On December 14th, "When nodules appear on the physical examination report" rushed to the hot search, with a reading of 140 million. It’s the year-end physical examination season again, and nodules, cysts, polyps, hyperplasia … migrant workers have exhausted their courage just by opening their year-end physical examination reports. On the 14th, the reporter interviewed experts from the Cancer Hospital affiliated to Chongqing University to teach you how to read the physical examination report and bring the correct way to open it.
Nodules: Nodules are not terrible, the key depends on the category.
Ma Huiwen, deputy director of the Department of Oncology, Cancer Hospital affiliated to Chongqing University, said that nodules refer to tangible localized round, oval or irregular substantive skin lesions, which are neither painful nor itchy.
In recent years, with the rapid development of medicine and more accurate examination equipment, the detection rate of pulmonary nodules, thyroid nodules and breast nodules is on the rise. Especially lung nodules and thyroid nodules, appear in the reports of many physical examination groups.
Nodules are not terrible, the key depends on the category. Whether it is lung nodule, thyroid nodule or breast nodule, the possibility of benign is the vast majority, which has no obvious influence on human body, so it is only necessary to observe without treatment. However, there are also some nodules that may be precancerous lesions or early cancer.
Pulmonary nodules: less than 5 mm, and low-dose CT can be reviewed every year.
Although pulmonary nodules are the scariest of all nodules. But first of all, it should be clear that pulmonary nodules are not equal to lung cancer.
The imaging manifestations of pulmonary nodules are focal, round-like, solid or sub-solid lung shadows with increased density, which can be isolated or multiple, without atelectasis, hilar lymphadenopathy and pleural effusion. Mainly divided into two categories: one is benign nodules or calcified nodules, and the other is nodules with uncertain nature.
Pulmonary nodule network diagram
Generally speaking, inflammation, tuberculosis, hamartoma and other diseases will also show small nodules. If the pulmonary nodule is less than 5 mm and is an isolated tiny nodule, only low-dose CT needs to be reviewed every year. If the nodule is 5-10 mm, it needs 3-6 months follow-up. Nodules larger than 10 mm, with burr and lobulated edges and uneven density inside nodules, can be clearly diagnosed by PET-CT and minimally invasive examination methods, and then treated according to the situation.
Even if it is highly suspected that the nodule is malignant, there is no need to panic. The success rate of early lung malignant tumor surgery can reach almost 100%, and the prognosis is good.
Thyroid nodule: Simple goiter is common.
In recent years, thyroid nodules are increasing year by year, and the increase in incidence depends largely on two factors: first, thyroid nodule disease is an age-related disease; Secondly, the existing population survey shows that the average life expectancy in most industrial countries is increasing. Generally speaking, the incidence of thyroid nodules in women is significantly higher than that in men, and simple goiter is more common in women.
Usually, thyroid nodules are found by neck color Doppler ultrasound, and TI-RADS will show how many grades the thyroid nodules are, so as to judge whether they are benign or cancerous. There are different ways to deal with different series:
Class 1-3: normal thyroid gland, diagnosable benign thyroid nodules, with a malignant risk of 0. If the nodule is large, it is recommended to follow up for half a year.
Class 4A: thyroid nodules with a certain possibility of malignancy, and the risk of malignancy is between 3% and 30%. Short-term (3-month) interval follow-up is recommended in clinic. Fine needle aspiration biopsy; If the biopsy result is negative, continue short-term follow-up.
Class 4B: thyroid nodules with fairly malignant potential, with a malignant risk ranging from 31% to 60%, and fine needle biopsy is recommended as the first choice in clinical practice; If the biopsy result is negative, repeat puncture at short intervals, or consider surgical treatment.
Class 4C: thyroid nodules with great possibility of malignancy, with the risk of malignancy ranging from 61% to 95%, and surgical treatment is recommended as the first choice in clinic; Surgical treatment after fine needle aspiration biopsy.
Category 5: Malignant thyroid nodules that can be diagnosed, with a malignant risk of > 94%, and immediate surgical treatment is recommended.
Category 6: Malignant nodules confirmed by pathology.
Breast nodules: 80% are mainly benign
Different types of breast nodules have different diseases. Breast nodules include proliferative nodules, neoplastic nodules, inflammatory nodules and so on. Specifically, breast nodules can be seen in various breast diseases, such as breast hyperplasia, breast cyst, breast fibroadenoma, plasma cell mastitis, breast cancer, etc. About 80% of them are mainly benign diseases.
The nature of nodules can be judged by BI-RADS classification of breast. The classification conclusions of 0 ~ 6 categories are made.
Class 0: Lesions cannot be evaluated comprehensively, and other imaging examinations are needed.
Class 1: negative signs, one-year follow-up.
Class 2: Considering benign changes, it is recommended to follow up regularly (once every June to December).
Category 3: Benign diseases are possible, but the follow-up period needs to be shortened (such as once every 3 to 6 months), and the proportion of malignant diseases at this level is less than 2%.
Category 4: Considering the possibility of malignant lesions (2%-95%), tissue biopsy is needed to further clarify. 4a: 3-8% malignant possibility, and follow-up for 6 months after obtaining benign cytological or histological examination results. 4b: Moderate quasi-malignant lesions, 9-49% malignant possibility. 4c: 50-94% malignant possibility, which does not represent the typical malignant characteristics of grade 5.
Category 5: highly suspected malignant lesions (almost identified as malignant diseases, > 95%), requiring surgical resection and biopsy.
Category 6: Malignant lesions confirmed by pathology.
It can be said that 0-3 categories can be judged as benign, and 4-6 categories need to be judged according to the actual situation. With this grading conclusion, the medical examiner can carry out physical management by combining his own medical history and signs.
Polyp: a benign tumor, some of which have a tendency to become malignant.
Ma Huiwen introduced that polyps may appear in many organs of the human body, such as nasal polyps, gallbladder polyps, stomach polyps, intestinal polyps and cervical polyps, but 80% of polyps occur in the gastrointestinal tract, especially in the colorectal region.
Some polyps occur because local mucosal tissues are stimulated by inflammation, and some are genetic mutations and genetic factors. In addition, the occurrence of polyps is also related to diet structure and living habits, for example, eating a lot of high-protein and high-fat foods, drinking alcohol for a long time, eating spicy irritants and so on. Polyp is a kind of benign tumor, and its recurrence rate is high, so it needs regular review, and some of them have the tendency of malignant transformation, which needs attention.
Intestinal polyp: The bigger the polyp, the higher the canceration rate.
Intestinal polyps are divided into non-neoplastic polyps and adenomatous polyps. Non-adenomatous polyps, such as inflammatory polyps and hyperplastic polyps, have little to do with the incidence of intestinal cancer. Adenomatous polyp is a recognized precancerous lesion. Studies have shown that more than 95% of colon cancer comes from colon adenoma, which is equivalent to a "time bomb". Of course, whether adenomatous polyp becomes cancerous is also related to the patient’s age, the number and size of polyps. Generally speaking, the probability of canceration of one or two polyps is not high, but the more the number, the higher the chance of canceration; The bigger the polyp, the higher the canceration rate. The canceration rate of polyps over 2 cm can reach 50%.
Intestinal polyp network diagram
Cervical polyp: Super soybean grain size can be minimally invasive resection.
Cervical polyps are the result of long-term stimulation of chronic cervicitis. Most of them are benign and have no obvious symptoms. A few patients will have bleeding symptoms similar to menstruation. Because cervical polyps will produce inflammatory secretions, it will destroy the vaginal physiological environment and reduce sperm vitality. Polyps will also form mucus plugs, which will prevent some semen from entering the uterus and affect pregnancy. If cervical polyps are found during pregnancy, they will slowly grow and bleed, which will affect the health during pregnancy.
Therefore, women should have regular gynecological examinations, and once cervical polyps are found, they should be treated under the guidance of a doctor. When the polyp is small, anti-inflammatory treatment can be taken first. If it exceeds the size of soybean, it can be removed by minimally invasive surgery. Pathological examination should be carried out after operation to confirm the nature of polyps and whether they are malignant. Like intestinal polyps, cervical polyps are easy to recur, so they should be reviewed regularly after operation.
Gallbladder polyp: adenomatous polyp larger than 1cm is at risk of canceration.
Gallbladder polyp is a polypoid lesion that originated in gallbladder, including cholesterol polyp, inflammatory polyp and adenomatous polyp, among which cholesterol polyp is the most common. Most patients have no clinical symptoms, and most of them find lesions during ultrasound examination. A few patients may have clinical symptoms, often manifested as recurrent right upper abdominal pain, radiation to the back, nausea, greasy, abdominal distension and so on. Gallbladder polyps are all benign diseases, but adenomatous polyps larger than 1 cm may be in danger of canceration and need to be surgically removed.
Nasal polyp: common benign tumor
Nasal polyp is a common benign tumor in the nose, which is mostly caused by long-term chronic inflammatory stimulation in the nose and is also related to heredity. Mainly manifested as increased nasal secretions, sometimes accompanied by sneezing, decreased sense of smell, severe nasal congestion, and even affect breathing and lead to hypoxia. When polyps are small, drugs can be used for local treatment, but surgery is the only treatment for growing nasal polyps.
Cyst: It can be regarded as a closed "blister"
Ma Huiwen introduced that cysts are also a benign disease, just like closed "blisters". The outer shell of the cyst is a fibrous cyst wall arranged by layers of cells with secretory function, and the cyst cavity is filled with clear colorless or yellowish, sterile and protein-rich cyst fluid.
Most cysts are formed for unknown reasons, both naturally and genetically. They are common in all parts of the body, and the common ones are liver, kidney and ovary. Small cysts generally have no clinical symptoms and are only found during routine physical examination without special treatment. However, when the cyst gradually increases, produces complications, and even tends to become malignant, it needs treatment.
Liver cyst: most of them will not become cancerous.
Hepatic cyst is a general term for all vesicular lesions that grow on the liver, and it is a common benign disease of the liver. There are more women than men, and the ratio of male to female is 1∶4. Its initial symptoms can begin at any age, but most of them occur at the age of 20 ~ 50, and most liver cysts will not become cancerous.
There are many types of hepatic cysts, such as congenital hepatic cysts, traumatic hepatic cysts, neoplastic hepatic cysts and inflammatory hepatic cysts. Usually, more than 90% of cysts are congenital hepatic cysts, and the hepatic cysts we usually say are also congenital hepatic cysts.
Bile cyst: slow growth, once a year, color ultrasound reexamination.
Most gallbladder cysts grow slowly, and their manifestations are different for everyone. They mainly show symptoms such as fullness after meals, loss of appetite, nausea and vomiting, and can also cause discomfort, dull pain or mild dull pain in the upper abdomen.
For simple hepatic cysts, abdominal color Doppler ultrasound is followed up regularly, usually once a year. When there are complications such as cyst rupture, pedicle torsion, intracapsular hemorrhage or huge compression of adjacent organs by cyst, the eater needs surgical treatment.
Ovarian cyst: Severe infertility.
Ovarian cyst is a kind of ovarian tumor. Here we talk about ovarian endometriosis cyst, which is also called "chocolate cyst" because its fluid is like chocolate. The most common symptom of chocolate cyst is pain, including dysmenorrhea, chronic pelvic pain, and acute abdominal pain. Another common hazard is abnormal menstruation, which can lead to infertility seriously, and a few of them will become malignant.
If the diameter is less than 5 cm, it is usually followed up for 3 months and then rechecked. If the cyst does not continue to grow up or disappear on its own, you don’t need to care too much; If the cyst does not disappear after half a year, or continues to grow, it should be treated according to the corresponding situation to further clarify its nature.
Network diagram of normal ovary and ovarian cyst
Renal cyst: More than 10cm in diameter requires surgical treatment.
Renal cyst can be divided into simple renal cyst and hereditary renal cyst. Simple renal cyst is the most common benign lesion with abnormal structure in adult kidney, which can occur unilaterally or bilaterally. The main manifestations are intermittent dull pain in the waist, abdomen and back, and severe hematuria, hypertension and renal insufficiency will occur. The diagnosis can be made by B-ultrasound or CT.
Asymptomatic simple renal cyst does not need treatment, but it is necessary to follow up regularly for 6 months to 1 year; When cysts with a diameter of more than 5cm will compress the surrounding tissues and cause urinary tract obstruction, it is necessary to perform cystic fluid aspiration and inject sclerosing agent into the cyst. For cysts with a diameter of more than 10cm, surgery is needed.
Network diagram of normal kidney and renal cyst
Breast cysts: 95% do not need special treatment.
In addition, breast experts from the Cancer Hospital affiliated to Chongqing University said that breast cysts can’t be regarded as breast diseases in a strict sense. 95% of breast cysts need special treatment, only regular observation, B-ultrasound every six months, and mammography every year for patients over 40 years old.
Hyperplasia: Pay attention to pathological hyperplasia.
Hyperplasia is divided into physiological hyperplasia and pathological hyperplasia. Physiological hyperplasia is sometimes beneficial to human body, and pathological hyperplasia is often harmful, but it does not mean that hyperplasia will definitely develop into cancer.
Bone hyperplasia: no discomfort and no special treatment.
X-ray examination often shows hyperplasia at joints, that is, "bone spurs", especially at cervical vertebrae, lumbar vertebrae and knee joints. Many elderly people think that bone spurs are diseases and find that they must be removed. Some people even listen to false advertisements and want to dissolve bones by taking medicine. Bone spur is usually considered as compensatory hyperplasia of human body, that is, it helps to support the body and stabilize the joints through hyperplasia. If it does not bring discomfort to the body, no special treatment is needed.
Prostatic Hyperplasia: No Evidence of Transformation from Benign Hyperplasia to Cancer
Most of the early BPH can be treated conservatively, and the effect is very good. There is no evidence of the transformation from benign prostatic hyperplasia to prostate cancer.
Breast hyperplasia: neither inflammation nor tumor.
Breast experts at the Cancer Hospital affiliated to Chongqing University said that mammary gland hyperplasia is a "popular disease", and there is no need to panic when it is detected by physical examination. Many people who are labeled as "mammary gland hyperplasia" do not really have breast diseases. About 70%~80% of women have mammary gland hyperplasia to varying degrees, mostly at the age of 25~45.
Hyperplasia is a phenomenon that the number of cells increases through division and reproduction. Hyperplasia in breast tissue is called breast hyperplasia, physiological hyperplasia and pathological hyperplasia. Physiological hyperplasia means that women may have periodic pain in one or both breasts before menstruation, and the pain disappears naturally after menstruation, which does not interfere with life, study and work. It is a normal physiological phenomenon and has nothing to do with tumors, and generally does not require medical treatment. Pathological hyperplasia, simply speaking, is sick, which requires a diagnosis from a doctor specializing in breast, and a biopsy to find out the extent of hyperplasia, whether it is general hyperplasia or atypical hyperplasia.
Does physiological hyperplasia not become cancerous? Mild hyperplasia of mammary glands has nothing to do with cancer, but it is caused by the long-term high estrogen level in women’s internal environment and stimulation of mammary duct, which is neither inflammation nor tumor.
If breast hyperplasia is serious, or accompanied by cysts, it is best to go to the hospital once every six months to prevent malignant transformation of benign breast diseases.
If it is "atypical hyperplasia", the chance of canceration is four times higher than that of the general population. If it is found during physical examination, it should be checked in the hospital regularly. Of course, women don’t have to worry too much. Breast hyperplasia does not mean the early stage of breast cancer.
There is no definite and effective treatment for hyperplasia of mammary glands. Some patients can often relieve themselves several months to 1-2 years after onset, and most of them do not need treatment. Patients with obvious symptoms and a wide range of lesions, those with severe pain, have affected their daily work and sleep, so they can take drugs under the guidance of professional doctors.
Upstream journalist Zhu Ting
