Last time I shared an article about physical examination with you, but there are still some issues that are not clearly explained, and there is no distinction between men and women. Today's article expands on these two issues.
I will arrange a physical examination for my parents once a year, about 3,000 yuan, which is already appropriate. But recently many readers have left messages with me, asking me to analyze the pros and cons of the physical examination package, which are suitable and which are not suitable, too many projects, chaotic, afraid of spending money unjustly, and afraid that the money that should be spent has not been spent.
1. What is the purpose of the physical examination?
The purpose of most people's physical examinations is to detect cancer early.
We have repeatedly said that if many cancers can be found early and in time, they can be surgically cut off or even cured, such as early liver cancer, lung cancer, and can really be cured. But if there is no physical examination, when it is found, it is already in the middle and late stages, the opportunity for surgery is lost, and it can only be held up by other methods, and it can be toped for a period of time, and the money is spent like flowing water, and the key cannot save its life, so it is necessary to have a physical examination.
The purpose of the physical examination is to detect cancer early. Of course, in addition, the physical examination can also find some other abnormalities, such as hypertension, hyperlipidemia, hyperglycemia, biliary stones, urinary tract stones, etc., but these are generally not fatal in the short term, and there is no symptoms of the stones generally do not need to be treated urgently.
Still repeating that sentence, the ultimate goal of the physical examination is to detect each cancer early.
2. What are the most common cancers?
Let's look at a set of 2020 data:
According to the latest global cancer burden data in 2020, there will be 19.29 million new cancer cases in the world in 2020, of which 4.57 million will be new cancers in China, accounting for 23.7% of the world. This may be related to culture, dietary patterns, low nutrient intake, and food contamination.
In 2020, the top ten cancers in our country in terms of new cancer cases are: lung cancer, colorectal cancer, stomach cancer, breast cancer, liver cancer, esophageal cancer, thyroid cancer, pancreatic cancer, prostate cancer, cervical cancer, these ten cancers account for 78% of the number of new cancers.
Regardless of men and women, the most common malignant tumors are lung cancer, stomach cancer, colorectal cancer, liver cancer, esophageal cancer, thyroid cancer, pancreatic cancer, male patients also add prostate cancer, female patients also have breast cancer, cervical cancer.
What kind of cancer do you die from most often? It's pretty much the same.
The most common cancer deaths are: lung, liver, stomach, esophageal, colorectal, pancreatic, breast, leukemia, and cervical cancer. I believe that everyone has a general understanding in their minds, whether it is the most common new cancer, or the most common cancer death, it is related to those cancers: lung cancer, liver cancer, stomach cancer, esophageal cancer, colorectal cancer, pancreatic cancer, breast cancer, cervical cancer.
Separately take out 2 to say: thyroid cancer incidence ranks in the top 10, but the mortality rate is very low, because thyroid cancer can generally be cured, is a tumor with a better prognosis, so patients with thyroid cancer should not be discouraged.
The incidence of leukemia is not in the top 10, but the mortality rate is in the top 10, which also shows that blood disease is more dangerous and should be paid special attention to.
So, let's plan for the first 10. These 10 cancers account for about 80% of all cancers. A medical checkup package that covers 80% of the cancer program is more comprehensive. To cover 100% is unrealistic.
3. How do men arrange medical examinations?
Because the 10 most common cancers in men are: lung cancer, stomach cancer, liver cancer, colorectal cancer, esophageal cancer, prostate cancer, bladder cancer, pancreatic cancer, lymphoma, brain cancer. So we have to do a physical examination project for the above cancer.
(1) Lung cancer, so for many years, lung cancer has been at the top of the list, so screening for lung cancer is critical. Routine screening of lung cancer examination is chest x-ray, chest x-ray is very cheap, about 100 yuan, but chest x-ray is not easy to find early lung cancer, easy to miss misdiagnosis, directly do conventional ordinary CT flat scan, the price of hundreds of yuan, 400-700 yuan, different places.
For screening lung cancer, chest CT flat scan is enough, people over 40 years old, can do it once a year, the amount of radiation is not large, do not be afraid. Do it once a year, if you don't find a problem last year, and if you find a problem this year, it is generally early (generally so, not always), so the success rate of treatment is much higher.
To prevent lung cancer, you must not smoke, eliminate second-hand smoke, and avoid exposure to air pollution (a little difficult, try).
(2) Stomach cancer, we all know that we must do gastroscopy to be clear. Gastroscopy directly from the mouth into, deep into the gastric mucosa, in order to see whether there is an ulcer is cancerous, ordinary hepatobiliary pancreas and spleen ultrasound is no way to judge whether there is stomach cancer, do not think that do visceral color ultrasound can sit back and relax. Gastroscopy must be done.
To achieve stomach cancer, we said esophageal cancer together. Because the discovery of esophageal cancer is also confirmed by gastroscopy. When doing the gastroscopy, we will look at the esophagus, the stomach, and the duodenum together. The price of gastroscopy is not much different from colonoscopy, it is best to do it once over 40 years old, and it is more recommended if there are high-risk factors (such as having stomach cancer relatives at home, you have atrophic gastritis, stomach pain, etc.).
If you do it for the first time and find it clean, then do it a second time in 3-5 years, and you don't need to do it every year. If a problem is found, repeat it on the advice of a doctor.
(3) Liver cancer, the common cause is hepatitis B, hepatitis C, alcohol, if there is no such factor, the possibility of liver cancer is relatively low, so patients with hepatitis must be well treated.
The method of screening liver cancer is actually simpler, do an abdominal color ultrasound, directly look at the liver, gallbladder, pancreas and spleen color ultrasound, as long as there is liver cancer, even if it is a relatively small liver cancer, color ultrasound can basically be found, and then do CT further examination. Among tumor markers, alpha-fetoprotein is very helpful in the confirmation of liver cancer, and patients with high risk factors can have blood drawn to check alpha-fetoprotein (AFP).
Patients with hepatitis B, hepatitis C, alcoholic liver, etc., once a year abdominal color ultrasound to see the liver (many units have this item in the physical examination, do not miss). Without these diseases, it is not necessary to do it every year, but it is best to do it once a year, after all, the color ultrasound is not expensive, and there is no radiation. Color ultrasound is about 100-200 yuan a time, you can look at the liver, gallbladder, pancreas and spleen, you can also look at the urinary tract bladder (kidney cancer, bladder cancer, etc. can be found), you can also look at the thyroid gland, do it together.
(4) Colorectal cancer, including colon cancer and rectal cancer, because these two are continuous, the location is also close, and the nature is similar, so it is collectively referred to as colorectal cancer. Colorectal cancer is a common tumor of the gastrointestinal tract and has the highest incidence in people aged 41-65 years.
If you want to detect colorectal cancer early, there is only one effective way to do colonoscopy. By looking at whether there is blood in the stool, constipation, etc. are inaccurate and easy to misdiagnose. Once in doubt, colonoscopy is done.
Therefore, from the perspective of early detection of colorectal cancer, it is best to do colonoscopy during physical examination, because some cancers have no obvious symptoms in the early stage, and you do not know whether there is a problem without colonoscopy. We recommend that over 40 years old, even as early as 35 years old, can have a colonoscopy.
But isn't everyone routinely screened? No, it is best to have high-risk factors (such as family history, frequent blood in the stool, etc.). Do the first time if it is very clean, any problem can be, then do not have to do it every year, every 3-5 years to do it again can be done (tumor growth is time-consuming, rarely will be said to grow up in the short term), if you do not worry about 3 years to do.
If you see a little inflammation or ulcers or something, then review once a year, see more than a few years, if there is no progress, you can appropriately extend the time, such as 2-3 years to do it again, after all, the colonoscopy is still somewhat sour (invasive), and the cost is not low. Ordinary colonoscopy is also hundreds of dollars, painless colonoscopy (after anesthetics to do) is more expensive, to more than a thousand close to 2000 have, different regions. Young people can consider ordinary colonoscopy and endure it.
Many middle-aged people have blood in the stool and have always thought it was hemorrhoids. In fact, you can't take it for granted, only if you have done a colonoscopy and don't see colorectal cancer, can you treat hemorrhoids with confidence. Mistake intestinal cancer for hemorrhoids, and it will be too late to regret it.
(5) Esophageal cancer, as mentioned above, esophageal cancer can be found by doing gastroscopy screening for gastric cancer, so as long as you do gastroscopy, you can find whether there is esophageal cancer. Esophageal cancer and long-term eating of high nitrosamine food, long-term smoking, drinking, over-hot food (hot pot, spicy scalding, etc.) are related, early symptoms are not obvious, there will be progressive swallowing difficulties in the middle and late stages, so you can not judge whether there is esophageal cancer by symptoms, and when there are symptoms, you may have intermediate and advanced stages, and you must do gastroscopy regularly. One gastroscopy does not see abnormalities, and a second time is done after 3-5 years.
(6) Prostate cancer, a common tumor in elderly men, is rare in young and middle-aged men. However, from the perspective of screening, it is easier to operate, because when you do a color ultrasound once a year, you can do the color ultrasound of the abdomen, urinary tract and thyroid gland together, and the urinary tract can see the prostate and bladder. The cost is relatively cheap. But color ultrasound can not always find early prostate cancer, it is best to do CT or MRI, which is relatively expensive. Because older men are highly prevalent, middle-aged men do not mean that they must be checked every year.
Tumor markers as screening is not helpful, but prostate-specific antigen (PSA) is still good, middle-aged and elderly physical examination can check this, if PSA is elevated, or further prostate examination.
(7) Bladder cancer, the most common tumor of the urinary tract, is very related to smoking, and 1/3 of bladder cancer is related to smoking. The main symptoms are painless gross hematuria (painless is mostly tumors, painful is mostly stones or infections), during the physical examination, urine routine and urinary tract ultrasound should be done. If you find a problem, do a further CT or MRI.
(8) Pancreatic cancer, pancreatic cancer and liver cancer are considered to be the king of cancer, pancreatic cancer is generally difficult to detect early, once found is in the middle and advanced stages, the prognosis is very poor and poor. Over 40 years old, more hairy, more men than women. The reliability of color ultrasound screening for pancreatic cancer is not too big, because the position of the pancreas is relatively deep, and the color ultrasound may not necessarily look very good, it is best to do abdominal CT, which can be seen more clearly. So just from the perspective of screening pancreatic cancer, CT will be better.
The price of CT is also several hundred pieces. Doing CT once a year will help, but pancreatic cancer progresses very quickly, you didn't see a tumor last year, and this year you may find that it has progressed to the middle and advanced stages, so you can only try to screen.
(9) Lymphoma: The most common symptom of lymphoma is painless lymphadenopathy, there will be repeated fever, screening is a bit difficult, because the blood routine is not necessarily a problem, part of the lymph node can be found by superficial lymph node ultrasound, and then further examination. Many patients have already experienced infiltration by the time they find it.
(10) Brain cancer, tumor of the central nervous system, the most common is glioma. Few people will be screened for brain cancer, because color ultrasound, X-rays, etc. are not good, and can only do CT and MRI. Most people find out when they have symptoms.
In summary, men are best to quit smoking, more than 40 years old (if you don't consider the cost, it is of course better to be earlier), every year there is chest CT (to see lung cancer), every 3-5 years gastroscopy colonoscopy (to see stomach cancer, esophageal cancer, colorectal cancer), every year to do hepatobiliary pancreatic spleen, urinary tract, thyroid, lymph node color ultrasound (to see liver cancer, bladder cancer, prostate cancer, thyroid cancer, lymphoma), while drawing blood to check liver and kidney function, blood lipids, etc., high-risk people can check tumor markers AFP, PSA, other is not recommended. If there are high risk factors, it is recommended to follow the above operation, and if there are no high risk factors, the time may be extended as appropriate.
4. How do women arrange physical examination items?
The 10 most common cancers in women: breast, lung, colorectal, thyroid, stomach, cervical, liver, uterine, esophageal, and brain.
(1) Breast cancer, which is basically a cancer that only women have, men will also have, but it is rare. Mammography or mammography can be used. The price is also similar, it is about 300 yuan, and different hospitals have differences. The high incidence of breast cancer is 45-50 years old, but it has gradually increased from the age of 20 years old, and it is rare under 20 years old. For women over the age of 35, it is best to do it once a year, there is no high-risk situation, and it is also possible to do it once every 2 years.
(2) Lung cancer, limited to space, not repeated, the same as male screening.
(3) Colorectal cancer, with male screening.
(4) Thyroid cancer, to find it is also dependent on color ultrasound, if you find a problem, you can further check the thyroid function and so on. Otherwise, a regular lookup is not required. Although thyroid cancer has a high incidence, it has a low mortality rate, which is a relatively fortunate cancer.
(5) Stomach cancer, with male screening.
(6) Cervical cancer, which is the second gynecological tumor. It is recommended that women who have sex life, it is best to do TCT and HPV examination once a year, can find lesions early, if they are normal for several consecutive years, then the later screening time can be extended to 2-3 years. Also a few hundred dollars at a time. Don't think that only middle-aged women have cervical cancer, 30-year-old or even 20-year-old cervical cancer is also there, so every year when the physical examination of gynecological examination to do, transvaginal ultrasound can also be done.
Now that we have the HPV vaccine, eligible women try to get it as much as possible. But now this vaccine is very hot, there is a suspicion of being hyped, and it needs policy guidance.
(7) Liver cancer, with male screening.
(8) Uterine cancer, including endometrial cancer and uterine sarcoma, the most common symptoms are abnormal vaginal bleeding. Most people become ill over 40 years of age (average age 50-60 years). It is recommended to carry out annual gynecological examination, transvaginal ultrasound, endometrial biopsy, etc. after 30-35 years of age.
(9) Esophageal cancer, with male screening.
(10) Brain cancer, with male screening.
In summary, women over 40 years old (without considering the cost, it is of course better to be earlier), every year there is chest CT (to see lung cancer), every 3-5 years gastroscopic colonoscopy (to see gastric cancer, esophageal cancer, colorectal cancer), every year to do hepatobiliary pancreatic spleen, thyroid, lymph node ultrasound (to see liver cancer, thyroid cancer, lymphoma), once a year gynecological ultrasound, breast ultrasound, TCT/HPV examination (to see cervical cancer, uterine cancer, breast cancer), while drawing blood to check liver and kidney function, blood lipids, etc., Tumor marker AFP may be examined in high-risk patients, others are not recommended.
If there are high risk factors, it is recommended to follow the above operation, and if there are no high risk factors, the time may be extended as appropriate.
Both men and women, in order to find lung cancer, liver cancer, colorectal cancer, stomach cancer, thyroid cancer, cervical cancer, breast cancer, pancreatic cancer, esophageal cancer, etc. as soon as possible, if you have not done a physical examination and are over 40 years old this year, then I will recommend that you go to the hospital to do these projects:
Chest CT, abdominal ultrasound (or direct abdominal CT), thyroid and breast ultrasound, gastroscopy, colonoscopy, gynecological examination (for female patients), this is an auxiliary examination, the cost is about 4000-5000. If you did a gastroscopy colonoscopy last year and didn't have anything to do, you don't want to do it this year, and the cost can be almost halved.
Blood draw also needs to be done, do a few things: blood routine, liver function, kidney function, blood uric acid, blood lipids, it is almost, 100-200 yuan can be done.
Urine should be left one, do the urine routine, you can see if there are red blood cells, which is helpful for urinary tract bleeding judgment, screening for stones or tumors. Feces can also be left to see if there is occult blood, which is of certain significance to the judgment of whether there is colorectal cancer.
On the whole, the cost of the first physical examination will be higher, to about 5,000 yuan. The second time may be 3,000 yuan can be done, much cheaper.
Okay, the above check items are suitable for all people over 40 years old, and everyone can be seated in the right number. But it is also emphasized that it can be added or subtracted here, and this package cannot cover all cancers, only most of them.
Finally, someone asked whether to do a dozen or dozens of tumor markers during the physical examination? I don't think it's needed. For screening, the significance of tumor markers is not very large (in addition to AFP, PSA and other relatively specific), tumor markers are mostly used for the evaluation of treatment effects, follow-up, etc., for screening is easy to confuse, you may randomly grab a person to test an indicator is positive, or there is a tumor is not high, what do you do? Therefore, routine physical examination does not require specific tumor marker examination.
The above is a separate physical examination and screening recommendation for men and women, and I hope that everyone will transfer it to those in need. It's also time for young people to help their parents get a full physical exam.