[肠癌康复期复查篇5] 肿瘤标志物超标? 看完不再讓指标自己吓到自己! | 学会看懂肿标与影像报告

作者:肠癌达人

肿标复查报告惊魂之 肿瘤标志物超标,学会看懂报告,在等待医生解画复查报告前胸有成竹

肿标报告的复发转移惊魂肿瘤标志物超标了!?

很多患者或家属见到肿瘤标志物超标了,就被吓得够呛,很多拿完报告还没见医生解画时,就被红色标注的肿瘤标志物ca724/ca199/ca125/ca153、ca242的某一项指标忽然升高超标吓一大跳,认为肿瘤标志物升高就等同于患者复发转移了,有些脆弱的家属拿到报告之后,找个没人的地方悲从中来大哭一场。哭完之后,才记得把检查报告发到群里来,经过我三言两语的报告解读之后瞬间转悲为喜,破涕为笑。

其实,上述说的肠癌患者在复查项目里,生化报告要求检测的肿瘤标志物敏感指标里,医生主要还是看癌胚抗原cea指标是否升高超过正常值,而在癌胚抗原cea值正常的情况下,ca724/ca199/ca125/ca153、ca242的某一项轻微升高甚至大幅升高了,并不意味着肠癌复发转移了。因为它们本来就不是特异性的肿瘤标志物,通常它们不正常的大幅升高还得合并癌胚抗原大幅升高,和影像检查互相印证才有参考意义。而当大概率的确认患者复发转移之后,我还会让患者或家属发术前核磁报告,术后病理报告,询问患者术后做了什么放化疗方案,完成放化疗方案的质量,会去梳理患者从确诊至复发转移的整个治疗过程有什么瑕疵,去大概率的分析出患者导致复发转移的大概率原因,以作为累积经验作为教训为后来者避免这种失误陷阱,储存反面案例教材,以警醒走弯路不回头的患者或家属。

Ct增强报告,胸正片报告,核磁影像报告的复发转移惊魂主要有下列几种:

1. 肝肺有多发囊肿或囊肿增大的;

2. 肝内有钙化灶的;

3. 肝有血管瘤,有强化结节描述的;

4. 肝内有囊性低密度影的;

5. 肝有异常灌注高密度影的;

6. 肺有强化条索影的;

7. 肺有首次描述的磨玻璃结节的

8. 肺有强化钙化灶、钙化片的;

9. 肝肺周边有淋巴结影货小淋巴结的;

10. 结直肠吻合口有不均匀增厚的;

11. 结直肠吻合口周围有小淋巴结影、或者小淋巴结的;

12. 吻合口有长t1,长t2信号接近水性结节的;

13. 双肾和膀胱、妇科器官囊性灶结节的;

14. 子宫肌瘤有强化灶表述的;

15. 胆结石强化灶的;

以上15种复发转移惊魂是我这6年来研究过的超过5000张复查报告里,患者或家属看见上述表述,而惊慌失措的复发转移惊魂的影像报告各种表述的大体内容,因为复发转移患者的报告通常会有高密度结节、强化结节、结节增大、多发类圆形的实性或强化结节、环形不均匀强化结节,环形强化结节,多发小淋巴结,多发肿大淋巴结的表述;所以多数一知半解的患者或家属在复查报告里,看见“多发”“低密度影”特别是“各种强化”表述,各种“增大”表述,各种“淋巴结增大”各种“增厚”表述特别敏感,也磨玻璃结节在肺癌来说就是很敏感的表述,所以患者和家属也非常敏感;而上述15种影像报告里的大概率良性表述语言,基本都是似是而非的包含了上述敏感词汇的某种信息,这对复查期如惊弓之鸟的患者或家属来说,这类杯弓蛇影的表述就足以让一些人大哭一场,让绝大部分患者和家属拿到报告的时候手发抖,足于让患者或家属辗转反侧、彻夜难眠;

影像报告要与肿标结合看,跟术后病理、术前核磁报告联系看,跟复查阶段综合看,跟诊疗和完成治疗质量综合判断,以期给患者或家属做出相对准确的初步判断

其实,一般肝肺,特别是肺部以前有过肺炎的人,多多少少都会在肺里留下一些钙化灶,或者轻度强化的条索影,而这些都是以前和现在留在肝肺里的旧伤形成的强化灶,而强化灶三个字就触动了不少一知半解患者和家属高度敏感的神经。而术区术后一般都会有吻合口的正常增厚,周边淋巴结也会正常的炎性反应而稍微增大;但是复发转移的患者也都会有这类描述,只不过程度不一样而已。所以这几种术后正常的“吻合口增厚”“周边淋巴结影或小淋巴结”都成为患者和家属所忌讳的报告表述语言。而在没有见到医生之前大多数都惶惶不可终日;我因为请教过不少医生和看过不少这类研究报告,也看过海量的这类表述的患者影像报告。在医生的解读和后续的复查都证明这类复查惊魂都是虚惊一场。有了八九成经验把握之后我一般都先告诉患者和家属,这些表述根据我的经验判断大概率是良性的。不需要太过紧张,可以放心的等医生做最后解读之后,你们就放心了。很多在群里见到我解读报告多了,也事后也印证绝大部分结果都跟我解读的结果差不多。很多的患者或家属听到我的不是复发转移的初步判断之后,多数都会如释重负,没见医生之前似乎就心中有数而淡定的不慌不忙的,过几天有其它事情要去医院时再顺便找医生解读报告了。

Ct增强报告,胸正片报告,核磁等影像报告的复发转移惊魂报告表述主要有下列几种:

而从影像报告加上其它检查报告因素综合起来判断,大概率是复发转移的患者复查报告,通常肝和(或)肺会有高密度结节、强化结节、增大结节、多发类圆形的实性或强化结节、环形不均匀强化结节,环形强化结节,纵膈会有多发小淋巴结,多发肿大淋巴结等表述。当有了上述的高概率复发转移怀疑的因素之后;除了结合癌胚抗原数值做判断以外,还得再结合影像检查的异常部位新发结节跟上述肿瘤标志物某个指标吻合,才能够高概率的怀疑某个地方可能出现复发转移了。如:ca119和癌胚抗原cea合并大幅升高,影像检查表述吻合口不正常增厚周边有不正常的包块,甚至肠镜报告发现吻合口有异常的新生物肿块或溃疡,医生会高度怀疑患者原位复发了。而开出PETCT检查单做PETCT检查,以期用PETCT的luv值的读数和非正常摄取值去判断患者是否原位复发,而开出PETCT单子让患者做全身最详细也是最昂贵的影像检查,去发现或者排除其它的器官和身体各部位是否有侵犯或转移病灶。

我通常还会再看看患者的术前核磁报告,看看怀疑复发部位术前核磁是否有复杂的肠外侵犯情况描述,看看术后病理切除出来的患者身体组织,是否有该部位切除过被肠外肿瘤侵犯的表述内容,去评判手术医生手术质量如何。如是否清扫指南规定的12个淋巴结,是否切除第二站淋巴结。发现术后病理做的很不专业,甚至会看看手术医生的简历去综合判断患者接受手术的大概质量,和相应的术后治疗措施是否合乎指南规范。看看肿瘤的性质是否是周边侵犯能力比较强的印戒淋巴癌,去多方面印证患者的复查报告表述内容和诊断结论表述,是否大概率的呼应和印证患者复发转移了!尽量做出患者是否大概率复发转移的初步判断。

每次都梳理勾勒了几个报告描述重点,让我的初步判断作为患者或家属跟医生请教、交流的重点项目,以帮助患者或家属能够在会见医生有限时间里,重点的跟医生讨论报告里关键的不确定因素,使患者或家属跟医生对话时有个交流基础和重点内容,它更是下次复查患者或家属要重点跟踪做对比的重要跟踪项目之一。

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[肠癌康复期复查篇5] 肿瘤标志物超标? 看完不再讓指标自己吓到自己! | 学会看懂肿标与影像报告》有3,949个想法

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