Cancer experts warn: If these words appear in your medical report, it may be cancer! But...

Nowadays, everyone attaches great importance to physical examinations. After getting the physical examination report, if the following words appear, you should be alert as it may be a malignant tumor (cancer). See a specialist for further examination, exclusion or diagnosis.

But it should be noted that this is only a preliminary reminder, and its purpose is to draw everyone's attention, rather than simply concluding that the person has cancer based on the preliminary report description. Simply jumping to the conclusion that the person has cancer is the worst choice.

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The examinations usually performed in routine physical examinations mainly include: laboratory tests including the three routine tests (blood routine tests, urine routine tests), biochemical tests, tumor markers, etc.; imaging tests including ultrasound (color Doppler ultrasound) and CT. Physical examinations generally do not start with magnetic resonance imaging, PET-CT and other tests; endoscopy includes esophagogastroscopy, colonoscopy, etc. Physical examinations generally do not start with bronchoscopy and other tests, so the following analysis is mainly from three aspects.

Cancer "clues" hidden in laboratory tests

1. Blood routine test

This is a very routine examination, not for checking cancer. A normal blood test does not mean that you do not have cancer, and a normal blood test is possible even if you have cancer. However, some abnormalities in the blood test may indicate a malignant tumor, so further examination is necessary .

Routine blood tests mainly include white blood cells, red blood cells, and platelets. If these indicators are abnormal (increased or decreased), there will be an upward or downward arrow to indicate this in the test report. Many people get worried when they see the arrows. In fact, there are many reasons for the abnormality of these indicators, including physiological reasons and sometimes test errors.

If it is only a slight increase or decrease, don't worry too much. If you are concerned, you can consult a doctor, who will analyze the situation based on many other factors.

If there are obvious abnormalities, such as a significant increase in white blood cells accompanied by a decrease in hemoglobin (anemia) and thrombocytopenia (easy bleeding), you should be alert to acute non-lymphocytic leukemia and chronic myeloid leukemia; if the white blood cells, mainly lymphocytes, are significantly increased, you should pay attention to rule out the possibility of lymphocytic leukemia.

Simultaneous decreases in white blood cells, red blood cells, and platelets (trilineage decrease) occur in all types of acute leukemia.

In addition, non-hematological malignancies sometimes also cause a significant abnormal increase in white blood cells.

Elevated platelet counts are also seen in non-hematological malignancies such as lung cancer and colon cancer.

Many cancers may cause low hemoglobin (anemia) when they develop to a certain extent.

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2. Blood biochemistry

It mainly includes liver and kidney function, blood sugar and blood lipids, myocardial enzymes, electrolytes, etc. This examination is certainly not for cancer detection, but abnormalities in certain indicators should also alert you to the possibility of cancer and further examination is necessary.

Abnormalities in liver function transaminases and bilirubin usually indicate problems with the liver, kidneys and pancreas, including malignant tumors. However, it should be noted that the liver has a strong compensatory capacity. In other words, the liver may have obvious problems but the liver function may still be normal. Therefore, do not assume that normal liver function means there is no problem with the liver, and certainly not that you do not have liver cancer.

For abnormal liver function indicators, further examination is required to rule out liver, gallbladder and pancreatic diseases, including malignant tumors such as liver cancer, bile duct cancer and pancreatic cancer.

The same is true for kidney function. Normal kidney function does not mean that there is no tumor. As long as one of the two kidneys is normal, the kidney function of the blood draw can be completely normal. If the kidney function is obviously abnormal, of course further examination is required to find the cause, including abnormal kidney function caused by malignant tumors (which is actually not very common).

If alkaline phosphatase is significantly elevated, pay attention to rule out bone tumors (including primary bone tumors and bone metastases from other cancers) and liver tumors.

Blood calcium is elevated and bone destruction occurs due to tumor bone metastasis, which may also increase blood calcium.

Lactate dehydrogenase (LDH) is also non-specific. As far as tumors are concerned, it may be significantly elevated in a variety of blood and lymphatic system tumors, such as leukemia, lymphoma, and multiple myeloma. It is related to tumor proliferation and infiltration, severity, and tumor burden, and can be used to assist in diagnosis, efficacy monitoring, and prognosis evaluation.

In fact, these tests are not specific, so don't simply equate their abnormalities with cancer.

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3. Tumor markers

As the name suggests, the relationship between tumor markers and tumors is relatively more specific than the above biochemical indicators, but they cannot be simply matched . In fact, the increase of these so-called tumor markers does not necessarily mean that you have cancer, and people with cancer can also have normal tumor markers.

Nowadays, these tumor markers are basically checked during physical examinations. In fact, I do not recommend excessive checking of these tumor markers, especially for non-tumor high-risk people under the age of 40. Checking these indicators frequently does more harm than good, because many people will have slight increases, which will cause anxiety, entanglement and even panic, and thus lead to unnecessary excessive imaging examinations such as CT.

If a physical examination reveals elevated tumor markers, it is recommended that you consult an oncologist. The doctor will analyze the specific situation based on a variety of factors. Some may only require regular follow-up examinations , while others may require further targeted examinations. The worst thing to do is to simply assume that you are in the right situation.

Cancer "clues" hidden in imaging examinations

1. Ultrasound examination

That is what everyone calls B-ultrasound and color ultrasound, which are very common in physical examinations and are mainly used for examinations of the thyroid gland, superficial lymph nodes, breast, heart, liver, gallbladder, pancreas, spleen, urinary system (kidneys, ureters, bladder, prostate, etc.), female uterus, ovaries, and fallopian tubes.

If the following words appear in the ultrasound examination report, be alert to the possibility of malignant tumors: low echo or very low echo, solid nodules, rough edges (angled, burred, etc.) or unclear edges, irregular shapes, aspect ratio greater than 1, tiny calcifications (gravel-like calcifications), rich blood flow signals, etc.

But remember not to simply take it for granted.

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In fact, ultrasound reports for thyroid, breast, etc. usually give RADS grades , which are the ratings given by ultrasound doctors based on the above information:

Grade 1 and 2 are benign, so don’t worry;

Level 3: Most cases are benign, so there is basically no need to worry. However, a very small number of cases may be malignant, with a malignancy probability of less than 2%. Regular follow-up examinations are required.

Level 4: The possibility of malignancy increases. It is a suspected malignant nodule (malignancy probability is about 2-95%), divided into 4a, 4b, and 4c levels. The possibility of malignancy increases step by step. It is usually recommended to undergo a puncture biopsy for pathological examination to confirm the diagnosis.

Level 5: The possibility of malignancy is extremely high, exceeding 95%, and a biopsy should be performed as soon as possible to confirm the diagnosis;

Grade 6 is a malignant tumor that has been pathologically confirmed.

So just by looking at this classification you can have a rough idea. Of course you need to consult a specialist for further advice. This is just to give you a preliminary impression.

2. CT scan

CT scans are rarely performed during routine physical examinations and are mainly used for lung cancer screening. Lung CT scans can detect three main types of lung nodules: solid nodules, partially solid nodules, and ground-glass nodules.

Among the three, solid nodules are relatively the safest, followed by ground glass nodules, and partially solid nodules are relatively the most dangerous . For solid nodules that have not changed (stable) for two years of follow-up examinations, or glass nodules and partially solid nodules that have shrunk or disappeared naturally, they are basically benign nodules and do not need to be worried too much, but it is still necessary to continue follow-up examinations. However , if the lung nodules have burrs, irregular edges, fast growth, and solid components inside the ground glass, it is necessary to highly suspect the possibility of malignancy .

This mainly refers to primary lung cancer, but if it is lung metastasis from other cancers, such as lung metastasis from colon cancer, the manifestation of metastatic lung nodules will be different. However, metastatic nodules should first be detected when other cancers are confirmed. For example, for a patient with a clear diagnosis of colon cancer, during the treatment or during the follow-up after the treatment, as long as there are new lung nodules, you should be vigilant.

Of course, this is just a preliminary analysis. If you find lung nodules, no matter what the situation is, you should go to a specialist (thoracic surgery, respiratory medicine, oncology) for further investigation or clear diagnosis .

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3. Other imaging examinations

Examinations such as MRI, bone ECT, and PET-CT are usually not used first in routine physical examinations. They are mostly used for further examinations when other examinations such as B-ultrasound or CT find abnormalities.

Cancer "clues" hidden in endoscopy

Gastroscopy (actually it is an esophagogastroscopy, which can reach the stomach only through the esophagus, so a gastroscopy is naturally an esophagogastroscopy and also a gastroscopy) and colonoscopy are mainly used for esophageal cancer and gastric cancer screening, and colorectal cancer screening, respectively.

Because this aspect is quite professional, not to mention ordinary people, even doctors, if they are not gastroenterologists or gastrointestinal endoscopists, may not be very professional sometimes. Unlike other examinations, if suspicious abnormal lesions are found during endoscopic examination, if there are no special circumstances, the endoscopist will take a biopsy at the time and send it for pathological examination. The results of the pathological examination usually take at least three days to come out, and the diagnosis is confirmed when the pathological results come out.

Finally, I would like to remind everyone again that if any abnormalities are found during the physical examination, you can consult the corresponding specialist. If you suspect cancer, you should consult an oncologist. The doctor will conduct a comprehensive analysis based on all aspects of information. Do not simply assume that you have a diagnosis .

Planning and production

Source: Oncologist

Author: Pan Zhanhe, deputy chief physician of the Department of Oncology, Zhongshan Hospital, Xiamen University

Editor: Yang Yaping