What Is Involved in Surgery for Lung Cancer?

Adenocarcinoma is a glandular epithelial malignant tumor that can have acinar, nipple, bronchioloalveolar, or solid growth patterns. It is often accompanied by mucus production. Detection of mucus requires special staining, especially in poorly differentiated tumors. Mucus testing can sometimes identify solid adenocarcinomas as well as large cell carcinomas with other morphological manifestations. ^[1]

Yang Yue	(Chief physician)	Department of Thoracic Surgery, Peking University Cancer Hospital
Zheng Qingfeng	(Attending physician)	Department of Thoracic Surgery, Peking University Cancer Hospital

Lung adenocarcinoma is a type of lung cancer that belongs to non-small cell carcinoma. Unlike squamous cell lung cancer, lung adenocarcinoma is more likely to occur in women and non-smokers. Originated from the bronchial mucosal epithelium, a few originated from the mucous glands of the large bronchus. Incidence rate is lower than squamous cell carcinoma and undifferentiated carcinoma, younger age, relatively common in women. Most adenocarcinomas originate in smaller bronchi and are peripheral lung cancers. There are usually no obvious clinical symptoms in the early stage, and they are often found on chest X-ray examination. It appears as a round or oval mass, which usually grows slowly, but sometimes hematogenous metastases occur early. Lymphatic metastases occur later.

Western Medicine Name: Lung adenocarcinoma
English name: lung adenocarcinoma

Affiliated Department: Surgery-Cardiothoracic Surgery
Disease site: lung
Contagious: Non-contagious

Classification of lung adenocarcinoma diseases

Causes of lung adenocarcinoma

The cause of lung cancer is not completely clear so far. A large number of medical data indicate that the risk factors for lung cancer include smoking (including second-hand smoke), asbestos, thorium, arsenic, ionizing radiation, halogenenes, polycyclic aromatic compounds, nickel, and so on. details as follows:

1. Smoking: Long-term smoking can cause bronchial mucosal epithelial cell hyperplasia, phosphorous epithelium-induced squamous epithelial cancer or undifferentiated small cell cancer. Non-smokers may also develop lung cancer, but adenocarcinoma is more common. Carcinogens are released when cigarettes burn. . ^[2]

2. Air pollution:

3. Occupational factors: Long-term exposure to radioactive substances such as uranium and radium and their derivative carcinogenic hydrocarbons arsenic chromium nickel copper tin iron coal tar asphalt petroleum asbestos mustard gas can induce lung cancer mainly squamous cell carcinoma and undifferentiated small cell cancer.

4. Chronic lung diseases: such as pulmonary tuberculosis, silicosis, pneumoconiosis, and lung cancer can coexist in these cases. The incidence of cancer is higher than that of normal people. In addition, chronic lung bronchial inflammation and pulmonary fibrous scar lesions may cause squamous metaplasia during the healing process. Or hyperplasia on this basis, some cases can develop into cancer.

5, human internal factors: such as family inheritance and immune function to reduce metabolic endocrine dysfunction and so on.

Pathophysiology of lung adenocarcinoma

Pathological changes in lung adenocarcinoma

(I) The gross morphology of the tumor is round or oval, most of which are not enveloped, but incomplete. The texture is medium hardness and the cut surface is off-white.

(2) Microscopic examination of the tumor cells showed significant atypia and varied structures. Some are solid masses or small strands arranged, some visible glandular cavity formation, and some arranged into a tubular or glandular structure. It is generally believed that those with glandular cavity-like structures have a higher degree of differentiation and a lower degree of malignancy. The connective tissue between small strips and small clumps is more or less variable. Many are similar to hard cancers, and those with less interstitial and more cancer cells can be called soft cancers.

(3) Biological characteristics Adenocarcinoma has highly infiltrating and destructive growth characteristics. Adenocarcinoma easily invades the walls of blood vessels and lymphatic vessels, and has more hematogenous and lymphatic metastases.

As seen by the naked eye

Adenocarcinoma is mostly located in the periphery of the lungs, with clear boundaries. Related fibrosis and pleural shrinkage can also be seen. The tumor can pass through the pleura to the chest wall. Whether the tumor penetrates the pleura is important in clinical staging and may require elastic fiber staining to confirm. The tumor was grayish white with bleeding and necrosis. If the tumor produces a certain amount of mucus, a luminous or mucus-like area can be seen on the section. These peripheral tumors are often unrelated to the bronchi, but malignant pleural effusions often occur. For this reason, sputum specimens have significantly less adenocarcinoma than squamous cell carcinoma.

What you see

Common bronchial adenocarcinomas form a glandular cavity structure, and tumors can be composed of well-differentiated and poorly-differentiated components. Intracellular mucus needs to be confirmed by special staining mucus card staining or PAS staining. In addition, papillary or small tubular structures can also be seen. Adenocarcinomas can also have unusual structures: clear cells, signet ring cells, and spindle cells. Pathological adenocarcinoma must be distinguished from mesothelioma. This is difficult for cytological specimens, and other auxiliary methods are needed to accurately type.

Adenocarcinoma cells are more consistent than squamous cell carcinomas or large cell carcinomas. Larger cells, larger nuclei, higher nuclear-plasma ratio, and obvious eosinophilic nucleoli. Visible vacuoles in the cytoplasm indicate mucus production. Unlike squamous cell carcinoma, the boundaries of the cells are unclear. Histological grades are classified as well differentiated, moderately differentiated, or poorly differentiated, and most are moderately differentiated. Adenocarcinoma is generally diagnosed without immunohistochemistry, but immunohistochemistry is needed to distinguish primary, metastatic, or mesothelioma.

Clinical manifestations of lung adenocarcinoma

Lung adenocarcinoma multiple population

Adenocarcinoma accounts for about 40% of primary lung tumors. More likely to occur in women and non-smokers.

Lung adenocarcinoma disease symptoms

Lung cancer does not have any special symptoms in the early stage. It is only a symptom common to general respiratory diseases, such as cough, sputum, low fever, chest pain, and suffocation. It is easy to ignore.

Early extrapulmonary manifestations of bone and joint symptoms: these symptoms are more common. Because lung cancer cells can produce some special endocrine hormones (heterologous hormones), antigens and enzymes, these substances work on bone and joint sites, causing bone and joint swelling and pain, often involving the tibia, fibula, ulna, radius and other bones and joints The ends of the toes tend to swell into club-shaped fingers. X-ray examination shows periosteal hyperplasia. Shoulder and back pain: Peripheral lung cancer often develops backward and upwards, eroding the pleura, involving ribs and chest wall tissue, causing shoulder and back pain. Such patients rarely have respiratory symptoms. Hoarseness: The lung cancer metastasis compresses the laryngeal nerve, which can make the vocal cords veneered and cause hoarseness. Because the metastases of lung cancer can appear at an early stage, and the county metastases can sometimes grow faster than the primary tumor, the clinical manifestations of the metastases can appear before the primary tumor.

Symptoms of advanced lung cancer will vary depending on the patient's physique. In advanced stage of lung cancer, the condition is more serious, and timely symptomatic treatment is needed. Pain is a symptom often seen in patients with advanced lung cancer. Most patients with lung cancer who have developed regional dissemination of the chest have symptoms of chest pain. Hoarseness is one of the advanced symptoms of lung cancer. The recurrent laryngeal nerve, which controls the left phonic function, descends from the neck to the chest, bypasses the large blood vessels of the heart, and returns to the larynx, thereby dominating the left side of the vocal organs. Therefore, if the tumor invades the left side of the mediastinum and compresses the recurrent laryngeal nerve, a hoarseness is produced, but there are no other symptoms of sore throat and upper respiratory tract infection. Facial and neck edema are also common in advanced symptoms of lung cancer. If the tumor invades and oppresses the superior vena cava on the right side of the mediastinum, it will initially cause the jugular vein to swell due to poor return flow, and eventually it will also cause facial and neck edema. Need to be diagnosed and addressed in a timely manner. Shortness of breath and pleural effusion are also manifestations of advanced symptoms of lung cancer.

Lung Adenocarcinoma Disease Hazard

It mainly includes the following aspects:

1. If lung cancer is not controlled in time, it will rapidly deteriorate and pose a great threat to the patient's life.

2. If lung cancer occupies most of the lungs, it will have a huge impact on the patient's breathing.

3. Swelling can cause bronchial obstruction, the normal alveolar sac cavity disappears, affecting the exchange of oxygen and carbon dioxide, and the patient will feel chest tightness and shortness of breath.

4, serious to a certain extent the harm of lung cancer can cause chest pain in patients, may also appear pleural effusion. Excessive pleural effusion compresses the lungs, increasing the difficulty of breathing for patients, which is quite difficult to treat

5. The nerves in the bronchus are quite sensitive, and the cancer irritates the bronchus, causing the patient to cough. Everyone has such a life experience, a rice grain falls into the bronchi, a few coughs, the rice grain is coughed, and it will no longer cough. However, the cancerous mass growing in the bronchi will not be coughed out, so a severe dry cough can occur and it is not easy to stop. Sometimes he coughs up blood.

Diagnosis of lung adenocarcinoma

Adjuvant examination of lung adenocarcinoma

For the diagnosis of lung cancer, there are several methods commonly used in clinical practice:

1. X-ray examination: X-ray examination is the most commonly used important method for the diagnosis of lung cancer. The location and size of lung cancer can be understood by X-ray examination. X-ray examination of early lung cancer cases has not yet revealed a mass, but local emphysema, atelectasis, or invasive lesions near the lesion or pulmonary inflammation may be seen due to bronchial obstruction.

2. Bronchoscopy: Bronchoscopy is an important measure for the diagnosis of lung cancer. The bronchoscopy can directly observe the pathological changes of the bronchial intima and lumen. Those who have seen cancer or invasion of cancer can take tissue for pathological examination, or take bronchial secretions for cytological examination to confirm the diagnosis and determine the type of histology.

3. Radionuclide examination: 67Ga-citrate and other radiopharmaceuticals have affinity for lung cancer and its metastatic lesions. After intravenous injection, they can be concentrated in cancerous tumors, which can be used for the localization of lung cancer, showing the scope of cancerous diseases and the positive rate. It can reach about 90%.

4. Cytological examination: Most patients with primary lung cancer can find shed cancer cells in sputum, and can determine the histological type of cancer cells. Therefore, sputum cytology is a simple and effective method for general screening and diagnosis of lung cancer. The positive rate of sputum cytology test for central lung cancer can reach 70 to 90%, and the positive rate of sputum test for peripheral lung cancer is only about 50%. Therefore, patients with negative sputum cytology test cannot rule out the possibility of lung cancer.

5. Thoracotomy: The nature of the lesion has not been clarified by multiple methods of examination and short-term exploratory treatment of lung masses, and the possibility of lung cancer cannot be ruled out. If the patient's general conditions permit, a thoracotomy should be performed. Corresponding treatment was given during the operation according to the lesions and pathological examination results. This can avoid delaying the disease and losing the opportunity for early treatment of lung cancer cases.

Due to the different biological characteristics of cancer cells, lung cancer is medically divided into two categories: small cell lung cancer and non-small cell lung cancer. The latter is divided into squamous cell carcinoma, adenocarcinoma, and large cell lung cancer.

Lung cancer, like other malignant tumors, can produce some biological substances such as hormone enzymes, antigens, and fetal proteins. However, these cancer markers have no application value in the diagnosis of lung cancer. Patients with unexplained mass shadows or inflammation that are found on a lung X-ray should be highly vigilant. Patients with lung cancer should be detected early, diagnosed and treated early to reduce the possibility of advanced metastasis and worsening of lung cancer.

6, ECT examination: ECT bone imaging is found 3 to 6 months earlier than ordinary X-rays, and bone metastases can be found earlier. If the lesion has reached 30% to 50% of decalcification in bone lesions in the middle stage, X-ray films and bone imaging have been positively detected. If the osteogenesis reaction in the lesions is at rest and metabolism is not active, the bone imaging is Negative X-rays are positive, and the two are complementary, which can improve the diagnosis rate.

7. Mediastinoscopy: When CT scans show that the anterior, paratracheal, and subprotuberance (2, 4, 7) groups have enlarged lymph nodes, general anesthesia should be performed under mediastinoscopy. Make a transverse incision in the upper part of the sternum, bluntly separate the anterior cervical soft tissue to the anterior tracheal space, bluntly release the anterior tracheal channel, place it in the observation mirror and slowly pass behind the innominate artery, observe the trachea, tracheobronchial angle, and subkeel, etc. The enlarged lymph nodes at the site were dissected with special biopsy forceps to obtain biopsy. The clinical data showed that the total positive rate was 39%, the mortality rate was about 0.04%, and 1.2% had complications such as pneumothorax, recurrent laryngeal nerve palsy, bleeding, fever and so on.

Differential diagnosis

It is mainly distinguished from other types of lung tumors, and secondly, it should be differentiated from pleural mesothelioma. It is mainly based on pathological examination. If it is difficult to obtain biopsy pathology, it depends on biological behavior and imaging findings, but it is often difficult to identify.

1. Benign tumors: common are hamartoma, bronchopulmonary cysts, giant lymph node hyperplasia, inflammatory myoblastoma, sclerosing hemangioma, tuberculoma, arteriovenous fistula, and pulmonary isolation. These benign lesions have their own characteristics in imaging examination. If it is not easy to distinguish them from malignant tumors, surgical resection should be considered.

2. Tuberculous lesions: These are the more common and most likely to be confused with lung cancer in lung diseases. Clinically, it is easy to misdiagnose and delay treatment. For clinically difficult to distinguish lesions, sputum cytology, fiberoptic bronchoscopy and other auxiliary examinations should be repeated until thoracotomy. Radiotherapy (hereinafter referred to as radiotherapy) or chemotherapy (hereinafter referred to as chemotherapy) are contraindicated before a clear pathological or cytological diagnosis is made, but diagnostic antituberculosis treatment and close follow-up can be performed. A positive tuberculin test cannot be used as an indicator of lung cancer exclusion.

3. Pneumonia: About 1/4 of lung cancers appear early in the form of pneumonia. Pneumonia with slow onset, mild symptoms, poor anti-inflammatory treatment effects, or recurring in the same area should be highly vigilant of the possibility of lung cancer.

4. Other: Including some rare and rare benign and malignant tumors in the lung, such as pulmonary fibroma and pulmonary lipoma, it is often difficult to identify before surgery.

Lung adenocarcinoma emergency measures

Lung adenocarcinoma is a type of lung cancer. If the disease progresses to advanced stages, the same first-aid measures as other lung cancers need to be taken.

Lung adenocarcinoma disease treatment

(1) Principles of treatment. The principle of comprehensive treatment should be adopted, that is, according to the body condition of the patient, the cytology and pathology type of the tumor, the scope of invasion (clinical staging) and development trends, a multidisciplinary comprehensive treatment (MDT) model should be adopted in a planned and reasonable manner. The use of surgery, chemotherapy, radiotherapy, and bio-targeting treatment methods, in order to achieve the goal of radical cure or maximum control of tumors, improve the cure rate, improve the quality of life of patients, and extend the survival of patients. At present, the treatment of lung cancer is still mainly based on surgery, radiation therapy and drug treatment.

(B) surgical treatment.

1. Principles of surgical treatment.

Surgical resection is the main treatment method for lung cancer, and it is also the only clinical cure for lung cancer. Lung cancer surgery is divided into radical surgery and palliative surgery, and radical resection should be strived for. The goal is to achieve the best and complete resection of the tumor, reduce tumor metastasis and recurrence, and conduct the final pathological TNM staging to guide comprehensive treatment after surgery. For surgically resectable lung cancer, the following surgical principles should be followed:

(1) A comprehensive treatment plan and necessary imaging studies (clinical staging) should be completed before non-emergency surgery. Fully evaluate the possibility of deciding surgical resection and develop a surgical plan.

(2) Complete resection of tumors and regional lymph nodes as far as possible; at the same time, try to retain functional healthy lung tissue.

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

(4) If the patient's physical condition allows, anatomic pneumonectomy (lobar resection, bronchial sleeve lobectomy, or total pneumonectomy) should be performed. If the physical condition does not permit, local resection is performed: segmental resection (preferred) or wedge resection, or VATS can be selected.

(5) In addition to complete resection (R0 surgery), the hilar and mediastinal lymph nodes (N1 and N2 lymph nodes) should be routinely removed in addition to the complete removal of the original lesion, and the location should be sent for pathological examination. Sampling or clearing the lymph nodes in at least 3 mediastinal drainage areas (station N2) to ensure that the lymph nodes are completely removed. The recommended range of right chest clearance is: 2R, 3a, 3p, 4R, 7-9 lymph nodes and surrounding soft tissues; the left chest clearance range is: 4L, 5-9 groups of lymph nodes and surrounding soft tissues.

(6) Pulmonary veins, pulmonary arteries, and bronchial tubes were treated sequentially during the operation.

(7) Sleeve lobectomy is performed during the rapid pathological examination to ensure that the margin (including the bronchus, pulmonary artery, or venous stump) is negative, and as much as possible to retain lung function (including bronchus or pulmonary blood vessels). The quality of life of the patients was better than that of patients with total pneumonectomy.

(8) Patients with recurrent lung cancer or solitary lung metastasis 6 months after complete resection of lung cancer, with the exception of distant extrapulmonary metastases, resection of recurrent side lung resection or lung metastasis can be performed.

(9) Patients with heart and lung function and other body conditions who have been assessed to be unable to undergo surgery can be switched to radical radiotherapy, radiofrequency ablation, and medication. ^[3]

2. Indications for surgery.

(1) Stages I, II, and part IIIa (T3N1--2M 0; T1-2N 2M 0; T4N0 -1M 0 can be completely removed) non-small cell lung cancer and partial small cell lung cancer (T1-2N0 1M0).

(2) N2 stage non-small cell lung cancer effective after neoadjuvant therapy (chemotherapy or chemotherapy plus radiotherapy).

(3) Part IIIb non-small cell lung cancer (T4N0 -1M0), if the tumor can be completely removed locally, including the invasion of the superior vena cava, other adjacent large blood vessels, atrial, bulge, etc.

(4) Some stage IV non-small cell lung cancers have single contralateral lung metastasis and single brain or adrenal metastasis.

(5) The lung nodules of lung cancer are highly suspected clinically, and a qualitative diagnosis cannot be obtained through various examinations, and surgical exploration may be considered.

3. Contraindications for surgery

(1) The general condition cannot tolerate surgery, and the vital organ functions such as heart, lung, liver, and kidney cannot tolerate surgery.

(2) The vast majority of stage IV, most stage IIIb, and part stage IIIa non-small cell lung cancer with clear diagnosis, and small cell lung cancer with stage later than T1-2N0 -1M0 stage.

(3) Radiation therapy. Lung cancer radiotherapy includes radical radiotherapy, palliative radiotherapy, adjuvant radiotherapy and preventive radiotherapy.

1. Principles of radiotherapy.

(1) Radical radiotherapy is applicable to patients with KPS score 70 (see Karnofsky score in Annex 2), including early non-small cell lung cancer that cannot be operated due to iatrogenic or / and personal factors, and unresectable locally advanced non-small Cell lung cancer, and localized small cell lung cancer.

(2) Palliative radiotherapy is suitable for the reduction of primary lung cancer metastases and metastatic tumors. Whole brain radiotherapy can be performed for patients with single brain metastases of non-small cell lung cancer.

(3) Adjuvant radiotherapy is suitable for patients with preoperative radiotherapy and positive postoperative resection margins. For patients with positive postoperative pN2, it is encouraged to participate in clinical research.

(4) The postoperative radiotherapy design should refer to the patient's surgical pathology report and surgical records.

(5) Prophylactic radiotherapy is suitable for whole brain radiotherapy for small cell lung cancer patients who are effective in systemic treatment.

(6) Radiotherapy is usually combined with chemotherapy to treat lung cancer. Due to different stages, treatment purposes and general conditions of the patient, the combined scheme can choose synchronous radiotherapy and sequential radiochemotherapy. Proposed concurrent chemoradiotherapy regimens are EP and purple shirt-containing regimens.

(7) Patients undergoing radiotherapy and chemotherapy may have increased potential toxic and side effects, and patients should be informed before treatment; when designing and implementing radiotherapy, care should be taken to protect the lungs, heart, esophagus, and spinal cord. Unplanned interruption of radiotherapy due to improper management of side effects.

(8) It is recommended to use advanced radiotherapy technologies such as three-dimensional conformal radiotherapy (3DCRT) and intensity modulated radiotherapy (IMRT).

(9) Patients receiving radiotherapy or chemoradiation should be adequately monitored and supported during treatment breaks.

2. Indications for non-small cell lung cancer (NSCLC) radiotherapy.

Radiotherapy can be used for radical treatment of early stage NSCLC patients who cannot be surgically treated due to physical reasons, preoperative and postoperative adjuvant treatment of operable patients, local treatment of patients with locally advanced lesions that cannot be removed, and important palliative treatment methods for patients with incurable late stages.

In patients with NSCLC who cannot receive surgery in stage I, radiation therapy is one of the effective local control measures. For patients with NSCLC undergoing surgical treatment, if the postoperative pathological surgical margin is negative and the mediastinal lymph nodes are positive (pN2), in addition to conventional postoperative adjuvant chemotherapy, postoperative radiotherapy is also recommended. For margin-positive pN2 tumors, concurrent chemoradiotherapy is recommended if the patient is physically acceptable. For patients with a positive margin, radiotherapy should begin as soon as possible.

For patients with stage II-III NSCLC who cannot undergo surgery due to physical reasons, conformable radiotherapy should be given in combination with concurrent chemotherapy if physical conditions permit. In patients who hope to be cured, when receiving radiotherapy or concurrent chemoradiotherapy, through a more appropriate radiotherapy plan and more active supportive care, the interruption of treatment time or the reduction of treatment dose is minimized.

For patients with stage IV NSCLC who have extensive metastases, some patients can receive radiation therapy for primary and metastatic lesions to achieve palliative reduction.

(4) Drug treatment for lung cancer. Drug treatment for lung cancer includes chemotherapy and molecularly targeted drug therapy (EGFR-TKI therapy). Chemotherapy is divided into palliative chemotherapy, adjuvant chemotherapy and neoadjuvant chemotherapy. Clinical indications should be strictly controlled and implemented under the guidance of oncologists. Chemotherapy should fully consider the patient's illness, physical condition, adverse reactions, quality of life, and patient's wishes to avoid overtreatment or undertreatment. The efficacy of chemotherapy should be assessed in a timely manner, adverse reactions should be closely monitored and prevented, and drugs and / or doses adjusted as appropriate.

The indications for chemotherapy are: PS score 2 (Annex 6, ZPS score, 5 points method), chemotherapy can be tolerated for important organ functions, and the PS score for chemotherapy for SCLC can be relaxed to 3. Encourage patients to participate in clinical trials.

1. Medication for advanced NSCLC.

(1) First-line drug treatment.

Platinum-containing two-drug regimens are standard first-line treatments; patients with EGFR mutations can choose targeted drug treatments; those with conditions can be combined with anti-tumor vascular drugs on the basis of chemotherapy. The currently available chemotherapeutics are listed in Annex 7. For patients with first-line treatment to achieve disease control (CR + PR + SD), those with conditions can choose maintenance treatment.

(2) Second-line drug treatment. Drugs for second-line treatment include docetaxel, pemetrexed, and targeted drugs EGFR-TKI.

(3) Third-line drug treatment. You can choose EGFR-TKI or enter clinical trials.

2. Medical treatment of non-surgical NSCLC.

Combination of radiotherapy and chemotherapy is recommended, and concurrent or sequential radiotherapy and chemotherapy can be selected according to the specific situation. The recommended chemotherapeutic drugs for concurrent treatment are podophylside / cisplatin or carboplatin (EP / EC) and paclitaxel or docetaxel / platinum. Sequential treatment of chemotherapy drugs see first-line treatment.

3. Perioperative adjuvant treatment of NSCLC.

For completely resected stage II-III NSCLC, a platinum-containing two-drug regimen is recommended for 3-4 cycles of adjuvant chemotherapy. Adjuvant chemotherapy begins when the patient's physical condition returns to normal, generally starting 3-4 weeks after surgery.

Neoadjuvant chemotherapy: For resectable stage III NSCLC, two platinum-containing drugs and two cycles of preoperative neoadjuvant chemotherapy can be selected. Efficacy should be assessed in a timely manner, and care should be taken to judge adverse reactions to avoid increased surgical complications. Surgery is usually performed 2-4 weeks after the end of chemotherapy. Postoperative adjuvant treatment should be based on the preoperative staging and the effect of neoadjuvant chemotherapy. Those who are effective continue the original protocol or adjust as appropriate according to the patient's tolerance, and those who do not should be replaced.

4. Principles of chemotherapy for lung cancer.

(1) KPS 2 lung cancer patients should not be treated with chemotherapy.

(2) Leukocytes less than 3.0 × 109 / L, neutrophils less than 1.5 × 109 / L, platelets less than 6 × 1010 / L, red blood cells less than 2 × 1012 / L, and hemoglobin less than 8.0g / dl Patients with lung cancer should not be treated with chemotherapy in principle.

(3) Patients with lung cancer have abnormal liver and kidney functions, laboratory indicators are more than twice the normal value, or patients with severe complications and infection, fever, and bleeding tendency are not suitable for chemotherapy.

(4) In the case of chemotherapy, the following circumstances should be considered for withdrawal or replacement:

If the disease progresses after 2 cycles of treatment, or if it worsens again during the rest period of the chemotherapy cycle, the original regimen should be stopped and other programmes should be used as appropriate; when the adverse reactions of chemotherapy reach level 3-4 and there is a significant threat to the patient's life, the medication should be discontinued. Switch to another plan for the second treatment; if severe complications occur, the drug should be discontinued and the next plan should be switched to another plan.

(5) The standardization and individualization of the treatment plan must be emphasized. Must understand the basic requirements of chemotherapy. In addition to conventional antiemetic drugs, platinum drugs require hydration and diuretics in addition to carboplatin. Blood tests were performed twice a week after chemotherapy.

(6) For the evaluation of the efficacy of chemotherapy, refer to the WHO evaluation criteria for solid tumors or RECIST. ^[4]

Prognosis of lung adenocarcinoma

In contrast, lung adenocarcinoma has a better prognosis than other types of lung cancer. Specific to the stage.

Lung adenocarcinoma disease prevention

1. Prohibition and control of smoking: The mechanism of lung cancer caused by smoking has been well studied. Epidemiological data and a large number of animal experiments have fully proved that smoking is the main factor causing lung cancer. The discussion on smoking ban is as follows.

(1) No smoking should be done immediately.

(2) The state should formulate strong laws to publicize that tobacco contains carcinogens that cause lung cancer.

(3) to reduce the harm of passive smoking.

2. Reducing the harm of industrial pollution: We should start from the following aspects.

(1) Workers in dust-contaminated environments should wear masks or other protective masks to reduce the inhalation of harmful substances.

(2) Improve the ventilation environment in the workplace and reduce the concentration of harmful substances in the air.

(3) Reform the production process and reduce the production of harmful substances.

3. Reduce environmental pollution: Air pollution is an important factor causing lung cancer. Among them are 3,4-dibenzopyrene, sulfur dioxide, nitrogen oxide and carbon monoxide. There are the following aspects to reduce environmental pollution and measures:

(1) Restrict the development of urban motor vehicles, improve the combustion equipment of motor vehicles, and reduce the emission of toxic gases.

(2) Research on harmless energy and gradually replace or eliminate those harmful energy.

Lung adenocarcinoma diet note

Nutritional treatment for lung adenocarcinoma

1. Quit smoking, this is the most effective way to prevent lung cancer;

2.Drink less alcohol;

3, do not eat moldy food, eat less pickled food;

4. When eating, you should chew slowly and not eat too hot food;

5. Don't take too much fat. The intake should be controlled below 30% of the total calories, that is, 50g to 80g of animal and plant fats taken daily. Eat more fresh vegetables and fruits, and supply 10g fiber and general daily. Levels of vitamins

6. Eat less smoked food;

7, do not abuse drugs, especially do not abuse sex hormone drugs and cytotoxic drugs, to prevent drug carcinogenic risks;

8. Eat fruits, vegetables, and coarse cereals daily;

Lung adenocarcinoma environment

Pay attention to pollution in the kitchen and strengthen kitchen ventilation;

Lung adenocarcinoma

Cultivate an optimistic and open-minded personality;

Lung adenocarcinoma other

Exercise at least 3 times a day to avoid weight

American medical experts surveyed 3,000 patients with various cancers and found that the life span of patients with weight loss is only half of normal weight, and those with lung cancer patients who have not lost more than 7% of their weight can be treated normally. If their weight is reduced by more than 18%, Treatment with anticancer drugs will be ineffective.

The above survey results show that whether cancer patients are wasting and the degree of wasting has a great impact on the prognosis. According to the above requirements, patients should drink two glasses of milk (450 grams) a day, eat one or two lean meats, half a catty of vegetables and fruits, of which half of the vegetables should be green leafy vegetables. When the weight loss is obvious, you can increase the amount of food and meals. If you eat 100 grams of steamed buns and 25 grams of meat, you can increase the calories in your body by 500 calories. Adding 500-1000 calories a day can increase your weight by 1 to 1.5 kilograms a month. Therefore, you can take the method of adding meals between meals, eat more sweets, milk, eggs and other foods, which can increase the calories a lot, and make up for the weight loss caused by excessive consumption of patients.

For cancer patients who cannot eat, in addition to injecting liquid food such as milk and malted milk through a gastric tube, an intravenous infusion should be performed to supplement a large amount of glucose, sodium ions, and serum proteins. These measures have a decisive role in enhancing the fitness of cancer patients, improving the therapeutic effects of radiotherapy and chemotherapy, and prolonging the survival time of patients. Almost everyone knows the idiom "disease enters by mouth", but the term "cancer enters by mouth" makes people feel strange. In fact, most cancers in life are a disease that people "eat", and only a few are related to factors such as genetics, radiation, and chemical stimulation. Second is to cultivate good eating habits, which is also the key to preventing cancer. According to research, many cancers, especially those of the digestive system, are mostly related to poor eating habits. Such as eating gorge, fast food, pickled, smoked, grilled food, love fat and moldy food, addiction to smoking, excessive drinking, unclean diet, etc. can cause cancer.

Lung adenocarcinoma disease care

Lung Adenocarcinoma Daily Care

1. Bed sores prevention: The nutritional status of patients with advanced lung cancer is generally poor. Sometimes combined with systemic edema, it is easy to produce bedsores, and they can quickly expand and be difficult to cure. It is especially important to prevent bedsores. Relieve local pressure and change body position on time. Places that are susceptible to pressure on the body are cushioned with air balloons, soft pillows, etc. to avoid long-term pressure. Keep the skin clean, especially for patients with incontinence, keep the bed clean and flat, and apply a baking lamp to the ulcerated skin to keep it partially dry.

2. Relieve symptoms: Fever is one of the main symptoms of lung cancer. Patients should be advised to keep warm and prevent colds to prevent pneumonia; for coughing irritants, antitussives can be given; when patients have persistent coughs at night, they can drink hot water. To reduce the irritation of the throat; if hemoptysis occurs, hemostatic medicine should be given. When a large amount of hemoptysis is reported, the doctor should be notified immediately, while the patient's head is tilted to one side, and the blood in the mouth is removed in time to prevent suffocation and assist the doctor in rescue.

3. Condition observation and nursing: Patients with advanced lung cancer often have metastases from different parts of the tumor, causing different symptoms, and should pay attention to observation and give corresponding care. Such as liver and brain metastases, there may be sudden coma, convulsions, and blurred vision. Nursing staff should promptly find and give symptomatic treatment. Bone metastasis should strengthen limb protection. Abdominal metastasis often occurs intestinal obstruction. Patients should be observed for symptoms such as abdominal distension and abdominal pain. Due to weakness, fatigue, decreased activity, etc., patients often have constipation, and should be given in time or relieved. Laxatives have a laxative effect. Edema can occur due to malnutrition and low plasma protein, and edema should be reduced by increasing nutrition and raising the affected limb.

4. Psychological care: Patients with advanced lung cancer will have anxiety, fear, sadness, etc., and often appear indifferent and lonely. We must have a high degree of compassion and responsibility, and strive to create a warm and harmonious cultivation environment for patients, placed in In the single-person ward, the language is cordial and the attitude is sincere. Patients are encouraged to speak their own psychological feelings, be enlightened in a timely manner, and actively introduce the patient's information to the patient's improvement.

The care of patients with advanced lung cancer is mainly to control the symptoms and reduce the patient's pain, to create a comfortable cultivation environment for them, and to give patients the greatest mental support and psychological comfort. In addition, anti-cancer traditional Chinese medicine can be used for conditioning. Although Western medicine has fast effects, it is extremely unstable, easy to recur, and has large side effects, and it is prone to drug resistance.

Postoperative care of lung adenocarcinoma

After lung cancer surgery, patients should be banned from smoking to prevent recurrence. Patients with reduced lung function should be instructed to gradually increase the amount of exercise.

Always pay attention to the patient's recovery after surgery. If there is recurrence, you should immediately go to the hospital for a doctor's consultation to decide whether to undergo radiation therapy or chemotherapy.

Pulmonary squamous cell carcinoma easily invades the local area after surgery and causes recurrence in the thorax.

Adenocarcinoma of the lung or undifferentiated carcinoma is susceptible to metastasis, such as to the lymph nodes, bones, liver, brain, and contralateral lungs.

Always pay attention to whether the patient has fever, severe cough, sputum, shortness of breath, chest pain, headache, vision changes, liver pain, bone pain, supraclavicular lymphadenopathy, hepatomegaly, etc. If you notice the above symptoms, you should go to the hospital in time . At the same time, patients should regularly go to the hospital for thoracic fluoroscopy and keep fresh sputum to check cancer cells.

Lung adenocarcinoma psychological care

1. Psychological counseling: Patients with advanced lung cancer are relatively fragile in psychophysiology. When patients are diagnosed recently, it is difficult for patients and their families to accept. Nurses should take the initiative to care and comfort the patients when they are admitted, introduce the ward environment, introduce the doctors and nurses, and eliminate the patient's rustiness. Feeling and tension, reduce the patient's fear of hospitalization, help patients get to know their patients, guide family members to give strong support in spirit and life, timely grasp the patient's psychological changes and take various forms to do a good job of psychological counseling for patients. 1.1 Use language art to comfort patients. Nurses should treat patients in good faith, be natural when talking, and always show concern for patients. Give appropriate psychological care at the right time to eliminate the patient's anxiety, stabilize the mood, stimulate the patient's confidence in the treatment, and actively cooperate with the medical care optimistically. 1.2 Establish a good nurse-patient relationship Establishing a good nurse-patient relationship is a prerequisite for timely and effective psychological counseling, so nurses should always communicate with patients. Pull in the distance with the patient through chat, listen patiently to the patient's report, and use the knowledge to properly explain the disease [1], through the conversation to experience the emotional and emotional changes hidden in the patient's language, and take timely and effective Psychological care.

2. Psychology of meeting the needs of patients: Many patients with advanced cancer are limited in their needs, which affects their emotions and behaviors. Therefore, it is necessary to carefully observe the needs of patients and meet the various needs of patients. 2.1 The need for survival Survival is the strongest need of cancer patients. They are eager to continue to feel the value of life and need people's understanding and support. Therefore, it is necessary to establish a good nurse-patient relationship with patients and family members, encourage family members and relatives and friends to be considerate and caring for patients, and often visit patients to make patients feel warm. As a medical staff, the head of the department and the head nurse also need to visit the patient often, give them encouragement, and make the patient feel warm and caring everywhere in the extraordinary family of the hospital. Active cooperation therapy. 2.2 Physiological needs The most important feature of patients with advanced lung cancer is dyspnea and exacerbation of asthma, which leads to a poor quality of life for patients. Many patients have irritability, irritability, pessimism and disappointment, insomnia, and even suicidal tendencies. Nurses should understand the dynamic changes of the patient's thinking in time, find problems in time, and deal with them accordingly. Enlighten the patient in a timely manner, introduce the patient's optimistic attitude towards life to patients with the same disease, encourage patients to give up any scruples as much as possible, and seek spiritual support; promptly teach patients to grasp several hypnosis techniques, such as rosary beads , Listening to light music, etc., and giving symptomatic treatment, so that patients get rid of the pain of insomnia, and regain their spirits and actively cooperate with treatment.

Lung adenocarcinoma diet care

1 . When lung cancer patients do not have difficulty swallowing, they should choose food freely. Without affecting treatment, they should eat more protein-rich and carbohydrate-rich foods to improve diet quality and create good conditions for surgery. If the nutritional status is poor, it is difficult to tolerate the trauma of the operation, the postoperative healing is slow, infection is easy, and it is not good for surgical rehabilitation.

2 . The diet is required to contain various nutrients necessary for the human body. When sufficient calories are supplied, protein nutrition can be supplemented to promote muscle protein synthesis. When the calories are insufficient, branched chain amino acids can also provide more thermal energy. There are many types of elemental meals. When applied, they should be started from a low concentration. If you take them orally, you should pay attention to slow drinking. Because the elemental meals are hypertonic, diarrhea and vomiting may occur if they are cited too quickly.

3 Postoperative diet allocation: Postoperative diet is adjusted according to the condition. Because surgical trauma can cause dysfunction of the digestive system, do not rush to achieve success in food selection and supplementation. Eat more fresh vegetables and fruits. Fruits and vegetables are rich in vitamin C, which is a tumor suppressor and can block the formation of cancer cells. In addition, garlic also contains anticancer substances. Develop a good life and eating habits, regular physical examinations, timely diagnosis and treatment.

Lung Adenocarcinoma Home Nursing

In addition to observing the patient for cough, expectoration, hemoptysis, chest pain, chest tightness, dyspnea, fever and other abnormalities, special attention should also be paid to swallowing difficulties, hoarseness, edema of the head and neck and upper limbs, or drooping upper eyelids. Difficulty swallowing may indicate tumor invasion or compression of the esophagus;

If hoarseness is present, it indicates that the tumor directly or indirectly compresses the recurrent laryngeal nerve; if head and neck and upper limb edema, congestion and varicose veins in the chest, accompanied by headache, dizziness, or dizziness, it indicates that the superior vena cava has occurred Compression syndrome; if there is an upper eyelid droop, an invagination of the eyeball, a dilated pupil, and no sweating on the forehead and upper chest on the same side as the lung tumor, Horner syndrome is indicated.

Advanced nursing care of lung adenocarcinoma

1 . The diet is rich, varied, light, and nutritious. It consists of various porridges, soups, such as meat porridge, fish porridge, egg porridge, barley porridge, lily porridge, wolfberry porridge, etc., with fruits and fresh vegetables.

2 . Help patients who cannot take care of themselves regularly turn over, scrub daily, massage hands and feet. Saffron alcohol can be used to smear the pressured area to prevent bedsores.

3 Patients with pain should try their best to meet their analgesic requirements, and don't be afraid of the addictiveness of narcotic analgesics to improve their quality of life.

4. For patients who can move lightly, accompany them to walk slowly, take a walk, and move their muscles and bones, so as not to overdo it.

5. It can properly listen to light music, folk music, and Beethoven's Symphony of Destiny, so as to relax the body and mind and improve its quality of life.

6. Give patients more spiritual comfort and eliminate their fear of death. Encourage and train patients' spouses and relatives, give them care, hugs, speak softly, communicate more, and express their love and nostalgia for patients, so that The patient gains spiritual joy.

7. Closely observe the patient's changes in breathing, blood pressure, pulse, body temperature, and consciousness. If there is an abnormality, report it to the doctor immediately and treat it symptomatically.

8 . If you have cough and phlegm, encourage the patient to spontaneously spit out. Those who have difficulty in sputum excretion can help sputum excretion. If necessary, use a sputum suction device. When sleeping, pay attention to the head lying on one side to prevent sputum. If you find that the patient suddenly has aphasia, changes in complexion, or stops breathing, you must report it to your doctor immediately for emergency treatment.

Lung adenocarcinoma complications

1. Respiratory complications: such as sputum retention, atelectasis, pneumonia, and respiratory insufficiency. Especially the elderly and infirm, the former chronic bronchitis, emphysema have a higher incidence.

2. Hemothorax, empyema and bronchopleural fistula after surgery: its incidence is very low. Hemothorax is a serious complication after surgery, and it must be treated urgently. If necessary, the thoracotomy should be performed again to stop bleeding.

3, cardiovascular system complications: old and frail, mediastinal and hilar traction during surgery, hypokalemia, hypoxia, and major bleeding often become its incentives. Common cardiovascular system complications include: postoperative hypotension, arrhythmia, pericardial tamponade, and heart failure.

Expert opinion on lung adenocarcinoma

Lung adenocarcinoma in Asians, especially female non-smokers, responds better to target therapy drugs gefitinib (brand name Irresa) than Westerners, which is related to the high EGFR mutation rate in non-smoker women in Asia .