Lung adenocarcinoma inchoate, the doctor says do not need to change cure, but have recrudescence high risk factor, how to do?
A netizen asked such a question: because the pulmonary ground glass nodules underwent surgery, the nodules were 1.5cm, and no lymph node metastasis was found. The pathological findings indicated that the acinar type was dominant, and the micropapillary type accounted for 10%.The doctor said the stage was early, no chemotherapy was needed, and no targeted therapy was needed.But I heard that there is a small nipple is not good, easy to relapse, how to do this situation?As we all know, the lung cancer presented by ground glass nodules is generally lung adenocarcinoma, and the lung adenocarcinoma with nodules smaller than 3cm has no lymph node metastasis, which belongs to early stage.However, early stage is a more general term, including in situ adenocarcinoma, micro-infiltrating adenocarcinoma, stage IA and Stage IB lung adenocarcinoma, and stage IA can be divided into stage IA1, IA2 and IA3 according to the size of lesions.According to the latest version of TNM staging, the stage of the above netizen is IA2, from staging, is relatively early lung cancer.In fact, there are many pathological subtypes of lung adenocarcinoma, including adherent type, acinar type, papillary type, solid type and micropapillary type.Different pathological subtypes have different prognosis.In general, adherent adenocarcinomas have a low risk of recurrence, acinar and papillary adenocarcinomas have a moderate risk of recurrence, and micropapillary and solid adenocarcinomas are considered to have the highest risk of recurrence.Among the various pathological subtypes of lung adenocarcinoma, the micropapillary component is considered to be the greatest predictor of poor prognosis.Studies have shown that micropapilla-dominated adenocarcinoma has a high probability of recurrence within 5 years.Even as little as 1% of the micropapillary component can affect patient survival.Micropapillary pulmonary adenocarcinoma is often prone to extensive lymphangitic thrombs at a very early stage of the primary lesion, and is more prone to early distant metastases, such as pleural and bone metastases.Since the pathological subtype of micropapillae means that it is easy to relapse, some very early lung adenocarcinoma patients with micropapillae components are very worried, staging is relatively early, but there are micropapillae components, how to do?Do you want chemotherapy?Do you want targeted therapy?How should prevent relapse?Even the latest version of the 2022 NCCN guidelines does not recommend adjuvant therapy, including adjuvant chemotherapy and targeted therapy, for patients with stage IA NSCLC.In other words, with or without micropapillary components, patients with stage IA lung cancer can be reviewed regularly after surgery without any treatment.However, for patients with stage IB NSCLC, the latest VERSION of the NCCN guidelines recommends postoperative adjuvant targeted therapy, preferably oxitinib, for patients with EGFR-positive mutations.It can be maintained with targeted drugs alone or after four cycles of chemotherapy for up to three years.Since stage IA patients do not need adjuvant therapy after surgery, how to prevent recurrence for patients with high risk factors, such as micropapillary or solid components, and patients with vascular cancer plug?It is important to recover after surgery, including a balanced diet, proper exercise, getting rid of any bad habits, ensuring good sleep, keeping a good mood and improving immunity.In terms of drugs, oral shenyi capsule, ubenmax or ridaxian can be injected to improve immune function, and also can be adjusted by traditional Chinese medicine.Overall, the vast majority of stage IA NSCLC patients can be cured with surgery, and the 5-year survival rate is 90%.Studies have shown that the EGFR mutation rate of lung adenocarcinoma with micropapillary component is relatively high. Therefore, genetic testing can be performed for this type of lung cancer after surgery. If there is EGFR mutation, targeted therapy can be carried out in time in case of recurrence and metastasis in the future.