With the improvement of tumor diagnosis and treatment level, tumor is not as terrible as before. Many patients are found early, operated in time, and after standardized chemotherapy and radiotherapy, their disease is controlled and enter into stable stage. Some patients are very nervous, suspecting tumor recurrence for no reason, and often do various examinations; some others, on the contrary, think everything is fine and never want to go to the hospital, and regret only when recurrence or metastasis occurs. So, what should we do in the days after the treatment is over, so as not to be overly nervous and not to delay the disease? What items should be reviewed so that we don’t miss them and don’t waste them?
Is it meaningful to review regularly?
Modern research has found that there are proto-oncogenes and oncogenes in human body. Under normal circumstances, proto-oncogenes maintain the normal function of cells, but when they are activated, the cells will deviate from the normal pathway and transform to malignant cells, becoming cancer cells and growing without restriction; oncogenes are the opposite of oncogenes, with the inactivation or absence of oncogenes, normal cells will develop in the malignant direction, and people will then suffer from tumors. After a tumor is found, surgery, radiotherapy and chemotherapy only remove and kill the already formed tumor, and no visible tumor is found temporarily, however, the oncogene has been activated, so the possibility of tumor reappearing is very high. Of course, there are many other factors to decide whether the tumor recurs or not, but this factor is currently recognized. Therefore, regular review is very necessary to detect the tumor in time for timely treatment.
How often is the review appropriate?
The growth rate of various tumors is different, therefore, the interval of review is also different. Tumors with fast growth rate, such as small cell lung cancer, various types of low differentiated cancers and malignant lymphoma, may change significantly within one month, and may need to be reviewed once a month during the high-risk period. Tumors with slow growth rate, such as thyroid cancer and various highly differentiated cancers with long growth cycle, may need to be reviewed once in 3-6 months.
The timing of review is also related to the duration of surgery and treatment, which generally increases with the duration of surgery. For example, the US NCCN guidelines stipulate that head and neck cancer should be reviewed every 1-3 months within 1 year after surgery, every 2-4 months after 2 years, every 4-6 months after 3-5 years, and every 6-12 months after 5 years. Lung cancer is highly malignant and the current average survival period is only 8-12 months, therefore, lung cancer patients need to be reviewed more closely within 1 year. It is generally believed that tumor patients are safer if there is no recurrence 5 years after surgery, and the risk of recurrence decreases and the interval between reviews can be extended. Most solid tumors, such as lung cancer, esophageal cancer, stomach cancer, intestinal cancer, pancreatic cancer, etc., should be reviewed every 3 months within 2 years after surgery, every 4-6 months from 2 to 5 years, and every 6-12 months after 5 years. However, some tumors are special, for example, the peak of recurrence of breast cancer is 3-4 years, therefore, it is generally recommended that breast cancer patients should be reviewed every 3-6 months within 5 years after surgery.
Strictly speaking, tumor patients should have regular review for their lifetime. Clinically, there are cases of recurrence 10 years after surgery, or even 17 years after surgery.
These experiences are gained through many years of observation of many cases, and will change as experience is gained.
What items should be rechecked?
1. CT should be done for tumor sites; chest CT should be done for lung cancer and esophageal cancer; abdominal CT should be done for stomach cancer, intestinal cancer, pancreatic cancer and kidney cancer.
For example, lung cancer is prone to liver metastasis, so in addition to chest CT, abdominal ultrasound should be done, and abdominal CT should be done when necessary.
3. Bone scan should be done before surgery. For diseases prone to bone metastasis, such as breast cancer, lung cancer, thyroid cancer and kidney cancer, bone scan should be done once every six months. Bone scan is more sensitive than X-ray film and can be detected at the early stage of bone destruction.
4.Check tumor markers. Different tumors have relatively sensitive tumor markers, for example, AFP (alpha-fetoprotein) has special significance for liver cancer, CEA (carcinoembryonic antigen) for lung cancer and gastrointestinal cancer, NSE (neuron-specific enolase) is more accurate for small cell lung cancer, CA125 (cancer antigen 125) is sensitive for ovarian cancer, and PSA (prostate-specific antigen) is sensitive for prostate cancer. Tumor markers are not 100％ accurate and need dynamic observation. If the marker is high when there is a tumor and decreases after surgery, then this marker is meaningful for this patient and changes in the disease can be monitored later based on the changes in this marker.
5. Stool routine and urine routine. A small amount of bleeding can be detected from the stool. Urine routine is a must-check item for urinary tract cancer.
6.Gastroscopy and colonoscopy. Patients with esophageal cancer, stomach cancer and intestinal cancer should have gastroscopy or colonoscopy at least once a year. If intestinal polyps are found, it is necessary to shorten the time of colonoscopy, because some polyps grow fast and will become malignant if not found in time.
7.Blood routine. Gastrointestinal patients who bleed will find a decrease in hematocrit; lymphoma recurrence will find an abnormal increase in white blood cells; and in case of bone marrow invasion, all blood images will be abnormal.
Liver and kidney function: elevated GGT (transpeptidase) often indicates liver metastasis; abnormal bilirubin means bile excretion problem, so check the liver, gallbladder and pancreas; low protein check the liver or kidney. Especially patients who have had abnormal liver and kidney function after chemotherapy should pay attention to is repeated.
9, physical examination. Such as weight, unexplained weight loss often means the recurrence of tumor. Superficial lymph nodes can also be checked during the review.
10.Brain CT, MRI. patients prone to brain metastasis, such as small cell lung cancer, should have brain CT or MRI every six months to one year. brain MRI is more suitable than CT to detect small metastases.
Examination of special conditions
When there are some special conditions, timely re-examination should be performed. Such as unexplained wasting, unexplained low fever, pain in fixed area, sudden headache, vomiting, incomprehensible mental abnormality, etc.
Examples of common tumor reexaminations
Lung cancer: review every 3 months within 2 years after surgery, every 4-6 months after 2 years, and every 1 year after 5 years. The review includes chest CT, abdominal ultrasound (abdominal CT if necessary), brain CT every time for small cell lung cancer, 1 brain CT before surgery and 1 brain CT every 4-6 months for non-small cell lung cancer; tumor markers CEA, CA125, CY21-1 (cytokeratin 19 fragment), SCC (squamous carcinoma antigen) for non-small cell lung cancer, NSE (neuronal specific enolase); routine postoperative bone scan once, if there are no related symptoms, once every six months; routine blood tests, liver function, kidney function; physical examination pay attention to breath sounds, supraclavicular lymph nodes, axillary lymph nodes, weight.
It should be noted that if there are symptoms then check at any time, such as hoarseness, which often means mediastinal lymph node metastasis; pain in fixed area, which has the possibility of bone metastasis; unexplained rapid weight loss, which is often caused by tumor recurrence; severe headache, or with jet-like vomiting, which is often a symptom of increased cranial pressure of brain metastasis …… If you encounter If you encounter these conditions, you should go to the hospital in time, preferably to the original doctor in charge, for relevant examination.