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复发转移迹象明显的患者要转院到省肿瘤医院以上专业医院诊疗的原因
第一节 有些报告内容手术医生叫随诊，你却有必要去上级医院复查一次
患者术后两年是2-3期患者复发转移的高发期，特别是t4a-t4b的2b-2c期和3b-3c期的结直肠癌患者，和需要新辅助放疗和术后放疗的超低位直肠癌患者，肿瘤位于升结肠肝曲、位于乙状结肠膀胱附近的患者，这类t4患者肠癌肿瘤一般已经突破肠腔侵犯肠周血管和（或）淋巴系统了，肿瘤术前具备通过淋巴系统和血行系统转移肝肺的能力，术前肝肺影像没有拍到怀疑转移结节，不等于患者肝肺就没有小于5mm指南规定需要报告的微小转移癌结节，也不等于患者血液和淋巴系统里就没有正在转移中的癌细胞，只不过它聚集于某个地方的癌结节太小，影像看不出来，或者小于5mm按照规定不需要报告出来给以跟踪而已。
所以，肝肺复查有大于5mm的实性结节就要引起医生和患者、家属的高度重视，肠组织比肺组织的密度高，所以大于5mm的实性结节，医生就会跟踪它是否继续长大或者强化，一般在影像报告里首次描述大于5mm的结节,而5mm的实性结节一般只能够随诊跟踪，密切观察，它还太小不可以刺穿取样去做活检确诊，所以医生一般叫随诊，下次复查再做影像比对！要是患者处于化疗期一般下次检查结节变大变小了都基本确诊转移，因为变大了是化疗药遏制不住转移结节继续长大，变小了是化疗有效转移结节通过化疗治疗变小了，跟上次相仿没有改变的结节一般是转移癌的概率就很低；因为它对化疗药不敏感。
第二节 省肿瘤医院医生能够更早的确诊转移，能够及时进行多学科诊疗之后切除单发肝肺转移病灶，根治处于四期早期患者病情，治愈率远远高于非专业医院
而群经验上胸外科或者肝胆外科或心肺外科医生，对这类怀疑肝转肺转的结节会比较敏感一些也会偏悲观一些，判断肝转肺转的时间一般早于肛肠科手术医生，省肿瘤医院的医生检查判断这种怀疑转移结节的时间，一般也会大大的快于和准确于地级市同专业科室的医生；而手术医生往往是最后一个确认肝转肺转、原位复发的医生；不管这种确诊时间差异是出于技术、检测手段意愿或稳妥的诊断，既然转移了早确诊早治疗对患者有着很大的治疗利益，早发现肝肺转移一般就是单发可切除的癌结节，而再随诊3个月甚至6个月再确诊，可能就是不可以做手术切除根治性手术的多发转移病灶了；而对于手术医生来说复发转移期离手术期太近，总会有是不是术前就已经转移？医生是不是术前没有查清楚肝肺是否转移就匆匆忙忙手术呢？或者是不是手术没有切除干净原发病灶才导致术后这么快就肝肺转移了呢？手术医生是不是在这种压力下，确诊肝肺转移就相对比较谨慎了呢？还是肠癌手术医生通常是肛肠外科医生，而肛肠外科医生是不是在肿瘤肝转肺转的专业知识上不如胸外科、肿瘤外科、肝胆外科、心肺外科医生呢？
第三节 全国十大肿瘤医院能够更早的确诊肝肺转移、具备专业技术切除多发肝肺转移病灶、更好的多学科诊疗机制和手段，拥有更高的肝肺转移晚期治愈率
经验上，群里很多很多的病例术后3-24个月每3个月一次的例行复查中，特别是12个月内，甚至3个月或6个月第二次复查中，就发现有肝肺转移的，而患者或家属往往先把报告拿给手术医生看，在几个复查报告肝肺实性结节明显是转移灶变大、变强化的情况下，手术医生都医嘱患者随诊三个月，甚至有癌胚抗原达到79的患者手术医生还说没事而医嘱随诊的；有三个月复查实性结节5mm，第二次复查这个结节莫名其妙的没有报告描述，而第三次报告描述就变成24mm、而且还变成多发转移了;按照半年两次复查高度怀疑的实性结节长大了19MM,其实第二次复查这个结节应该是10-14mm才对，这么大的结节怎么会在第二次复查就看不出来没有描述了呢？但是我在第二次复查报告中找不到这个结节的任何描述，更加没有诊断意见。我们为什么不在肝转单发首次5mm就随诊跟踪，而在第二次复查转移癌在10mm以内的单发时就把它确诊，再把它手术切除呢？！
所以，这两年发现这种肝肺高度怀疑转移结节首次大于5mm开始报告时，我都会叮嘱患者或家属下次复查紧紧的盯着这个结节是否变大和变强化，特别是那些从术前核磁报告、术后病理报告、肿标报告癌胚抗原cea超标，确认原发病灶肿瘤出肠具备远端转移能力的患者；那些梳理出来手术瑕疵和患者放化疗疗程不完整的患者；我会大概率的判断患者的增大强化结节已经大概率是转移灶了；原医院和手术医生确诊不了、或者不肯确诊，就建议患者或家属去省肿瘤医院以上、最好是去全国十大肿瘤医院找专家确诊或排除；确诊了就在有丰富治疗四期肠癌患者成功经验和能力的专业医院治疗，其实患者一旦肝肺任何一个器官转移就涉及多学科联合诊疗，就要去拥有晚期肠癌治愈率最高的全国十大肿瘤医院治疗。
第四节 不专业医院确诊肝肺转移的时间和确诊后的治疗手段有限，患者和家属要当机立断
一般地级市以下不够专业的医院面对肝肺高度怀疑转移患者，往往确诊手段有限确诊时间比较慢，确诊后的转移癌也比较大，以至于超出了这些医院胸外科、肝胆外科或心肺外科医生可以手术切除的能力，导致在地级市确诊肝肺转移的患者的治疗手段大部分除了化疗还是化疗，要是低位直肠癌伴原位复发还有放疗，其它的基本就剩下化疗手段一途，介入消融在这一级医院还很不成熟，就是有这种科室和治疗服务提供其治疗效果也差强人意；导致在地级市确诊复发转移的患者，要是不转院到全国十大肿瘤医院去治疗的话，在地级市治疗晚期肠癌的患者，结局大多数都是一直化疗、化疗到患者身体血象和肝肾功能垮掉为止；而通常第3-4次复查才确诊肝肺转移的患者通常都刚做完化疗不久，身体还没有从第一次化疗的疗程中恢复过来，就进入第二个也是患者可以最高耐受极限的第二个化疗疗程，而这种术前就转移或者手术切除不干净，或者患者完成第一次化疗不完整的病情，10mm以内确诊不了，超过10mm的多发转移肝肺结节，就不是通过一味化疗就可以把转移癌化掉的。
非专业肿瘤医院，不单只不具备做复杂而专业性强t3-t4超低位肠癌手术，面对复发转移的患者治疗技术与手段也非常有限，通常只有放化疗条件，和不成熟的介入治疗条件，根本不具备多学科联合诊疗的非专业医院，一般很难根治四期肠癌患者的病情，缺乏早期做肝肺单发转移确诊，肝肺单发转移切除综合能力、患者进入多发肝或（和）肺多发转移甚至全身转移之后，本来应该根据患者身体素质和病情综合考虑之后转入舒缓治疗的患者；往往还在做毫无目的或者叫做不可能达到目的的积极加大治疗强度，导致患者身体急速垮掉的病例比比皆是，令人唏嘘。
第五节 肝肺结节超过5mm要跟踪对比，实性、高密度结节要引起高度注意，增大、强化字样是警钟
患者在每次影像复查报告上发现首次大于5mm实性结节，或者上次是3-4mm结节首次超过5mm实性结节，就要引起患者和家属的高度重视，就要在见医生解读报告时，问清楚这个实性结节医生的判断意见是否高度怀疑这个实性结节是转移癌结节，要是医生很肯定的告诉你这个结节是一般的低度怀疑结节，并医嘱随诊观察，等三个月复查对比之后再做结论；因为此时医生没有太好的检查手段去排除或者确诊这个怀疑结节，那么你可以听医生的随诊三个月下次在同一个医院做复查，此时5mm的结节也很难刺穿取样做活检，你下次复查时记得下次的复查结果跟这次的复查结果做对比，看看这个结节是否长大？是否变小，还是与上次相仿，是否强化或环形强化？要是你在省会城市你也可以再去省肿瘤医院重复做一次这种影像设备的检查，检查报告拿给省肿瘤医院胸外科专家看看，听听专家的意见是否跟原手术医院的结论一致，是不是也是要随诊观察三个月的医嘱；是的话证明你现在的肝肺结节省一流的肿瘤医院和专家也无法确诊或者排除这个结节的性质；那么你只能够忐忑的再等三个月再去做复查对比了。
若你这个结节是影像报告（包括术前术后的报告）第二次描述这个5mm或大于5mm的实性结节了，而且还出现高密度结节的描述，而原手术医院手术医生看完报告之后，没有开增强核磁进一步检查，还是无法进一步判断这个增大的高密度实性结节是不是转移癌，还是医嘱随诊三个月或六个月在复查做对比的话，那么，你就有必要做出去省肿瘤医院做进一步检查的决策，在医院复印就诊以来所有的检查报告去省肿瘤医院再一次检查，让省肿瘤医院的专家去做确诊或排除，排除了你可以继续在离家近的原医院做下一次复查；确诊了你就要在有多学科联合诊疗条件、有省里最先进治疗设备和技术、有更高四期肠癌肝肺转移患者治愈率的省肿瘤医院治疗，而不是回原手术医院治疗；原医院对高度怀疑肝肺转移结节的确诊和排除能力的高低，其实也就反映了它对肠癌患者肝肺转移的综合治疗能力，你不要期望一个对两次复查肝肺高密度增大的实性结节无法做出确诊或排除的医院和医生，能够第一时间用科学的方法治疗患者生命攸关的肝肺早期转移病情。
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