What are the treatment principles for lung cancer? Introduction to the main treatment options for lung cancer

Many lung cancer patients have developed a fear of cancer and believe that cancer means death. In fact, this idea is incorrect. In many cases, early detection of the early symptoms of lung cancer and timely treatment can lead to recovery. Lung cancer patients are no exception. The following describes a plan for treating lung cancer for reference by lung cancer patients.

(I) Treatment principles. The principle of comprehensive treatment should be adopted, that is, according to the patient's physical condition, the cytological and pathological types of the tumor, the scope of invasion (clinical stage) and the development trend, a multidisciplinary comprehensive treatment (MDT) model should be adopted, and surgery, chemotherapy, radiotherapy and biological targeting and other treatment methods should be used in a planned and reasonable manner, in order to achieve the purpose of radical cure or maximum control of the tumor, improve the cure rate, improve the patient's quality of life, and prolong the patient's survival. At present, the treatment of lung cancer is still mainly surgical treatment, radiotherapy and drug therapy.

(B) Surgical treatment.

1. Principles of surgical treatment.

Surgical resection is the main treatment for lung cancer and the only way to cure lung cancer clinically. Lung cancer surgery is divided into radical surgery and palliative surgery, and radical resection should be strived for. In order to achieve the best and thorough removal of the tumor, reduce tumor metastasis and recurrence, and conduct the final pathological TNM staging to guide postoperative comprehensive treatment. For surgically resectable lung cancer, the following surgical principles should be followed:

(1) A comprehensive treatment plan and necessary imaging examinations (clinical staging examinations) should be completed before non-emergency surgical treatment. The feasibility of surgical resection should be fully evaluated and a surgical plan should be developed.

(2) Complete removal of the tumor and regional lymph nodes should be achieved as much as possible, while preserving functional healthy lung tissue as much as possible.

(3) Video-assisted thoracoscopic surgery (VATS) is a minimally invasive surgical technique that has developed rapidly in recent years and is mainly suitable for patients with stage I lung cancer.

(4) If the patient's physical condition permits, anatomical lung resection (lobectomy, bronchial sleeve lobectomy or pneumonectomy) should be performed. If the patient's physical condition does not permit, limited resection should be performed: segmentectomy (preferred) or wedge resection, or VATS can be selected.

(5) Complete resection (R0 surgery) In addition to complete resection of the primary lesion, routine resection of the hilar and mediastinal lymph nodes (N1 and N2 lymph nodes) should be performed and the locations should be marked for pathological examination. At least three lymph nodes in the mediastinal drainage area (N2 station) should be sampled or cleared, and the entire lymph node should be removed as much as possible. The recommended right chest clearance range is: 2R, 3a, 3p, 4R, 7-9 lymph nodes and surrounding soft tissues; the left chest clearance range is: 4L, 5-9 lymph nodes and surrounding soft tissues.

(6) During the operation, the pulmonary veins and pulmonary arteries are treated in sequence, and finally the bronchi.

(7) Sleeve lobectomy preserves as much lung function (including bronchus or pulmonary blood vessels) as possible, provided that rapid pathological examination during the operation ensures that the resection margin (including the bronchus, pulmonary artery or vein stump) is negative. The quality of life of patients after surgery is better than that of patients undergoing pneumonectomy.

(8) For patients with recurrence or isolated lung metastasis 6 months after complete resection of lung cancer, resection of the remaining lung on the recurrent side or resection of the lung metastasis lesion can be performed if distant extrapulmonary metastasis is excluded.

(9) Patients in stages I and II who are assessed to be unable to undergo surgery due to their cardiopulmonary function and other physical conditions can be treated with radical radiotherapy, radiofrequency ablation, and drug therapy.

2. Indications for surgery.

(1) Stage I, II and some stage IIIa (T3N1-2M0; T1-2N2M0; T4N0-1M0) non-small cell lung cancer and some small cell lung cancer (T1-2N0～1M0).

(2) N2 non-small cell lung cancer that has responded to neoadjuvant therapy (chemotherapy or chemotherapy plus radiotherapy).

(3) Some patients with stage IIIb non-small cell lung cancer (T4N0-1M0) can undergo complete local resection of the tumor, including invasion of the superior vena cava, other adjacent large blood vessels, atrium, and carina.

(4) Some patients with stage IV non-small cell lung cancer with single contralateral lung metastasis, single brain or adrenal gland metastasis.

(5) For pulmonary nodules that are highly suspected of lung cancer but cannot be qualitatively diagnosed after various examinations, surgical exploration may be considered.

3. Contraindications to surgery

(1) Patients whose general condition cannot tolerate surgery, and whose important organs such as heart, lung, liver, and kidney cannot tolerate surgery.

(2) The vast majority of clearly diagnosed stage IV, most stage IIIb, and some stage IIIa non-small cell lung cancers, as well as small cell lung cancers with a stage later than T1-2N0-1M0.

(III) Radiotherapy. Radiotherapy for lung cancer includes radical radiotherapy, palliative radiotherapy, adjuvant radiotherapy and preventive radiotherapy.

For lung cancer patients, they not only have to endure the abnormal physical changes brought about by chemotherapy and surgery, but psychological fear is also a major factor. Therefore, the patient's family should also give the patient appropriate spiritual support and not let the patient feel lonely and helpless.