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We all know that cunning lung cancer is difficult to detect in the early stage, without obvious symptoms, even in symptomatic patients, because of the non-specific clinical manifestations , easily confused with some pre-existing symptoms or signs, thus affecting the timeliness and accuracy of diagnosis.
The well-known and typical symptoms of lung cancer include cough, difficulty breathing, hemoptysis, chest pain, and fever. However, when these symptoms appear and then go for examination, it is often already in the middle and late stages of lung cancer. About 2/3 of the patients had metastatic disease when they were found, and the prognosis was poor. The 5-year survival rate was only about 16%[1].
Are there any symptoms that can help people find signs of lung cancer early and get treatment in time?
Do you remember this hotly searched news? In the news, Ms. Jiang’s finger was swollen into a radish head, which is called “clubbing (toe)” in clinical practice. With the early warning of the clubbing and the doctor’s advice, Ms. Jiang was diagnosed with lung cancer in the middle and early stages. He also received prompt surgical treatment and recovered well.
Image source: Sina Weibo News Screenshot
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Is it an early warning of lung cancer? Don’t worry, let’s see Koppjun tell you in detail.
Pestle What is a finger?
As the name suggests, it is a finger that looks like a pestle.
The distinctive features of clubbing are:
Hypertrophy, hypertrophy, and clubbing of the ends of fingers or toes;
The terminal finger (toe) segment is obviously widened and thickened, and the finger (toe) nail is arched from the root to the end;
The base angle formed by the skin on the back of the finger (toe) end and the finger (toe) nail is equal to or greater than 180°.
We can judge whether we have clubbing fingers through the following picture.
Image source: Reference [3]
The figure represents various types of clubbing fingers, and N is a normal person
Image source: Reference [3]
Measurement method in the figure
Measurement method:
A. Normal human thumb base angle is about 160°< /span>
C. The base angle of the late clubbing is greater than 180°.
Large Practice has shown that the vast majority of clubbing has clinical diagnostic significance, that is, it has auxiliary diagnostic value, and sometimes it can be used as an important diagnostic clue. In the news exemplified above, we can also see that clubbing is inextricably linked to lung cancer.
Finger clubs sound the alarm for lung cancer patients
The mechanism of clubbing of the fingers (toes) is complex. Currently, it is believed that the tissue hypoxia at the finger (toe) end causes the arteriovenous branches of the local microcirculation to open through vasoactive substances, and promotes tissue proliferation. .
According to existing research, many diseases have been found to be closely related to clubbing. Finger clubbing can occur in diseases of various systems of the body. It has been reported in the literature.75%-80% are seen in lung diseases, 10%-15% are seen in other diseases< /span>[2]:
respiratory diseases< span> 75%-80%. Primary bronchial lung cancer, especially oat cell carcinoma, is more common. In addition, it can also be seen in various metastatic lung cancers, mediastinal tumors, pleural mesothelioma, bronchiectasis, lung abscesses, cystic fibrosis, diffuse pulmonary interstitial fibers, pneumoconiosis, open pulmonary tuberculosis, etc.
Cardiovascular disease10%-15%. Congenital cyanotic heart disease, subacute bacterial endocarditis, aortic arch aneurysm, innominate aneurysm, subclavian, ulnar aneurysm, infection after abdominal aortic repair, or patent ductus arteriosus with regurgitation.
Digestive system diseases account for 5%-10%. Found in primary biliary and portal cirrhosis, ulcerative colitis, esophageal cancer, colon cancer.
Others: such as chronic mountain sickness, hyperthyroidism after symptom control and some hereditary clubbing [3].
In lung cancer, the incidence of clubbing is about 1.6% to 9.4%[4], is the most common extrapulmonary sign of lung cancer[5], which is characterized by short-term appearance and rapid development, and may be accompanied by obvious pain. It can also be one of the earliest signs of lung cancer, appearing months or even years before other symptoms and signs, even before respiratory symptoms and signs.
Isn’t this a proper disease warning? Lung cancer can be detected and treated as soon as possible, so that patients can gain more hope for survival.
Sub Tumor syndrome and its common symptoms
In addition to clubbing, early lung cancer also has Are there signs to follow?
Yes, that isParaneoplastic Syndrome . In fact, clubbing is a feature of paraneoplastic syndromes, the extrapulmonary manifestations of lung cancer.
Paraneoplastic syndrome, also known as paraneoplastic syndrome ( paraneoplastic syndrome) refers to the non-metastatic extrathoracic manifestations of lung cancer, which are clinical manifestations caused by certain special hormones, antigens, enzymes or metabolites produced by cancer cells.
Paraneoplastic syndromes can occur in any malignancy, but lung cancer, especially small cell lung cancer, is the most common [6].
Paraneoplastic syndromes can affect virtually every organ in the body and sometimes herald the emergence or recurrence of tumors. Including Cushing’s syndrome, vasopressin syndrome, hypercalcemia, carcinoid syndrome, paraneoplastic neurological syndrome, cutaneous paraneoplastic syndrome, coagulation and hematopoietic abnormalities, paracarcinoid rheumatoid syndrome, and secondary proliferation Osteoarthritis, etc.[7].
Main lung cancer-related paraneoplastic syndromes See the table below:
Image source: Reference [7]
For detailed symptoms of lung cancer-related paraneoplastic syndromes, you can refer to this article:
Top 10 paracancerous syndromes caused by lung cancer
Although paraneoplastic syndrome can be an early warning of cancer, we still cannot take our own health lightly. Especially for the high-risk groups of lung cancer, Keppel recommends early prevention and screening.
< span>People at high risk of lung cancer should be prevented and screened early
The survival time of lung cancer patients is closely related to the sooner or later clinical diagnosis. Studies have shown that the 5-year survival rate of lung cancer decreases with the increase of the diagnosis stage.The 5-year survival rate of stage I is 55.5%, while that of stage IV is only 5.5%.3%[8].
Evidence at home and abroad indicates that screeninglow-dose helical CT in high-risk groups of lung cancer can detect lung cancer early, improve prognosis, and reduce lung cancer mortality[9].
Recommendations of the Guidelines for Lung Cancer Screening, Early Diagnosis and Treatment in China: Lung cancer screening is recommended for people at high risk of lung cancer. It is recommended that people at high risk of lung cancer should meet one of the following conditions:
(1) Smoking: smoking pack years*≥ 30, including the number of pack years of smoking ≥ 30, but less than 15 years of smoking cessation;
(2) passive smoking: Living or working in the same room with a smoker for ≥20 years;
(3) suffering from COPD (chronic obstructive Lung disease);
(4) History of occupational exposure (asbestos, radon, beryllium, chromium, cadmium, nickel , silicon, soot and soot) for at least 1 year;
(5) FDR* diagnosed lung cancer.
*Note 1: Years of smoking pack = number of packs smoked per day (20 cigarettes per pack) × number of years of smoking
*Note 2: FDR refers to parents, children, and siblings
There are many unidentified risk factors for lung cancer, even if there are no The above-mentioned high-risk factors do not mean that there is no risk of lung cancer. Factors such as kitchen fumes, environmental pollution, smog, and high life pressure may also cause people to suffer from lung cancer. Therefore, Copejun recommends that non-high-risk groups also do early prevention and screening.
References:
[1]Cancer survival in China, 2003-2005: A population-based study.[J]. International Journal of Cancer, 2015, 136( 8):1921-1930.
[2] Li Zongming. Differential diagnosis of clinical symptoms [M]. 3rd edition. Shanghai Science and Technology Press, 1995:631-635 .
[3] He Quanying. Clubbing and its clinical significance[J]. China Medical Journal, 1996, 031(001):3-4.
[4]Hamilton, W. Diagnosis of lung cancer in primary care: a structured review[J]. Family Practice, 2004, 21(6):605-611.
[5]Julie, Fridlington, and, et al. Secondary hypertrophic osteoarthropathy associated with solitary fibrous tumor of the lung[J]. Journal of the American Academy of Dermatology, 2007.
[6]Hoftberger R, Rosenfeld MR, Dalmau J. Update on neurological paraneoplastic syndromes.[J]. Current Opinion in Oncology, 2015, 27(6):489-495.< /p>
[7]Clinical Oncology Manual Sixth Edition
[8] Zhang Minlu, Wu Chun Xiao, Gong Yangming, et al. Survival analysis of lung cancer in Shanghai population [J]. China Oncology, 2017, 27(5): 326-333.
[9] He Jie, Li Ni, Chen Wanqing, et al. Guidelines for lung cancer screening, early diagnosis and early treatment in China (2021, Beijing) [J]. China Oncology 2021 Vol. 30, Issue 2, pp. 81-111, ISTIC PKU CSCD CA, 2021.
cover Image source: TuCong Creative
Responsible editor: Mijian Science < /p>