Let me ask you a question first: how long does it take from ground glass nodules to 7cm advanced lung cancer?
Don't worry. Let's take a look at an advanced case:
Figure 1
This is a 70 year old man who coughed and coughed up blood for half a month. CT found a 7.0cm large mass in the right lung. The pathology was invasive lung adenocarcinoma, poorly differentiated, and could not be operated on.
Moreover, the tumor has entered the accelerated growth period. After only 40 days of reexamination, the tumor has further increased at a rate visible to the naked eye. It is very troublesome
How many years has the lung cancer grown to 7cm?
We inquired about the old man's previous examination data. He had a lung CT seven years ago. At that time, it was found that he had a mixed ground glass nodule, 6.3mm. It is recommended to have regular re examination:
Figure 2
It's a pity that the old man hasn't come back for even one reexamination in the past seven years. This lung nodule has grown up secretly during this unsupervised time and has become a 7.0cm advanced lung cancer
This case reminds us that regular reexamination of ground glass nodules (including mixed grinding) is very necessary!
Scientific treatment of ground glass nodules
So the question is: is it better to cut it directly? What should I do when I grow up?
The answer is very simple. There are too many pulmonary nodules. Benign nodules are far more than malignant nodules! Even for ground glass nodules, most of them are inert lesions that can remain unchanged for decades. There is no need for excessive medical treatment, spending money, damaging the lung, or even some complications.
Therefore, for relatively small ground glass pulmonary nodules, the first observation is usually selected. Generally, the first reexamination interval is recommended to be 3 months to avoid missing a few fast-growing nodules. If there is no change, the reexamination interval will be extended in the future.
In case this nodule is lung cancer, will the follow-up observation delay the treatment? Will cancer cells spread during the observation period, thus losing the opportunity for surgery?
Today, Xiaobian sorted out several cases to demonstrate the follow-up results of ground glass pulmonary nodules, including mixed ground glass nodules.
The first outcome was the most beautiful, and the nodules disappeared after reexamination
For the ground glass nodules found for the first time, if there is no definite malignant sign, they are usually followed up and observed first. Some benign nodules will be absorbed (this is the best result), as shown in the following figure:
Figure 3
This is not uncommon. Most of them are inflammatory nodules, which can be absorbed through anti-inflammatory treatment, enhancing immunity and other methods. Even some nodules can be absorbed and dissipated without taking any measures.
Therefore, for the ground glass nodules detected for the first time, wait. Don't worry about the operation. Some benign nodules will be absorbed. This is the first outcome.
The second outcome: the nodules remained stable for a long time
This is the most common condition, and you don't need to rush for surgery. Just have a regular review:
Figure 4
The picture above shows a 50-year-old man who found four ground glass pulmonary nodules in physical examination, the largest of which is 5mm. He has been rechecked regularly. It has been 7 years without any change, and he has gradually become reassured and rational from his initial panic.
Regular reexamination of ground glass pulmonary nodules can be continued as long as there is no increase in volume and density. With the continuous progress of medicine, there may be non-invasive treatment methods in the future.
Long term stability, which may be accompanied by a lifetime, is the second and most common outcome of ground glass nodules.
In three studies specifically targeting multifocal ground glass nodules, 60%-95% of pure ground glass nodules remained stable, a few decreased or disappeared, and only a few increased or became partially solid (suggesting resection).
The third outcome: reexamination of progress, requiring active treatment
Some ground glass nodules will progress and become life-threatening malignant tumors, usually manifested as increased density and / or volume (the increase of solid components in the mixed ground glass nodules also indicates the progress). Therefore, the thoracic surgeon is required to take disciplinary measures to clean up the body:
Figure 5
This is a middle-aged woman. During physical examination, she found that the pure ground glass nodule in the right lung was 1.1cm in length. Regular re examination showed that it seemed to have increased a little after 3 years, with a diameter of about 1.2cm, and a small amount of thin cord shadow appeared at the edge. She didn't want to observe any more. She underwent thoracoscopic minimally invasive surgery. The pathology was adenocarcinoma in situ.
Ground glass nodules associated with lung cancer usually include atypical adenomatous hyperplasia (Aah), adenocarcinoma in situ (AIS), microinvasive adenocarcinoma (MIA), and adherent growth adenocarcinoma (LPA). The first two of them are pre invasive lesions (Aah, AIS). Most of them are inert lesions, which can be followed up for a long time without metastasis and diffusion.
Another example:
Figure 6
This is a middle-aged woman. A 3mm micro nodule was found in the physical examination. After 8 months, it became a 9mm ground glass nodule. The surgical pathology was micro invasive adenocarcinoma (MIA).
The follow-up of ground glass nodules increases, or the density increases, which requires surgical treatment and can be cured! This is the third outcome.
The fourth outcome was ignored, and a small part of them progressed to advanced lung cancer
If pulmonary nodules are found, without regular reexamination, and only by maintaining a happy mood, or some folk prescriptions, the fourth outcome may occur. Just like the first patient in this article, he will progress to advanced lung adenocarcinoma after 7 years:
Figure 7
This is the most regrettable. It could have been prevented and cured through scientific follow-up observation.
Finally, add a sentence: the reexamination of pulmonary nodules should be conducted in the same hospital with the same CT for comparison; In addition, for people with pulmonary nodules, low-dose CT Reexamination is not recommended because low-dose scanning reduces the image definition and is not conducive to detailed observation.
Original link：
https://www.medsci.cn/article/show_article.do?id=24d4e30341ee
