Nodules are a far cry from cancer, as more than 90% of nodules are benign and the number of nodules that need attention is only a very small fraction, usually less than 5%. Patients with nodules should maintain a good mood and try to control and balance their emotions.
China Women's Daily reporter Zhang Zheng.
Thyroid nodules, pulmonary nodules, breast nodules, ......In recent years, with the general improvement of national health awareness, physical examination has become more and more popular. Once the word "nodule" appears on the physical examination report, some people will have trouble sleeping and worrying about whether they have cancer.
So what exactly is a nodule? How do we deal with these nodules? How far away is the nodule from the cancer?
Nodules are not a stand-alone disease and have a very small chance of becoming cancerous
According to Li Bofei, a resident physician at Shanghai Chest Hospital, a nodule is a relatively small lump, and a slightly larger one is called a mass, which can occur in any part of the body. It is usually a feature or sign of the disease, but it is not a stand-alone disease. When a nodule is found during a physical examination, further assessment of its nature and degree of risk is required. Depending on the location, it can be divided into different types such as pulmonary nodules, thyroid nodules, and breast nodules.
Pulmonary nodules are abnormal density shadows in lung tissue found during imaging tests. Their morphology can be regular, such as round or oval, or irregular.
With the gradual improvement of CT resolution, the detection rate of pulmonary nodules is getting higher and higher. Most of these pulmonary nodules are benign, such as inflammation, fibrotic scars, or calcifications left behind by old tuberculosis. Some are precancerous lesions of lung cancer, such as dysplasia. There are also a few lung nodules that are malignant, which is what we call lung cancer.
In February 2022, the national cancer statistics released by the National Cancer Center showed that there are 820,000 new cases of lung cancer in China every year, ranking first among all types of tumors. In recent years, with the advancement of imaging technology and the improvement of people's awareness of physical examination and screening, the detection rate of pulmonary nodules has gradually increased. In the past three years, chest CT screening has become more common, further increasing the detection rate of pulmonary nodules, and more and more people are discovering that they have pulmonary nodules.
Professor Wang Haofei, deputy director of the Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, introduced that the detection rate of pulmonary nodules is about 20% in the general population, and can reach 35% and 45% or even higher in high-risk groups (such as those over 40 years old, long-term smoking history, family history of lung cancer, chronic lung disease, autoimmune diseases, etc.).
It is not scary to find lung nodules, and the risk of lung cancer will vary depending on the quality of nodules. There are three main types of pulmonary nodules: ground-glass nodules, solid nodules, and mixed nodules, and the larger the nodules, the higher the probability of malignancy.
Thyroid nodules are scattered lesions caused by abnormal local growth of thyroid cells, mostly related to the endocrine system, and are often detected by thyroid ultrasonography. The vast majority of thyroid nodules are benign, but they can also be malignant.
Breast nodules are one of the most common breast diseases in women, usually caused by the proliferation of breast tissue cells. Most breast nodules found on physical examination are benign, such as fibroadenomas of the breast, which is related to the abnormal sensitivity of fibroblasts in the lobules of the breast to estrogen; Cystic hyperplasia of the breast (also known as breast adenopathy) is caused by an imbalance in the ratio of estrogen and progesterone, resulting in excessive or incomplete prosthetic hyperplasia of the mammary glands; However, there are also a small number of breast nodules that are malignant.
Li Bofei concluded that nodules refer to the appearance of things that should not appear in normal organs, and are abnormal phenomena that do not conform to normal structure and function. In general, the probability of a nodule becoming cancerous is very small.
The treatment of nodules varies depending on the site
Pulmonary nodules. For low-risk** patients >35 years of age, solid and subsolid nodules with a diameter of 6 mm or less usually do not require further follow-up. For nodules larger than 6 mm in diameter or multiple ground-glass nodules, it is recommended to bring the examination materials (CT film is mandatory) to the clinic for consultation. Doctors usually perform surgical removal of lesions that are enlarged during follow-up and that are suspected to be malignant.
After the discovery of pulmonary nodules, whether to follow up or operate immediately, Professor Wang Haofei said that a specialist doctor should give standardized advice, and for patients who choose follow-up, they should try to find a fixed and trusted doctor for long-term follow-up. "Some nodules don't seem to change in size, but a lot of details need to be observed in a computerized moving image, and the doctor can measure the changes in the density and shape of the nodules, and can also capture subtle changes. Fixed follow-up and accurate measurement in computer moving images are very important for expert judgment. ”
Thyroid nodules. For thyroid nodules, the medical examination report is usually marked with the TI-RADS classification. Ti-RADS is a tool used to assess the risk level of thyroid nodules, and different Ti-RADS grades correspond to different malignant probabilities.
According to the TI-RADS classification, thyroid nodules are classified into 5 grades. Ti-RADS grade 1 is completely normal thyroid tissue; Ti-RADS grade 2 indicates the presence of a thyroid nodule but presents with benign features that generally do not require further treatment; Ti-RADS grade 3 indicates that the thyroid nodule may be benign, but there is some uncertainty and regular follow-up is recommended. For thyroid nodules of Ti-RADS grade 4a, 4b, 4c, and 5, doctors will perform ultrasound-guided fine-needle aspiration biopsy to determine the pathological nature according to the size of the nodule.
In general, for thyroid nodules that are pathologically proven malignant by biopsy, doctors will recommend surgical removal. For some benign nodules, surgical removal is often recommended if the nodule is large, compressive or unsightly, or if there is hyperthyroidism that is difficult to control with medication.
Breast nodules. For breast nodules, the results of imaging diagnosis are recorded and analyzed using a similar risk level method as thyroid nodules, i.e., the "Breast Imaging Reporting and Data System (BI-RADS)".
Imaging tests of the breast include breast ultrasound, mammography, and magnetic resonance imaging (MRI). Because each of these three tests has its own focus, the results of the BI-RADS grading may vary. For example, ultrasound may show Bi-Rads grade 3 for the same breast nodule, but breast contrast MRI may show Bi-Rads grade 4A. In this case, doctors usually recommend that the patient go to a breast clinic for further evaluation.
In general, breast nodules of grade 1 and 2 BI-RADS usually do not require special management and regular screening is sufficient. For breast nodules of BI-RADS grade 3, there is a high probability of benign nodules, but there is still a 2% or so chance of malignant nodules, and regular follow-up or biopsy is recommended. For BI-RADS grade 4a, 4b, 4c, and 5 breast nodules, doctors recommend biopsy to determine the pathologic nature.
When we find that the words pulmonary nodules, thyroid nodules, and breast nodules appear on the physical examination report, we should not be overly nervous and panicked, but at the same time, we should not take it lightly, and the best way is to go to the specialist clinic for examination and diagnosis in time. Nodules are a far cry from cancer, as more than 90% of nodules are benign and the number of nodules that need attention is only a very small fraction, usually less than 5%. In the face of nodules, you don't have to worry too much, don't ignore them, relax your mind, face up to the nodules, and live a normal life.
Traditional Chinese medicine believes that nodules are related to "qi stagnation".
Experts from the First Affiliated Hospital of Henan University of Traditional Chinese Medicine believe that the formation of nodules is mainly related to qi stagnation, phlegm coagulation, and blood stasis. From the perspective of traditional Chinese medicine, thyroid nodules are mainly closely related to emotional internal injury, diet, and soil and water disorders. Breast nodules are caused by emotional disability, depression, long-term depression and liver injury, or mental stimulation, impatience and irritation, resulting in stagnation of liver qi, blockage of qi and organs, and accumulation in the breast; Pulmonary nodules are mainly caused by the deficiency of righteous qi and the relapse of external evils.
The constitution that is prone to nodules is inseparable from the "qi stagnation" in traditional Chinese medicine, and is most closely related to the liver. The discharge of liver qi is directly related to the rise and fall of the body's qi and the smooth regulation. Therefore, what is visible is the nodules of the body, and what is not visible is the tangles in the heart. Therefore, patients with nodules should keep their mood comfortable and try to control and balance their emotions.
First of all, in terms of medicine, you can use traditional Chinese medicine such as Bupleurum Shugansan, Muxiang Shunqi Pills, and Prunella Granules to regulate the liver and regulate qi appropriately, and you can usually use roses, tangerine peel, Poria cocos, white plum blossoms, bergamot and other soaked water to drink.
Secondly, it is necessary to get rid of bad habits, not to eat fat and sweet, not to smoke, drink less, and not to stay up late. At the same time, pay attention to personal hygiene, maintain a happy mood, and adhere to moderate physical exercise.
Finally, it is necessary to exercise outdoors more, adhere to a regular life, and promote the flow of qi and blood throughout the body through a variety of activities, so that the spirit is comfortable and conducive to the dispersion of stagnation.