I already have lung cancer. Is it meaningless to quit smoking? The truth is...

Recently, the topic #刘谦患pulmonary adenocarcinoma# has become a hot search topic. The 48-year-old man recently confirmed that "he is indeed suffering from stage 0 lung adenocarcinoma and had undergone surgery in mid-February." In addition to regular checkups, he has also quit smoking for many years. He also revealed that his uncle died of lung cancer not long ago.

The screenshot is from the hot search on Weibo. The topic #Liu Qian suffers from lung adenocarcinoma# has also aroused discussion and interest among netizens. In response to netizens' discussions and common questions, let's talk about lung cancer and common misunderstandings surrounding lung cancer.

Aren't lung cancer and lung adenocarcinoma the same thing?

Primary bronchogenic carcinoma, also known as lung cancer, is one of the malignant tumors with high morbidity and mortality in my country and other countries around the world. According to cell morphology, it can be divided into small cell lung cancer, non-small cell lung cancer (squamous cell carcinoma, adenocarcinoma, large cell carcinoma, etc.). The "lung adenocarcinoma" that Liu Qian suffered from was not any other cancer. It was just the most common pathological type of lung cancer, accounting for about 1/3 of all lung cancers. In recent years, the incidence of lung adenocarcinoma has shown an increasing trend in my country year by year.

Screenshot from Weibo

The "Chinese Medical Association Guidelines for Clinical Diagnosis and Treatment of Lung Cancer (2023 Edition)" points out that lung cancer ranked first among all new cases of malignant tumors in my country in 2022, and the number of deaths from lung cancer also ranked first among the total number of deaths from malignant tumors in China. Therefore, it is indeed necessary for us to understand the knowledge of lung cancer.

Annual physical examinations were normal, but I still got lung cancer. Does this mean that physical examinations are useless? Not really. Early lung cancer often has no obvious symptoms. Clinically, most patients are already in the late stage when they develop symptoms and seek medical treatment, having missed the best time for radical surgical treatment.

The "Chinese Expert Consensus on the Diagnosis of Early Lung Cancer (2023 Edition)" points out that the 5-year survival rate of lung cancer patients after surgery shows that the 5-year survival rate of stage I patients after surgery is 77%~92%, while that of stage IIIA~IVA patients is only 10%~36%, showing a significant difference in the 5-year survival rate.

The 10-year disease-specific survival rates of adenocarcinoma in situ (AIS) and microinvasive adenocarcinoma (MIA) that are diagnosed early and completely removed are 100% and 100%, respectively, and the overall survival rates are 95.3% and 97.8%, respectively. Liu Qian said that he was at "stage zero", which should mean carcinoma in situ or microinvasive carcinoma, which is basically cured by resection. Therefore, if a diagnosis can be made early, the prognosis of lung cancer can be improved and patients can live longer.

Let's talk about whether physical examinations are useful. First of all, we must make it clear that "routine physical examinations ≠ cancer screening." Every year, the physical examination shows that the condition is normal, but one still gets lung cancer. One of the reasons may be that some people use chest X-rays for lung examinations. This type of examination has a low resolution and is prone to miss small nodules, so it is not suitable for lung cancer screening. Low-dose CT scans of the lungs are usually recommended for lung cancer screening, but the final diagnosis of lung cancer still needs to rely on pathological examinations. The "Chinese Medical Association Guidelines for Clinical Diagnosis and Treatment of Lung Cancer (2023 Edition)" recommends that the starting age for screening of high-risk groups for lung cancer is 45 years old, and the recommended interval for lung cancer screening is 1 year.

Lung nodules = lung cancer?

With the advancement of medical imaging and the popularization of physical examinations, a large number of patients with "lung nodules" appear in the annual physical examinations. Their attitudes towards nodules are polarized. Some people think that lung nodules = cancer and must be checked immediately to be relieved, while others read some popular science about lung nodules and think that everyone has them and do not take it seriously.

The correct approach is actually to have regular check-ups and pay attention to whether the lung nodules are growing larger or increasing in number. In this regard, Liu Qian's operation this time can be regarded as a model.

Liu Qian said that he had discovered "lung nodules" 3-4 years ago. He had a routine CT scan before the Spring Festival Gala this year and highly suspected that the nodules had become malignant. It was because Liu Qian insisted on regular checkups that the doctor discovered the abnormality in time and did not give lung cancer room to develop further.

If people with "lung nodules" have regular checkups and find that the nodules grow rapidly in a short period of time or other new nodules are found, they need to pay attention. When doctors judge whether lung nodules are benign or malignant, they will make a comprehensive judgment based on the chest CT imaging characteristics of the nodules, as well as the patient's age, occupation, smoking history, chronic lung disease history, personal and family tumor history, etc. Here we remind everyone again that we don't need to be nervous about the appearance of nodules, but we can't ignore it completely. Regular checkups are enough.

Is there no point in quitting smoking if you already have lung cancer?

People gradually understand the relationship between quitting smoking and preventing lung cancer. Many patients quit smoking as soon as they are diagnosed. However, some people are still reluctant to quit smoking, thinking that since they have cancer, there is no need to quit. However, this view is incorrect. Please remember the saying "It is never too late to quit smoking".

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Studies have shown that the younger the age at which people start smoking, the more they smoke every day, and the longer they smoke, the higher the incidence of lung cancer, which is consistent with our common sense. After contracting lung cancer, people who quit smoking have a longer overall survival rate than those who continue to smoke. Lung cancer patients who quit smoking have a significantly reduced risk of death and a longer lifespan. If you stop smoking, the treatment of lung cancer will be more effective and adverse reactions will be reduced. For early lung cancer, people who quit smoking have a higher surgical cure rate than smokers. Quitting smoking can increase the efficacy of chemotherapy and targeted therapy. Another very important point is that quitting smoking can reduce the recurrence rate of tumors. Therefore, even for lung cancer patients, quitting smoking is by no means a superfluous move. This time, Liu Qian also said that he has quit smoking for many years.

Up to 90% of deaths from lung cancer are related to smoking. As long as you quit smoking and maintain a healthy lifestyle, the risk of lung cancer will be greatly reduced. Quitting smoking is beneficial for both healthy people and patients diagnosed with lung cancer.

Are old smokers more likely to develop lung cancer?

The "White Paper on the Quality of Life of Lung Cancer Patients in China in 2022" shows that among the 10,092 valid samples collected, the age of the respondents diagnosed is mainly concentrated in the age group of 40 to 69 years old, accounting for 84% of the total respondents, of which the age group of 50 to 59 years old is the largest, accounting for 35.1% of the total respondents. However, lung cancer has also shown a certain trend of younger age. Many people have lung cancer in their 30s, and even in their 20s. It is not uncommon, so young friends should not take it lightly. Although smoking is an important cause of lung cancer, the following reasons cannot be ignored. For example: 1. Is it exposed to the environment of "second-hand smoke" and "third-hand smoke" for a long time? 2. Is it long-term contact or exposure to ionizing radiation? 3. Is there long-term contact with radon, arsenic, beryllium, chromium, cadmium and its compounds, as well as asbestos, silica and soot? 4. Do you often stay up late and work overtime? Cause immune function and endocrine disorders? 5. Do you inhale a lot of kitchen fumes for a long time? 6. Are there factors such as family genetic history? 7. Do you have a history of chronic lung disease: such as chronic obstructive pulmonary disease, tuberculosis and pulmonary fibrosis. The number of non-smoking lung cancer patients and young patients is gradually increasing, which may be related to environmental, dietary and genetic factors. Young people with high-risk factors should also pay attention to regular physical examinations and screenings, and timely targeted examinations should be carried out if suspicious symptoms occur.

Advanced lung cancer = no hope?

In the late stage of lung cancer, the tumor has spread to other parts outside the lungs. The goal of treatment is no longer a radical cure, but to prolong the patient's survival time and improve the quality of life. The main ways to treat advanced lung cancer include chemotherapy, targeted therapy, immunotherapy, etc. The key to the survival of lung cancer patients lies in the staging and classification of lung cancer. As the treatment drugs for lung cancer become more and more diverse, advanced lung cancer is not incurable. In particular, the emergence of precision therapies such as immunotherapy and targeted therapy has significantly improved the survival rate of patients with advanced lung cancer, and more and more patients can achieve long-term survival after treatment. Finally, I would like to remind everyone again that high-risk groups should have regular physical examinations and lung cancer screening, and they should not delay it until the late stage if they can.

Author: Hu Zhongdong, Healthy China Action Spokesperson, Associate Chief Physician, Registered Nutritionist, Health Manager

Review | Pan Zhanhe, deputy chief physician of the Department of Oncology, Zhongshan Hospital, Xiamen University