Why are some people still diagnosed with advanced cancer after annual physical examination?

Can a general physical examination detect cancer?

The answer is: Yes

The next question:

Why do you still find late-stage cancer during physical examination every year?

It is difficult to detect cancer directly by physical examination, and it may not be able to detect all precancerous lesions/early cancers.

However, physical examination can identify high-risk groups of different cancers as much as possible. If there is no further examination to capture this early signal, it is possible that the cancer is at an advanced stage as soon as it is discovered.

Early detection of cancer is inherently difficult, and for most people, annual checkups may be one of the best ways to detect cancer early. one.

Why cancer is detected early Difficult

Is it too late?

Most cancers do not have typical symptoms in the early stage, and it is often in the middle and late stages when they cause obvious symptoms.

Some of the early symptoms may be low fever, weight loss, fatigue, etc. These symptoms are relatively mild and easily overlooked.

Image source: TuZong Creative

Many cancers have developed to a certain extent Only when the degree of cancer is at an advanced stage can it attract the attention of the patient and the doctor. At this time, the cancer may have reached the middle and late stages.

A few examples:

For example pancreatic cancer.

When tumor cells form a solid tumor, it will cause obstruction of the bile ducts, bilirubin will enter the blood, and the patient’s skin and sclera will appear yellowish (medical It is called jaundice), when there are obvious symptoms, the patient may go to the doctor, and the tumor is already very large at this time.

The tumor squeezes the outlet of the biliary tract, causing obstruction of bile excretion

bilirubin into the blood and skin. Yellow staining of the sclera

Image source: Internet

such as liver cancer.

When the patient feels significant pain, it may be that the tumor has grown to a certain extent or has originally occurred near the serosa , The liver is a relatively “taciturn” organ. In fact, there are very few sensory nerves in the liver, and there is almost no feeling in small lesions.

For example, cancer of the urinary system (kidney, ureter, bladder, prostate).

When an elderly patient comes to a doctor with painless hematuria, the doctor must first think of malignant tumors of the urinary system.

At this time, during the growth of tumor tissue, the tumor blood vessels are different from normal blood vessels and are prone to bleeding. The blood goes into the urine and is found by the patient.

Urinary system cancer patients, there will be blood in the urine


Picture source: Internet

In conclusion, solid tumors often begin to take shape when they cause perceptible symptoms.

This also gives you a basic impression – when you arrive at the hospital, the cancers found are often in the middle and late stages, and most early cancers are discovered by accident. .

Most patients found out that they had cancer because of the corresponding symptoms (such as pain, bleeding, persistent cough, weight loss, etc.) and went to the hospital for a more detailed examination was discovered.

Then the problem comes, the early hidden symptoms of these tumors,

Can the annual routine check-up detect it?

The physical examination is difficult to direct Cancer is detected

but high-risk groups are found

We first Let’s take a look at the content of the routine physical examination.

The contents of medical examinations for different inspection purposes and different fee levels are definitely different.

Take out your physical examination form for the previous year (take a list of items of a routine examination package as an example), We will analyze them one by one from top to bottom: What are these inspection items for? Can you spot early signs of cancer?


General Checks (45 items)


Specific items: 17 blood routine items, 12 urine routine items, 15 stool routine items, and 1 stool occult blood item.

It is mainly to have a preliminary understanding of the blood components in your body (mainly blood cell components) and the basic health of the urinary system.

If you have blood system diseases, such as anemia, leukemia, systemic infections, allergies, you can find clues through blood routine;< /span>

If there is fecal occult blood, it often indicates gastrointestinal bleeding, which can be caused by peptic ulcers, parasites and bleeding from gastric and colon cancers.

In these cases, the medical examiner generally recommends a gastroenteroscopy.


Biochemical tests (18 items)< /strong>

Specific items:

1. Liver function test (10 items): such as alanine transferase, aspartate Acid transferase, α-hydroxybutyrate dehydrogenase, etc.;

2. Renal function (2 items): urea ammonia, creatinine;

3. Diabetes Screening (1 item): Blood Glucose;

4. Uric Acid Screening (1 item): Uric Acid; p>

5. Blood lipids (4 items): triglyceride, total cholesterol CHO, high density lipoprotein cholesterol, low density lipoprotein cholesterol;

This part is generally used to understand the health status of the liver and kidney function and metabolic system.

If some people have malignant tumors in the liver and kidney, these indicators may fluctuate.


Immunization (9 items)< /strong>

Specific items:

1. Hepatitis B (5 items): 5 items of hepatitis B.

2. Cancer screening (2 items): carcinoembryonic antigen, alpha-fetoprotein.

3. Syphilis screening serum test (1 item): Determination of syphilis serum-specific antibodies.

4. Tuberculosis screening (1 item): Mycobacterium tuberculosis antibody test.

Hepatitis B and the occurrence of liver cancer are closely related, so hepatitis B examination can be considered as part of liver cancer screening.

The two indicators of cancer screening are carcinoembryonic antigen (CEA) and alpha-fetoprotein (AFP), There are also some test packages that include a full set of blood tumor marker tests:CA125 (ovarian cancer), CA199 (pancreatic cancer, hepatobiliary cancer, gastric cancer, colorectal cancer), PSA (prostate cancer) and many more.

Tumor markers can be regarded as an important part of the evidence chain for cancer diagnosis, but cannot be used as a basis for cancer diagnosis by themselves. Some benign diseases or completely normal conditions can also raise tumor markers in the blood.

At present, except for a very small number of abnormally high-risk groups, it is not recommended to perform any tumor marker tests in general physical examinations. None of the elevations found in . These markers should only be checked for long-term disease assessment in patients who have already been diagnosed with cancer.

If the tumor marker test is wrongly done, and there are obviously abnormal results, you can consult a specialist to evaluate whether it is necessary Follow-up inspection.


B ultrasound (12 items) and X-ray examination (7 items)

B-ultrasound examination items:

liver, liver Inner bile duct, common bile duct, gallbladder, hepatic portal vein, kidney, pancreas, spleen and others (male: prostate; female: uterus, ovary, bladder).

When the malignant tumor reaches a certain size, it can be detected by B-ultrasound. However, it is often difficult to make benign and malignant judgments by relying solely on B-ultrasound.

X-ray examination (7 items), ieHeart, Lungs, septal, mediastinum, thoracic cavity, frontal chest image, lateral chest image, can find a lot of important information.

Especially for lung cancer, the shadow of lung cancer can be found on the chest radiograph, and sometimes it can also be seen caused by lung cancer. atelectasis.

The shadow indicated by the arrow

probable central lung cancer

Image source: Wikipedia

X-rays can detect some signs of lung cancer, but it is too late when X-rays are found, and it has little meaning for disease treatment . Therefore, routine X-ray examinations are not recommended for physical examinations, but low-dose helical CT is used for lung examinations after the age of 50 for those at high risk of lung cancer who smoke a lot.


Mammography (1 item)< /strong>

There are often tiny calcifications in breast cancer tissue. These calcifications can be observed under low-dose radiation, which are early signs of cancer that can be captured.

Picture Source:6000> width=”wudg/640″ Station Cool Hero


Otolaryngology (13 items)

Specific items:

Auricle, nasal cavity, Smell, tonsils, hearing, external auditory canal, tympanic membrane, nasal septum, turbinates, sinuses, nasopharynx, pharynx, larynx (vocal epiglottis);

Don’t underestimate this test, many early-stage nasopharyngeal cancers are discovered through “seeing”.

Of course, some nasopharyngeal carcinoma lesions are blocked by the soft palate, which cannot be seen by normal rhinoscopy or oropharyngeal examination.

However, during the physical examination, the doctor will usually ask if there is often blood in the nasal discharge. If you have this situation, answer truthfully That’s it.

The medical examiner will focus on the examination, or give you advice, go to the ENT department for fiberoptic nasal endoscopy.

Nasopharyngeal carcinoma detected by fiberoptic nasal endoscopy

Image source: p>


Ophthalmology (11 items) < /strong>

Specific items:

vision, color discrimination, intraocular pressure, eyelid, conjunctiva, lacrimal organ, cornea, iris, lens , vitreous body, fundus;

Some intracranial tumors may cause eye damage due to compression of the oculomotor or optic nerve Movement disorders or visual field defects.


Many oral cancers actually have precancerous lesions in the early stage, such as oral leukoplakia and submucosal fibrosis, which can be found by oral examination:

Submucosal fibrosis caused by chewing nut, resulting in contraction of the oral mucosa and limiting the patient’s mouth opening

Source: Internet


Gynecology (7 items)

Specific items:

vulva, external urethra, vagina, cervix, uterine appendages , Anterior and posterior fornix, leucorrhea routine;

Cervical cancer, which makes women talk about discoloration, can be detected by gynecological examination in the early stage of cervical mucosal changes.

But the more recommended early tests for cervical cancer are TCT (Liquid-Based Thin Layer Cell Test) and HPV. They are more sensitive to the identification of cervical lesions, and follow-up colposcopy and other inspection plans are formulated according to the different results.

Early diagnosis can gain valuable time for early treatment.

cervical appearance

Image source: Zhankuhailuo >


Surgery (13 items)< /p>

Specific items:

skin, thyroid, breast, spine, lymph nodes (neck, underarm, groin, supraclavicular), anus , rectum, prostate, joints of limbs, genitourinary organs, inguinal, dorsal artery of foot, veins of lower limbs;

through the Palpation of the breast, thyroid, rectum and testes, and prostate can help find suspicious nodules in these areas.

After the discovery, the doctor will recommend a more targeted examination.


Internal Medicine (8 items)

Specific items:

cardiac border, heart rhythm, heart murmur, lung, liver, spleen, bowel sounds, fat thickness.

The above-mentioned abnormalities can occur in patients with tumor.


pulmonary function tests ( 4 items)

Specific items:

spirometric capacity, ventilation function test, small airway ventilation function, blood oxygen saturation.

Lung cancer patients may have pulmonary insufficiency, but more often, pulmonary insufficiency and chronic obstructive pulmonary disease (COPD) correlation is higher.

In summary, Ordinary physical examination is difficult to directly detect cancer.

However, you can delineate some signs of highly suspected cancer, capture early signs of cancer, and guide you to various specialized further examination by the department.

Have you had a physical exam this year? Sometimes there may be a problem of “excessive alarm” during physical examination, But overall the cost performance is still very high.

I hope more people can forward this content to the family group,Let family members have regular physical examinations, which is one of the best methods for early detection of cancer at present.

If you want some more precise screening for cancer, Starting at age 20, some cancer screening Check the project and you can do it.

We have teamed up with doctors to cover all age groups and have compiled a list of cancer screenings by gender.

Simple and convenient, as long as you click on it according to your gender and age, you will immediately know what checks you should do