If the smoking index is more than 400, you should be alert to lung cancer. How to carry out tertiary prevention？

On March 1st, the Regulations of Shanghai Municipality on Controlling Smoking in Public Places (Revised Edition) was fully implemented. Smoking is prohibited in indoor public places, indoor workplaces and public transport in Shanghai.

As we all know, smoking is harmful to health! Smoking is an important risk factor for lung cancer, and the mortality rate of lung cancer is 10-13 times that of non-smokers. In the past 10 years, the incidence and mortality of lung cancer have been ranked first in the world. The incidence of lung cancer is also increasing in China, and it has become the first common malignant tumor in cities. Zhou Chao, the chief physician of the Department of Respiratory Medicine of Shanghai Zhou Pu Hospital, gave a lecture on "Early detection and prevention of lung cancer" for the public.

Risk factors of lung cancer

1. Smoking: recognized as an important risk factor, the mortality rate of lung cancer is 10-13 times that of non-smokers; The longer you smoke, the more you smoke, the higher the incidence and mortality of lung cancer. Smoking is not only harmful to smokers’ own health, but also causes many people to become victims of passive smoking, and the harmful substances they inhale are no less than the smokers themselves.

2. Occupational hazards: long-term exposure to harmful environments, such as asbestos, inorganic arsenic, tobacco heating products, etc., including lung cancer caused by asbestos, lung cancer caused by chloromethyl ether, lung cancer caused by coke oven emissions, lung cancer caused by acetate manufacturing, and lung cancer caused by arsenic; Other carcinogenic factors include nickel compounds, polycyclic aromatic hydrocarbons in soot, tar and petroleum.

3. Air pollution: including indoor small environment and outdoor big environment pollution; The incidence of female lung cancer is related to indoor air pollution, such as coal tar, cooking fume and incomplete combustion products in the kitchen ring; Inhalation of secondhand smoke, etc. Outdoor air pollution, such as smog, fuel waste gas, etc., is becoming more and more serious today with increasing industrialization. Inhaling seriously polluted air is equivalent to inhaling more than 20 cigarettes per person.

4. Ionizing radiation: High dose ionizing radiation can cause lung cancer, and different kinds of radiation have different effects.

5. Others: family inheritance, decreased immune function, viral and fungal infection, imbalance between diet and nutrition, etc.

Early symptoms of lung cancer

Especially for those over 40 years old, who have been smoking excessively for a long time, and the smoking index (smoking years × daily cigarettes) is more than 400.

● Irritating cough with no obvious inducement lasts for 2-3 weeks, and the treatment is ineffective.

Low original chronic respiratory diseases, cough nature change.

● Staying with blood in sputum continuously or only for a short time without other explanations.

● Recurrent pneumonia in the same part, especially segmental pneumonia.

● Lung abscess with unknown causes, no toxic symptoms, no large amount of pus and phlegm, no history of foreign body inhalation and no obvious anti-inflammatory effect.

● Unexplained joint pain of limbs and clubbed fingers (toes)

● X-ray localized emphysema or segmental atelectasis.

● Isolated round lesions and unilateral hilar shadow enlargement.

● The original pulmonary tuberculosis and focus have been stabilized, but the shape or nature has changed.

● Pleural effusion without symptoms of infection and poisoning, especially bloody, which increases rapidly.

● Extrapulmonary manifestations: Be alert to the extrapulmonary manifestations of lung cancer.

What are the screening methods for lung cancer?

At present, there are many screening methods for lung cancer, such as chest fluoroscopy, chest X-ray, chest CT, sputum-based cytology, bronchoscopy, fluorescent fiber bronchoscopy and positron emission tomography (PET), but each has its own advantages and disadvantages, and sometimes it needs to be combined and arranged reasonably.

Chest X-ray: It is the simplest and most economical examination method, but its clarity is low, so it is rarely used now.

● Chest X-ray: It is economical and convenient, and it is an important method to diagnose lung diseases, but it has little effect on improving the screening rate of early lung cancer, so it is not recommended to use it alone for early screening of lung cancer.

● Chest CT: It plays an important role in lung cancer screening. Cross-sectional CT imaging completely eliminates the interference of overlapping tissues and surrounding tissues, and has high density resolution. It can detect hidden lesions that are difficult to find on chest plain film, especially for small nodules in the lung, and can find more early lung cancer.

● Radionuclide imaging: Positron tomography (PET) can reflect tumor metabolism earlier and more accurately, which is beneficial to early diagnosis of tumor, understanding the metastasis and recurrence of disease, staging and evaluation of curative effect, but it is expensive.

● Sputum exfoliated cell examination: the first choice to obtain histopathology of lung cancer is non-invasive examination, but there are many factors affecting the positive rate. (Examiner’s technique, tumor type, frequency and quality of examination)

● Bronchoscopy: It can confirm the pathology and the lesion site.

CT-guided transthoracic puncture: cell and tissue biopsy of peripheral lesions.

● Lung biopsy under mediastinoscopy and thoracoscopy: it is also widely used.

Exploration of thoracotomy: sputum, fiberoptic bronchoscopy and transthoracic puncture are negative and can be used. Consider the patient’s age, lung function and surgical complications to weigh the advantages and disadvantages.

● Others: histopathology (metastatic lymph nodes, pleural biopsy, chest puncture), tumor markers, etc.

How to prevent lung cancer

Like other malignant tumors, lung cancer advocates a three-level preventive strategy.

Primary prevention: At present, it is recognized that smoking is the main related factor of lung cancer, so primary prevention should focus on smoking control. We can: strengthen tobacco control legislation and focus on the supervision of smoking ban in public places; Strengthen publicity, improve the awareness of self-health care of the whole people, and change bad lifestyles; Strive to create a smoke-free environment and reduce the damage to passive smokers.

In addition, air pollution and occupational hazards in the working environment are increasingly closely related to the occurrence of lung cancer. In addition to strengthening personal protective measures, it is also necessary for the state to promulgate and conscientiously implement relevant laws to protect the environment on which we live.

For individuals, besides staying away from harmful substances, it is also important to have a balanced diet, live a regular life, combine work and rest, persist in physical exercise, and increase the ability to prevent and resist diseases.

Secondary prevention: early detection of lung cancer patients mainly through chest X-ray, sputum cytology and chest CT; It is necessary to carry out regular check-ups for high-risk groups, such as occupational physical examination.

Tertiary prevention: Generally speaking, the clinical treatment effect of lung cancer is not ideal, and the average 5-year survival rate after diagnosis is only about 10%. The purpose of tertiary prevention measures for lung cancer is to promote recovery, reduce recurrence and complications, prevent disability and tumor metastasis, relieve pain, provide social, psychological and spiritual support, improve the quality of life and prolong the survival period through various comprehensive treatments.