Lung cancer requires different steps according to different situations

Lung cancer is a very common primary malignant tumor, and its incidence is also very high, which makes people have to pay great attention to it. The diagnosis of primary bronchial lung cancer includes symptoms, signs, X-ray manifestations and sputum cancer cell examination (sputum examination). In the diagnosis work, different steps should be taken according to different situations.

(a) X-ray negative, sputum negative

1. Asymptomatic patients with three high-risk factors (male, age ≥45 years, and smoking >400 cigarettes/year) should undergo 70-100 mm fluorescent microscopic X-ray or chest fluoroscopy and sputum cytology every six months.

2. Patients with hemoptysis and/or dry cough accompanied by the three major high-risk factors should undergo repeated sputum cytology examinations and receive regular anti-inflammatory treatment; fiberoptic bronchoscopy (bronchoscopy) and video fluoroscopy can be considered. If repeated sputum examinations or microscopic examinations are still negative, they should be reexamined every two months for one year.

(ii) X-ray negative, sputum positive

1. Exclude upper respiratory tract and esophageal cancer

2. Perform bronchoscopy and try to see the sub-sub-segment. If there is any suspicious local mucosal thickening, roughness or blood stains, brush, wash or puncture the bronchial wall mucosa to look for cancer cells. If the local area is uneven or obviously rough, consider taking a bite biopsy.

3. Perform TV fluoroscopy, change body position, and pay special attention to small nodules in hidden areas.

4. If the above examinations fail to find the lesion, sputum, electrodialysis and bronchoscopy should be repeated every two months. CT examination can also be performed, and sub-layering should be performed in suspicious areas. Regular reexamination should continue for no less than one year.

(III) X-ray positive, sputum negative

1. Patients with segmental or lobar pneumonia or obstructive pneumonia and suspected central lung cancer should undergo bronchoscopy, including transbronchial biopsy (TBB), or selective bronchography; and repeated sputum examination should be performed.

2. Local sectional films should be taken for masses or nodules. Transbronchial lung biopsy (TBLB), percutaneous lung biopsy, or aspiration for cytological diagnosis can be performed if conditions permit.

3. Perform sputum examinations at least twelve times continuously.

4. If repeated sputum tests are still negative but X-rays highly suspect lung cancer, exploratory thoracotomy and frozen section biopsy should be performed.

(IV) X-ray positive, sputum positive

1. Actively prepare for surgery.

2. When regional lymphadenopathy is suspected, AP and lateral oblique slice films can be taken. CT can be performed if necessary. For limited-stage small cell lung cancer, CT and AP and lateral oblique slice films, liver B-ultrasound, bone isotope scanning and bone marrow puncture biopsy smear examinations should be routinely used in large hospitals to facilitate the formulation of treatment plans.

Therefore, experts remind that if you feel that you have early symptoms of lung cancer, you should go to a regular hospital for examination and treatment as soon as possible. Early detection and early treatment can avoid delaying the disease and causing serious consequences.

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