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Lung cancer: The most complete review process and key points
Lung cancer: The most complete review process and key points. Follow-up follow-up after cancer treatment is an indispensable process, so what preparations should be made before re-examination?
the patient from Henan found a nodule in the lower lobe of the left lung during the physical examination, and went to the hospital to check it turned out to be non-small cell lung cancer. Due to the early discovery, the attending doctor, Professor Zhang, performed a lung cancer resection for the patient , combined with adjuvant treatment after the operation, and the patient was soon discharged from the hospital.
Before being discharged from the hospital, Professor Zhang told him that he must return to the hospital for follow-up review after three months.
After the patient stayed at home to cultivate for a period of time, he kept remembering the time for review. Seeing that the time was approaching, the patient was a little confused: what exactly should be checked in the recheck? How to check? What should I do if there is a bad result?
These problems bothered the patient and made him restless. Regarding the question of review, let us follow the patient to start the review journey!
▌The first stop of the review-at home
Key points: Prepare all materials and do not drink or eat after 10 o’clock the night before the review.
The patient put his medical records, examination reports, medical insurance cards, ID cards and other documents in the bag in advance, and made an appointment for Professor Zhang’s outpatient clinic tomorrow morning.
I heard that the next day will be taken on an empty stomach for blood tests, as well as liver and kidney functions. the patient stopped eating anything after 10pm the previous night. In order to prevent possible hypoglycemia tomorrow, the patient stuffed milk in his bag. , Bread and other foods.
After finishing everything, the patient fell asleep early.
▌Re-check the second stop-outpatient
Key point: Give accurate feedback to your doctor about your recent physical feelings.
On the morning of the review day, the patient came to Professor Zhang’s outpatient room as scheduled. After checking the patient ‘s medical record, Professor Zhang asked about his postoperative physical recovery and whether he had any discomfort.
After listening to Uncle L’s description, Professor Zhang went on to undergo a palpation physical examination and opened several inspection items forthe patient to review.
▌Re-check the third station-laboratory
According to the inspection items, Uncle L first came to the hospital’s laboratory to draw blood for hematological examination. Although several tubes of blood were drawn, the blood in different test tubes has different functions. They all help to detect the physical condition and detect whether cancer cells have recurred and metastasized.
So, do you know what kind of blood is used for inspection? If you have any unclear friends, let’s take a look at the popular science!
1. Blood routine
Blood routine is the most basic clinical examination, mainly checking platelets, red blood cells, white blood cells, hemoglobin, lymphocytes and so on. There will be a reference range of normal values in the test sheet. If a certain indicator exceeds or falls below the normal range, it means that the body may be abnormal and needs to be dealt with in time.
For example, the white blood cell count is normal (4.0~10.0)*109/L. When the test result is lower than this value, it indicates that the body’s immune function is low and it is vulnerable to various pathogens. This may be caused by infection, acute bleeding, tissue damage, etc.
It should be noted that lung cancer patients are most likely to have low white blood cell levels during chemotherapy, but most patients return to normal levels after 14-21 days. If the white blood cell count is too low, you need to get white shots for treatment.
2. Liver and kidney function
Part of the treatment has a certain impact on liver and kidney function, so patients with lung cancer should check liver and kidney function regularly to find abnormalities as soon as possible.
When checking liver and kidney function, it must be done on an empty stomach, no high-fat, high-protein food, no alcohol, and no stay up the night before, so as not to affect the accuracy of the test results.
3. Serum tumor markers
Currently, there are many researches on lung cancer and the relatively common tumor markers are:
① Carcinoembryonic antigen (CEA): The normal reference value is 0~5ug/ml. 70% of lung cancer patients can have elevated CEA, and the sensitivity of different pathological types is also different. The sensitivity of CEA in non-small cell lung cancer patients is 40% to 62%, and the sensitivity of adenocarcinoma is the highest, while in small cell lung cancer Among patients, the sensitivity is lower, at 30%.
②Neuron enolase (NSE): The normal reference value is 0~15.2ug/l. NSE has a sensitivity of 80% for patients with small cell lung cancer and a specificity of 80% to 90%, but it is not particularly sensitive for other types of lung cancer. Therefore, NSE is generally regarded as the main tumor marker of small cell lung cancer.
③Cytokeratin 19 fragment antigen 21-1 (CYFRA21-1): The normal reference value is 0~3.6ug/l. CYFRA21-1 is a relatively new tumor marker, especially suitable for patients with non-small cell lung cancer. Its concentration increases with the severity of the disease, and its sensitivity to squamous cell carcinoma is higher than that of adenocarcinoma and small cell lung cancer.
In addition, there are cancer antigen 125, cancer antigen 242, ginsenoside-RH2 and so on. Generally, multiple tumor markers are combined for detection to increase sensitivity.
It should be noted that a slight increase in tumor markers detected once alone cannot determine whether a recurrence occurs. Only when dynamic monitoring continues to increase in tumor markers can it have clinical significance.
However, if there is a more obvious increase, you need to seek the help of a doctor to determine whether the next step is necessary.
▌Re-check the fourth stop-imaging department
After the patient finished the blood draw, he received the QR code from the laboratory and went to the imaging department. According to the project opened by Professor Zhang, the inspection items that the patient needs to do are:
- B-ultrasound of neck, abdomen, double groin
- Chest CT
Among them, the B-ultrasound examination of the neck, abdomen, and double groin is to see whether the liver, adrenal glands, or abdominal cavity, and neck lymph nodes have metastases; and the chest CT is to understand whether there are new nodules, inflammations, and accumulations in the lungs. Fluid, gas accumulation, thickening of the pleura and adhesions, etc., to determine whether there is the possibility of recurrence and metastasis.
the patient listened to some patients before the review that they might have to do bone scans, craniocerebral magnetic examinations, fiberoptic bronchoscopy and so on. However, the doctor told him that patients with different symptoms, different stages, and different treatments need to do different review items, and not every item needs to be done.
For lung cancer patients, during imaging examinations, unless symptoms appear or the doctor requires them, too many examinations are generally not performed.
If you have bone pain recently, you need a bone scan; if you have neurological symptoms such as blurred vision, memory loss, and twitching of hands and feet, you need a brain CT; if there are residual tumors after surgery, central lung cancer requires fiberoptic bronchoscopy; In the case that other detection methods cannot clarify the condition, ordinary CT can be abandoned and PET-CT examination can be used, which is more accurate.
▌Re-check the fifth station-outpatient
After a period of time, after the patient got the test report from the imaging department, he used the QR code given by the laboratory to get the test report on the machine for self-receiving the report, and then returned to Professor Zhang’s outpatient clinic. Professor Zhang was looking at it. After reviewing the inspection results, I told the patient good news: there is nothing wrong with the review!
This made the patient happy, and finally let go of his hanging heart. Before leaving, Professor Zhang once again asked the patient to take good care of himself when he returned home, and to come back for a review three months later. After listening to Professor Zhang’s instructions, the patient collected his checklist and went home happily.
Generally speaking, the re-examination interval for lung cancer patients is: 1 to 2 years every 3 months; 3 to 4 years and 6 months; from the 5th year, usually once a year.
At this point, the patient’s review journey is over. I wonder if you already understand how the review should be done?
It should be noted that the review should be individualized, and related items should be selected based on one’s physical condition and symptoms, and the results of the review must also be checked by the attending doctor. Don’t worry too much about the occurrence of some mild abnormalities. Follow the doctor’s advice, observe closely, review regularly, do not blindly follow, and do not worry, and do every review.
(source:internet, reference only)