A patient consulted me by phone online, and his tone was full of worry. In August, he found a lung nodule, and made an immediate surgery. The postoperative diagnosis was early lung cancer, and genetic testing can be a target. to medicine.
We know that if a 9mm nodule does not have any metastasis, it belongs to early stage lung cancer. No matter whether such lung cancer has a sensitive gene mutation, it is not necessary to take targeted drugs and do not need any other treatment. Yes, but this patient’s blood tumor marker CYFRA211 increased three times in a row, and it increased every time, and it did not decrease after surgery.
This is more difficult, mainly for the following considerations.
1. Postoperative treatment is not required for early stage lung cancer. This patient wants to take targeted drugs because of elevated tumor markers, but if he is advised not to take it according to the guidelines, in case There is a paradoxical risk of recurrence. A 9mm nodule cannot completely rule out the possibility of recurrence as long as it is not carcinoma in situ.
2. If he is advised to take targeted drugs orally, first of all, targeted drugs can only reduce the recurrence rate, and cannot guarantee complete elimination of recurrence. It must be able to ensure the reduction of tumor markers, and there are side effects, so for early stage IA lung cancer, postoperative oral targeted drugs may not be beneficial.
3. Tumor markers are sometimes not caused by lung tumors, especially if the lung nodules have been surgically removed. If this indicator is still rising, be sure to check other than the lungs. Organs have tumors.
Finally, in addition to recommending him to do other organ inspections, I also recommend that he do a blood circulating tumor cell test or a CtDNA test, these two are microscopic examinations of tumor cells in the body. Residual, if the index is high, it can also be considered to continue treatment, but this has not entered the international guidelines, it needs to be carefully selected.