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Annual physical examination
Many people will be emotional
One to thirty years old
How many times will the physical examination reveal some minor problems
For example, pulmonary nodules
For this nodule
Should we face the enemy?
Or should I just ignore it?
Today
Department of Respiratory Medicine, The First Affiliated Hospital of Zhejiang University School of Medicine
Want to share the story of a 36-year-old young man
And talk about lung nodules all at once!
36-year-old migrant worker
Cough for a month suspected of cancer
The protagonist of today’s story, Xiaohu (pseudonym), is 36 years old this year, a native of Yunnan, and has been working away from home since he was young. In recent years, he has worked in a shoe factory in Wenzhou.
A month ago, Xiaohu developed cough symptoms without obvious incentives, not severe cough, no fever, no sputum chest pain and other symptoms, Xiaohu had no symptoms. Seriously. It’s just that after coughing intermittently for about ten days, Xiaohu felt shortness of breath when he walked faster or lifted heavy objects. Although it was relieved by sitting down and resting for a while, the symptoms of shortness of breath became more and more severe. It came more and more frequently, so Xiaohu walked into the local hospital in Wenzhou under the persuasion of his wife.
“A large amount of pleural effusion on the right side with incomplete expansion of some tissues.” The local hospital chest CT scan showed that Xiaohu’s lungs had been compressed by pleural effusion , resulting in incomplete expansion of some tissues. After the pleural effusion was drained out, the local hospital performed an examination and found that the tumor marker carcinoembryonic antigen (CEA) in the pleural effusion was 74.30 ng/ml. Less than 5ng/ml, meaning that Xiaohu is very likely to have malignant tumor, but no cancer cells were found in the local pleural effusion smear. To this end, the local hospital suggested that Xiaohu go to a higher-level hospital in Hangzhou for further examination.
For this reason, Xiaohu went to the outpatient service of Zhang Zeying, the attending physician of the Department of Respiratory Medicine of the First Hospital of Zhejiang University. Considering that Xiaohu’s pleural effusion had been drained, Dr. Zhang reviewed the lung CT for Xiaohu. CT results showed that Xiaohu’s right lung had space-occupying and multiple solid nodules.
Advanced lung cancer diagnosed
Never had a medical examination
Lung space-occupying, massive pleural effusion, elevated carcinoembryonic antigen… All of the above symptoms, the attending physician Zhang Zeying thought of lung cancer pleural metastasis, and immediately admitted Xiaohu to the hospital. But why can’t cancer cells be found in the pleural smear? Wang Jie, deputy chief physician of the Department of Respiratory Medicine, explained that pleural effusion is caused by increased pleural permeability, and tumor cells may not be found in pleural effusion smears. Pathological examination to confirm the diagnosis, but according to the patient’s current symptoms and examination, the situation is not optimistic.
“Lung adenocarcinoma, advanced stage.” The pathological results confirmed the expert’s preliminary judgment. Since Xiaohu’s lung cancer has already metastasized to the pleura, it is in the fourth stage of lung cancer. In this case, there is no possibility of surgical treatment for advanced lung cancer. It can only be treated by radiotherapy and chemotherapy, and genetic testing to see if there is a sensitive gene mutation, so that targeted therapy can be used.
“Doctor, how can someone who is fine with me suddenly get lung cancer?” 36 years old, is in his prime, with the old and the young. As the mainstay of the family, Xiaohu really can’t believe that he was diagnosed with advanced lung cancer just because of a cough.
“Lung cancer is by no means sudden, it’s just that you don’t have regular physical examinations to find its changes and development.” Chief Physician Zhou Jianya said that since Xiaohu has never done regular examinations, it is impossible to judge this. How long does it take for advanced lung cancer to develop from pulmonary nodules? “All lung cancers do not grow in a few days, so we say that early detection, early diagnosis, and early treatment are very important.”
Of course, Xiaohu was diagnosed with advanced lung cancer at a young age. In addition to irregular physical examinations, he also has a high-risk factor, which is 8 years of smoking history. , Anxiety caused by bad living habits, accelerated life rhythm and increased work pressure also has an important impact on the body’s immunity. Daily exposure to dust, paint, and radioactive substances in the working environment will also increase the incidence of lung cancer.
Is a lung nodule necessarily lung cancer?
Tell me once
After reading Xiaohu’s story, let’s go back to the lung nodules that everyone cares about. Many people are concerned about the problem of lung nodules. First of all, we need to understand what is a lung nodule?
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Pulmonary nodules are the most commonly found round, dense shadows in the lungs on lung cancer screening. In terms of size, those with a diameter less than 5 mm are called micronodules, those with a diameter of 5 mm to 10 mm are called small pulmonary nodules, and those with a diameter less than 30 mm A pulmonary nodule is a millimeter in diameter, and if it is more than 30mm in diameter it should be “respectfully” called a mass. Lung nodules can be caused by inflammation or tumors.
It can be divided into three types of nodules according to its morphology:
1
Ground glass nodules. This nodule looks like a cloud on the CT film.
2
Mixed ground-glass nodules. The so-called hybridity means that there are also solid components in the cloud.
3
Solid nodules. It looks like a solid point.
Among the three types of nodules, the most malignant nodules are mixed ground glass nodules. Chief Physician Zhou Jianya said that solid nodules have the lowest malignant probability; Ground-glass nodules are the second most likely to be malignant. Although they have the highest clinical detection rate, they may be just common inflammation or fungal infection; many small solid nodules are like plaques on our faces, which are time to stay on the lungs However, it should be noted that larger solid nodules are not less likely to become malignant.
So, does the detection of lung nodules require surgery? Which pulmonary nodules require immediate characterization or surgery? How should follow up?
Chief Physician Zhou Jianya emphasized that with the popularization of low-dose CT in physical examination, the detection rate of micronodular lesions in the lungs has increased significantly. Most pulmonary nodules are actually benign, and the ground-glass nodules that people talk about are not as scary as they think. However, its etiology is complex, the clinical manifestations lack specificity, and the diagnosis of benign and malignant is difficult.
How to judge whether a pulmonary nodule will be cancerous? Doctors need to comprehensively consider its density, size, shape, growth location and growth rate. To frighten yourself, you can come to a regular hospital for examination and treatment. Sometimes unsatisfactory nodules are found, and appropriate follow-up follow-up does not affect the treatment effect and patient survival rate. Surgery that is too small and premature can also lead to overtreatment.
Doctors recommend that people older than 40 years old and with any of the following risk factors have a low-dose helical CT scan at least once a year, which is currently the most Effective screening methods:
1
Those who have smoked for more than 400 years, or have smoked for more than 400 years but have quit smoking for less than 15 years;
2
Have a history of environmental or high-risk occupational exposure (such as exposure to asbestos, beryllium, uranium, radon, etc.);
3
Patients with chronic obstructive pulmonary disease (COPD), diffuse pulmonary fibrosis or previous history of tuberculosis;
4
Past malignancy or a family history of lung cancer, especially a family history of first-degree relatives;
5
In addition, people who have long-term exposure to kitchen fumes, second-hand smoke, dust, gas and other volatile substances should also pay attention.
This article is original by the First Academy of Zhejiang University
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