Silent early cancer: Early screening makes hidden lesions invisible!

Author: Li Ya, deputy chief physician of Yiyang Central Hospital

Xu Bin, deputy chief physician of Yiyang Central Hospital

Reviewer: Liu Wenguang, Chief Physician, Yiyang Central Hospital

Let me give you an example first.

Three months ago, 52-year-old Ms. Guo went for a routine physical examination organized by her company. It happened that there was an optional item worth 500 yuan in the physical examination package, so she came to consult me.

Figure 1 Copyright image, no permission to reprint

Considering her age, family history, passive smoking and cooking fume exposure, she was assessed as a high-risk group for lung cancer, and further low-dose spiral CT (LDCT) of the chest was recommended. "But I don't have any symptoms such as coughing or expectoration, so how can I be a high-risk group?" Ms. Guo was a little confused.

At my suggestion, Ms. Guo used WeChat to search for the "Chinese Residents Cancer Prevention and Control Action" applet released by the National Cancer Center (NCC), and completed the cancer risk factor assessment questionnaire under my guidance. According to the evaluation results, Ms. Guo accepted the fact that she was indeed in the high-risk group. "So what should I do next?"

The Chinese Medical Association's Guidelines for Clinical Diagnosis and Treatment of Lung Cancer (2024 Edition) states that currently both domestic and international lung cancer screening guidelines recommend the use of low-dose spiral CT (LDCT) for lung cancer screening. After Ms. Guo completed the LDCT examination, she found a solid lung nodule with a diameter of 1.6 cm in the left upper lung. After the hospital's specialist physicians completed the relevant examinations, they submitted it to a multidisciplinary collaborative team including the Department of Imaging, Department of Respiratory Medicine, Department of Thoracic Surgery, and Department of Oncology for comprehensive discussion. Based on the suggestions after the discussion, Ms. Guo chose surgical treatment and was diagnosed with early lung cancer.

Figure 2 Copyright image, no permission to reprint

It took only a little over a month from the discovery of the lung nodules to the surgical diagnosis and then to full recovery. Ms. Guo was undoubtedly unfortunate - she was unfortunately diagnosed with cancer in her middle age, but she was also lucky. Early cancer screening gave her the opportunity for clinical cure.

Let us now learn about cancer screening, early diagnosis and early treatment.

1. What is screening and early diagnosis and treatment?

Screening and early diagnosis and treatment are secondary prevention of cancer, which is to use quick and simple tests, examinations or other methods to distinguish those who may be sick from those who are not sick among apparently healthy people. Screening of precancerous lesions or early cancer patients in specific high-risk groups can help to detect, diagnose and treat cancer early, so as to improve the survival rate and quality of life of cancer patients.

Cancer is a major public health problem that threatens the health of Chinese people. It is currently the leading cause of death among residents. Screening and early diagnosis and treatment have been recognized as the most effective ways to prevent and control cancer. The latest data from GLOBOCAN shows that about a quarter of the world's newly diagnosed malignant tumor cases occurred in China in 2022. The incidence of malignant tumors in my country is close to the world average, lower than that of high-income countries, but the mortality rate is much higher than that of high-income countries.

In recent years, the overall five-year survival rate of malignant tumors in my country has improved, but there is still a gap compared with developed countries such as the United States. Due to the lack of obvious early symptoms of malignant tumors and the lack of awareness of early diagnosis and treatment among residents, most malignant tumors have already infiltrated and metastasized when they are diagnosed, missing the best time for treatment. Tumor screening helps to detect suspicious lesions and precancerous lesions in advance, significantly reducing the incidence of tumors and the mortality rate caused by tumors.

2. Types of cancer suitable for screening and screening methods

To avoid overdiagnosis and overtreatment, cancer screening should be carried out in high-risk groups. Internationally recognized cancers suitable for screening include lung cancer, colorectal cancer, breast cancer, cervical cancer, etc. Among them, the currently recommended lung cancer screening method is mainly low-dose spiral CT; the screening methods for esophageal cancer and gastric cancer are mainly upper gastrointestinal endoscopy; the screening methods for colorectal cancer are mainly fecal occult blood test and colonoscopy; the screening methods for breast cancer are mainly mammography combined with breast ultrasound; the screening methods for liver cancer are mainly serum hepatitis B surface antigen (HBsAg) and serum alpha-fetoprotein (AFP) detection, abdominal ultrasound; the screening methods for cervical cancer are mainly cytology (Pap smear thin layer liquid-based cytology), high-risk HPV DNA detection, acetic acid iodine staining, and naked eye observation; the screening methods for nasopharyngeal carcinoma are mainly serum Epstein-Barr virus-related antibody detection and nasopharyngeal microscopy.

3. Suitable Population for Screening

Tumor screening is suitable for people with more risk factors and healthy people, with the goal of early detection and early treatment. For example, people with a certain family history and genetic disease history; people with bad living habits such as irregular diet and staying up late; people who smoke and drink a lot for a long time; people over 45 years old.

4. What symptoms may be warning signs of cancer?

The "Guidelines for Cancer Prevention and Screening (Popular Science Edition)" points out that when the following symptoms appear in the body, you should pay attention and go to a regular medical institution for diagnosis and treatment in time.

1. Abnormal lumps appear in superficial parts of the body.

2. Moles or warts on the body surface become darker or grow larger rapidly in a short period of time.

3. Abnormal sensations in the body, such as choking, pain, etc.

4. Skin or mucous membrane ulcers that do not heal for a long time.

5. Persistent indigestion and loss of appetite.

6. Changes in bowel habits and bowel characteristics, or blood in the stool.

7. Persistent hoarseness, dry cough, and blood in sputum.

8. Abnormal hearing, nose bleeding, and headache.

9. Abnormal vaginal bleeding, especially contact bleeding.

10. Painless hematuria and difficulty urinating.

11. Unexplained fever, fatigue, and progressive weight loss.

At present, NCC (National Cancer Center) has released the "Chinese Residents Cancer Prevention and Control Action" applet. By joining the applet, you can complete the cancer risk factor assessment questionnaire independently, understand your own cancer risk, and make an independent screening appointment nearby. Early detection and early treatment can nip cancer in the bud. Let's take action!

References

[1] Chinese Medical Association Oncology Branch. Chinese Medical Association Guidelines for Clinical Diagnosis and Treatment of Lung Cancer (2024 Edition)[J]. Chinese Medical Journal, 2024, 104(34): 3175-3213.

[2] National Cancer Center. Cancer Prevention and Screening Guidelines (Popular Science Edition) [M]. Beijing: People's Medical Publishing House, 2021.

[3] Chen Wanqing, Li Ni. Screening technology: 2023 China Cancer Integrated Diagnosis and Treatment Technology Guidelines (CACA) [M]. Tianjin: Tianjin Science and Technology Press, 2023.

[4] Ji Yuting, Liu Siwen, Zhang Yunmeng, et al. Comparison of disease burden, epidemic trends and attributable risk factors of malignant tumors in China and the United States[J]. Chinese Journal of Oncology, 2024, 46(7): 646-656.