他为什么是晚期才发现？而且全身已经多处转移了？ 不抽烟的他得的非小细胞肺癌有一定遗传。需要看他的家族史。肺癌要看分型小细胞肺癌不抽烟也可能是家族史。一般50岁以下得癌的都可能是基因https://ccr.cancer.gov/news/article/genetics-not-just-smoking-influence-small-cell-lung-cancer-risk Genetics, not just smoking, influence small cell lung cancer risk 给非小细胞癌在这里，都要看家族史 Most non-small-cell lungcancer is caused by smoking, but your genes may also help determine your chances of getting the disease. Lung cancer is when cell growth in the lungs becomes abnormal and cancer cells are created. A gene mutation, or change, can make this happen. https://www.webmd.com/lung-cancer/nsclc-genes Genetic tests for non-small-cell lung cancer may not be offered by every doctor or hospital, but you may want to ask for a tumor marker test if you’ve been diagnosed.
hellohey 发表于 2024-12-20 14:49 他为什么是晚期才发现？而且全身已经多处转移了？ 不抽烟的他得的非小细胞肺癌有一定遗传。需要看他的家族史。肺癌要看分型小细胞肺癌不抽烟也可能是家族史。一般50岁以下得癌的都可能是基因https://ccr.cancer.gov/news/article/genetics-not-just-smoking-influence-small-cell-lung-cancer-risk Genetics, not just smoking, influence small cell lung cancer risk 给非小细胞癌在这里，都要看家族史 Most non-small-cell lungcancer is caused by smoking, but your genes may also help determine your chances of getting the disease. Lung cancer is when cell growth in the lungs becomes abnormal and cancer cells are created. A gene mutation, or change, can make this happen. https://www.webmd.com/lung-cancer/nsclc-genes Genetic tests for non-small-cell lung cancer may not be offered by every doctor or hospital, but you may want to ask for a tumor marker test if you’ve been diagnosed.
hellohey 发表于 2024-12-20 14:49 他为什么是晚期才发现？而且全身已经多处转移了？ 不抽烟的他得的非小细胞肺癌有一定遗传。需要看他的家族史。肺癌要看分型小细胞肺癌不抽烟也可能是家族史。一般50岁以下得癌的都可能是基因https://ccr.cancer.gov/news/article/genetics-not-just-smoking-influence-small-cell-lung-cancer-risk Genetics, not just smoking, influence small cell lung cancer risk 给非小细胞癌在这里，都要看家族史 Most non-small-cell lungcancer is caused by smoking, but your genes may also help determine your chances of getting the disease. Lung cancer is when cell growth in the lungs becomes abnormal and cancer cells are created. A gene mutation, or change, can make this happen. https://www.webmd.com/lung-cancer/nsclc-genes Genetic tests for non-small-cell lung cancer may not be offered by every doctor or hospital, but you may want to ask for a tumor marker test if you’ve been diagnosed.
It is the emotions that play the most important part, genes may increase the risk but it is not the whole story. Read Dr. MATE'S book when the body says no.
louaci 发表于 2024-12-20 16:16 It is the emotions that play the most important part, genes may increase the risk but it is not the whole story. Read Dr. MATE'S book when the body says no.
Hepatitis B is a common disease in the United States. The good news is that the hepatitis B vaccine gives 80% to 100% protection to people who get the vaccine. /www.hhs.gov/immunization/diseases/hepatitis-b/index.html#:~:text=Hepatitis%20B%20is%20a%20common,people%20who%20get%20the%20vaccine 工作太忙太累，抵抗力下降的时候。我说的是真事某大三甲外科医生手术划伤手指后来乙肝，看病人传染性强不强当时，外加自己抵抗力。20多年前我在中国听说的一件事。 而且你应该看到过华人上不少人分享过，家里人接种乙肝疫苗种不上，少数人在接种完3剂疫苗后没能产生表面抗体 zqb.cyol.com/html/2023-06/20/nw.D110000zgqnb_20230620_1-12.htm 乙肝疫苗会失效，没有抗体需及时补种
Results. Of 144 susceptible patients in whose surgery the infected surgeon participated, 19 had evidence of recent HBV infection (13 percen www.nejm.org/doi/full/10.1056/NEJM199602293340901 He did not use double gloves, but after contracting hepatitis B he modified his behavior by frequently changing gloves during operations. All surgical staff members, including the surgeon, reported that blood was routinely present on their hands when they removed their gloves after an operation, whether or not visible tears were present in the gloves and regardless of the type of gloves used. The Centers for Disease Control and Prevention (CDC) estimate that 1900 U.S. surgeons are chronically infected with hepatitis B virus (HBV) www.facs.org/about-acs/statements/the-surgeon-and-hepatitis/#:~:text=The%20risk%20of%20transmission%20of,contract%20or%20transmit%20HBV%20infection. The risk of transmission of HBV from a patient to a surgeon is much greater than the risk of transmission from an infected surgeon to a patient. It is worth emphasizing that an immune surgeon cannot contract or transmit HBV infection. The risk of exposure to HBV (and all blood-borne pathogens, including HCV) begins early in a surgeon''s career and is greater than the risk to most HCWs during the entire professional life of a surgeon
我们是 自费做，就选 71271 Explanation of Protocols: 1. CPT Code 71271 (Low-Dose CT for Lung Cancer Screening): • This is the standard low-dose CT screening for lung cancer used in high-risk individuals (e.g., smokers or ex-smokers). • It is typically used for individuals aged 50–80 years, with a 20+ pack-year smoking history, and who are either current smokers or have quit within the past 15 years. • This is a comprehensive exam tailored for lung cancer screening. 2. G0297 (Medicare Code for Low-Dose CT): • This code is specific to Medicare beneficiaries and is used for annual lung cancer screening in high-risk individuals. • It is essentially the same procedure as 71271 but used for billing purposes under Medicare. Which Protocol to Choose? • If you are covered by Medicare: Select Low Dose - G0297 for lung cancer screening. • If you are not covered by Medicare: Choose Low Dose - 71271, which is the universal protocol for low-dose lung CT screening.
斯坦福大学医学院教授 Bryant Lin（林彦峰）长期从事肺癌相关研究
但他未曾想自己会成为病例之一
今年5月从不抽烟的他被诊断为晚期非小细胞肺癌，伴有全身多处转移
经综合治疗，病情得到控制
巧合的是，林彦峰近年的研究方向正是亚裔非吸烟者肺癌的趋势和原因
患病后 Lin 以自己为研究对象，在斯坦福大学新开了一门选修课：
“从诊断到对话：一名医生与癌症的实时斗争”
他通过自己的抗癌视角，为其他癌症患者提供个性化探索
他不确定自己还能活多久，“从某种意义上，这门课是我最后想说的话。”
在麻省理工学院获得电气工程和计算机科学本科、硕士学位后，他在塔夫茨大学医学院和塔夫茨医学中心相继完成医学博士和内科培训
来到斯坦福大学后，他担任过心脏电生理学研究员和生物设计研究员，后留在医学院任教
2018年，他在斯坦福大学成立亚洲健康研究与教育中心，聚焦亚裔人群癌症风险，尤其关注非吸烟者肺癌。
21世纪初至今，美国的肺癌发病率、死亡率连年下降，不吸烟者的肺癌数却在增加
美国疾控中心数据显示，不吸烟者肺癌在肺癌总发病数中约占10%-20%
其中，年轻、不吸烟女性从2006年至今的肺癌年发生率增长2%，成为疾病增长较为明显的群体之一
肿瘤学家Heather Wakelee认为，基因突变或能解释部分原因，“约50%的亚裔非吸烟肺癌患者能检出基因突变，明显高于其他族群。”
林彦峰创立斯坦福大学亚洲健康研究教育中心后，主要任务之一就是为该疾病趋势寻找答案
他希望引导资源，让学者们多加关注EGFR突变相关肺癌研究
意想不到的是，作为这项研究的发起者，林彦峰竟成为了典型病例之一
短短几个月内，林彦峰经历了从医生到患者的身份急转
学生们在课堂上提出的主要问题之一是：
作为医学专家、拥有大量医疗资源，为什么没能早些发现？
这其实与肺癌早筛策略有关
传统意义上的癌症筛查过于聚焦“高危人群”，从而导致其他人可能错过早期发现的机会
就癌症早筛标准来说，美国癌症协会去年11月更新的指南建议是：50-80岁，目前吸烟或既往吸烟（≥20包年，1包年即每年每天吸烟20支）的无症状人群，应每年做1次低剂量CT检查
因此非高危人群更容易错过早诊早治的窗口期
一项小型调查显示，肺癌患者通常在最早出现症状的138天后才开始接受治疗
林彦峰正是典型案例之一
今年3月，有季节性过敏的他开始咳嗽，后不断加剧，数周的抗生素、激素、抗过敏治疗均无效
完善了一系列检查后，CT提示其右肺有异常肿块影、积液，肿块直径达11厘米
林彦峰在两周内收到诊断报告，被确诊为晚期肺癌
此时，距离他最早出现咳嗽已过去8周，影像学资料显示，他的骨骼、肝脏、皮肤、大脑均有转移灶
确诊后，林彦峰开始接受进一步治疗
基因测序提示，他存在EGFR突变，这会造成EGFR蛋白质过量，促使癌细胞成长；还会增加肿瘤细胞的侵袭性，更易发生转移
对于EGFR突变目前临床已有靶向药物，能有效抑制突变基因的活性
对于亚裔不吸烟者基因突变几率更高的真实原因，全球医疗界仍在努力寻找答案
按医嘱，林彦峰每3周做一次化疗，同时每天口服第三代靶向药EGFR-TKI
临床研究显示，该药物能延长无进展生存期，对肺癌脑转移亦有疗效，生存数据有待确定
截至2024年10月，林彦峰大脑的50个病变灶消失了
他也承认，自己的生存期是个“谜”，一年两年或五年？
因为靶向治疗普遍存在耐药性问题，将会影响、削弱治疗的精准性和长效性
如今，他更能体会癌症患者的艰辛，包括语言差异、保险条件欠佳、无法请假看病等治疗过程中的困难处境，因而对其他患者更具同理心
今年秋天林彦峰决定开设一门新的课程，分享自己从医生变成患者的抗癌历程，让更多人知道肺癌的风险并尽早识别症状
按照林彦峰的规划，这门新课每周一次，持续10周
首节课程讨论现代癌症诊断关键步骤的得失
除了讲授不吸烟者肺癌的流行病学现状，这门独一无二的课程，也将深入探讨筛查策略、针对性疗法、专业护理、营养支持、精神支持等重要辅助疗法
在课堂上，林彦峰平淡地讲述着自己的故事，参与医学讨论并回答学生提问，丝毫看不出是一名晚期肺癌患者
有人评价称，他勇敢地公开了自己的诊疗经历，有助于减少疾病污名化，向大家传递出“任何人都能患癌”的信息，以此引起广泛重视
在最后一节课中，林彦峰等将探讨癌症治疗的前沿进展，包括CAR-T细胞治疗、抗体-药物偶联物和下一代免疫疗法
他希望通过一系列讨论，能够鼓励每个人思考个性化的癌症治疗EGFR突变
是很年轻，50岁
Genetic tests for non-small-cell lung cancer may not be offered by every doctor or hospital, but you may want to ask for a tumor marker test if you’ve been diagnosed.
应该是比较年轻，早期无症状，有症状之后以为只是过敏，才50岁，不会一下子想到是肺癌。
美国的医疗体系下，年检几乎等于无，发现就是晚期肺癌，太正常了！
30岁的非小细胞肺癌，晚期的，美国，我都听说过几起！
为什么小细胞癌，和非小细胞癌，要分开说？
EECS转医，这个跨度很大呀。
听说是烟鬼 小细胞癌 多，普通人 非小细胞癌多。30岁的，来美国读书工作的，烟鬼几乎没有的
肺癌到出现症状时，都是已经扩散晚期了。 凤飞飞一直没有症状，只是一天自己发声唱歌有问题，一查就是肺癌晚期了，6个月后过世。 我朋友发现症状到肺癌过世，才3个月。
小细胞肺癌只占肺癌中7%不到，极其凶险。绝大多数是非小细胞肺癌。
国内体检by default包括肺部CT 自费也就几百块最多一千 准备每次回国每两年做一个 比在美国周转于各个医生之间、和保险公司扯皮要简单多了
情绪or心情的影响，那么大？
https://radiologyassist.com/
上次人家不是贴了上面这个嘛，自费100多，CT Lung cancer screening. 找他们consultant 出referral. 我还没试过，但决定每年做一次
因为这个基因突变EGFR只存在于肿瘤组织，要活检或手术切下肿瘤组织后才能检测到，不是那种全身携带的基因突变。
现在肿瘤微环境是癌症研究的热点，而情绪or心情可以改变体内的信息化学分子水平，能影响到肿瘤微环境很合理。
居然完全没有gap，一般这种完全没关系的专业，申请前不需要补课，shadow吗？
Blessings
是呀，所谓psychoimmunology 特别是被压抑的情绪，自己都不知道那种，其实很多研究，但大家都盯着基因，忽略房间里的大象
年轻的时候非常压抑好多年，中年倒是不压抑了。也许可以躲过去。😱
听说过肿瘤科医生自己得了晚期肠癌。这个真有运气在里面。
是不是有家族史，或者上班时候接触了病毒。有的外科医生开刀的时候伤到手得了乙肝也有的，乙肝、肝硬化、肝癌。有的人乙肝一辈子到100岁才走，也没有肝癌。
那怎么才能不压抑情绪呢？运动？锻炼？和心理医生倾诉？高质量的性生活？
外科医生？这是谁说的？乙肝疫苗干什么去了？
mark
Hepatitis B is a common disease in the United States. The good news is that the hepatitis B vaccine gives 80% to 100% protection to people who get the vaccine. /www.hhs.gov/immunization/diseases/hepatitis-b/index.html#:~:text=Hepatitis%20B%20is%20a%20common,people%20who%20get%20the%20vaccine 工作太忙太累，抵抗力下降的时候。我说的是真事某大三甲外科医生手术划伤手指后来乙肝，看病人传染性强不强当时，外加自己抵抗力。20多年前我在中国听说的一件事。
而且你应该看到过华人上不少人分享过，家里人接种乙肝疫苗种不上，少数人在接种完3剂疫苗后没能产生表面抗体
zqb.cyol.com/html/2023-06/20/nw.D110000zgqnb_20230620_1-12.htm 乙肝疫苗会失效，没有抗体需及时补种
Results. Of 144 susceptible patients in whose surgery the infected surgeon participated, 19 had evidence of recent HBV infection (13 percen www.nejm.org/doi/full/10.1056/NEJM199602293340901 He did not use double gloves, but after contracting hepatitis B he modified his behavior by frequently changing gloves during operations. All surgical staff members, including the surgeon, reported that blood was routinely present on their hands when they removed their gloves after an operation, whether or not visible tears were present in the gloves and regardless of the type of gloves used. The Centers for Disease Control and Prevention (CDC) estimate that 1900 U.S. surgeons are chronically infected with hepatitis B virus (HBV)
www.facs.org/about-acs/statements/the-surgeon-and-hepatitis/#:~:text=The%20risk%20of%20transmission%20of,contract%20or%20transmit%20HBV%20infection. The risk of transmission of HBV from a patient to a surgeon is much greater than the risk of transmission from an infected surgeon to a patient. It is worth emphasizing that an immune surgeon cannot contract or transmit HBV infection. The risk of exposure to HBV (and all blood-borne pathogens, including HCV) begins early in a surgeon''s career and is greater than the risk to most HCWs during the entire professional life of a surgeon
是的，要螺旋CT
这些都有帮助，但这不是最本质的，要找到authentic self, 而且能自洽，这个比较难，特别对我们这种良民一辈子按着社会家庭文化期望成长起来的。但是authentic self 有时会和最重要的亲密关系产生冲突，比如父母配偶孩子或者职业上的关系，人一辈子就是这样拉扯过来的。但要认识到真正的自己和自己的情绪不管多么难以启齿难以被社会家庭文化所接受，对各种疾病都有本质性的帮助。
第一步是意识到自己的情绪和感受。
鱼🐟一辈子待在水里，它很难认识到水的存在；就跟人会忽略空气一样。
如果我们从小被各种情绪浸淫，那就会习惯了时刻处于强烈的感受中，过不了平静安宁的生活，没有问题也要潜意识里去制造矛盾和冲突。
总是听说有低密度CT，国内体检怎么从没听说过？CT好像就是CT不分高密度低密度的
能展开说说吗？
Chest X-ray 也不是说一定看不到，但毕竟是二维的，看到的影像是一个方向上所有x光吸收的叠加。三维成像分辨率要好很多
我婆婆也是 只是后腰脊椎的位置疼 还以为只是腰疼 结果一查是肺癌晚期扩散了 三个月就走了
真是要吓死人了。3-5am老醒过来，情绪曾长期压抑，亚裔大妈。 不行，必须要去CT
同问。选哪个？
谢谢分享。我所在城市CT是300-400。我觉得40岁后应该至少2～3年一次CT，可以提早发现问题。
医疗保险公司实在是体制之恶
我们是 自费做，就选 71271
Explanation of Protocols: 1. CPT Code 71271 (Low-Dose CT for Lung Cancer Screening): • This is the standard low-dose CT screening for lung cancer used in high-risk individuals (e.g., smokers or ex-smokers). • It is typically used for individuals aged 50–80 years, with a 20+ pack-year smoking history, and who are either current smokers or have quit within the past 15 years. • This is a comprehensive exam tailored for lung cancer screening. 2. G0297 (Medicare Code for Low-Dose CT): • This code is specific to Medicare beneficiaries and is used for annual lung cancer screening in high-risk individuals. • It is essentially the same procedure as 71271 but used for billing purposes under Medicare.
Which Protocol to Choose? • If you are covered by Medicare: Select Low Dose - G0297 for lung cancer screening. • If you are not covered by Medicare: Choose Low Dose - 71271, which is the universal protocol for low-dose lung CT screening.
感谢分享。