#千万IP创科学普# How to prevent China’s number one cancer?

Recently, Liu Qian, a young magician who has "lit up" the CCTV Spring Festival Gala six times, disclosed his battle with lung cancer. Previously, lung cancer had left a shadow in his family and had taken the lives of his relatives. Therefore, as a veteran smoker, Liu Qian underwent surgery as soon as he found abnormalities in his lungs and successfully quit smoking. In recent years, many celebrities have also been invaded by lung cancer, and some have even been killed by lung cancer: the famous actor Ji Chunhua died of advanced lung cancer in 2018; the young singer Jiang Zhihao revealed in 2023 that he was suffering from advanced lung cancer; Zong Qinghou, the founder of Wahaha Group, also died of the disease in February 2024.

The news that Liu Qian was diagnosed with stage 0 lung adenocarcinoma sparked heated discussions. What is the difference between adenocarcinoma and squamous cell carcinoma? How is the treatment effect of stage 0? Lung cancer is so close to us, how should we prevent it? What are the treatment methods? Li Ming, chief physician of the Department of Thoracic Surgery at Jiangsu Cancer Hospital (Affiliated Cancer Hospital of Nanjing Medical University), answered these questions for us.

Lung cancer is the most common cancer in China

Lung cancer, or primary bronchial lung cancer, is a malignant tumor that originates in the airways (including the trachea and bronchi) or lungs. It mainly occurs in the epithelial tissue of the lungs. As tumor cells grow, they gradually form masses and may spread to other parts of the body through the lymphatic system or blood circulation.

Lung cancer is not only the malignant tumor with the highest mortality rate in the world, but also the cancer with the highest mortality rate and incidence rate in China. According to the latest data from the World Health Organization's GLOBOCAN, the incidence rate of lung cancer in China exceeds 40/100,000, which means that more than 40 people out of every 100,000 people are suffering from the disease, mainly in men over 40 years old. The main risk factors for lung cancer include smoking, air pollution and secondhand smoke. At the same time, people who are exposed to cooking fumes, chemicals such as chromium, nickel, asbestos, excessive ionizing radiation, or have a family history of lung cancer are also at higher risk.

"In fact, lung cancer does show a trend of getting younger." Li Ming said that according to data from 2022, the new lung cancer patients in China include not only elderly people over 60 years old, but also a large number of young patients, some of whom were diagnosed with lung cancer before the age of 20. Although most young patients are fortunately discovered and cured in the early stages, many are discovered in the late stages. "This trend may be related to bad living habits caused by high work pressure, the younger age of smokers, the influence of gene mutations and environmental impacts."

What is the difference between adenocarcinoma and squamous cell carcinoma?

Li Ming introduced that lung cancer is mainly divided into non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). Non-small cell lung cancer accounts for more than 95% of lung cancer patients. Squamous cell carcinoma and adenocarcinoma in non-small cell lung cancer are the two most common types, with different treatment methods and prognosis.

Squamous cell carcinoma is often associated with smoking and often occurs in the main bronchi. If detected early, it can be removed surgically. For patients with squamous cell carcinoma who are inoperable or advanced, radiotherapy is a common treatment option. Chemotherapy is often used for patients with advanced squamous cell carcinoma or those who are inoperable. Under certain conditions, such as squamous cell carcinoma patients with high PD-L1 expression or with specific genetic markers, they may benefit from immunotherapy.

Adenocarcinoma is more common in non-smokers and often occurs in the periphery of the lungs. Similarly, it can be removed surgically when detected early. For patients with advanced adenocarcinoma, chemotherapy is the main treatment. Adenocarcinoma patients have more options in targeted therapies, such as EGFR and ALK inhibitors, especially in patients with relevant gene mutations. Immunotherapy may also be suitable for patients with advanced adenocarcinoma who express specific biomarkers. Treatment choices often depend on the specific characteristics of the tumor, the patient's overall health, and the stage of the tumor. Each type of lung cancer requires an individualized treatment plan to provide the best treatment effect and quality of life.

How to treat stage 0 lung cancer?

Liu Qian received surgery at stage zero of lung cancer. Many people are unfamiliar with the staging of lung cancer and are confused about how to treat it. Li Ming said that stage zero of lung cancer means that the cancer cells are limited to the bronchial epithelium and have not invaded the basement membrane, which is carcinoma in situ. This is the initial stage of lung cancer, and it will take 3-5 years or even longer to develop into lung cancer. Clinically, most people do not intervene at this stage, and close observation is the main approach. However, people like Liu Qian who have been smoking for a long time and have a family history are at high risk of lung cancer, and the risk of cancer progression is relatively high. Active intervention through surgery or radiotherapy, as well as changing bad living habits, often achieves a relatively good prognosis.

"The key to preventing lung cancer is to reduce known risk factors." Li Ming said that quitting smoking is the most direct and effective preventive measure, and at the same time, we should try to avoid exposure to secondhand smoke and thirdhand smoke. The air quality in the living or working environment is also very important, and exposure to air pollution and harmful chemicals should be minimized. Excessive drinking is also a risk factor for lung cancer, and quitting smoking and limiting alcohol consumption is a very wise choice. Maintaining a healthy lifestyle is also important for preventing lung cancer, such as maintaining a balanced diet, eating more vegetables and fruits, exercising regularly, and maintaining a healthy weight.

Common symptoms of lung cancer include persistent dry cough, hoarseness, or occasional hemoptysis. Patients may experience mild chest pain or fever, and may experience weight loss or loss of appetite. However, these symptoms often appear relatively late. Li Ming recommends that for people with a family history of lung cancer, long-term smokers, or those over 50 years old, regular low-dose CT screening can detect lung cancer early, thereby greatly improving the success rate of treatment and survival rate.