Traditional Culture Encyclopedia - Traditional festivals - Physical examination reports frequently appear "nodules". What exactly is a nodule? How far is it from cancer?

Physical examination reports frequently appear "nodules". What exactly is a nodule? How far is it from cancer?

I'm afraid it will take me half a day to explain this topic in a simple sentence. Nodules are small soft tissue masses, and large ones are called masses. As for what it is, it is closely related to its position, size and shape. Let me take the nodules in the three most common locations as examples to explain.

First, breast breast nodules are actually morphological changes on the breast imager, which is only a reality, not the disease itself. In fact, many cases can be called breast nodules, such as breast hyperplasia, breast cyst, breast fibroadenoma, plasma cell mastitis, breast cancer and so on.

Why are there breast nodules?

In fact, there are many reasons for breast nodules, such as endocrine factors, ovary, thyroid gland, hypothalamus and so on. They mainly maintain women's secondary sexual characteristics and developmental function, which will lead to hormone secretion disorder; In addition, with the development of society, the pressure on women is increasing, such as late pregnancy and late childbirth, and bad eating habits. , will affect the endocrine. If endocrine disorders, it will cause breast nodules.

So, how to distinguish between benign and malignant breast nodules?

Generally speaking, breast nodules are benign with a probability of about 80%, but it should be noted that if the ultrasound shows that the echo of the mass is uneven, the boundary is unclear, there are obvious blood flow signals, the edge is irregular, it shows burr-like or crab-foot-like changes, and there are clustered micro-calcification, these are typical and special breast cancers; Self-examination should also be done in life, such as the lump feels hard, has no pain, has poor mobility, a single lump, has a family history of breast cancer, and has a fast growth rate, so we should be vigilant. This is the case with malignant nodules of breast.

How should breast nodules be examined? What should I do if I find breast nodules?

B-ultrasound is a commonly used screening method, which is widely used in clinic. It can find very small masses, clearly distinguish the size, shape, cystic solidity and clear boundary of the masses, and roughly judge whether the masses are benign or malignant. Molybdenum target is more sensitive to calcification, and it is also an important means to screen breast nodules. Breast MRI can analyze benign and malignant tumors more objectively and clearly. After screening breast nodules by imaging examination, it is necessary to analyze the family history and clinical symptoms of the patients, and if necessary, it is necessary to conduct breast nodule biopsy to further clarify the nature and treat the symptoms.

Second, the thyroid gland in China, thyroid nodules have become a "high-frequency word" in the physical examination report. 20 10 "The First Epidemiological Survey of Thyroid Diseases among Community Residents in Ten Cities in China" announced that the prevalence of hypothyroidism was 6.5%, and the prevalence of thyroid nodules was as high as 18.6%.

When a thyroid nodule is detected, the first feeling must be panic. After all, there are things that should not exist. Who knows if it has anything to do with cancer? In fact, only 7% 15% of thyroid nodules are malignant lesions, and the vast majority of thyroid nodules are benign.

So, how to distinguish between benign and malignant thyroid nodules? What should I do if I find thyroid nodules?

Ultrasound examination is preferred.

Medical data show that in China, the prevalence of thyroid nodules found by palpation in the past only accounts for 3%-7% of the population, but now the detection rate of thyroid nodules can reach 20%-70% by high-definition ultrasound.

With the appearance of ultrasound and color Doppler ultrasound in the middle of last century, the diagnosis of thyroid diseases has undergone revolutionary changes. Especially in recent years, thyroid high-frequency ultrasound technology can not only clearly show thyroid anatomical structure, hemodynamics, microcirculation perfusion and other manifestations, but also find tiny nodules of 2-3 mm. At the same time, it provides a lot of valuable information for accurately distinguishing thyroid colloid retention from solid masses and judging whether solid masses are necrotic.

Therefore, thyroid ultrasound examination is the first choice for patients with thyroid nodules, and it is also a necessary item.

Generally speaking, the sonographic features of malignant nodules can be shown as follows:

Solid hypoechoic nodule with unclear boundary and irregular shape;

Aspect ratio1;

Small calcification or punctate calcification can be seen in some nodules.

Color Doppler ultrasound showed that blood flow signals were scarce or abundant.

Puncture biopsy is performed if necessary.

Some nodules are difficult to be identified by B-ultrasound, and further puncture biopsy is needed.

Fine needle aspiration biopsy (FNAB) is the most commonly used method for preoperative qualitative diagnosis of thyroid nodules.

The guidelines for 20 15 thyroid nodule puncture made by American thyroid association (ATA) are as follows:

For suspected malignant nodules, preoperative fine needle aspiration biopsy can reduce unnecessary operations and guide the next treatment plan.

Self-symptom that cannot be ignored

(1) Thyroid nodules existed for many years, and increased significantly within one month;

(2) Symptoms of oppression, such as hoarseness or dyspnea;

(3) The activity of thyroid nodule is poor, and it hardly moves up and down when swallowing;

(4) Cervical lymphadenopathy.

Thyroid nodules don't have to be "cut"

Most thyroid nodules are benign, and not all thyroid nodules need to be removed. According to the doctor's appraisal, only a few thyroid nodules need surgery. Most benign thyroid nodules do not need special treatment, but only need regular follow-up for half a year to one year.

Only when the nodules cause local compression symptoms, such as compression to the respiratory tract and esophagus, hyperthyroidism, progressive growth of nodules, tendency to malignant transformation, and mental anxiety of patients affecting normal life, will surgical resection be considered.

Moreover, at present, the medical community believes that even if thyroid cancer is diagnosed, surgery is not necessarily needed. For example, papillary thyroid cancer, the most common thyroid cancer, is actually a very slow-developing cancer. Many top hospitals, including Mayo Clinic and Memorial Caitlin Cancer Center in Si Long, believe that surgical removal of this cancer may do more harm than good. Their suggestion is that for small and low-risk papillary thyroid carcinoma, active monitoring can be taken.

Combined with the above, thyroid nodules are common, but the malignant ratio is low. The nature of thyroid nodules can be identified by B-ultrasound and puncture. For most benign thyroid nodules, surgery is not needed.

3. A pulmonary nodule is a small round or oval lump in the lung. Its diameter is less than 3 cm. Any growth larger than 3 cm is no longer called a pulmonary nodule. This is a lung mass, which is more likely to be cancer. Most pulmonary nodules are found by accident in routine imaging examination, such as chest X-ray or CT scan. Most nodules are benign (non-cancerous). However, some risk factors, such as smoking history, age and other cancers currently diagnosed, increase the chances of nodule canceration. About 910 of pulmonary nodules with a diameter less than 2 cm are benign.

Causes of pulmonary nodules

Lung nodules are divided into two categories:

1. Malignant tumor (cancer)

2. Benign (non-cancerous)

Most nodules smaller than 2 cm are benign. These nodules are probably caused by infection. The pulmonary infection that causes pulmonary nodules can be bacterial infection or fungal infection. Mycobacterium tuberculosis or Mycobacterium intracellulare is an example of bacterial infection. Aspergillus and histoplasmosis are examples of fungal infections. These infections cause lung irritation, which can lead to the development of granuloma. Granuloma is a mass of cells formed by inflammation caused by lung infection, just like scar tissue. As the tissue heals, these granulomas gradually calcify (calcium aggregation). In imaging, it can be manifested as pulmonary nodules. These may manifest as single or multiple pulmonary nodules.

Benign pulmonary nodules have other non-infectious causes. Such as sarcoidosis and rheumatoid arthritis. These disease processes may also lead to granuloma. Other abnormal growths, called tumors, can develop in the lungs. Examples of benign pulmonary hyperplasia are:

Fibroma (connective tissue mass)

Hamartoma (abnormal grouping of normal tissues)

Embryoblastoma (immature cell mass)

Neurofibroma (nerve tissue mass)

All these are either aggregated tissues or cells that develop into benign nodules in the lungs.

Malignant nodule is a kind of cancer that occurs in the lungs. For example:

lung cancer

lymphoma

Benign tumor malignant transformation

sarcoma

Cancer can spread from other primary cancers in the body to the lungs. For example, colon cancer or kidney cancer can spread to the lungs. This is called lung metastasis, which manifests as pulmonary nodules.

symptom

Pulmonary nodules are usually asymptomatic. That's why you didn't know, until it was found in the image inspection. If the nodule is large, or lung cancer, the patient may have a new cough, hemoptysis, feeling tired or losing weight unintentionally. Usually, if the nodule is less than 3 cm, even lung cancer has no symptoms.

diagnose

When pulmonary nodules are found, they are usually found by imaging examination of another problem. Such as preoperative symptoms of lung infection or standard chest X-rays. Once found, your doctor will know your medical history. This includes whether you are exposed to the following environments:

Do you smoke?

Have you ever had cancer?

Exposure to chemical or environmental toxins.

If the nodule is benign, no further follow-up is needed. If the nodule is cancer, depending on the type of cancer, more treatment plans are needed.

"Nodules" often appear in physical examination reports, such as thyroid nodules, breast nodules, lung nodules and liver nodules. Many people are very scared when they see the word "nodule", which is directly related to cancer, thus causing serious psychological burden on themselves. This kind of worry is understandable and reasonable, because many tumors start in the form of "nodules". However, it should be noted that "nodule" is only a description of medical images, not a clinical diagnosis. Whether this abnormal finding of medical imaging examination is a tumor or not needs a comprehensive analysis and judgment by clinicians combined with other clinical data. The probability of malignant transformation of nodules in each organ is different.

Generally speaking, most nodules are benign, and malignant nodules only account for a small part. 95% of the most common thyroid nodules in women of childbearing age are benign nodules, and only 5% are malignant. Consider the risk of cancer.

China is a big country of tobacco consumption, and besides smokers, a large number of people in China are exposed to second-hand smoke. Tobacco is a risk factor for lung cancer. Lung cancer screening is very important in China. Some people can find pulmonary nodules in chest CT screening. Pulmonary nodules can be divided into benign and malignant, and 70% pulmonary nodules are benign, which may be caused by inflammatory lesions, fibrous nodules, tuberculoma, hamartoma and so on. Whether it is benign or malignant depends on the shape, density and size of the nodule.

In a word, nodules are descriptive reports of imaging. It is most important to distinguish benign from malignant nodules after physical examination. Doctors need to comprehensively evaluate the benign and malignant tendency of nodules based on more clinical data. When some nodules cannot be determined only from the imaging description, CT or puncture biopsy is needed. Even if benign nodules are considered, regular follow-up and review are needed to be alert to the malignant transformation of nodules.

With the emphasis on physical examination, more and more people choose annual physical examination. It is also because of the popularity of physical examination that many healthy people are diagnosed with pulmonary nodules and begin to worry. It seems that I will be fine without a medical examination. Nodules were found as soon as the physical examination, and I was always worried about what the nodules would have to do with cancer. Next, I will take pulmonary nodules as an example to explain some nodules to you.

What do we need to know about pulmonary nodules?

Pulmonary nodules mainly refer to round and dense lung shadows found by CT and X-ray examination. Those with a diameter greater than 3cm are called lung masses, and those with a diameter less than 3cm are called lung nodules. If the diameter is less than 1cm, it is also called a small nodule.

What causes can lead to pulmonary nodules during physical examination?

There are many reasons for pulmonary nodules, such as bacterial infection, fungal infection, tuberculosis, hemangioma, hamartoma and other diseases can also cause pulmonary nodules. Of course, malignant tumors, such as primary lung cancer and tumors in other parts, will also have pulmonary nodules when they metastasize to the lungs.

Moreover, clinical data show that less than 5% of pulmonary nodules may be malignant tumors, so don't worry too much after finding pulmonary nodules.

How to evaluate the benign and malignant lung nodules?

As I said just now, less than 5% of pulmonary nodules are malignant. Now let's see what the doctor said about pulmonary nodules.

Doctors generally judge nodules according to their size, density and shape. If the nodule is calcified and has high density, it may be a benign nodule; If the nodule is less than 5cm, there are also clinical data showing that there is basically no possibility of deterioration of this kind of nodule; But most nodules need dynamic observation.

This is a malignant tumor, that is, a group of "unruly" cancer cells, which often divide quickly, so continuous dynamic observation can help doctors judge whether the nodule is benign or malignant. If a lung nodule is 5-8mm, but there is no change after 2-3 years of continuous follow-up, the possibility of subsequent nodule deterioration is relatively low.

Then, if some nodules are large, but they can't be completely judged as malignant, it may be necessary to obtain the tissues in the nodules through bronchoscopy and puncture, make pathological diagnosis and see the malignant degree of the nodules.

Another possibility is that the doctor may arrange surgical resection directly when he sees that the nature of the nodule is not very good.

In fact, when you see this, you may find that the doctor's judgment is very complicated after the physical examination finds pulmonary nodules. However, most pulmonary nodules are benign, so don't worry about seeing pulmonary nodules found in physical examination. At the same time, we also need to be vigilant. When pulmonary nodules are found, we also need to go to the hospital in time to ask a doctor to help us judge the nature of the nodules and decide how to deal with you in the future.