When Your Health Report Shows 'Nodules' or 'Polyps—— Should You Be Worried?
The peak season for annual physical examinations has arrived. Many friends, upon receiving their test reports, notice words like “nodule” or “polyp,” and anxiety can be triggered instantly. Will polyps gradually turn into cancer? Once a nodule is found, should one immediately consult a doctor for removal? Can existing polyps and nodules disappear on their own? These questions have become hot topics online.
Don’t be afraid. Let’s first understand them.
What is a nodule?
A nodule is a round protrusion on the surface or within the tissues of a living organism[1]. They are commonly found on the skin surface but can also appear in organs such as the lungs, breast, and thyroid. Nodules on the body surface can usually be detected through visual inspection or palpation by a clinical doctor, whereas nodules inside organs require medical imaging for detection. With the improvement of diagnostic equipment accuracy, the detection rate of various nodules has been increasing. Nodules are not inherently frightening; the key is their type. Most nodules are benign and only require observation. However, certain signals may indicate that a nodule is precancerous or an early-stage cancer, which should be taken seriously.
What is a polyp?
Colon polyps, gallbladder polyps, cervical polyps… many organs in the human body may develop polyps. Most polyps grow inconspicuously and can be detected through endoscopy and other examinations[2]. Polyps are abnormal growths protruding from the mucosal surface and include various types, such as hyperplastic polyps, inflammatory polyps, and hamartomatous polyps. Some polyps are caused by localized mucosal inflammation, while others are due to genetic mutations and may be related to heredity, dietary habits, and lifestyle.
Does your physical examination report include these types of nodules and polyps?
When we receive a test report indicating “nodule” or “polyp,” what should we pay attention to? Is further examination or treatment necessary? Here is a detailed explanation of some common nodules and polyps you may be concerned about.
Thyroid Nodules
Ultrasound examination of the thyroid in the neck is a routine item in physical exams and is the main method for detecting thyroid nodules. In 2020, about 60% of adults were found to have one or more thyroid nodules, of which approximately 95% were benign and only about 5% were confirmed as malignant[3].
Although the probability of a malignant diagnosis is low, it is essential to rule out the possibility of malignancy in thyroid nodules. Clinically, the TI-RADS (Thyroid Imaging Reporting and Data System) is commonly used to classify thyroid nodules according to their benign or malignant potential[3][4].
According to the “2020 Chinese Guidelines for Risk Stratification of Thyroid Nodules by Ultrasound: C-TIRADS” published in the Chinese Journal of Ultrasound Imaging, nodules graded 4–6 are recommended to follow the clinical doctor’s advice for targeted measures, including thyroid function tests, fine-needle aspiration, and further examination and treatment. Nodules graded 3 or below generally only require regular follow-up to observe changes.
Breast Nodules
Breast nodules can be benign or malignant. Benign nodules include fibrocystic changes, breast cysts, and fibroadenomas, while malignant nodules may indicate breast cancer.
Clinically, breast screening is performed via ultrasound or mammography, with the BI-RADS (Breast Imaging Reporting and Data System) used for evaluation. This system classifies the malignancy risk of breast nodules into six levels based on shape, margin, blood flow signals, and the ratio of vertical to horizontal dimensions; the higher the level, the greater the likelihood of malignancy[5].
As a common condition in women, breast nodules require attention. Female friends are advised to avoid staying up late, manage stress, maintain a low-fat, high-fiber diet, and exercise appropriately.
Lung Nodules
The causes of lung nodules are not entirely clear; they may result from scar tissue following trauma, lesions caused by infection, or malignant tumors. According to the NCCN guidelines, recommendations are given based on nodule size and density[6].
Gallbladder Polyps
Gallbladder polyps are classified as benign or malignant, with the vast majority being benign. Benign polyps can be non-neoplastic or neoplastic, among which gallbladder adenomas are high-risk factors for gallbladder cancer, and their size correlates directly with malignancy risk.
• Polyps >10mm have a higher risk of malignancy; surgical removal and pathological examination are recommended.
• Patients aged >50 years or with concurrent gallstones should receive clinical surgical intervention regardless of polyp size[7][8].
• Polyps 6–9mm should undergo ultrasound follow-up every 6 months for 5 years[8].
Intestinal Polyps
Intestinal polyps include several types, mainly inflammatory polyps, hyperplastic polyps, and adenomas. Inflammatory, lymphoid, and hyperplastic polyps have a low risk of malignancy, whereas adenomatous polyps are the source of the majority of colorectal cancers. Studies indicate that 50%–70% of adenomas may develop into colorectal cancer, with cancer risk increasing for larger polyps. Generally, colorectal polyps >20mm have a malignancy rate of 10%[9][10].
Familial adenomatous polyposis (FAP) is the most common polyp condition. Without timely screening and treatment, about three-quarters of patients develop cancer before age 35, and the risk remains high after 50[9].
Therefore, regular colonoscopy examinations are essential. A diet rich in vegetables and fruits, and avoiding smoking and alcohol, is recommended. Once intestinal polyps are detected, prompt medical consultation and removal are advised. Due to the tendency of polyps to recur, even after removal, regular follow-up is necessary.
References
[1] http://www.a-hospital.com/w/%e7%bb%93%e8%8a%82
[2] http://www.a-hospital.com/w/%E6%81%AF%E8%82%89
[3] Grani G, Sponziello M, Pecce V, Ramundo V, Durante C. Contemporary Thyroid Nodule Evaluation and Management. J Clin Endocrinol Metab. 2020 Sep 1;105(9):2869–83. doi: 10.1210/clinem/dgaa322. PMID: 32491169; PMCID: PMC7365695.
[4] Chen X, Chen S, Lü G. Diagnostic value of ultrasound TI-RADS classification for thyroid nodules. Chin J Ultrasound Med, 2012, 28(12):1066-1069.
[5] Chinese Women’s Breast Cancer Screening Standard (T/CPMA 014-2020)[J/OL]. Chin J Cancer Prev Treat:1-10[2021-02-18].
[6] NCCN Clinical Practice Guidelines: Lung Cancer Screening 2020.1
[7] Kalbi D P, Bapatla A, Chaudhary A J, et al. (July 02, 2021) Surveillance of Gallbladder Polyps: A Literature Review. Cureus 13(7): e16113. doi:10.7759/cureus.16113
[8] CSCO Gallbladder Cancer 2020 Guidelines
[9] Morson B C. Genesis of colorectal cancer. Clin Gastroenterol. 1976, 5: 505-525.
[10] Wu H, Li P. Analysis of 1032 cases of colorectal polyps treatment. Chin J Dig, 2005, 25: 374
