules< /strong>

It must be judged according to the specific situation

So, once nodules in the lungs are detected, what should be done? Under normal circumstances, the doctor will judge according to the specific situation of the nodule:

If the nodule diameter d≤0.8 Pulmonary nodules smaller than 1 cm do not require surgical treatment, only regular follow-up is required. During the follow-up, pulmonary nodules with the following changes are considered benign:

①Short-term changes in the external characteristics of the lesion Obviously, there is no lobulation or very deep lobulation, and the edge becomes smooth or blurred; ②The density is uniform or light; ③The lesion shrinks or disappears without increasing the density.

Pulmonary nodules are considered malignant when they have the following changes during follow-up:

①The diameter increases, and the doubling time conforms to the law of tumor growth; ②The lesion is stable or enlarged, and real components appear; ③The lesion shrinks , but there is a real component or an increase in the solid component; ④ Angiogenesis conforms to the law of malignant pulmonary nodules;

Pulmonary nodules with diameter d>0.8cm need to undergo non-surgical biopsy or surgical resection according to the specific situation , radiotherapy and chemotherapy, follow-up and other treatments.

Encountered Pulmonary nodules, whether it is the patient himself or his family, do not need unnecessary panic. Pulmonary nodules are actually just a “paper tiger”. Keep a positive and optimistic attitude, quit bad habits, follow the advice of medical staff, and follow up regularly. Why should you be afraid of pulmonary nodules?

References:

[1]. Wang Lu and Hong Qunying, interpretation of Chinese expert consensus on diagnosis and treatment of pulmonary nodules (2018 edition). Chinese Journal of Practical Internal Medicine, 2019. 39(05): pp. 440-442.

[2] D. Han, M.A. Heuvelmans, C.M. van der Aalst, L.H. van Smoorenburg, M.D. Dorrius, M. Rook, K. Nackaerts, J.E. Walter, H.J.M. Groen, R. Vliegenthart, H.J. de Koning, M. Oudkerke, New Fissure-attached Nodules in Lung Cancer Screening: A Brief Report from The NELSON Study, J Thorac Oncol (2019) .

[3]. Fan Chunkai and Ma Mingjuan, CT imaging diagnosis of small solitary malignant pulmonary nodules Essentials Research. Capital Food and Medicine, 2018. 25(14): Page 86-87.

Author | Liang Zhu, Deputy Chief Physician, Department of Cardiothoracic Surgery, Affiliated Hospital of Guangdong Medical University

Review | Associate Professor, Deputy Chief Physician of Thoracic Surgery

This article is reproduced from: “Popular Science China” (invaded and deleted)

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