The incidence and mortality of lung cancer in the world have increased significantly in recent decades due to the increasing environmental p
The incidence and mortality of lung cancer in the world have increased significantly in recent decades due to the increasing environmental pollution and the increase in smoking and smoking. In the United States, about 160 thousand people die each year from lung cancer, of which 75% of patients with non-small cell lung cancer. The latest statistics show that the incidence of lung cancer in major cities in China has exceeded the incidence of various malignant tumors. Nearly 800 thousand people die of lung cancer every year in China, of which, non-small cell lung cancer accounts for about 80%. However, due to the fast development of lung cancer, complex etiology, treatment of multiple doping factors, in order to reduce the blindness and inappropriate treatment, regulate the guiding treatment of, to enable patients to achieve the most effective treatment to take the economy is very necessary.
Treatment of lung cancer must be integrated to determine the best treatment options. In most cases, the best treatment is multidisciplinary therapy.
First to determine the type of lung cancer. Lung cancer is divided into non small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) according to pathology, which accounts for about 80% of the total number of lung cancer and 20%. Non small cell lung cancer and squamous cell carcinoma, adenocarcinoma, large cell carcinoma and other types. Small cell undifferentiated carcinoma is more sensitive to radiotherapy and chemotherapy, but easy to relapse. Overall, lung cancer is the best surgical treatment.
Second, look at the staging of lung cancer. The international standard of lung cancer can be divided into four stages: I, II, III and IV. The characteristics of stage I and II are small, easy to remove, and there is no distant metastasis. It can be treated with surgery, radiotherapy and chemotherapy. In the third stage, surgery combined with radiotherapy and chemotherapy. Stage IV lung cancer can not only use surgery, radiotherapy and chemotherapy.
Third depends on the patient's physical condition. Mainly to check the patient's vital organs, heart, liver, lung, kidney function is normal, no diabetes, myocardial infarction and other important underlying diseases.
Combined with the above situation, to find the best treatment. For patients who are not suitable for surgery and radiotherapy, and recurrence after surgery and radiotherapy or systemic metastases have been reported in patients with chemotherapy. In addition, chemotherapy can also be used as adjuvant therapy before surgery and after surgery and radiotherapy to consolidate the efficacy of the means.
Optimal treatment of I non-small cell lung cancer
Non small cell carcinoma (NSCLC) is not an ideal response to chemotherapy, and surgery is the best treatment option. Radiotherapy is effective in a small number of cases, and most cases can be palliative treatment, chemotherapy for advanced cases can generally improve survival, and can relieve symptoms.
There are two major issues to consider when preparing for surgical treatment of lung cancer, the ability to remove and the ability to operate. The basis of the ability to remove is its staging, the need to take into account the invasion of organs, metastasis or not, and its location. The ability to accept the patient's surgical operation and reduce the lung volume and lung function, a series of preoperative examination of the patient's body to assess the situation. The size and location of the tumor resection on the lobectomy is complete excision of lung resection, resection of bronchial wedge resection for pulmonary segments. Small peripheral tumor, wedge resection of lung tissue, involving the main bronchus sleeve resection for tumor. These procedures are often performed by thoracotomy, but VAT has been widely used in our hospital and other hospitals. VATS has the advantage of less trauma to the patient, cutting off very few tissues, and less impact on lung function after surgery.
The following is based on the National Cancer Institute proposed treatment options, the recommended treatment.
0 stage NSCLC surgical resection.
IA and IB phase
Surgery is the preferred treatment for patients with stage IA and IB NSCLC. Patients who do not have surgery or positive margins may be treated with radiotherapy in order to achieve a therapeutic effect, which generally increases the survival rate of 5 years. Patients with stage IIB resection should be considered experimental chemotherapy to reduce the chance of metastasis, but current adjuvant radiotherapy has a lower survival rate.
IIA and IIB phase
IIA and IIB NSCLC, its treatment for treatment of clinical trials of adjuvant chemotherapy and radiotherapy to surgery, radiotherapy and surgery, similar to IA and IB NSCLC, and in the preoperative evaluation before responding patients do serious surgery. Lung tumor due to local invasion and distant metastasis of heavier, less difficult to handle, so the local treatment of these tumors seem better able to achieve the purpose of treatment, preoperative chemoradiotherapy and surgery may in some cases reach the treatment effect, direct tumor invasion of chest wall, using surgery for some patients often can reach the therapeutic effects.
Phase III (IIIA, IIIB): all patients were treated with preoperative chemoradiotherapy or concurrent chemoradiotherapy
The prognosis of patients with stage A NSCLC was poor. However, 5% to 10% of patients with radiotherapy had long-term survival. These patients currently recommended comprehensive treatment, can improve the survival of patients, some patients suitable for surgery alone chose, preoperative chemoradiation is helpful for postoperative local tumor control, received chemotherapy after operation.
Phase III B
The best treatment for stage B is chemotherapy alone and radiotherapy, or combination therapy, depending on the site and characteristics of the tumor. Most of the patients were treated with combination therapy, which can reduce the mortality rate by 10% compared with the radiotherapy alone, and the patients with poor curative effect were treated with palliative radiotherapy.
Patients with stage IV are suitable for chemotherapy, radiotherapy, palliative treatment to relieve local symptoms, even if its role is limited, and there is a high risk and side effects, there are a variety of similar therapeutic regimens
Targeted therapy for non-small cell lung cancer
The effectiveness of targeted therapy is not high, and the specificity of targeted therapy is not enough. Targeted drug therapy is not targeted, the results are not satisfactory.
Treatment of II small cell lung cancer (SCLC)
The following recommendations are the principles of treatment proposed by the National Cancer institute.
Tumor staging and histologic classification are important factors in determining the treatment plan, since most patients have a potential and significant metastasis at the time of diagnosis. In the stage of small difference, no significant difference between the survival, therefore, the actual treatment of small cell lung cancer patients, the previous mentioned complex TNM staging system, and the most commonly used is the diffuse period and limited stage stage.
Localized phase SCLC
Only 1/3 of patients in the diagnosis of a limited period of time, chemotherapy is the main treatment of limited SCLC. In patients with complete remission, 35% to 65% of the patients were treated with the central nervous system (CNS) at the end of the treatment period of 2 years. Therefore, patients with complete remission were also required to have prophylactic cranial irradiation (PCI).
Diffuse phase SCLC
The chemotherapy regimen for patients with diffuse phase is similar to that used in the patients with limited stage. Therefore, chemotherapy is the main treatment. Chemotherapy can not immediately ease the transfer of the site, especially the brain, epidural and bone metastases, the need for radiotherapy.
The application of targeted therapy drugs: Iressa (female, Asian, not smoking, alveolar cell carcinoma), gefitinib. Tarceva. Avastin, bevacizumab. Bufotanine medicine in the treatment of non-small cell lung cancer.
Chinese medicine treatment: Lentinan Injection, Haiwei mixture. Jin Fukang oral liquid, Qingfei Sanjie pill, weidakang granule, Xianchan tablet, Hechan tablets. Asparagus preparation for treatment of lung cancer has achieved good results. Application of hydrothorax aweihuapi plaster with western medicine for lung cancer, interleukin 2 and interferon injection, cisplatin, treatment of intrapleural Corynebacterium after hydrothorax drainage.
In the past fifty years, many countries have made a great deal of clinical observation and experimental data to improve the level of comprehensive treatment. According to Information Times reported, learned from relevant departments, in order to change the disorder present in the treatment of cancer, so that patients get the most effective treatment to spend most of the economy, China's Ministry of health, Chinese Medical Association and Chinese Cancer Association three party together, in two years will organize experts to develop standardized treatment the corresponding for each cancer disease, and published in the country, the uniform implementation of. After the standardization of cancer treatment, the patient's effective survival rate will be greatly improved, and the hospital will not have to add the equipment, and the patient's survival rate will be increased by 15%. The best treatment strategy of lung cancer is the standardization of treatment, we look forward to the standardization of lung cancer treatment program as soon as possible to benefit patients.
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