Medical Guidance/Professor Qiao Guibin, Director of Thoracic Surgery and Deputy Director of Cancer Treatment Center of Guangdong Provincial People’s Hospital, and a young and middle-aged doctor in Guangzhou.
A young man, who has been traveling all over the country for several months, was carrying a suitcase of CT films. When he saw the doctor, he "knelt down" to help him cut the small nodules on his lungs. Such patient stories are not uncommon.
A few days ago, Guangzhou Daily’s famous doctor lecture hall online "found pulmonary nodules, what should I do?" In the micro-class, Professor Qiao Guibin, director of the Department of Thoracic Surgery of Guangdong Provincial People’s Hospital, pointed out that according to incomplete statistics, if nearly 1.4 billion people in China go for a chest CT examination, more than 100 million people may find pulmonary nodules.
Small pulmonary nodules are divided into benign and malignant, which also means that they can be far or near from cancer, so they are particularly nervous and helpless. What should I do if I find small pulmonary nodules? Qiao VIP told them one by one.
case
The young man is carrying a box of CT films to "cut"
"The discovery of pulmonary nodules has brought too much psychological pressure to patients!" Qiao VIP sighed.
More than half a year ago, a young man from other provinces came to Joe’s VIP clinic, carrying a big suitcase and opening the CT film full of it! It turned out that his physical examination had found small nodules on his lungs, so he went to doctors everywhere for diagnosis. As a result, some said "nothing" and some said "like lung cancer", which made him extremely nervous.
In order to seek medical treatment, the young man even resigned and had a CT examination once a month. "Whether it is cancer or not, please help me cut it!" The young man almost knelt down, and even his wife who accompanied him helped him: "He has been living in the shadow of lung cancer, which is too painful!"
Can Qiao VIP look carefully, judging that it is very likely that it is not cancer, and the imaging features are all inflammatory. In view of his situation, Qiao VIP took him to a psychologist, who was diagnosed with severe depression and anxiety, and gradually calmed down after comprehensive treatment. As for the small pulmonary nodules, they were followed up for more than half a year under the guidance of Qiao VIP, and there was no problem at all.
data
90% pulmonary nodules are benign.
Clinically, the detection rate of pulmonary nodules is very high. According to medical estimates, if all the people in China have a chest CT, more than 100 million people may find pulmonary nodules.
Although it is so common, many people don’t know that pulmonary nodules are actually not the name of the disease, but an imaging diagnosis — — It is a round, oval or cloud-like shadow after two-dimensional CT imaging of human chest, which is pure white or gray. This shadow is not found in normal lungs, so it is abnormal.
The so-called pulmonary nodules mean that the shadow diameter is less than 1 cm. If it is not discovered by chance, such as physical examination, injury or illness examination, people simply don’t know that there are nodules in the lungs and there are no related discomfort symptoms.
Small pulmonary nodules can be divided into benign and malignant. Qiao VIP pointed out that most people don’t have to be nervous, and clinical findings show that 90% are benign.
In the first benign case, pulmonary nodules are actually caused by inflammation and scars; In the second case, pulmonary nodules are benign tumors, which account for the majority of all pulmonary nodules. They neither grow up nor spread outward, and do little harm to the human body. There are many benign nodules of two kinds of lungs, such as hamartoma, inflammatory granuloma, scar, lymph nodes and inflammatory nodules.
But we can’t let it go, because 10% of pulmonary nodules are malignant, which means precancerous lesions and even early lung cancer, so we must pay attention to them.
distinguish
How to find out 10% "malignant nodules"?
Qiao VIP said that to distinguish whether pulmonary nodules are benign or malignant, look at "face value" and "family background" and look at the growth trajectory, and identify "image" from the shadow.
A look at the "face value" means that judging from the shape of the small nodule, the edge is smooth and the density is uniform, which is good-looking and mostly benign; However, it is not smooth, has burrs, cavities, blood vessels and trachea shadows, and the density is uneven, which belongs to the ugly appearance and belongs to the malignant shape of "low face value".
Second, look at "family history", that is, whether there is a family history of malignant tumors such as lung cancer. If immediate family members have had it, genetic factors should be considered.
Third, looking at the growth trajectory refers to the development of small nodules. If "first look" and "second look" are uncertain, then observe it dynamically to see if its shape, size and density have changed before deciding. According to the consensus of experts at home and abroad, the harm and malignancy of small nodules are low, especially less than 5 mm, and it is too late to deal with them when changes and progress are detected.
observe
Small pulmonary nodules can disappear completely.
If the benign and malignant pulmonary nodules can’t be clearly distinguished for the time being, you must never give up and don’t take "dynamic observation" seriously.
The pulmonary nodules disappeared, which is the best result of dynamic observation.
Another result of dynamic observation is that the small nodule has not changed, and doctors will think it is safe. If it does not move for two or three years, or even five or eight years, the possibility of benign is very high.
It should be noted that because of its existence, dynamic observation needs to last for life, but considering the radiation problem, the observation interval can be gradually lengthened. For example, people in their fifties and sixties can have a chest CT every year; Young man, it’s okay to do it in two or three years.
The last result of dynamic observation is that the nodules are constantly changing, getting bigger and bigger, uglier and denser, and need to be dealt with as soon as possible.
operation
More than 90% minimally invasive will be done.
Generally speaking, it is very common to find pulmonary nodules, so there are three ways to deal with them:
First, for those who are highly suspected to be precancerous lesions or even early cancers, they can be removed by surgery. Now, large hospitals can generally use thoracoscopy for minimally invasive surgery, and more than 90% of them can be "fixed".
Second, for those whose diameter is less than 1 cm and the judgment is benign or ambiguous, dynamic observation is generally adopted, and surgery is performed after changes, so that it is too late.
Third, puncture biopsy. If it is highly suspected that it is a lung malignant tumor, it is generally recommended to operate directly without biopsy. However, if the patient’s physical condition is poor and he can’t bear the operation, he needs to do a puncture biopsy to diagnose and then consider how to treat it next.
prevent
Leave a "base version" for the lungs when you are young.
Small pulmonary nodules, even malignant, can be completely cured clinically if treated in time. Therefore, it is highly recommended that people at high risk of lung cancer have a low-density spiral CT examination every year.
Who are the high-risk groups? Including:
Smokers, this is the most dangerous and highly correlated factor of lung cancer, especially heavy smokers, such as smoking more than 1 pack/day for 20 consecutive years;
Those who are over 40 years old and have had patients with tumor or lung cancer in their previous families (especially immediate family members) should strengthen their consideration of genetic background;
Being over 40 years old, having a previous history of lung diseases, such as tuberculosis, chronic obstructive pulmonary disease, asthma, etc., or suffering from tumor diseases, shows that the lung "environment" is damaged, which leads to increased risk;
Engage in special occupations, such as working under mines or in particularly polluted environments.
Professor Qiao pointed out that in recent years, considering the younger onset of lung diseases, more women and non-smoking, it is suggested that the age of chest CT examination should be advanced to 45 or even 40 years old. In addition, the thoracic surgeon also specially suggested that if conditions permit, doing a lung CT when you are young is equivalent to leaving a "base version" for your lungs. In case of illness, it can be used for later examination and comparison to help accurate diagnosis. (Text/Guangzhou Daily All-Media Reporter He Xuehua Correspondent Hao Li, Zhang Lanxi, Yan Ting)