Many basketball lovers' heart was broken by a weibo posting from Beijing Ducks Basketball Club: Ji Zhe, the former team leader who led the team winning three CBA League Champions died after a year-long fight against lung cancer.

The death of Ji Zhe leaves us great regret, while also calls up an old question: what inflicts lung cancer on these young sporty non-smokers?

Lung cancer: common, deadly, and young

In most of the country, lung cancer is a top-rank cancer in both morbidity and mortality. Some research show steady and even dropping morbidity among middle-age and old-age populations, while it increases year by year among youngsters.

Illustration from: National Cancer Center

As predicted by the China North-South Lung Cancer Summit, the lung cancer population will go over 1 million by 2025 with an increasingly young patient mix. The onset age is 5-10 years earlier by comparison. The morbidity of lung cancer among young population is increasing at an annual rate of 4.5%. In terms of age onset, the mid-point age is 67-78 years old among elderly patient, and 32-36 years old among younger patients.

Lung cancer is intimidating, but don't worry.

The MDT team from thoracic surgery and thoracic cancer center in DeltaHealth Hospital will tell you the risk factor, prevention and treatment of lung cancer.

Am I in high-risk group of lung cancer?

Tobacco use is a major inducing cause of lung cancer. However, there are other major causes, including family history of tumor, indoor air pollution (including secondhand smoking, indoor fuel burning, kitchen fume) and bad habits. Therefore, never assume that lung cancer is an elderly disease and young people are safe from it.

Lung Cancer High Risk Population

Over 40 years old and fits in any of the following categories

Uses more than 400 cigarettes yearly use (daily cigarette use * No. of years of smoking), or used to use ≥ 400 cigarettes yearly use and ceased smoking for ≤15 years

History of environment exposure or high risk occupational exposure, for example, prolonged exposure to asbestos, beryllium, uranium, radon, etc.

Has COPD, diffuse pulmonary fibrosis or history of tuberculosis

History of malignant tumor at other sites, or family history of lung cancer (history of lung cancer among first degree relatives)

Lung Cancer Middle Risk Population

Over 40 years old and fits in any of the following categories

Passive smoking ≥20 years (the patient is not a smoker, but live closely to a smoker for a long time, therefore is exposed to “secondhand smoke”)

Exposure to cooking smoke ≥20 years

Office workers living a high-pressure life and with compromised immune function

How can I avoid lung cancer?

One of the most used tools to discover and diagnose early or ultra-early lung cancer

Low dose chest CT

People over 35 years old should take annual low dose lung CT to rule out early lung cancer

High quality CT machine helps to spot early lung cancer nodules 2mm in diameter or even slower, when they can be resected

Timely discovery of early lung cancer can be treated with resection surgery and requires no post-operative intervention. It helps to protect patient’s quality of life and significantly cuts risks of relapse and metastasis. If lung cancer is left untreated and develops to middle stage or late stage, patient need to under go multiple chemotherapies and radiotherapies to sustain life, and life with significantly higher risk of relapse and metastasis.

Frequently asked questions

Q: I heard that CT has high radiation, isn’t annual chest CT riskier for my health?

A: Low dose chest CT has a radiation dose 75%-90% lower than common CT, which can be lower than 1mSv. It is even fewer than the radiation you absorb after a 7-8 hour flight. It has no harm on your health and is particularly suitable for annual lung cancer screening among healthy people.

Q: I have tested for tumor marker, do I still need a chest CT?

A: Tumor marker tests are complimentary to chest CT. Chest CT is an important tool for early screening of lung cancer. It cannot be replaced by tumor marker tests.

Tumor marker tests

• CEA

• SCC

• CYFRA21-1

• CA125

• NSE

• ProGRP

High risk population are recommended to take the chest CT screening along with tumor marker tests. It helps with effective diagnosis of miscellaneous lung cancers and determination of histological type, which in turn facilitated development of customized treatment plan.

What should I do if I am diagnosed with lung cancer?

If you are diagnosed with lung cancer, there is no need to worry. The oncology MDT team of DeltaHealth Hospital will give you a customized treatment plan

1. There are no two lung cancers alike

Lung cancer is an umbrella term for a few dozens of diseases. Lung cancer covers multiple pathological categories (small cell lung cancer/SCLC and non-small cell lung cancer/NSCLC), tumor stages (Stage 0 to IV) and molecular gene type (different pathogenic gene mutation), which produces a few dozens of combinations. Based on the characteristic of tumor growth, risk of spreading and sensitivity to various treatment methods and medicines, lung cancers can be treated with a spectrum of several dozens treatment plans.

In addition, the age, gender, tumor site, symptoms, baseline health and past medical history should all be taken into consideration. Most oncology experts agree that “there are no two lung cancers alike”.

2. Lung cancer treatment plan should be customized

Meanwhile, new generation lung cancer treatments keep emerging. Apart from the traditional choices of surgery, radiotherapy and chemotherapy, patients can also try suitable new generation therapies like targeted drugs and immunotherapy. It makes lung cancer treatment a highly personalized business. Developing a customized treatment plan that best suit the current condition requires comprehensive assessment of the patient by a team of doctors.

It is worth noting that each targeted drug is only good for lung cancer patients with special gene mutation, like a key (targeted drug) and a lock (gene mutation). Before using targeted drug, a gene test must be done to determine the type of mutation of the cancer cells. Currently, most targeted drugs are for mutations of NSCLC. Therefore, if you are diagnosed with late-stage NSCLC, you should take a gene test as soon as possible. On the other hand, if you are diagnosed with squamous cell carcinoma or SCLC, there are very few targeted drug available, leaving chemotherapy the dominant treatment plan.

3. MDT model is essential in lung cancer treatment

The above consideration is only a small piece of lung cancer treatment, making lung cancer treatment a highly specialized medical endeavor. In such cases, a strong lung cancer MDT team (Multi-Disciplinary Treatment) makes great difference.

The Oncology MDT team of DeltaHealth Hospital is led by Prof. Zhao Heng, a seasoned expert who has worked in Shanghai Thoracic Hospital for more than 3 decades and has done more than 30,000 cases of surgeries as the chief surgeon. The team brings together renowned medical experts in radiology, oncological pathology, respiratory medicine, thoracic surgery and oncology. With one-stop, convenient and efficient examinations and group consultation, in 3-4 days, the team is able to formulate and administer a treatment plan most suitable for the patient.

Healthy tips from DeltaHealth doctors

1. Quit smoking if you can. If you are not a smoker and has no history of occupational exposure, it is still necessary to caution against the risk of lung cancer.

2. Take routine health check after 35 years old if conditions allow. It is best to take the safe and efficient test of low dose spiral CT in a proper hospital to rule out early lung cancer.

3. If unfortunately, you are diagnosed with lung cancer or suspected with cancer-like lung nodule, please keep in mind, “diagnosis and treatment of tumor is a race against the clock. The battle against death relies on doctors’ experience and knowledge.” Bringing in a reliable oncology MDT team is the first winning move in your long fight against the tumor.

References:

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[2]2018年国家癌症中心最新癌症报告

[3]与癌共舞论坛沈波教授专访

[4]肺癌多学科团队诊疗中国专家共识

[5]菠萝聊肺癌第二期：肺癌到底是如何分类的

[6]肺癌为啥盯上了年轻人 ？哪些人属于肺癌高发人群？

[7]低剂量螺旋CT—早期肺癌筛查的最佳方法

[8]Association between cooking oil fume exposure and lung cancer among Chinese nonsmoking women: a meta-analysis. OncoTargets and Therapy. 2016(9):2987–2992

[9]Forrest LM et al.Br.J Cancer. 2005; 93(9):977-78

[10]Fleissing, A., et al. (2006). Lancet Oncol 7(11):935-943

[11]MacDermid E et al. Colorectal Disease. 2008; 11(3):291-95