The physical examination showed that the tumor markers were elevated. Do I have cancer? It is important to understand the physical examination form!

Every year during the physical examination season, there are always many patients holding their physical examination reports, tossing and turning for several days, and then taking the trouble to squeeze into the car, queue up, and get a few numbers, and then come to see the doctor with abnormal results: Doctor, look at this report, it says that I have "increased lung texture", "There are several arrows here", "Do I have a serious disease?"

Here we will explain to you the most common questions in the physical examination report and provide corresponding medical advice, hoping to resolve some of your doubts.

Elevated uric acid

meaning:

If fasting blood uric acid is measured twice on different days and the test results are both higher than a certain value, it is called "hyperuricemia". This value is different for men and women: men are greater than 420umol/L, and women are greater than 360umol/L.

The hyperuricemia discovered accidentally during our health examinations is mostly asymptomatic hyperuricemia, that is, only the blood uric acid level is elevated, but there are no uric acid-related diseases such as gout, uric acid stones, etc.

The first metatarsophalangeal joint is the most common joint affected by gout.

Possible causes:

The body has a system that regulates the level of uric acid in the blood. If you eat too much, the kidneys will excrete more uric acid. When the kidneys cannot excrete more uric acid due to certain diseases (kidney disease, lymphatic or myeloproliferative diseases) and drugs (diuretics, levodopa, cyclosporine, pyrazinamide, etc.), or when we eat too much uric acid-producing food and exceed the kidney's processing capacity, the blood uric acid level will rise. Medical Guide:

If a physical examination indicates hyperuricemia, but the blood uric acid level has not yet reached 476umol/L, doctors generally do not first intervene with medication. Instead, they recommend adjusting lifestyle, controlling diet and improving metabolism to achieve the goal of lowering uric acid [1]. If the blood uric acid level is found to be higher than 476umol/L, it is recommended to go to the hospital for treatment and seek help from a rheumatologist or endocrinologist. The test will generally be repeated. Lifestyle advice:

Lifestyle changes are recommended for all patients with hyperuricemia:

A low-purine diet, especially eating less animal offal, seafood, and meat should be limited

Quit drinking (especially beer and liquor)

Drink plenty of water

Obese people lose weight to standard weight

sports

Elevated transaminases

Meaning: Transaminases (AST and ALT) are mainly present in liver cells. Elevated transaminases often indicate liver damage.

Possible causes: Elevated transaminase can be seen in non-alcoholic fatty liver disease, alcoholism, drug-induced liver damage, viral hepatitis, etc. In addition, strenuous exercise, excessive fatigue, or eating greasy food before the physical examination may also cause a temporary increase in transaminase. Medical Guide: It is recommended that as long as the transaminase exceeds the normal upper limit, you should go to the gastroenterology department for treatment. When you see the doctor, clearly tell the doctor about your usual medication (including Chinese medicine) and drinking.

Lifestyle advice: In fact, many liver damages are caused by drugs, including commonly used antipyretic analgesics, lipid-lowering drugs, antibiotics (commonly known as "anti-inflammatory drugs"), and certain Chinese patent medicines, so you need to be cautious when using drugs, and never prescribe drugs for yourself. Especially when the doctor indicates that certain drugs have obvious liver damage, you need to follow the doctor's advice to regularly check your liver function.

Fatty liver

What it means: Abdominal ultrasound reports fatty liver, which means that lipid substances (triglycerides, cholesterol, etc.) have accumulated in the liver.

Possible causes: There are many reasons for the accumulation of lipid substances in the liver. It may be related to long-term drinking, obesity, etc., or due to taking some drugs (methotrexate, amiodarone, tamoxifen, etc.) or certain genetic metabolic diseases. Most people who are found in physical examinations have no symptoms in daily life. Medical guidance: If the physical examination also finds elevated transaminase, see a gastroenterologist as soon as possible.

If the transaminase level is normal but obesity, diabetes, dyslipidemia, etc. exist at the same time, it is likely caused by metabolic syndrome. It is also recommended to visit the gastroenterology department first. After excluding other causes of liver fatty changes, it is possible to refer to the endocrinology department for treatment.

Lifestyle advice: For people with fatty liver and normal transaminase levels, it is recommended to adjust the diet structure and reduce the intake of high-sugar and high-fat foods in addition to treatment.

sports

lose weight

Dyslipidemia

Meaning: The blood lipids tested in the physical examination include 4 items:

①Total cholesterol

②Triglycerides

③ Low-density lipoprotein cholesterol

④High-density lipoprotein cholesterol

Possible causes: In addition to some congenital factors, dyslipidemia is mostly related to metabolic disorders, drinking, smoking, and reduced activity.

Medical Guide: If you have simple dyslipidemia, please go to the endocrinology department for treatment; if you also have coronary heart disease, it is recommended to go to the cardiology department for treatment.

Life advice: Control your weight and exercise: Do aerobic exercises such as jogging, brisk walking, swimming, and aerobics.

Quitting smoking

Control your diet: Meat, eggs (especially egg yolks) and dairy products usually contain more cholesterol and fatty acids, so you need to limit your intake. Vegetable oil is the main edible oil, and it is best not to exceed 30g per day.

Thyroid nodules

Meaning: Thyroid nodules can be easily found through B-ultrasound examination. Thyroid nodules are lumps that grow inside the thyroid gland, which can be one or more.

Possible causes: Thyroid nodules can be caused by a variety of causes, such as tumors, nodular goiter, excessive or insufficient iodine intake, thyroiditis, etc. Those found during physical examinations are often asymptomatic. In general, single nodules should be considered as a possible malignancy.

Medical Guide: If you find a thyroid nodule, it is recommended that you visit the endocrinology department or general surgery department. The doctor will check the thyroid function based on the B-ultrasound results and may puncture the nodule for a pathological biopsy to determine whether it is benign or malignant if necessary.

Life advice: The life advice given by doctors will be different for thyroid nodules caused by different reasons, but one thing is that most thyroid nodules are benign, so you don’t need to be too nervous if you find nodules during examination.

Increased lung texture

Meaning: A chest X-ray during a physical examination may sometimes report "heavier or increased lung markings." This description depends on the quality of the photo, the radiologist's personal experience, and the physical condition of the person being examined, and is generally not very meaningful.

Possible causes: Increased lung markings may be related to smoking, occupational dust exposure, bronchitis, etc., and may also occur in normal people.

Medical advice: If you do not have symptoms such as coughing, expectoration, and shortness of breath during activity, you can ignore it. If you have the above symptoms, it is recommended to see a respiratory doctor.

Life Advice: If you smoke, it is strongly recommended to quit! Elevated tumor markers

Meaning: Blood tests during physical examinations often include alpha-fetoprotein (AFP), prostate-specific antigen (PSA), carcinoembryonic antigen (CEA), neuron-specific enolase (NSE), progastrin-releasing peptide (PROGRP), cancer antigen 125 (CA125), etc. People are accustomed to referring to these indicators as tumor markers, and generally believe that their elevation is related to malignant tumors.

Possible reasons: In fact, the above markers are not necessarily signs of malignant tumors. They often increase due to certain benign diseases and even exist in normal tissues. In some patients with malignant tumors, the tumor markers in the blood are not elevated. In other words, it is unreliable to screen for malignant tumors by checking all tumor markers: normal tumor markers cannot rule out all malignant tumors, and elevated tumor markers do not necessarily mean that there is a malignant tumor. Medical Guide: There are two markers that need to be paid attention to: alpha-fetoprotein (AFP) and prostate-specific antigen (PSA).

AFP is the most important marker for primary liver cancer and can indicate primary hepatocellular carcinoma, but a negative AFP cannot rule out the possibility of primary liver cancer. At the same time, elevated AFP is also seen in acute and chronic hepatitis, cirrhosis, pregnancy, gastric cancer, etc. If you have chronic viral hepatitis or cirrhosis and your AFP is elevated, you need to see a gastroenterologist or liver disease center. If nodules or masses are found in the abdominal B-ultrasound at the same time, you should also see a gastroenterologist or liver disease center as soon as possible. If only AFP is elevated and the above two situations do not exist, you can recheck this indicator.

PSA is a marker for prostate cancer and can be used for prostate cancer screening. Generally, the PSA level is between 4 and 7 ng/ml. It can be rechecked after a few weeks (do not ride a bicycle or ejaculate within 48 hours before the recheck). If it is above 7 ng/ml, you need to see a urologist directly.

As for malignant tumors of the lungs, gastrointestinal tract, gynecology and abdominal organs, screening relies on chest X-ray, gastroenteroscopy, gynecological examination, cervical smear and abdominal B-ultrasound. Generally, tumor markers may have some significance for identification only when there are abnormalities in the above examinations.

Breast hyperplasia

Meaning: Breast hyperplasia is divided into simple breast hyperplasia and cystic breast hyperplasia.

Simple breast hyperplasia is a physiological change, which is caused by changes in hormone levels in women. It is more common in women aged 30 to 40. In simple hyperplasia, there will be breast pain and soft, unclear lumps. The lumps are usually bilateral. The size of the lumps will change with menstruation, becoming larger and harder before menstruation and shrinking and softening after menstruation.

Cystic breast hyperplasia is a pathological hyperplasia with the risk of malignant transformation, with a malignant transformation rate of 3% to 4%. The peak age group for cystic breast hyperplasia is 40 to 49 years old, and the incidence of the disease will drop rapidly after menopause. Possible reasons: The occurrence and development of breast hyperplasia are closely related to the endocrine state of the ovaries. The estrogen is the one behind the scenes, and its excessive secretion leads to the "exuberance" of the breast. Specifically, when the ovarian endocrine system is out of balance, estrogen is secreted excessively, and progesterone is relatively reduced, while stimulating the hyperplasia of the breast substance, it will also cause the glandular duct to expand and form cysts.

Medical treatment guide: Usually, the nature of the hyperplasia will not be clear in the physical examination report. If the physical examination report indicates breast hyperplasia, you should go to the breast surgery department for further examination. Some hospitals do not have a special breast surgery department, and you can also choose glandular surgery or thyroid and breast surgery.

In addition, women should be aware that if they experience breast pain 2-3 times during menstruation, they should go to the hospital for treatment. Lifestyle advice: Simple breast hyperplasia is self-limiting and can heal itself, but sometimes it will recur. Excessive fatigue, irregular life and excessive mental stress will increase the incidence of the disease. Usually, you should pay attention to relieving life and work pressure and combine work and rest.

If a doctor confirms that breast hyperplasia is pathological, you should follow the doctor's advice and not blindly try folk remedies online and delay treatment.

Regardless of whether or not they have breast disease, it is recommended that women aged 30 to 50 go to a regular hospital for a breast examination every six months to a year.

Uterine fibroids

Meaning: Uterine fibroids are the most common benign tumors of the female reproductive system and are more common in women aged 30 to 50.

Uterine fibroids can be one or more. If the uterus is regarded as a house, then the fibroids can protrude outside the house or inside the house. Fibroids can also grow in the corridor leading to the house, which is called cervical fibroids. Possible reasons: Fibroids are related to sex hormones. Fibroids grow faster during pregnancy or under the action of exogenous high estrogen.

Medical guide: Most people discover that they have uterine fibroids during a physical examination. It is recommended to see a gynecologist, who will provide individualized treatment based on the patient's age, whether they want to have children, whether they have symptoms (increased menstrual flow and prolonged menstrual period, increased leucorrhea, frequent urination, etc.) and the location of the fibroids.

Lifestyle advice: Most uterine fibroids are benign, so don't be too nervous. Some patients only discover uterine fibroids during prenatal checkups, which is a very tricky problem because fibroids are easy to degenerate during pregnancy. Therefore, it is recommended that women must have a gynecological checkup every year.

Prostate calcification

Meaning: Prostate calcification and fibrosis are what is left after the prostate inflammation heals. If they continue to develop, they will turn into prostate stones.

Prostate calcification is a common disease in middle-aged and elderly men, especially in men over 50 years old. In recent years, the incidence rate in young and middle-aged people has been on the rise. Possible reasons: The etiology and formation mechanism of calcification are still unclear. Many studies believe that calcification may be related to chronic prostatitis, prostate duct stenosis and social and psychological factors.

Medical Guide: If prostate calcification found during physical examination is asymptomatic, no special treatment is needed and there is no need to be overly nervous. If it is accompanied by frequent urination, urgency or pain during urination, you need to go to the urology department of the hospital in time.

Life advice: Don’t overwork and stay up late. Especially for the elderly, overwork can cause low immunity and cause repeated attacks of prostate diseases.

Drink more water and urinate more often to help excrete prostate secretions, avoid sitting for long periods of time, and insist on proper physical exercise to improve blood circulation and facilitate the absorption of local inflammation.

Because the cause is not clear, and most prostate calcifications have no symptoms, it is almost impossible to prevent the disease. All we can do is pay more attention to it in our daily lives to reduce the possibility of the disease.

Editor: odette, Muyi Yangyang

References

[1].https://www.uptodate.com/contents/asymptomatic-hyperuricemia?search=hyperuricemia&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H170944346

[2]. Dong Shouyi, Geng Cuizhi (eds.), Diagnosis and Treatment of Breast Diseases (3rd edition), Beijing: People's Medical Publishing House

[3]. Gu Fangliu. Modern Prostatology. Beijing: People's Military Medical Publishing House, 2002: 522

[4]. Zhang Yi, Yuan Mei, et al. Study on the correlation between diagnosis and age distribution of focal prostatic calcification. Chinese Journal of Andrology, 2011, 17 (4)

[5]. Wang Zhengbin, Tang Jie, Yang Bin, et al. Ultrasonic diagnosis and differential diagnosis of urogenital system diseases. Beijing: People's Publishing House, 2010

[6]. Sun Jinxiao, Ding Yiqin, Lu Jiqiang, Ultrasonic characteristics and examination value of prostate calcification in physical examination population, Western Medicine, 2017-12-20