After two cancer surgeries in four years, a malignant tumor was found again. What kind of lung nodules may be malignant?

Zhejiang Medical Online, in collaboration with Hangzhou Cancer Hospital affiliated to Zhejiang University School of Medicine and Hangzhou Anti-Cancer Association, jointly launched the "Famous Doctors and Experts Talking about Cancer" series, inviting well-known cancer experts from the Municipal Cancer Hospital to provide professional and authoritative cancer prevention science popularization for readers.

When many people hear the word "pulmonary nodules", they think of "lung cancer". Are pulmonary nodules really that scary? What kind of pulmonary nodules are likely to be malignant? How should we deal with pulmonary nodules when we find them?

We invited Associate Chief Physician Wu Yueguang, head of the First Department of Oncology Surgery at Hangzhou Cancer Hospital affiliated to Zhejiang University School of Medicine , to talk about the issue of lung nodules.

The following is Wu Yueguang's oral statement:

In recent years, many people have found lung nodules during physical examinations. Many people are worried when they see the test results: Is this nodule benign or malignant? Is it lung cancer?

Of course, some patients with lung nodules are indeed lung cancer patients, but there is no need to be afraid of the word "nodule". Moreover, even if the nodules may be malignant, doctors will develop the most appropriate treatment plan that maximizes the patient's interests based on the situation of each patient.

Some time ago, I treated a lady in her 50s who was introduced to me by a fellow patient.

When I asked about her medical history, I learned that she had a left breast nodule during a physical examination four years ago. Further examination confirmed breast cancer. She underwent a modified radical mastectomy at a local hospital and recovered well. However, two years ago, she was unfortunately diagnosed with right lower lung cancer during a follow-up examination. Fortunately, it was discovered early and the surgical treatment was effective.

This lady is quite optimistic and strong. Although she has undergone two cancer surgeries in four years, she has a positive attitude and still lives a fulfilling life.

It was not until a month ago, when she visited the doctor again, that the doctor told her that a small nodule was found in the lower left lung, which was showing a tendency to grow larger. It was suspected to be a malignant lung tumor and further surgery would be required if necessary.

Hearing the word "malignant tumor" would make anyone feel uncomfortable, let alone she had experienced it twice. This time she was on the verge of collapse, anxious and unable to sleep all night, and almost lost confidence in life.

She said that she had sought medical advice everywhere and even left messages on various websites, hoping to find a good treatment for herself. But the results made her even more sad. A doctor told her that the location of the small lung nodule was deep, and the operation was difficult. If she underwent the operation, she might lose the lower lobe of her left lung.

This was undoubtedly a double whammy for her, as she had already undergone surgery on her right lung, and if she had another surgery to remove the lower lobe of her left lung, it would have a significant impact on her daily life.

Some netizens also suggested that she undergo radiofrequency ablation or choose radiotherapy, but she was worried about the side effects and didn't know which one to choose.

I checked her lung images and found that the nodules were indeed located quite deep, making surgery difficult. It might be difficult to find the lung nodules, and more lung tissue would be removed, which would have a great impact on her future life.

But this does not mean that there is no chance and possibility of surgery. I consulted with multidisciplinary experts in the hospital and finally decided to perform lung CT thin-layer plain scan and three-dimensional reconstruction technology to fully understand the location of the left lower lung nodule in the lung lobe and its relationship with the pulmonary veins, arteries, and bronchi, so as to develop a comprehensive and accurate surgical resection plan.

This examination is quite professional, and I explained it to the patient in detail. After listening to it, she felt much more at ease and thought it was a feasible method.

The results of lung CT thin-layer plain scan and three-dimensional reconstruction technology examinations showed that the small nodule in the left lower lung was located between the ninth and tenth segments of the left lower lung, relatively close to the eighth segment. With our current surgical technology, the tumor can be completely removed by removing the ninth and tenth segments of the left lower lung, thereby minimizing the negative impact on the patient.

After a thorough preoperative examination, I performed a single-port thoracoscopic minimally invasive surgery. The next day after the operation, she was able to get out of bed and walk.

The pathological results showed that it was primary early lung cancer and no further chemotherapy or targeted therapy was needed. She is now recovering well and has been discharged from the hospital. She only needs to go to the hospital for regular checkups.

What kind of lung nodules may be malignant? A lung nodule is an isolated lesion located in the lungs. It can be round or oval in shape. In recent years, the detection rate of lung nodules in various examinations has become increasingly higher, but most of these nodules are benign, so there is no need to be overly nervous.

In addition, it should be noted that lung nodules are not equal to lung cancer. There are generally two reasons for the formation of lung nodules. One is the granulation tissue generated in the lungs due to inflammation, tuberculosis, infection, sarcoidosis, etc. This nodule is a relatively independent symptom and is basically benign. The other situation is induced by malignant tumors. However, lung nodules caused by malignant tumors are generally accompanied by other symptoms in addition to nodules.

According to the size of the nodules, they can be divided into micronodules (less than 5 mm in diameter), small nodules (5-10 mm in diameter) and large nodules (10-30 mm in diameter). According to the density, they can be divided into solid nodules and non-solid nodules.

No need to worry too much about nodules with a diameter of less than 5 mm. Generally, a routine lung CT check once a year is sufficient. For nodules with a diameter of 5 to 10 mm, it is recommended to check the lung CT every 3 to 6 months to understand the changes in the nodules. For nodules with a diameter of 10 to 30 mm, you should go to the hospital for further examination as soon as possible.

Lin Lin, reporter of Orange Persimmon Interactive

Correspondent Xie Wenzhu