What Is the Pathophysiology of Lung Cancer?

Bronchogenic lung cancer is a highly malignant primary lung tumor, which accounts for the vast majority of lung cancer and has a poor prognosis.

Bronchial cancer

Bronchial cancer is generally divided into four types of histology: squamous cell carcinoma, which often occurs in larger bronchial tubes, usually spreads through direct spread or lymph node metastasis; small cell undifferentiated cancer, which produces blood-borne metastases in the early stage; large cells are not Differential cancer, often spread through the bloodstream; adenocarcinoma, often peripheral, generally spread through the bloodstream. All types can spread through the lymphatic vessels. The etiology of lung cancer is complex and has not been fully understood so far. Smoking is the main cause of bronchial lung cancer, accounting for more than 90% of male patients, more than 80% of females, and 87% of lung cancer is related to exposure to tobacco.

Introduction to Bronchial Cancer

Bronchogenic lung cancer is a highly malignant primary lung tumor, which accounts for the vast majority of lung cancer and has a poor prognosis.

Bronchial cancer Bronchogenic lung cancer accounts for more than 90% of all lung tumors. Primary lung cancer is the second most common cancer in men (13%) and third in women (13%). Lung cancer is the leading cause of cancer death in men and women, with 32% in men and 25% in women. The incidence of women is rising rapidly, and the disease mostly occurs between the ages of 45 and 70.

It is quite common for malignant tumors that originate in other parts of the body to metastasize to the lungs through the blood or lymphatics. According to statistics, about 20-30% of the cases of death from malignant tumors have lung metastases. The time at which lung metastases occur in malignant tumors varies from day to night. Most cases have metastases within 3 years after the appearance of the primary cancer. There are also cases of more than 10 years. . The primary malignant tumors that metastasize to the lung are mostly from the breast, bone, digestive tract, and urogenital system.

Most of lung metastatic tumors are multiple lesions that spread across the lungs on both sides, with different sizes and uniform density. There is no effective treatment for these advanced cancer cases. In a few cases, only a single isolated metastatic lesion in the lung can be considered surgical treatment.

Clinical symptoms of bronchial cancer

Solitary pulmonary metastasis cases generally do not show obvious symptoms clinically, and most of them are found during chest X-ray examination of the primary tumor with follow-up. A few cases may have cough and sputum. Lung X-ray signs are similar to those of peripheral primary lung cancer.

Etiology of bronchial cancer

Overview of bronchial cancer

Smoking is the main cause of bronchial lung cancer, accounting for more than 90% of male patients, more than 80% of females, and 87% of lung cancer is related to exposure to tobacco. Stronger

Bronchial cancer The dose-response relationship of smoking is shown in the three most common lung cancers: squamous cell carcinoma, small cell carcinoma, and adenocarcinoma; the slope of the small cell cancer curve is the steepest, and adenocarcinoma is the lowest. Recent epidemiological studies support previous data suggesting that smoking cessation can delay the occurrence of lung cancer and reduce the risk of developing specific tissue types of lung cancer. A small percentage of lung cancers (15% male, 5% female) are related to occupational factors, which are common causes of disease. They are: asbestos, radiation, arsenic, chromates, nickel, chloromethyl ether, mustard gas (gas war) ) And coke oven emissions. The exact role of air pollution is unknown. A few cases are importantly related to exposure to indoor radon. However, in Finland, a large number of case-control studies have not demonstrated that exposure to indoor radon increases the risk of lung cancer. Occasionally, lung cancer, especially adenocarcinoma and alveolar cell carcinoma, is associated with lung scars, DNA damage, activation of oncogenes of cells and stimulation of growth factors are considered to play an important role in the pathophysiology of lung cancer.

The etiology of lung cancer is complex and has not been fully understood so far. The currently recognized factors are as follows.

Bronchial cancer smoking

A large number of survey data show that long-term smoking cigarettes are closely related to the occurrence of lung cancer, especially squamous cell carcinoma and undifferentiated small cell carcinoma. Cigarette burning smoke mainly contains a variety of carcinogens such as nicotine, carbon monoxide, benzopyrene, nitrosamines, and a small amount of radioactive element pyrene. It has been reported at home and abroad that smoking is positively correlated with the incidence of lung cancer and is proportional to the amount of smoking. The longer the smoking time, the larger the amount, the younger the age of smoking, the higher the morbidity and mortality. The length of smoking is more important than the amount of smoking. Bruce Arme of the United States pointed out that carcinogenic substances in cigarettes are not carcinogenic by weight, but if they are inhaled too much, the carcinogenicity will increase. If you smoke 20 cigarettes a day, it is almost equivalent to smoking 1 g of asphalt dust mist every day. A study by Hirayama Hiroshi of the National Cancer Center in Japan shows that the risk of carcinogenicity of a cigarette is equivalent to 1 to 4 mrad of radiation. If you smoke 30 cigarettes a day, it is equivalent to 120mrad of radiation, which is equivalent to the amount of X-rays of chest X-rays performed once a day. The incidence and mortality of lung cancer are more than 10 times higher in smokers than in nonsmokers. Ten to 15 years after quitting smoking, the incidence and mortality of lung cancer have decreased significantly, almost similar to those of non-smokers. In recent years, foreign studies have proven that husbands who smoke cigarettes (passive smokers) have lung cancer twice as often as couples who do not smoke. The risk of developing lung cancer increases with the number of cigarettes smoked by her husband. Pathological examination showed that bronchial epithelial cell cilia fall off, squamous metaplasia, atypical hyperplasia, and nuclear abnormalities were observed in heavy smokers, similar to precancerous lesions of lung cancer.

Air pollution from bronchial cancer

According to statistics, the incidence of lung cancer in cities is higher than that in rural areas, higher in large cities than in small and medium cities, higher in urban areas than in suburbs, higher in suburbs than in outer suburbs, and higher in industrial developed countries than in backward industrial countries. This may be related to the pollution of the atmosphere by industrial exhaust gases and carcinogens (mainly benzopyrene). The main sources of benzopyrene are coal and petroleum combustion, and the exhaust gas from internal combustion engines is the main source of pollution.

Some occupational lung cancer factors of bronchial cancer

Such as asbestos, arsenic, chromium, nickel, beryllium, coal tar, mustard gas, chloroform, chloromethyl ether, tobacco heating products, radioactive materials such as uranium, radon and radon daughter bodies produced during the decay of radium, ionizing radiation , Microwave radiation, etc., as well as long-term exposure and inhalation of dust, can induce lung cancer. Some people have observed that smokers exposed to asbestos can increase the risk of lung cancer by about 100 times, suggesting that there may be a synergistic effect.

Stimulation of bronchial cancer scar tissue

Patients with chronic bronchitis, tuberculosis, and diffuse interstitial fibrosis have a higher incidence of lung cancer than the normal population. According to British studies, the incidence of lung cancer in patients with chronic bronchitis is about twice as high as that in patients without chronic bronchitis. Adenocarcinoma can occur in the scars of the lungs caused by a healed tuberculosis lesion. Our hospital summarized 236 cases of lung cancer, of which 8.5% were associated with tuberculosis. Of the 37 cases of bronchioloalveolar carcinoma, 3 had pulmonary tuberculosis, 24 had inflammatory scars, and 19 had chronic bronchitis.

Other causes of bronchial cancer

In addition, viral infections, mycotoxins (aflatoxins), vitamin A deficiency, low immune status, endocrine disorders and familial inheritance, proto-oncogene activation such as gene mutation, amplification, overexpression, and tumor suppressor gene deletion, mutation The loss of balance of cell regulation and other factors may play a comprehensive role in the occurrence of lung cancer.

Bronchial cancer pathology

Bronchoalveolar cell carcinoma (a subtype of adenocarcinoma) consolidates the air cavity and usually does not spread outside the lungs. Although it can be isolated, it can sometimes be distinguished from other types of bronchial cancer based on the origin of its multiple lesions.

Symptoms of bronchial cancer

The appearance of a tumor depends on its location and the type of spread. Because most bronchial cancers are located in the bronchi, patients typically present with cough, with or without hemoptysis. In patients with chronic bronchitis, the original cough is aggravated and stubborn, indicating the possibility of new organisms. The amount of sputum produced by bronchial tumor ulcers is generally small (although the sputum of bronchioloalveolar cell carcinoma can sometimes be large and watery), but it can contain inflammatory exudates and is often bloodshot. Hemoptysis is uncommon in small cell carcinomas, and large (uncommon) hemorrhages strongly suggest that large blood vessels have been violated. Bronchial stenosis can cause gas traps with localized wheezing, often causing atelectasis with mediastinal displacement, reduced lung dilatation, and dullness of dullness and respiratory sounds. Infections in the blocked lungs can cause fever, chest pain, and weight loss. Persistent localized chest pain suggests that new organisms are invading the chest wall. Peripheral nodular tumors are asymptomatic until they do not invade the pleura or chest wall and cause pain or metastasis to distant organs. Late symptoms include fatigue, fatigue, decreased activity, increased cough, difficulty breathing, poor appetite, weight loss, and chest pain. Malignant tumors often cause serous bloody pleural effusions, which often occur in large numbers and occur repeatedly.

Horner syndrome (due to violations of the cervical and thoracic sympathetic nerves) manifests as invagination of the eyeballs, narrowing of the pupils, drooping of the upper eyelid, and no sweat on the ipsilateral side. Pancost syndrome (due to brachial plexus and adjacent ribs, as well as tumor infiltration of the spine) manifests as pain, numbness, and weakness in the affected upper arm. Both of the above syndromes can coexist.

Signs of bronchial cancer

Tumors can directly invade the esophagus, causing obstruction, and sometimes with fistulas. Invasion of the phrenic nerve can cause diaphragmatic paralysis. Cardiac arrhythmias, heart enlargement, and pericardial effusion occur. Obstruction of the superior vena cava and paralysis of the left recurrent laryngeal nerve (causing hoarseness) are caused by direct compression of the tumor or compression of adjacent lymph nodes.

In superior vena cava syndrome, obstruction of venous return causes dilatation of the upper thoracic and neck collateral veins; edema and congestion of the face, neck, and upper trunk (including breasts); conjunctival redness and swelling; supine asthma; Systemic symptoms (such as headaches, visual disturbances and disturbance of consciousness). The superior vena cava syndrome has significant clinical manifestations. Although it requires close attention, it is not an emergency. For mediastinal masses of unknown origin, the most important thing is to make a histological diagnosis.

Lymphatic carcinoma can occur in the lungs of primary and secondary cancers, causing subacute pulmonary heart disease, exacerbation of hypoxemia, and severe dyspnea. Secondary blood-borne lymph node metastases in the lung are common, but secondary bronchial invasion is rare. Hematogenous metastases to the liver, brain, adrenal glands, and bones are common and can occur early, and symptoms can occur before obvious lung symptoms appear.

The paracancerous syndrome of lung cancer has many manifestations and is a distant effect outside the lungs of the tumor. They cause metabolic and neuromuscular disorders unrelated to the primary tumor or metastasis, and may be the first symptoms of cancer occurrence or recurrence. They do not indicate that the tumor has spread outside the chest. Hypertrophic osteoarthropathy (known to all) is the clubbing deformation of the fingers and toes and the periosteal bulge of the distal long bone. All parts of the nervous system can be affected-mainly encephalopathy, subacute cerebellar degeneration, encephalomyelitis, Eaton-Lambert syndrome, and peripheral neuropathy. Polymyositis and dermatomyositis can occur or metabolic syndrome can occur due to the production of substances with hormonal effects. Small cell carcinoma can secrete ectopic ACTH, which leads to Cushing's syndrome; or ADH, which causes water retention and hyponatremia, and can also cause carcinoid syndrome (redness, wheezing, diarrhea, and heart valve damage). Squamous epithelial cell tumors secrete parathyroid hormone-like substances and produce hypercalcemia. Other endocrine syndromes associated with primary lung cancer include breast enlargement in men, hyperglycemia, thyroidism, and skin pigmentation. Hematological diseases can also occur, including thrombocytopenic purpura, leukemia-like reactions, bone marrow anaemia, red blood cells, and debilitating thrombosis.

Bronchial cancer diagnosis

The main sources of diagnostic data are medical history and chest X-rays. If there are early local symptoms in the medical history, it may cause suspicion of tumors; chest X-rays can identify the lesion and show its impact on the surrounding tissue structure, but many Large-scale studies at the Cancer Center have not proven that chest X-rays and sputum specimens help screen for lung cancer. Although the above methods may detect lung cancer at an early stage, early detection has no effect on patient survival.

When lung cancer is suspected, tissues are obtained immediately after the chest radiograph to confirm the diagnosis histologically. Body temperature is often non-specific, and signs of metastatic disease (swollen lymph nodes or liver enlargement) may occasionally be found. Other extrapulmonary physical findings have been discussed previously. X-ray findings depend on the site of involvement.

In asymptomatic patients, a small peripheral nodular mass is often seen on the chest X-ray. If the mass is less than 5-6 mm in diameter, it is difficult to find. The previous X-ray examination results are valuable for understanding new organisms. For smaller isolated nodules, penetrating X-rays and tomography can show calcification. The number of calcifications must be more than one spot in order to be diagnosed as a benign tumor or chronic granulomatous lesion and exclude lung cancer. CT can show lesions not seen with other techniques, and can help stage the tumor based on the signs of lymph node spread. Occasionally a chest magnetic resonance imaging (MRI) examination is needed, which is most helpful to show whether the apical Pancoast tumor has a chest wall and vertebral invasion.

In symptomatic patients, chest X-rays can show bronchoconstriction and irregular pulmonary parenchymal infiltration, or atelectasis. Cavitation may be seen in the occluded area or inside the surrounding tumor. Obstructive emphysema is uncommon. Occasionally, X-rays can show infiltration or obstruction in non-adjacent lung lobes. This phenomenon cannot be explained by a single tumor focus but is the result of diffuse submucosal lymphatic penetration of the bronchial tree. Pleural exudate is often associated with infiltration or peripheral Related to tumors, cytology of the pleural fluid or pleural biopsy can provide a diagnosis. In rare cases, tumor cells can be found in the sputum when no lung lesions have been found.

Chest MRI for the diagnosis and evaluation of the efficacy of lung cancer is still experimental. MRI can provide the exact location of the tumor tissue plane before lung cancer surgery.

Bronchoscopy can be used to display and biopsy bronchial tumors. With rigid bronchoscopy, the visible range is limited to the main bronchus and its primary branches. Generated resistance. The fiberoptic bronchoscope can expose the secondary bronchus, and tumor specimens can be taken by irrigation, brushing, and biopsy. Many surgeons perform mediastinoscopy before surgery to understand the mediastinal and hilar lymph nodes, determine the diagnosis, and distinguish whether the tumor can be operated on.

No more than 10% of cases require a thoracotomy to determine the diagnosis and whether the tumor can be removed. Contraindications include distant or mediastinal metastases and cardiopulmonary insufficiency. When mediastinoscopy or parasternal mediastinotomy (mostly replaced by the oblique lymph node biopsy) or pleura, liver biopsy has proven to have metastases, then no thoracotomy is required. Touchable lymph nodes and metastatic skin nodules are important diagnostic data.

The staging of lung cancer is helpful for judging the comparison and choice of prognosis and treatment methods. Lung cancer can be staged by clinical manifestations, but it is more accurate to stage lung cancer after thoracotomy after understanding the local and systemic conditions by various means. CT can detect liver, brain and adrenal metastases. Radionuclide scans can indicate bone involvement due to metastases. Traditional bone X-rays or MRI are often used to confirm the findings of abnormal bone scans. Cytological examination or histological biopsy of sputum can directly determine the presence of tumor and its metastasis.

The TNM (tumor, lymph node, metastasis) system is a standard for classification of non-small cell lung cancer by disease stage. Small cell lung cancer generally metastasizes when the diagnosis is clear. It is classified as limited (limited to one side of the thoracic cavity with or without mediastinal and ipsilateral subclavian lymph nodes) or extensive (spread beyond the above range).

Differential diagnosis of bronchial cancer

Differential diagnosis of lung nodules includes foreign bodies, non-segmental pneumonia, intrabronchial focal lung manifestations of tuberculosis, systemic fungal disease, autoimmune disease, and metastatic disease caused by primary extrathoracic cancer, isolated Lung nodules are particularly difficult to identify.

A solitary pulmonary nodule is a single lesion. Regardless of its size, 2/3 of its circumference is surrounded by lung parenchyma, is not connected to the hilar or mediastinum, and is not associated with atelectasis or pleural effusion. Important causes of solitary pulmonary nodules are new organisms, infections, and collagenous vascular diseases. About 40% of solitary pulmonary nodules are malignant, 90% of which are primary bronchial cancers. The most common causes of infection can be divided into Coccosporium spp., Capsular tissue cytoplasmic bacteria, or tuberculosis Mycobacterium. Rheumatoid arthritis and Wegener's granulomatosis are the most common causes of collagen-induced vascular disease.

Solitary pulmonary nodules are first evaluated by comparison with previous chest radiographs. If the lesion does not increase within 2 years, it is suggested that it is benign. CT scans can help find calcifications (usually benign signs) and nodules.

Clarification of the cause of neonatal or enlarged lesions requires culture or histological examination. Cultured specimens and tissues can be obtained by bronchial aspiration, fiberoptic bronchoscopy, thoracoscopy or thoracotomy. Until a specific diagnosis is obtained, the lesion should be considered benign.

Benign lesions rarely cause superior vena cava syndrome, but tuberculosis, fungal infections, posterior sternum, and aortic aneurysms are possible. Malignant tumors, including lymphoma, Hodgkin's disease, small cell lung cancer, squamous cell carcinoma, germ cell tumor, and breast cancer often cause superior vena cava syndrome.

Prognosis and prevention of bronchial cancer

Primary bronchial cancer has a poor prognosis. Generally speaking, primary bronchial cancer can survive for 8 months without treatment, and about 10% to 35% of tumors can be removed, but the overall 5-year survival rate is about 13%. It is clear that the 5-year survival rate of patients with slow-growing tumors can vary from 15% of stage IIIA non-small cell lung cancer to 70% of stage non-small cell lung cancer. Peripheral small nodule lesions have the best effect through lobectomy. Survivors should be followed up carefully, because 6% to 12% of people will develop a second lung cancer. Because most patients with small cell lung cancer have a cancer at the time of diagnosis To parts other than the original lesion, surgery is often impossible. In rare cases, early small cell lung cancer can be surgically resected, but because the tumor is easy to recur, cisplatin and etoposide are used as adjuvant chemotherapy. The incidence of the second primary cancer after early small cell lung cancer treatment is 25% ~ 50%.

Prevention of bronchial lung cancer includes quitting smoking and avoiding possible industrial carcinogens, and drug prevention studies for a second primary cancer are ongoing.

Bronchial cancer treatment

Western medicine treatment of bronchial cancer

Non-small cell lung cancer stage I and II are treated with surgical resection; patients with stage IV or IIIB with malignant pleural effusion are not eligible for surgery, and patients with T3N0M0 or T3N1M0 classification (due to invasion of the chest wall) should be considered for surgical resection. Surgical resection should be performed without contraindications, that is, no extrapulmonary spread, intratracheal tumors not too close to the trachea, and no other serious conditions (such as pulmonary insufficiency with coronary heart disease or chronic obstructive pulmonary disease). CT scans of the chest and upper abdomen (including liver and adrenal glands) should be performed on all patients considering surgery. MRI and CT scans are needed for patients considering any neurological symptoms and signs (such as cranial nerve palsy, altered visual field, unconsciousness, or disorientation). If the patient complains of bone pain, tenderness, or elevated serum alkaline phosphatase due to increased bone destruction, a radionuclide bone scan is required.

Elderly patients are not excluded from surgical resection. Lung cancer is highly invasive in the elderly. Patients with untreated lung cancer often survive <8 months. In comparison, the average life expectancy of a 70-year-old in the United States is 11.1 years for men and 14.8 years for women. The limiting factor is survival, not age.

For safety reasons, central bronchial lesions require lung resection and removal of adjacent lymph nodes. Tumors that have spread to the chest wall can be removed in one piece; there are reports of benefits from postoperative radiotherapy, especially for lung apical tumors.

The use of neoadjuvant chemotherapy can significantly reduce tumor burden and improve healing and overall survival. Some studies on neoadjuvant chemotherapy show promising prospects. However, based on the results of all the studies, there is no consensus on the role of non-small cell lung cancer in surgical resection or quantitative radiotherapy.

Traditional Chinese Medicine Treatment of Bronchial Cancer

Bronchial lung cancer is a common disease in oncology. Surgical resection is preferred for early treatment. However, due to various reasons, most patients have reached the middle and advanced stages when they seek medical treatment, and they have lost the opportunity for surgical treatment. In recent years, traditional Chinese medicine has obtained exact results in treating lung cancer, and has played a role in alleviating symptoms and extending survival. In 1983, Beichuanxun isolated 20 (S) -ginsenoside-Rh2 from red ginseng for the first time. It has been confirmed that ginsenoside Rh2 has anti-cancer activity that induces apoptosis, differentiation and regulates the cell cycle of cancer cells, and enhances the body's natural immune ability to inhibit the proliferation and metastasis of cancer cells.

Traditional Chinese medicine treatment according to the clinical manifestations of patients, pulse signs, tongue coating, appearance, and other dialectical treatment of lung cancer with traditional Chinese medicine can improve the patient's symptoms; improve the immunotherapy. Reduce pain, improve quality of life; extend life. Traditional Chinese medicine has achieved good results in all stages of lung cancer treatment. Jinfukang Oral Liquid specifically targets the treatment of non-small cell lung cancer, which can be used in early, middle and advanced stages; Shendan Sanjie Capsule is particularly suitable for middle and advanced stage lung cancer, which can well control the spread and metastasis of lung cancer and alleviate advanced symptoms. The treatment of pleural effusion in the advanced stage of lung cancer is the first choice for the treatment of pleural effusion. The traditional Chinese medicine Lishui has the incomparable advantages of western medicine without side effects.

TCM's discussion on the etiology, pathogenesis, and syndrome differentiation of lung cancer:

Sputum knotting is the pathological basis of lung cancer

"Difficult classics" cloud: "The product of the lungs, the name of which is breathlessness ... It is breathtaking cold, cough, and lungs." "Su Wen · Zhuang Yi Lun" said: "Under the threat of illness, full of energy and insufficiency, two or three years old ... the disease name is called the product of interest." "Su Wen · Yu Ji Zhen Zang Luan" detailed records of the symptoms of fever, chest pain, shoulders, and cachexia in advanced lung cancer, stating "the bones are withered, the meat is swollen, the chest is full of gas, the breathing is inconvenient, and the internal pain leads to the shoulders Item, body heat and flesh? ". It can be seen that "Xi Xie", "Xiang Xie", "Xi Ji", and "Xi Ji" can all be classified into the category of TCM disease names of bronchial lung cancer.

The etiology and pathogenesis of lung cancer, "Zixi, the source of miscellaneous diseases" is more relevant, saying: "In the evil chest, the Qi is blocked, the Qi cannot pass, and it is sputum ... for blood, all fight against evil, and evil wins. If it is not possible to make it, then it will take shape and become a block. " This article deeply understands the pathogenesis of sputum knots and visible clumps in the chest. Regardless of whether the internal qi is deficient, the internal organs are imbalanced, or external evils invade the lungs, or the heat is too cold, all pass through the pathological process of qi depression and accumulation into sputum. Without sputum, there is no lung volume, so sputum in the lungs is the pathological basis of lung cancer. The spleen is the source of sputum, and the lung is the device for storing sputum. The lungs and spleen are deficient in qi and spleen, and the yin and yang are out of harmony. Due to the evil of wind or heat, they fail to accumulate at first. , Is into a lung product. Phlegm stasis and heat, burning blood veins, cough and sputum. The sputum is condensed under the skin, and pelvic tuberculosis is seen. When it flows to the bone, it becomes osteoporotic. When it flows to the brain, it causes headache. The pathogenesis of lung cancer is closely related to the lungs and spleen. The sputum node runs through the entire course of lung cancer from primary to metastatic.

Differential Treatment of Bronchial Cancer

According to the pathological mechanism of lung cancer, and according to the characteristics of syndrome differentiation of traditional Chinese medicine, lung cancer is roughly divided into four common clinical syndrome types: lung stagnation and fever, qi deficiency and phlegm dampness, yin deficiency and phlegm fever, and qi and yin deficiency. The dialectical points and treatment methods are described below.

Bronchial carcinoma

Poor coughing, blood in sputum, chest pain or tightness, shortness of breath, dry lips, constipation, red or dark red tongue, yellow fur, and thin pulse strings. The card is stagnation of lung qi, blood stasis and phlegm. Expelling Xiefei, qi and phlegm. The side is flavored with Qianjin reed stem soup. Prescription: 30g of reed stem, 15g each of peach kernel, raw coix seed, columbine, winter melon kernel, 20g of Zhejiang Fritillaria, 10g each of mulberry leaf, panax notoginseng, 5g of gong palace, 12g of French pinellia, 6g of peel and licorice

Bronchial cancer with qi deficiency and phlegm dampness

Cough and sputum, chest tightness, shortness of breath, less gas, lazy words, appetite and weight loss, abdominal distension will be diarrhea. The tongue is pale or red, with tooth marks on the sides, greasy fur, and pulses or slippery. The syndrome is of weak lung qi, child disease and mother, loss of spleen, and internal resistance of damp phlegm. Expelling Qi and strengthening the spleen, removing phlegm and dissolving. Fang Sheng Shen Bai Zhu San was added and subtracted. Prescription: 20g each of Codonopsis, raw Coix seed, 15g each of Poria, Atractylodes macrocephala, Fritillaria chinensis, white lentils, fried pangolin (fried first), 25g yam, 10g each of Chinese bellflower and Amomum villosum (6g each).

Bronchocarcinoma of yin deficiency and phlegm fever

Cough with little phlegm, or dry cough, dry throat discomfort, or bloody expectoration, chest fullness, shortness of breath, hot flashes, night sweats, dizziness, tinnitus, upset, dry mouth, yellow urine, dry stool. The tongue is red, the moss is peeling or the tongue is moss-free, and the pulse strings are weak. This card is lung and kidney yin deficiency, phlegm and heat stagnation, remedy nourishing kidney and clearing lungs, removing phlegm and clearing heat. Fang Xiebai powder flavor. Prescription: Mulberry peel, Raw Rehmannia glutinosa, Zhimu, A. ginseng, Ophiopogon japonicus, Fritillaria japonicus (fried first), Raw Coix seed, Houttuynia cordata each 15g, Licorice 6g.

Bronchi cancer with qi and yin deficiency

Dry cough, low sputum, or low bloody sputum, weight loss, tiredness, dry mouth, shortness of breath, loss of eyesight, irritability and palpitations, lack of appetite, red or tender tongue, dry or no moss, pulse sinking fine. The syndrome is a deficiency of the lungs and spleen, and the kidney is depleted. Expelling qi and nourishing yin, righting and removing product. Fang Yongsheng Sanhe Liuwei Dihuang Decoction was added and subtracted. Prescription: Codonopsis, Ophiopogon, Schisandra, Poria, Rehmannia glutinosa, Dogwood, Lily, Fritillaria cirrhosa, 15g each, 25g yam, 10g eustoma, 6g Cordyceps and licorice.

Pulmonary function tests do not provide a clear answer to whether or not surgery is possible, but there are a few that can certainly be used as simple criteria for thoracotomy. Keep in mind that the extent of resection can only be determined at the time of surgery and may require lung resection. The lung function criteria for lung resection is that the forced expiratory volume in the first second (FEV1)> 2L, which is greater than the estimated forced vital capacity (FVC) ) 50%. Furthermore, PaCO2 should be normal at rest. If any of these do not match, then a quantitative lung perfusion scan should be performed, if possible, with ventilation scans to assess local lung function (expected postoperative FEV1 equal to the percentage of unremoved lung perfusion) Multiply FEV1 before surgery). If these tests show that the patient's FEV1 will still be> 800ml after pneumonectomy or after surgery is still greater than 30% to 40% of the expected value of normal FEV1. This risk is acceptable, such as the closer the value is to these standards, the patient's activity Capabilities will be limited.

Radiotherapy has proven beneficial for controlling bone pain, superior vena cava syndrome, spinal cord compression, brain metastases, hemoptysis, and bronchial obstruction. Postoperative radiotherapy has no benefit or improvement in stage and lung cancer. Sometimes radiotherapy is also used for those who cannot perform thoracotomy due to insufficient cardiopulmonary function or other serious diseases. 3 months after radiotherapy, patients should be closely observed for X-rays and clinical symptoms (including cough, dyspnea and fever) of radiation pneumonitis. Prednisone 60mg / d can be used for oral control for 1 month, and then gradually reduced to control radiation pneumonitis. Prophylactic cranial radiotherapy may not be used in patients with complete remission of small cell lung cancer. This method reduces brain metastases, but has not been shown to extend overall survival. Brachytherapy can relieve symptoms when a large bronchus is blocked by a bronchial lesion.

In patients with small cell lung cancer, multiple drugs, especially cisplatin and topoisomerase inhibitors with or without radiation, have a higher survival rate than surgery. Very few cures. There have been some reports of the use of drug chemotherapy to improve the condition, but research on the most effective combined chemotherapy regimen for bronchial cancer is still in progress. For stage III A and III B non-small cell lung cancer that cannot be resected by surgery, chemotherapy can increase the mid-term survival by 6 to 12 weeks and improve the symptoms of patients. Effective drugs include platinum-containing preparations (cisplatin and carboplatin), vinblastine (vinblastine, vincristine, and isovinblastine), taxanes (docetaxel and paclitaxel), and multiple topoisomerase inhibitors Agent.

Airway obstruction can be treated with bronchodilator drugs, oxygen, laser bronchoscopy, and physiotherapy, and antibiotics are used in patients with infection.

For isolated or occasional multiple lung metastases, the primary tumor is usually removed after removal, and the 5-year survival rate is about 10%.

Patients with uncured lung cancer often have anxiety and persistent pain. A combination of sedatives, anesthetics and other drugs is required (see section 167 Cancerous pain).

Given the high mortality of lung cancer patients, hospice care needs to be given early. In the terminal stage, large doses of morphine can be given intravenously to relieve pain such as hypoxia and pain. The use of transdermal medications (such as fentanyl) is beneficial to hospice care and will allow more patients to die peacefully at home.

If histologically diagnosed as superior vena cava obstruction syndrome, treatment includes chemotherapy (for small cell lung cancer, lymphoma, or germ cell tumor) or radiation therapy (for breast cancer, squamous cell carcinoma, or lymphoma). Although corticosteroids have less effect on the syndrome caused by lung cancer than those caused by other diseases (such as lymphoma), they can still have a certain effect.

Benign bronchial tumors can continue to grow or become malignant due to adverse local effects. Most benign peripheral tumors cannot be diagnosed before surgical exploration and resection.