Uncle Li, who is over 70 years old, has more than half a year of pain in his shoulders and waist and legs. He is prominent on the left side and radiates to the neck, left breast and lower limbs. Left shoulder joint and lumbar vertebrae positive lateral radiograph: left humeral osteolytic lesions 1 to 3 vertebral degenerative changes, diagnosed as periarthritis of the shoulder and lumbar vertebrae osteoarthritis, symptomatic treatment. As the condition gradually worsened, it was transferred to a higher level hospital for CT examination: left central type lung cancer with bone metastasis. Fiberoptic bronchoscopy biopsy report: poorly differentiated adenocarcinoma, has lost the opportunity for surgery, can only accept general symptomatic treatment, life is on the eve. Patients and their families are reluctant to sigh, and can’t help but lament: Why can’t lung cancer be diagnosed early?
Lung cancer was misdiagnosed and missed
Lung cancer is the most common primary malignant tumor in the lungs. The incidence and mortality of lung cancer are increasing worldwide. In June 2019, the authoritative medical journal The Lancet published a heavy paper analyzing the causes of death among residents of 34 provinces (including Hong Kong, Macao and Taiwan) in the past 30 years from 1990 to 2017. Among them, lung cancer ranked third. . Recently, Johns Hopkins University scholars in the article “Diagnosis” pointed out: “Lung cancer is also the third most frequently misdiagnosed disease.”
According to statistics, more than 70% of lung cancer patients in China have entered the middle and late stages when they are diagnosed. The most important reason is that both doctors and patients have insufficient understanding of the causes of lung cancer and the complexity of clinical manifestations. The reasons for misdiagnosis and missed diagnosis are:
1. The onset of lung cancer is hidden, confusing
Most patients with lung cancer have mild symptoms in the early stage, cough, mostly dry cough, and secondary infection may be accompanied by a small amount of sputum. Some patients may have chest pain, hemoptysis, asthma, etc., often first consider the general respiratory diseases, and the treatment of cough symptomatic.
2. Imaging performance is not typical
Because lung cancer is very similar to pneumonia, tuberculosis, bronchiectasis and other diseases in chest X-ray, especially bronchioloalveolar cell carcinoma and pneumonia, tuberculosis on the chest radiographs are diffuse patchy or nodular shadows of the lungs. Therefore, lung cancer is often misdiagnosed as pneumonia, tuberculosis, etc.
3. Lung cancer extra-diversity
Some patients with lung cancer have no obvious symptoms at the first visit, and they appear as paraneoplastic syndromes due to involvement of the central nervous system, peripheral nerves, and muscles. Extra-thoracic metastasis of lung cancer often metastasizes to the brain, causing an increase in intracranial pressure, manifested as headache, nausea, vomiting, and mental disorders. Extrathoracic metastasis of lung cancer can also be transferred to the bone, causing bone pain and pathological fractures, and can also be transferred to the abdomen and superficial lymph nodes.
4. Covered by the symptoms of the combined disease
Studies have shown that chronic obstructive pulmonary disease (COPD) and tuberculosis are risk factors for lung cancer. On the one hand, this part of the patient has a history of smoking, and smoking is both a trigger for COPD and tuberculosis, and the exact cause of lung cancer. At the same time, chronic inflammation of the lungs, tissue cells in the process of proliferative repair, easy to malignant to form tumors. Therefore, when patients with previous history of COPD and tuberculosis have no obvious incentives for the original symptoms and signs, clinicians should be alert to the possibility of new lung cancer and avoid missed diagnosis and misdiagnosis.
5. Lack of vigilance against high-risk groups of lung cancer
High-risk groups of lung cancer include: middle-aged and older people over 55 years of age, the incidence of lung cancer is gradually rising, reaching the peak at the age of 75 to 80 years old. Long-term smokers over the age of 40. People who smoke more than one pack a day, who are more than 20 years old, have a greater risk of developing lung cancer. Those who are often exposed to soot or oil smoke, gas, asphalt, coking workers, those who receive excessive radiation exposure inside and outside, occupationally exposed to inorganic arsenic, asbestos, chromium, nickel, etc., the incidence of lung cancer is higher than the general population.
13 early signs of lung cancer
According to statistics, about 20% to 30% of lung cancer patients can have hoarseness at different stages of the disease, including up to 40% of central lung cancer.
There are two causes of fever caused by lung cancer, one is inflammatory fever, but most of it is around 38 °C, rarely more than 39 °C; the second is cancerous fever, which accounts for 20% to 30% of the first symptoms, this fever Anti-inflammatory drugs are not effective.
Blood or hemoptysis in the sputum is also a common symptom of lung cancer, which accounts for about 30% of the first symptoms. Hemoptysis of lung cancer is characterized by intermittent or persistent, repeated small amount of blood in the sputum, or a small amount of hemoptysis, occasionally due to large blood vessel rupture, large cavity formation or tumor rupture into the bronchus and pulmonary blood vessels, which also leads to uncontrollable large Hemoptysis.
The most common symptoms of lung cancer, cough as the first symptom accounted for 35% to 75%. For patients with smoking or chronic bronchitis, such as increased cough, frequency conversion, cough properties such as high-pitched metal sounds, especially in the elderly, should be highly alert to the possibility of lung cancer.
5. Chest pain
Lung cancer accounts for about 25% of patients with chest pain as the first symptom. Often manifested as irregular pain or dull pain in the chest. Persistent pain in the shoulder or chest and back suggests a tumor invasion in the proximal mediastinum of the medial lobe. Most of the chest pain occurs in the middle and late stages of lung cancer. However, if the cancer is close to the pleura, chest pain may occur earlier, mostly irregular pain or dull pain. If the cancer invades the pleura, it may cause sharp pain and increase in cough and breathing.
6. Finger lesions
The first finger and toe joint are hypertrophy, the nails are bent, often accompanied by pain, and there may be symptoms of migratory arthritis, which are characterized by burning pain in the elbow, knee, wrist, ankle, and palm joint, and activity disorder. Be alert to the possibility of lung cancer.
7. Male breast enlargement
When a male’s breast is enlarged on one side or both sides, such as a woman, it is also necessary to be alert to the possibility of lung cancer.
8. Upper limb pain
The cancer at the tip of the lung compresses the brachial plexus and can cause severe pain in the ipsilateral upper limb. Lung cancer invades or oppresses the cervical sympathetic plexus, which can cause ipsilateral eyelid ptosis, eyeball invagination, pupil dilation, and frontal sweat.
About 85% of polymyositis may appear before the typical symptoms of lung cancer, which is characterized by progressive weakness, loss of appetite, difficulty in walking when aggravated, and difficulty in bed.
10. Skin disease
A small number of lung cancer patients can be manifested as pruritic dermatitis, dermatomyositis, herpes zoster, etc., as well as black acanthosis and thrombophlebitis of the skin. Often seen in dermatology.
11. Refractory hyponatremia and hypochloremia
Many lung cancer patients, especially those with small cell lung cancer, have low chlorine and low sodium, and may have water poisoning such as anorexia, nausea and vomiting.
12. Chest tightness
Lung cancer invades the pericardium, and there may be aggravation of cancerous pericardial effusion, chest tightness, shortness of breath, etc., and edema.
13. Asymptomatic pulmonary nodules
Many people find pulmonary nodules at the time of physical examination, but there is no special discomfort, especially for isolated single nodules, which need to be highly valued, sometimes this is the performance of early lung cancer.
Anyone with the above symptoms should think of the possibility of lung cancer, and must not be taken lightly.
Scientific use of related examinations can reduce misdiagnosis. In general, the diagnosis of lung cancer is to take a chest radiograph or chest CT. After finding a lung mass or shadow, further detailed imaging examination is performed to judge its basic properties. Then, tissue or surgery can be used to obtain a mass tissue by needle biopsy. , for histopathological diagnosis and further immunohistochemical diagnosis. If necessary, it is necessary to cooperate with genetic diagnosis.