Professor Xiang Yi: Lung cancer - precision treatment, breathing first

The 2022 national cancer report shows that lung cancer has an annual incidence of 828,000 people and an annual death of 657,000, ranking first in malignant tumors [1], which is a disease that seriously threatens the life and health of Chinese residents, and 68% of lung cancer patients are diagnosed in the advanced stage, and the 5-year survival rate of early lung cancer less than 1cm is 92%, while the 5.
8% of advanced lung cancer is only 5.
8% [2].

Therefore, early screening and diagnosis of lung nodules/lung cancer is a key factor
in improving the 5-year survival rate of lung cancer.
As one of the first departments for many lung cancer patients, the Department of Respiratory Medicine plays an important role
in the whole process of lung cancer treatment.

Expert profiles

Professor Yi Xiang

Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine

Doctor of Medicine, Chief Physician, Master Supervisor, Director of Thoracic Interventional Center

Respiratory Disease Branch, Chinese Medical Association, Pleural and Mediastinal Disease Group, Deputy Team Leader

Member of the Interventional Respiratory Disease Group of the Respiratory Disease Branch of the Chinese Medical Association

Member of the Interventional Respiratory Disease Group of the Respiratory Disease Branch of the Chinese Geriatric Society

Member of the Prevention Committee of the China Lung Cancer Prevention and Control Alliance

Member of the Lung Oncology Professional Committee of the Chinese Medical Education Association

Member of the Tumor Immunotherapy Professional Committee of the Chinese Medical Education Association

Member of the National Clinical Research Center-China Respiratory Cancer Collaborative Group

Member of the special committee of thoracic tumor, tumor respiratory endoscopy, brain metastasis and other special committees of Shanghai Anti-Cancer Association

Editorial board member of the Journal of Clinical Oncology Chinese edition of lung cancer and reviewer of several academic journals

Lung cancer diagnosis has obvious advantages

Professor Xiang Yi: After more than half a century of development, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine has complete subspecialties in respiratory and critical care medicine, and regards the comprehensive diagnosis and treatment of lung cancer as the top priority of the development of the discipline, and has established a full-process management
from early screening to late rehabilitation.

As one of the leading departments in the field of lung cancer diagnosis, the Department of Respiratory and Critical Care Medicine of Ruijin Hospital has unique advantages, and respiratory doctors are the first line
of defense for lung cancer diagnosis.
Among them, Professor Xiang Yi, chief physician, said that a series of key technologies such as tracheoscopy, thoracoscopy, CT or B-ultrasound guided needle biopsy that respiratory doctors are good at play an irreplaceable role
in the early diagnosis of lung cancer.
At the same time, the acquisition of small specimens of respiratory endoscopy by respiratory doctors is conducive to pathologists to carry out pathological typing and molecular typing, thereby guiding subsequent precision treatment
.
Respiratory physicians specialize in the treatment of comorbidities and complications such as chronic bronchitis, COPD, interstitial lung disease, lung infections, and pulmonary complications of targeted therapy and immunotherapy
.
Respiratory doctors have the comprehensive management ability of respiratory and critical care medicine, and have specialized advantages in the management of lung cancer complications such as dyspnea and infection, and respiratory support treatment, which can provide the best support
for lung cancer patients to prolong their survival time and improve their quality of life.
All in all, respiratory physicians have unique expertise
in lung cancer screening, diagnosis, staging, treatment and management.

Lung cancer treatment, precise and advanced

Professor Xiang Yi: After a series of diagnoses, the respiratory doctor will give a professional treatment plan
.
Professor Xiang Yi said that the Department of Respiratory and Critical Care Medicine of Ruijin Hospital has advanced precision treatment methods
for lung cancer.
Depending on the histological type of cancer, clinical stage, and functional assessment of the patient, the treatment used for lung cancer is also different
.

For early-stage lung cancer, surgical resection is the treatment of choice; The extent of resection depends on the size and location
of the tumor.
For inoperable stage III patients, radical concurrent chemoradiotherapy and chemotherapy should be selected according to the patient's specific situation; For patients with stage IV NSCLC, a combination of systemic therapy is currently recommended
.

In addition to systemic therapy, some stage IV patients require further adjuvant local therapy, such as airway obstruction caused by tumors that can cause dyspnea, obstructive pneumonia, or hemoptysis, and respiratory surgeons can relieve these symptoms by intervention, thereby improving the response
of systemic therapy.

Multidisciplinary diagnosis and treatment collaboration, individual characteristics

Professor Xiang Yi: In addition to the above precision treatment, Professor Xiang Yi introduced that Ruijin Hospital has also established a characteristic multidisciplinary diagnosis and treatment collaboration group for lung cancer to meet the needs of different lung cancer patients and formulate personalized diagnosis and treatment plans
.
The collaborative group consists of
a team of specialists in thoracic surgery, respiratory, radiotherapy, radiology and pathology.
The Lung Cancer Multidisciplinary Diagnosis and Treatment Collaborative Group will routinely open a multidisciplinary integrated lung cancer clinic (MDT) every Thursday afternoon to provide multidisciplinary precision treatment for lung cancer patients.

The MDT model integrates the advantages of multidisciplinary experts to reduce time and labor costs, seize the best treatment time, and provide the most optimized treatment plan
.

Professor Xiang Yi said that in the special MDT outpatient clinic, patients can directly register for medical treatment in the MDT outpatient clinic, and multidisciplinary experts will discuss diagnosis and treatment in a centralized manner, providing theoretical knowledge and the latest technological progress from various disciplines, regardless of outpatient follow-up, inpatient treatment, and participation in clinical trials, all completed under the coordination and cooperation of MDT related departments
.
In this way, patients can be avoided from multiple referrals and repeated examinations, thereby reducing waiting time, reducing economic burden, providing full-process and all-round diagnosis and nursing management for lung cancer patients, providing patients and their families with high-quality medical experience, and achieving satisfactory treatment results
.

Professor Xiang Yi continued, "Adhere to and expand equally, inheritance and innovation walk together", this is the medical philosophy that the Department of Respiratory and Critical Care Medicine of Ruijin Hospital has always adhered to, and it is also the direction
of my personal efforts.
In the future, Ruijin Hospital will continue to inherit the good tradition of multidisciplinary cooperation, while maintaining and inheriting the traditional heritage, constantly give new content to the construction of disciplines, and continuously improve the level
of service for patients through multidisciplinary collaborative innovation of scientific research, talent training, social service and cultural inheritance.

With the rapid improvement and development of lung cancer diagnosis and treatment in China, the diagnosis and treatment of lung cancer has entered the era of
accurate and personalized comprehensive whole-course management.
From traditional treatment to the development of new anti-tumor technology, cancer treatment methods have been continuously upgraded, which has greatly improved the survival of
lung cancer patients.
Diagnosis of lung cancer does not mean death, through accurate, personalized and appropriate treatment plans, you can still achieve tumor survival and continue to create your own better life
.

References

[1] Zheng R , Zhang S , Zeng H , et al.
Cancer incidence and mortality in China, 2016[J].
Journal of the National Cancer Center, 2022.
[2] Goldstraw P, Chansky K, Crowley J, et al.
The IASLC Lung Cancer Staging Project: Proposals for Revision of the TNM Stage Groupings in the Forthcoming (Eighth) Edition of the TNM Classification for Lung Cancer.
J Thorac Oncol.
2016; 11(1):39-51.