People are not confused at forty, and they also begin to have a midlife crisis. The child is half a year old and begins to rebel; the partner has long since lost its freshness, and the relationship between husband and wife is in danger: the parents are old and about to enter the autumn of illness.
In a few years, some people will find out that they have cancer, which is even worse.
If people want to survive the midlife crisis, there is an important premise, that is, they must live healthily.
If you want to live healthily, you need to have regular medical examinations.
Now, many hospitals and physical examination centers will provide some physical examination packages, but due to money reasons, some valuable examinations are likely not to be routinely included.
Today we will talk about the necessary examination of these middle-aged people.
1. Low-dose thin-layer CT scan of the chest.
We can often see who and who, every year to do physical examinations, chest X-ray, but recently found out that there is lung cancer, it is already advanced!
Why do I take a chest X-ray every year, but I can't find early lung cancer?
Lung cancer is the number one and highest incidence of cancer in the mainland.
The most painful point is that the discovery of lung cancer in mainland China is relatively late.
Lung cancer this disease, early detection, the treatment effect is very good, to the middle and late stages to find out, the treatment effect is very bad.
What kind of treatment effect can be achieved in the early detection of lung cancer?
I saw a large sample of statistics showing that the 5-year survival rate of stage Ia lung cancer can reach 80% to 90%, and the 5-year survival rate of Ib lung cancer can reach 70%.
A 2006 new England Journal of Medicine reported that clinically stageD I lung cancer detected by low-dose CT screening had an estimated 10-year survival rate (non-5-year survival rate) of 88% after treatment.
Don't underestimate this number, this is almost comparable to the ten-year survival rate of the best cancer, papillary thyroid cancer.
You know, Int J Cancer. 2014 Sep 20 (International Journal of Cancer) According to statistical reports, the five-year survival rate for lung cancer in mainland China is 16% and in the United States is 17%. It looks pretty much the same. However, the average age of onset of lung cancer patients in the United States is 67 years old, while the average incidence of lung cancer patients in China is 40 to 50 years old, which is still very different.
Therefore, lung cancer is internationally recognized as one of the four most screening cancers. (The other three are colorectal, cervical, and breast cancer.) Today, we will talk about the initial screening of lung cancer. ）
Early-stage lung cancer, which usually has no symptoms, requires screening to detect it.
Screening for lung cancer is mainly done by two means: chest x-ray and chest CT.
1. Chest x-ray.
We used to use chest x-rays as a means of screening for lung cancer, although the current chest x-rays, which most hospitals have used computers to assist in imaging, will be clearer.
However, due to the large blood vessels in the chest cavity, if the tumor is in the mediastinum and the back of the heart, it is difficult to find the tumor on chest x-ray.
The resolution of the chest x-ray is also not enough to find nodules smaller than one centimeter.
Therefore, according to the literature, about half of lung tumors with a diameter of less than 2 centimeters cannot be found on chest x-ray. Therefore, chest x-ray as an early screening for lung cancer is not ideal.
There are more people with tuberculosis in the mainland, and there are very few people under the age of 30 who will have lung cancer, (The average age of onset of lung cancer patients in the United States is 67 years old, but the average incidence of lung cancer patients in China is 40 to 50 years old. Therefore, as a routine physical examination, chest x-ray is still one of the necessary tests.
Therefore, we recommend that people under the age of 40 can still choose chest x-ray for routine physical examination.
2. Low-dose thin-layer CT scan.
In 2011, the NEJM medical journal published the advantages of low-radiation tomography, and also found that 80% of the lung cancers detected in the screening were earlier lung cancers, which could reduce lung cancer mortality by 20%.
When you scan your lungs on a CT scan, you should hold your hands on the top of your head.
During a low-dose thin-layer CT examination, the doctor reduces the dose of the X-ray tube output, and the amount of radiation received by the natural human body is reduced.
Its radiation dose is about 1/6 to 1/10 of the traditional chest CT dose (about 5 to 7 mSv), but it is not inferior to traditional chest CT in the function of finding small nodules in the lungs.
Some scholars have reported that it is estimated that a low-dose thin-layer lung CT scan is equivalent to about 1.3 ~ 2 of taking a chest orthostatic plus lateral chest x-ray. 2 times, the U.S. literature statistics (mainland did not find, maybe no one studied these. Their per capita background radiation is 3.6 mSv. Judging from the radiation dose, a low-dose thin-layer lung CT scan is still safe.
With current CT imaging technology, low-dose thin-layer CT scans can find lung nodules with a diameter of 0.2 cm, of course, the larger the nodules, the easier it is to find. As mentioned earlier, the nodule of our colleague's lungs is only 0.7 centimeters in diameter. Such an early detection of lung cancer, the treatment effect will definitely be good.
However, there is no one-size-fits-all solution in medicine, and low-dose thin-layer CT scans also have the following problems that have not been well solved:
1, this kind of examination is too sensitive. This can lead to false-positive results.
Some people have a nodule in their lungs and, if they don't know it, may be fine for a lifetime. But if you check it, if you know, if you don't have surgery, if you still have to track, some people are afraid, then the day will be sad. Many patients with lung nodules often require CT-guided biopsy or surgery to confirm the diagnosis, which can also cause harm to the patient.
2. It will also cause the problem of over-diagnosis and over-treatment.
Data from a foreign study show that after using low-dose thin-layer CT for screening, the detection rate of small nodules in the lungs increased by 3 times, but the surgical rate of small nodules in the lungs increased by ten times.
Fortunately, the current thoracoscopic technique is widely used in the operation of small nodules in the lungs, the operation is becoming more and more minimally invasive, in order not to miss the early lung cancer, I think that appropriate overtreatment, or worth it.
After all, the trauma of thoracoscopic surgery is relatively small.
3. Repeated CT scans may make healthy people increase the chance of lung cancer because of radiation.
Because screening needs to be done every year, if there is a small nodule tracking, CT should be reviewed once every 3 to 6 months.
That is to say, low-dose thin-layer CT scans also have some harms that cannot be avoided, so not everyone is suitable for and needs to do it. Only by strictly mastering the indications can we maximize the benefits of doing CT and minimize the damage.
At present, the consensus of the medical community is that the general population in China, starting from the age of 40, (unlike in the United States. The first lung cancer screening for low-dose thin-layer CT is done.
Such screening, at least once every two years.
Here are those at high risk of lung cancer:
1. People who often smoke and smoke second-hand smoke.
2. People who have been in the working environment of air pollution, oil smoke and exposure to chemical substances for a long time.
3. People with a family history of lung cancer.
4. People who have received radiation therapy in the chest cavity.
5. Those who have had tuberculosis or other chronic inflammatory diseases of the lungs (such as chronic obstructive pulmonary disease, pulmonary fibrosis).
For high-risk groups, the age should be lowered, and it is recommended to screen once a year to two years and do low-dose chest CT.
Cancer cells grow exponentially after cell division, and because lung cancer multiplier growth times vary greatly (from 32 to 1,000 days), it is possible that new cancers will occur in the time between tests.
Based on the theory of cancer multiple growth, the detection rate of T1 tumors (referring to tumors less than 3 cm) can be detected in annual screening, and if it is only checked once every two years, the detection rate of T1 tumors is reduced to 78%.
So even if you screen once a year, there may be unexpected situations. However, in order to consider the economic cost and the damage of radiation to the human body, it is not recommended to do multiple screenings a year for high-risk groups (small nodule follow-up observation is not counted).
We also do not recommend that lung cancer screenings be screened for more than 2 years in high-risk populations.
If small nodules are found on initial CT screening and surgery is not performed for the time being, a low-dose thin CT screening is required over 3 to 6 months.
Tumor indicators, bronchoscopy, MRI, PET, puncture cytology and other examination methods related to lung cancer are mostly used as further examinations after preliminary screening.
2. Gastroscopy and colonoscopy.
People are middle-aged, if you have not yet done a colonoscopy and gastroscopy, I suggest that you try to arrange to do it as early as possible.
The main purpose of colonoscopy is to prevent colon cancer.
Colon cancer has the characteristics of the disease itself, more than 85% of colorectal cancer is transformed from large intestinal polyps (the statistics of mainland Taiwan scholars are 90%), that is, early detection and treatment of polyps can prevent more than 85% of colorectal cancer.
Colorectal polyps and early colorectal cancer tend to be asymptomatic, but can often be detected by screening.
From colorectal polypoidoma to bowel cancer, it takes 5 to 10 years to evolve, that is, even if your genetic genes for colorectal cancer have been activated, you have developed a colorectal adenoma, and you are likely to suffer from bowel cancer in the future, but as long as you follow the current medical advice, check the colonoscopy in time, and remove the colorectal adenoma under the colonoscopy, you can remedy it successfully. You will not have bowel cancer in the future!
Colorectal cancer screening can often find colorectal polyps or early colorectal cancer, at this time, often can reach a very good therapeutic effect, it is possible to achieve clinical cure.
Even if colorectal cancer is found relatively late, such as colorectal cancer liver metastasis, there will still be a better treatment effect, of course, the earlier colorectal cancer is found, the better the treatment effect.
That is to say, the screening of colorectal cancer, from polyps to adenomas to early colorectal cancer to intermediate and advanced colorectal cancer, as long as the screening can be found, at any stage, it can be found earlier than the symptoms, and the treatment effect is better, which is the meaning of colorectal cancer screening.
Screening for colorectal cancer can be divided into general populations and high-risk groups.
The general population refers to people who are asymptomatic, have no family history, and have no other risk factors. (If the general population has symptoms, diagnostic tests are done and are not included in the screening.) The general population is not screened under the age of 50, and the over-50 year old is screened.
A. Stool occult blood test is preferred, once a year for 3 consecutive days, and one stool specimen is sent for testing every day. If there is more than one positive result in the stool occult blood test, 3 specimens, then colonoscopy should be done.
Stool occult blood test results and procedures in the general population.
B. Starting at the age of 50, be sure to do a colonoscopy. The starting process is as follows:
Colonoscopy (colonoscopy) in the general population
C. Simulated colonoscopy (CT colonoscopy), the sensitivity is as high as 90-98%, the examination results are relatively poor compared to colonoscopy, the price is expensive, and the intestines are also prepared, only do the re-screening method for patients who are unwilling to colonoscopy.
D. Barium colonography. Some people are reluctant to do a colonoscopy, some places do not have colonoscopy, there is no CT colon imaging technology, barium barium colography can be partially replaced.
Don't laugh at me, I'm telling the truth. In many county-level hospitals in many places in the northwest of the mainland, there are really many hospitals that will not have the last two examinations. We must face reality and come up with a methodology.
High-risk groups include:
(1) Previous history of colorectal cancer and colorectal polyps or adenomas;
(2) First-degree relatives have a history of colorectal cancer, and the age ≥ colorectal cancer patients are 10 years old;
(3) Family members with hereditary non-polyposis colorectal cancer, age ≥ 10 years;
(4) First-degree relatives have a history of familial adenoma, and the age ≥ 10 years;
(5) Gallbladder removal of more than 10 years; (6) history of radiation in the lower abdomen for more than 10 years;
(7) Have a history of chronic schistosomiasis;
(8) Those with the following two or more items: a, chronic diarrhea; b, mucus bloody stool; c, chronic constipation; d, chronic appendicitis; e, history of mental stimulation; f, history of biliary tract disease.
The screening process for high-risk groups is as follows:
Screening process for high-risk groups
We also in the clinic, often encounter some people in the routine physical examination, ignore the routine examination of stool, often people do not leave stool, so missed a very good opportunity to screen for colorectal cancer.
3. Female breast molybdenum examination.
It is currently believed that women start at the age of 40, have an annual breast palpation plus breast B ultrasound, and do molybdenum target photography every two years. Women at high risk of breast cancer, starting from the age of 30, check breast palpation once a year plus breast B ultrasound, and do a molybdenum target photography.
People at high risk of breast cancer refer to people with the following risk factors:
1. The first menstruation comes early, and it is generally believed that menstruation comes early at the age of 11.
2. Late menopause, it is generally believed that 55-year-old menopause is considered to be late.
3. Late marriage and late childbirth (the first child is born after the age of 30. )
4. Long-term use of contraceptives, it is generally believed that eating contraceptives for more than 5 years is considered to be long-term eating contraceptives.
5. Use estrogen for more than four years.
6. Have a family history of ovarian cancer, breast cancer and endometrial cancer.
Women under the age of 35 are most suitable for breast ultrasound examination.
Breast ultrasound examination.
Breast ultrasound is a non-invasive, radiation-free examination.
Young women, especially women in non-high-risk groups younger than 35 years of age, may be more affected by radiation and should generally not be assessed by mammography.
Ultrasound testing is therefore preferred for women under 35 years of age. For a clearly felt mass, its possible diagnosis includes: breast cancer, benign fibroadenoma, breast lobular hyperplasia, etc., for typical cases, ultrasound B is easy to make a diagnosis, and its accuracy is even higher than mammography.
Young women's breast glands are dense, and ultrasound B can often find lumps that cannot be found by mammography.
Therefore, if mammography shows that the patient's breast tissue is relatively dense, ultrasound examination is an indispensable auxiliary examination. Ultrasound can also be used for guided fine needle aspiration cell examination or coarse needle tissue biopsy.
For women over the age of 50, the molybdenum target is the best screening tool for breast cancer.
Mammography of the mammary glands.
Mammography of irregular masses or dense irregular microcalcification spots may indicate an early breast cancer focus that can be removed using stereoposition.
Sub-molybdenum-target manifestations of breast cancer.
Mammography can reveal small calcification foci of the breast, most of which are benign lesions; but some of which are malignant breast cancer.
Because the molybdenum target can find small calcification foci, breast cancer can be detected early. After surgery, patients with early breast cancer have an excellent prognosis and hardly affect normal lifespan.
Breast B ultrasound and mammography have their own advantages in the diagnosis of breast diseases, and the two complement each other to detect untouchable early breast cancer.
In this way, breast cancer patients can be detected early, the treatment effect is good, and the cost is small; early breast cancer can also preserve the breasts, retain the perfect figure of women, and be a woman very good!