The doctor said I have a "nodule". Is it okay not to have it removed?

Reviewer: Qu Bo

Chief Physician of General Surgery, Yangtze River Shipping General Hospital

Whenever they get a physical examination report, many people will be troubled by the word "nodules" in the report. Terms such as thyroid nodules, breast nodules, lung nodules, liver nodules, and skin nodules are like keywords in red and bold that attract our attention. Some people are terrified of nodules and are worried about them; others think that they are common phenomena and are not worth mentioning. "Sub-health" has become the norm, and nodules are not uncommon. What attitude should we take to face them?

Thyroid nodules found in physical examination reports

Source: A physical examination report

What are nodules?

In medicine, nodules are a relatively general concept. A small mass in our body that is different from normal tissue is called a "nodule". Nodules can appear in various parts of the body, such as the subcutaneous tissue, lungs, breasts, thyroid glands, and prostate glands. They can be irregular, round, or oval in shape; they can vary in size, including small nodules (less than 1 cm in diameter) and tiny nodules (less than 0.5 cm in diameter). The diameter of a general nodule does not exceed 3 cm.

Lung nodules Source: CCTV News

From the perspective of nodule types, some are scars left after recovery from a disease, some are inflammatory reactions caused by infection, and some are benign tumors. The proportion of malignant tumors that we are most worried about is very small. According to the data obtained from the public's physical examination reports, thyroid nodules, breast nodules and lung nodules are relatively common.

Thyroid nodules: They mostly grow in the thyroid gland below the Adam's apple and on both sides of the trachea. Their causes are related to genetics, ionizing radiation, chronic inflammation, high iodine or iodine deficiency, thyroid cysts, etc.

Source: Zhihu

Breast nodules: They are manifestations of breast hyperplasia, breast fibroadenoma, breast cancer and other diseases. They may be caused by breast infection or damage, or by endocrine disorders, gene mutations and other factors that stimulate cell proliferation.

Pulmonary nodules: formed by excessive proliferation of lung cells, usually occurring in long-term dusty environments or induced by lung inflammation.

Why are nodules becoming more common?

In recent years, we feel that more and more people around us are troubled by nodules. This is indeed the case. Compared with the past, the detection rate of various nodules has increased significantly. In 2011, data from an epidemiological survey on thyroid diseases showed that the incidence of thyroid nodules in the general population was 18.6%. To put it bluntly, on average, 1 in 5 people has nodules.

Source: See watermark

Some experts explain that there are three main reasons for the high nodule detection rate. First, the incidence of nodules is indeed increasing; second, the public attaches great importance to physical examinations, and the detection rate naturally increases after active screening; third, the improvement of the accuracy of medical testing instruments and the enrichment of examination methods have made it possible for the original tiny nodules to be detected, such as using color ultrasound, molybdenum target, nuclear magnetic resonance and other examinations to detect breast nodules, using color ultrasound, CT, and angiography to detect thyroid nodules, and using chest X-rays, CT and nuclear magnetic resonance examinations to detect lung nodules.

Don't believe these nodule rumors

1. Can nodules become cancerous?

The reason why many people are afraid of "nodules" is that they are influenced by the rumor that "nodules can turn into cancer". In fact, the chance of benign nodules turning into malignant ones is very small. Specifically, more than 90% of thyroid nodules are benign nodules, and only 10%-20% of lung nodules, which are common in Asia, are malignant. It is also a good thing to find malignant nodules, because there is a period of development between malignant nodules and cancer. In other words, the earlier they are found and treated, the farther away from cancer they are.

There is no need to be overly anxious if nodules are found during physical examination

Source: pixabay

2. Do nodules have to be removed?

Some people want to remove the nodules once they are found during physical examination, which is also wrong. After the benign nodules are found, follow up for 3-6 months and pay attention to their changes. If there are no changes during the 1-2 year observation period, there is no need to worry all the time. Surgery to remove the nodules may damage blood vessels and nerves. Surgery can only be considered based on the examination results and the doctor's evaluation.

3. Nodules are not a big deal, so just ignore them?

It is not okay to ignore the nodules completely. Always remember to observe them dynamically, and do not end after a short period of worry. Especially those who are prone to nodules must be observed, such as those with a family history of related diseases, those who have been in radiation or radioactive environments for a long time, or those who work at a fast pace and high intensity. Doctors also remind that some skin nodules should be taken seriously. The causes of such nodules are complex and may be manifestations of systemic diseases, which require systematic observation and treatment.

How to deal with nodules

Since the multi-occurrence of nodules has become a fact, how should we deal with these "tumors" that can occur in various parts of the body? The current research on nodules has not yet given a clear answer to their cause. Nodules are more of a descriptive term in imaging.

To truly determine the nature of the nodule, further examination or regular review is needed. Imaging examination combined with palpation is a necessary means to determine the nature of the nodule.

The criteria for judging whether a nodule is benign or malignant are based on a combination of multiple indicators, including size, shape, texture, whether there are burrs on the edges, whether there is ulceration or infiltration, whether there is tenderness, and how fast the doubling time is.

Malignant features of pulmonary nodules on CT images: A-lobulation; B-spikes and spicules; C-vacuoles

Source: Baidu

Nodules with the following characteristics must be taken seriously: large diameter, calcification tendency, rapid proliferation in a short period of time, hard to the touch, and irregular shape. Once such nodules are found, they cannot be left alone and must be promptly biopsied or pathologically diagnosed after the nodules are removed.

X-ray of lung nodules

Source: Wikipedia

A healthy body is what everyone hopes for. The causes of nodules are complex, but good living habits can prevent the formation of nodules, such as maintaining a regular work and rest schedule, taking into account delicious and nutritious diet, and maintaining a reasonable amount of exercise. In addition, regular physical examinations are also important to detect nodules in time and avoid more serious diseases.