肺癌是一个致死率极高的恶性疾病,是全球头号的癌症杀手,而早诊断、早治疗是提高肺癌总体治疗效果的唯一途径。专家指出,通过规范化治疗和多学科联合诊治,晚期肺癌的总生存时间从过去的2-4个月延长到现在30个月左右。
01
发病:肺癌致死率极高,号称“全球头号癌症杀手”
肺癌并非是不治之症,科学防治肺癌,从了解肺癌开始。据悉,不论是发达西方国家还是中国,肺癌的发病率和死亡率高居恶性肿瘤前列,我国每年有60万人死于肺癌,已成为名副其实的“肺癌第一大国”
[1]。因为肺癌是一个致死率极高的恶性疾病,是“全球头号的癌症杀手”。
从1985年以来,肺癌已成为全世界发病率和死亡率最高的恶性肿瘤,每年因肺癌死亡的人数多于乳腺癌、前列腺癌和肠癌死亡人数的总和。目前,肺癌已成为一个严重的公共健康问题。预计到2025年,我国每年仅死于肺癌的人数将接近100万人。
据我国的数据显示,肺癌在男性癌症死因中已居首位,在女性中仅次于乳腺癌居第二位。在城镇癌症死亡病例中,每3至4人中即有1人是肺癌。多在40岁以上发病,发病年龄高峰在50~65岁之间。
02
肺癌的病因
肺癌发病病因主要有吸烟、环境污染、职业接触、肺部慢性病以及遗传基因易感性等。其中吸烟是肺癌发病的首位高危因素,80%以上的肺癌被认为是由于吸烟而引起
[2]。据悉,吸烟者患肺癌的几率比不吸烟者高10倍以上,尤其是50岁以上、20年吸烟史及平均每天吸20支烟,这类患者的肺癌风险就是非常高了。
有报道称,近年来在临床女性患上肺癌的比例明显上升。有研究表明可能和中国女性烹饪习惯中产生的厨房高油烟有关。很多女性长期接触厨房油烟、喜欢用高温煎炸食物、做饭时厨房门窗关闭,导致厨房小环境油烟污染严重,毒烟雾长期刺激眼和咽喉,会损伤呼吸系统细胞组织。
另外,像大气污染、居住环境的空气污染、工作压力大等也是诱发肺癌的重要因素。此外,肺结核、支气管扩张慢性肺病,也是高危人群,尤其需要关注和定期筛查。还有一部分是职业病患者,比如煤矿工人、接触如石棉等化学制剂的工人,他们都是尘肺病和肺癌的高危人群。
03
体检很重要
目前在中国80%的肺癌病人一发现已是晚期
[3],失去了手术机会。早期肺癌无任何症状,只能靠体检发现。
肺癌的可疑症状包括:干咳,咯血,胸背痛。干咳是肺癌最早期的症状,尤其是在没有感冒和咽炎等情况下干咳超过两周,必要时要做CT检查,如果出现咯血和胸背痛等情况,就更加提示肺癌的可能。
在日本为40岁以上吸烟者行免费肺癌体检,他们对控烟非常严格,室内严禁吸烟,就算在室外吸烟,烟灰也不能弹在地上,违反者都需要罚款。他们有60%的早期肺癌发现率,但中国只有2%-5%,差距非常大,所以我们还需要不断努力。
低剂量胸部CT是发现早期肺癌的最有效的方法,其敏感度是常规胸片的4-10倍,可以检出早期周围型肺癌。国际早期肺癌行动计划数据显示,低剂量胸部CT年度筛查能发现85%的I期周围型肺癌,术后10年预期生存率达92%,可以降低整体肺癌死亡率20%左右。所以有肺癌高危因素的人群建议每年检查胸部CT。2015年四川大学华西医院为本单位四十岁以上职工胸部CT体检,在1389名员工中共发现确诊了21例肺癌。非常令人震惊,其中男女的发病率是相近的。
04
胸片、胸透能起到早期筛查肺癌的作用吗?
做胸透和拍胸片,如果有肿块挡在心脏、食管、膈肌、肋骨后面,特别是对于小于1cm的小结节,医生是看不见的。有些人也许会有疑问,为什么肺癌那么可怕,病人自己却没有明显不适?这跟我们肺的结构有一定关系,人体有五个肺叶,左肺有两个肺叶,右肺有三个肺叶,人体只要有两个肺叶能正常工作就能基本正常地生活,最多出现易疲劳、气短等表现,所以很多时候当出现症状后已经是肺癌晚期了,这也是肺癌最恐怖的地方
CT进入中国30多年,低剂量螺旋CT对肺癌患者的早期诊断、肺癌生存质量改善、降低病死率有很大作用
[4]。目前在很多地方,政府已经认识到CT对发现早期肿瘤的作用,CT的价格也在逐渐下降。
目前一个晚期肺癌患者在中国大陆,平均治疗花费11万元,而且治疗后生存期是按月计算,并不长。如果可以早期发现,术后一般不需要化疗,只需要注意复查,一个微创手术大概5-6万,术后可以达到长期生存目的,10年生存率达到90%。而真正到了晚期,11万仅仅只是平均数字,有些甚至达到了几十万元,几百万。
一些人认为国内技术有限,跑到外国去治疗,其实国内外的治疗区别不大,主要是病情发展到了一定阶段,并不是说去了最好的医院就能治好的,因为全世界的医学信息是共享的,国内外最大的区别可能在于一些美国上市的药物中国还没有上市,但是那些药都是非常贵的。
05
高危人群多久做一次CT比较合适?
“如果有上述的高危因素,年纪超过50岁,有长期吸烟史、家族里有肺癌病史或者既往检查发现有肺部结节的,建议每年做一次胸部CT。但如果抽烟大于20年的,即使没到50岁,也建议每年做一次胸部CT。”
专家认为,“如果筛查时发现肺里有小结节,就要根据肺部结节的大小和性质来决定随访的间隔,以明确疾病性质以及是否要做手术。肺癌筛查用的不是CT的常规剂量,是低剂量的螺旋CT,这时的射线是正常射线量的1/6,也就是连续6年,每年做一次CT筛查,辐射剂量跟平时一次CT的剂量一样。即使是按照常规剂量计算,几年做一次胸部CT对于健康也没有什么影响。”
06
肺部小结节是肺癌吗?
肺癌早期有相当一部分表现为结节,但是结节也可能是良性病变,恶性结节占30%-40%。临床中一般认为肺部结节小于0.8厘米,边缘清楚光滑的,良性的可能性比较大,但仍然需要定期观察,如果结节在短时间内快速增大,则不能排除是恶性的(如果是恶性结节,病变增大一倍的时间约为300~400天;如果结节倍增时间大于600天,那么说明其恶性概率很低。)
大多数结节在两年内未观察到生长,一般可视为良性。如果肺部结节大小超过0.8厘米,特别是边缘不规则,看上去有又短又细的毛,则认为恶性的可能性比较高。
参考文献
[1] 吴志. 防抗肺癌的新理念——围、堵、歼[J]. 老年人, 2014(11):52-53.
[2] 邹小农. 吸烟是肺癌最重要的致病因素[J]. 抗癌之窗, 2014(11).
[3] 支修益. 晚期肺癌是手术禁区吗?[J]. 抗癌之窗, 2016, 000(001):P.47-47.
[4] 廖玲玲. 低剂量螺旋CT肺癌筛查的临床价值[J]. 影像研究与医学应用, 2018, 002(012):131-132.
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174, 86, .1);--weui-TAG-TEXT-BLUE: rgba(16, 174, 255, .6);--weui-TAG-BACKGROUND-BLUE: rgba(16, 174, 255, .1);--weui-TAG-TEXT-BLACK: rgba(255, 255, 255, .5);--weui-TAG-BACKGROUND-BLACK: rgba(255, 255, 255, .05)}}@media screen and (min-width:1024px){body:not(.pages_skin_pc) .wx-root,body:not(.pages_skin_pc) body{--appmsgExtra-BG: #F7F7F7}}@media screen and (min-width:1024px){body:not(.pages_skin_pc) .wx-root[data-weui-theme=dark],body:not(.pages_skin_pc) body[data-weui-theme=dark]{--weui-BG-0: #111;--weui-BG-1: #1e1e1e;--weui-BG-2: #191919;--weui-BG-3: #202020;--weui-BG-4: #404040;--weui-BG-5: #2c2c2c;--weui-FG-0: rgba(255, 255, 255, .8);--weui-FG-HALF: rgba(255, 255, 255, .6);--weui-FG-1: rgba(255, 255, 255, .5);--weui-FG-2: rgba(255, 255, 255, .3);--weui-FG-3: rgba(255, 255, 255, .1);--weui-FG-4: rgba(255, 255, 255, .15);--weui-FG-5: rgba(255, 255, 255, .1);--weui-RED: #fa5151;--weui-ORANGERED: #ff6146;--weui-ORANGE: #c87d2f;--weui-YELLOW: #cc9c00;--weui-GREEN: #74a800;--weui-LIGHTGREEN: #3eb575;--weui-BRAND: #07c160;--weui-BLUE: #10aeff;--weui-INDIGO: #1196ff;--weui-PURPLE: #8183ff;--weui-WHITE: rgba(255, 255, 255, .8);--weui-LINK: #7d90a9;--weui-TEXTGREEN: #259c5c;--weui-FG: #fff;--weui-BG: #000;--weui-TAG-TEXT-RED: rgba(250, 81, 81, .6);--weui-TAG-BACKGROUND-RED: rgba(250, 81, 81, .1);--weui-TAG-TEXT-ORANGE: rgba(250, 157, 59, .6);--weui-TAG-BACKGROUND-ORANGE: rgba(250, 157, 59, .1);--weui-TAG-TEXT-GREEN: rgba(6, 174, 86, .6);--weui-TAG-BACKGROUND-GREEN: rgba(6, 174, 86, .1);--weui-TAG-TEXT-BLUE: rgba(16, 174, 255, .6);--weui-TAG-BACKGROUND-BLUE: rgba(16, 174, 255, .1);--weui-TAG-TEXT-BLACK: rgba(255, 255, 255, .5);--weui-TAG-BACKGROUND-BLACK: rgba(255, 255, 255, .05)}}@media screen and (min-width:1024px){body:not(.pages_skin_pc) .wx-root[data-weui-theme=dark],body:not(.pages_skin_pc) body[data-weui-theme=dark]{--appmsgExtra-BG: #121212}}@media screen and (min-width:1024px){body:not(.pages_skin_pc)body:not(.pages_skin_pc){background:var(--weui-BG-2)}}@media screen and (min-width:1024px) and (prefers-color-scheme:dark){body:not(.pages_skin_pc) .wx-root[data-weui-mode=care]:not([data-weui-theme=light]),body:not(.pages_skin_pc) body[data-weui-mode=care]:not([data-weui-theme=light]){--weui-BG-0: #111;--weui-BG-1: #1e1e1e;--weui-BG-2: #191919;--weui-BG-3: #202020;--weui-BG-4: #404040;--weui-BG-5: #2c2c2c;--weui-FG-0: rgba(255, 255, 255, .85);--weui-FG-HALF: rgba(255, 255, 255, .65);--weui-FG-1: rgba(255, 255, 255, .55);--weui-FG-2: rgba(255, 255, 255, .35);--weui-FG-3: rgba(255, 255, 255, .1);--weui-FG-4: rgba(255, 255, 255, .15);--weui-FG-5: rgba(255, 255, 255, .1);--weui-RED: #fa5151;--weui-ORANGERED: #ff6146;--weui-ORANGE: #c87d2f;--weui-YELLOW: #cc9c00;--weui-GREEN: #74a800;--weui-LIGHTGREEN: #3eb575;--weui-BRAND: #07c160;--weui-BLUE: #10aeff;--weui-INDIGO: #1196ff;--weui-PURPLE: #8183ff;--weui-WHITE: rgba(255, 255, 255, .8);--weui-LINK: #7d90a9;--weui-TEXTGREEN: #259c5c;--weui-FG: #fff;--weui-BG: #000;--weui-TAG-TEXT-RED: rgba(250, 81, 81, .6);--weui-TAG-BACKGROUND-RED: rgba(250, 81, 81, .1);--weui-TAG-TEXT-ORANGE: rgba(250, 157, 59, .6);--weui-TAG-BACKGROUND-ORANGE: rgba(250, 157, 59, .1);--weui-TAG-TEXT-GREEN: rgba(6, 174, 86, .6);--weui-TAG-BACKGROUND-GREEN: rgba(6, 174, 86, .1);--weui-TAG-TEXT-BLUE: rgba(16, 174, 255, .6);--weui-TAG-BACKGROUND-BLUE: rgba(16, 174, 255, .1);--weui-TAG-TEXT-BLACK: rgba(255, 255, 255, .5);--weui-TAG-BACKGROUND-BLACK: rgba(255, 255, 255, .05)}}@media screen and (min-width:1024px) and (prefers-color-scheme:dark){body:not(.pages_skin_pc) .wx-root:not([data-weui-theme=light]),body:not(.pages_skin_pc) body:not([data-weui-theme=light]){--weui-BG-0: #111;--weui-BG-1: #1e1e1e;--weui-BG-2: #191919;--weui-BG-3: #202020;--weui-BG-4: #404040;--weui-BG-5: #2c2c2c;--weui-FG-0: rgba(255, 255, 255, .8);--weui-FG-HALF: rgba(255, 255, 255, .6);--weui-FG-1: rgba(255, 255, 255, .5);--weui-FG-2: rgba(255, 255, 255, .3);--weui-FG-3: rgba(255, 255, 255, .1);--weui-FG-4: rgba(255, 255, 255, .15);--weui-FG-5: rgba(255, 255, 255, .1);--weui-RED: #fa5151;--weui-ORANGERED: #ff6146;--weui-ORANGE: #c87d2f;--weui-YELLOW: #cc9c00;--weui-GREEN: #74a800;--weui-LIGHTGREEN: #3eb575;--weui-BRAND: #07c160;--weui-BLUE: #10aeff;--weui-INDIGO: #1196ff;--weui-PURPLE: #8183ff;--weui-WHITE: rgba(255, 255, 255, .8);--weui-LINK: #7d90a9;--weui-TEXTGREEN: #259c5c;--weui-FG: #fff;--weui-BG: #000;--weui-TAG-TEXT-RED: rgba(250, 81, 81, .6);--weui-TAG-BACKGROUND-RED: rgba(250, 81, 81, .1);--weui-TAG-TEXT-ORANGE: rgba(250, 157, 59, .6);--weui-TAG-BACKGROUND-ORANGE: rgba(250, 157, 59, .1);--weui-TAG-TEXT-GREEN: rgba(6, 174, 86, .6);--weui-TAG-BACKGROUND-GREEN: rgba(6, 174, 86, .1);--weui-TAG-TEXT-BLUE: rgba(16, 174, 255, .6);--weui-TAG-BACKGROUND-BLUE: rgba(16, 174, 255, .1);--weui-TAG-TEXT-BLACK: rgba(255, 255, 255, .5);--weui-TAG-BACKGROUND-BLACK: rgba(255, 255, 255, .05)}}@media screen and (min-width:1024px) and (prefers-color-scheme:dark){body:not(.pages_skin_pc) .wx-root:not([data-weui-theme=light]),body:not(.pages_skin_pc) body:not([data-weui-theme=light]){--appmsgExtra-BG: #121212}}@media(prefers-color-scheme:dark){body:not([data-weui-theme=light]).my_comment_empty_data{background-color:#111}}body,.wx-root{--weui-BG-6: rgba(0, 0, 0, .05);--weui-ACTIVE-MASK: rgba(0, 0, 0, .05)}body,.wx-root{--weui-REDORANGE: #ff6146;--weui-BG-0: #ededed;--weui-BG-1: #f7f7f7;--weui-BG-2: #fff;--weui-BG-3: #f7f7f7;--weui-BG-4: #4c4c4c;--weui-BG-5: #fff;--weui-FG-0: rgba(0, 0, 0, .9);--weui-FG-HALF: rgba(0, 0, 0, .9);--weui-FG-1: rgba(0, 0, 0, .55);--weui-FG-2: rgba(0, 0, 0, .3);--weui-FG-3: rgba(0, 0, 0, .1);--weui-FG-4: rgba(0, 0, 0, .15);--weui-FG-5: rgba(0, 0, 0, .05);--weui-RED: #fa5151;--weui-ORANGERED: #ff6146;--weui-ORANGE: #fa9d3b;--weui-YELLOW: #ffc300;--weui-GREEN: #91d300;--weui-LIGHTGREEN: #95ec69;--weui-BRAND: #07c160;--weui-BLUE: #10aeff;--weui-INDIGO: #1485ee;--weui-PURPLE: #6467f0;--weui-WHITE: #fff;--weui-LINK: #576b95;--weui-TEXTGREEN: #06ae56;--weui-FG: #000;--weui-BG: #fff;--weui-TAG-TEXT-RED: rgba(250, 81, 81, .6);--weui-TAG-BACKGROUND-RED: rgba(250, 81, 81, .1);--weui-TAG-TEXT-ORANGE: #fa9d3b;--weui-TAG-BACKGROUND-ORANGE: rgba(250, 157, 59, .1);--weui-TAG-TEXT-GREEN: #06ae56;--weui-TAG-BACKGROUND-GREEN: rgba(6, 174, 86, .1);--weui-TAG-TEXT-BLUE: #10aeff;--weui-TAG-BACKGROUND-BLUE: rgba(16, 174, 255, .1);--weui-TAG-TEXT-BLACK: rgba(0, 0, 0, .5);--weui-TAG-BACKGROUND-BLACK: rgba(0, 0, 0, .05)}body,.wx-root{--weui-BG-0: #ededed;--weui-BG-1: #f7f7f7;--weui-BG-2: #fff;--weui-BG-3: #f7f7f7;--weui-BG-4: #4c4c4c;--weui-BG-5: #fff;--weui-FG-0: rgba(0, 0, 0, .9);--weui-FG-HALF: rgba(0, 0, 0, .9);--weui-FG-1: rgba(0, 0, 0, .55);--weui-FG-2: rgba(0, 0, 0, .3);--weui-FG-3: rgba(0, 0, 0, .1);--weui-FG-4: rgba(0, 0, 0, .15);--weui-FG-5: rgba(0, 0, 0, .05);--weui-RED: #fa5151;--weui-ORANGERED: #ff6146;--weui-ORANGE: #fa9d3b;--weui-YELLOW: #ffc300;--weui-GREEN: 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rgba(255, 255, 255, .1)}}@media(prefers-color-scheme:dark){.wx-root:not([data-weui-theme=light]),body:not([data-weui-theme=light]){--weui-BTN-DEFAULT-ACTIVE-BG: rgba(255, 255, 255, .126)}}@media(prefers-color-scheme:dark){.wx-root:not([data-weui-theme=light]),body:not([data-weui-theme=light]){--weui-DIALOG-LINE-COLOR: rgba(255, 255, 255, .1)}}@media(prefers-color-scheme:dark){.wx-root:not([data-weui-theme=light]),body:not([data-weui-theme=light]){--APPMSGCARD-BG: #1E1E1E}}@media(prefers-color-scheme:dark){.wx-root:not([data-weui-theme=light]),body:not([data-weui-theme=light]){--APPMSGCARD-LINE-BG: rgba(255, 255, 255, .07)}}@media(prefers-color-scheme:dark){.wx-root:not([data-weui-theme=light]),body:not([data-weui-theme=light]){--weui-BG-COLOR-ACTIVE: #373737}}@media(prefers-color-scheme:dark){.wx-root:not([data-weui-theme=light]),body:not([data-weui-theme=light]){--weui-BG-6: rgba(255, 255, 255, .1);--weui-ACTIVE-MASK: rgba(255, 255, 255, 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59, .6);--weui-TAG-BACKGROUND-ORANGE: rgba(250, 157, 59, .1);--weui-TAG-TEXT-GREEN: rgba(6, 174, 86, .6);--weui-TAG-BACKGROUND-GREEN: rgba(6, 174, 86, .1);--weui-TAG-TEXT-BLUE: rgba(16, 174, 255, .6);--weui-TAG-BACKGROUND-BLUE: rgba(16, 174, 255, .1);--weui-TAG-TEXT-BLACK: rgba(255, 255, 255, .5);--weui-TAG-BACKGROUND-BLACK: rgba(255, 255, 255, .05)}}@media(prefers-color-scheme:dark){.wx-root:not([data-weui-theme=light]),body:not([data-weui-theme=light]){--discussInput-BG: rgba(255, 255, 255, .03)}}@media(prefers-color-scheme:dark){.wx-root:not([data-weui-theme=light]),body:not([data-weui-theme=light]){--nickName-FG: #959595}}@media(prefers-color-scheme:dark){.wx-root:not([data-weui-theme=light]),body:not([data-weui-theme=light]){--weui-BG-0: #111;--weui-BG-1: #1e1e1e;--weui-BG-2: #191919;--weui-BG-3: #202020;--weui-BG-4: #404040;--weui-BG-5: #2c2c2c;--weui-FG-0: rgba(255, 255, 255, .8);--weui-FG-HALF: rgba(255, 255, 255, .6);--weui-FG-1: rgba(255, 255, 255, .5);--weui-FG-2: rgba(255, 255, 255, .3);--weui-FG-3: rgba(255, 255, 255, .1);--weui-FG-4: rgba(255, 255, 255, .15);--weui-FG-5: rgba(255, 255, 255, .1);--weui-RED: #fa5151;--weui-ORANGERED: #ff6146;--weui-ORANGE: #c87d2f;--weui-YELLOW: #cc9c00;--weui-GREEN: #74a800;--weui-LIGHTGREEN: #3eb575;--weui-BRAND: #07c160;--weui-BLUE: #10aeff;--weui-INDIGO: #1196ff;--weui-PURPLE: #8183ff;--weui-WHITE: rgba(255, 255, 255, .8);--weui-LINK: #7d90a9;--weui-TEXTGREEN: #259c5c;--weui-FG: #fff;--weui-BG: #000;--weui-TAG-TEXT-RED: rgba(250, 81, 81, .6);--weui-TAG-BACKGROUND-RED: rgba(250, 81, 81, .1);--weui-TAG-TEXT-ORANGE: rgba(250, 157, 59, .6);--weui-TAG-BACKGROUND-ORANGE: rgba(250, 157, 59, .1);--weui-TAG-TEXT-GREEN: rgba(6, 174, 86, .6);--weui-TAG-BACKGROUND-GREEN: rgba(6, 174, 86, .1);--weui-TAG-TEXT-BLUE: rgba(16, 174, 255, .6);--weui-TAG-BACKGROUND-BLUE: rgba(16, 174, 255, .1);--weui-TAG-TEXT-BLACK: rgba(255, 255, 255, .5);--weui-TAG-BACKGROUND-BLACK: rgba(255, 255, 255, .05)}}@media(prefers-color-scheme:dark){.wx-root:not([data-weui-theme=light]),body:not([data-weui-theme=light]){--appmsgExtra-BG: #121212}}.rich_media_content p{clear:both;min-height:1em}td p{margin:0;padding:0}@media screen and (min-width:1024px){body:not(.pages_skin_pc) :root{--appmsgPageGap: 20px;--appmsgPageBottomGap: 40px}}:root{--articleFontsize: 17px}:root{--sab: env(safe-area-inset-bottom)}:root{--wxBorderAvatarRatio: 3}:root{--discussPageGap: 20px}:root{--immersive-safe-bottom: env(safe-area-inset-bottom)}:root{--appmsgPageGap: 20px;--appmsgPageBottomGap: 40px}*{margin:0;padding:0}.rich_media_content *{max-width:100%!important;box-sizing:border-box!important;-webkit-box-sizing:border-box!important;word-wrap:break-word!important}
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