The original DrX theory of medical rivers and lakes
A middle-aged male patient came to the clinic. The patient said that during his physical examination, he found that carcinoembryonic antigen (CEA) exceeded the reference value a little. At that time, the doctor in charge of physical examination didn’t say anything, but asked him to consult the oncology department.
When he heard the word oncology, he seemed extremely flustered and wondered if he had cancer. Oncologists must also often encounter this situation, patiently explaining:
"Although there is a cancer word in this test, it does have something to do with cancer, but it does not mean that you will get cancer as soon as the index rises. If the index is obviously rising, or if many inspections are rising, and it is higher every time, it is more or less problematic. Your occasional high is not necessarily a problem. Don’t be so nervous. "
In the face of life and health, no one dares to be careless, and no one dares to gamble on life and health, so everyone in modern society suffers from something more terrible than cancer: "fear of cancer."
Maybe he didn’t hear an affirmative answer, but he still made a whisper in his heart. He always felt that there was a problem. After thinking for a long time, he finally asked, "Does that mean there may still be a problem?"
The oncologist explained it to him for a long time. On the surface, it seems that he has dispelled his doubts. In fact, the doctor knows in his heart that he will think about this problem more or less for a long time to come, and then fall into deep anxiety and uneasiness.
The story of this patient can be said to be the true epitome of many people. I don’t mean to criticize anyone here, but I want to say that the development of medicine is beneficial to mankind and should not be a burden.
Take carcinoembryonic antigen as an example, it is actually a detection index during cancer treatment and follow-up, and we can preliminarily judge whether cancer recurs through this index. However, the increase of carcinoembryonic antigen index does not mean that you must have cancer. In clinic, many situations will lead to the increase of this index, such as smokers, people with pancreatitis, colon polyps, active liver disease and ulcerative colitis.
Therefore, even if the carcinoembryonic antigen index rises, what we should do is to pay attention to it, not to panic. Panic is not only useless, but also delays the follow-up diagnosis and treatment.
Seeing this, some people may say, doctor, are you mistaken? It is said on the Internet that a certain tumor marker rises to represent the corresponding cancer. Are you unreliable?
So, in the panic, I did a full set of tests, spent a lot of money, suffered physically, and suffered a huge burden psychologically, but finally I didn’t find any big problems.
This situation is very common in routine physical examination. Some people check a lot of items in each physical examination, but most of them are not targeted. Check the items that should not be checked back and forth, but the ones that should be checked are not found.
Next, I will take tumor markers as the starting point to talk about which items should not be touched easily in physical examination. Of course, these projects are based on the premise that you don’t have any symptoms and high-risk factors.
1. Tumor markers
There may be many people who are dissatisfied with this first one. Don’t all people who say that they have cancer have high tumor markers? Why does the doctor advise me not to check easily now?
Because tumor markers are a powerful basis for judging the curative effect, prognosis and selection of malignant tumor treatment, they are limited to this and can only be used as an auxiliary means.
If we find that this indicator has increased in the routine physical examination, then what? Must have cancer? Not necessarily!
The increase of tumor markers may be related to many reasons, and we have listed several common reasons above. Let’s take alpha-fetoprotein (AFP) as an example, which is generally related to liver cancer and testicular cancer. In addition to primary liver cancer, pregnancy, active hepatitis and reproductive system tumors may all lead to the increase of this index. In addition, different detection instruments and reagents sometimes lead to false positives.
In addition, not every cancer patient’s tumor markers will increase. Take Cancer Antigen 125(CA125) as an example, it is generally used to monitor the therapeutic effect and recurrence of ovarian cancer. There are some patients with advanced ovarian cancer whose CA125 has always been normal, even before and after the operation.
2, prostate color ultrasound
Generally, middle-aged men will have prostate color Doppler ultrasound in physical examination items, which is mainly used to screen whether they have prostate cancer. But the fact is, it is difficult to distinguish whether the nodule is benign or malignant by color Doppler ultrasound, and it can’t play a role in diagnosis, so this examination is of little significance.
3、PET-CT
I have to admit that there is obvious abuse of PET-CT now, and its abuse is mainly related to interests. After all, the price of making a PET-CT is not cheap, even the salary of many people for several months.
PET-CT is abused because it is so well publicized in commercial propaganda that people mistakenly think that cancer can be detected all over the body as long as PET-CT is done once.
In fact, medicine has not developed to that degree. PET-CT is mainly used to accurately check the metabolism of a certain part of the body, which can be used for clinical diagnosis and treatment, but for ordinary people, this screening is of little significance.
PET-CT is not only expensive, but also radioactive, which is harmful to the body. The usual physical examination is aimed at healthy people, which is definitely different from those who have already got cancer. Healthy people who are willing to have a physical examination will have to bear so much radiation, but cancer patients can bear it. After all, radiation is nothing in front of cancer and life.
4. Chest film
Chest X-ray, as a common physical examination item, many people hope to screen lung cancer through chest X-ray. It must be clearly told here that if you want to screen lung cancer through chest X-ray, it doesn’t make much sense.
If you want to find a suspected tumor through chest X-ray, lung cancer is likely to have entered the middle and late stage when it is found, and other symptoms will appear even if you don’t check your body. If you want to detect early lung cancer during physical examination, it is recommended to choose low-dose spiral CT.
Read the original text