At that mont, a young man walked in.
"Mom? Are you not done yet?"
The woman turned her head to glance at her son and said, "The doctor here says it's not a lung disease. It might be the thyroid gland pressing on a nerve that's causing the dry cough."
Hearing his mother's words, the young man was taken aback and looked at the doctor, "Doctor... what's the situation? The thyroid can cause a dry cough?"
Chen Cang, upon hearing this, nodded his head, "Yes, I've just perford a palpation of your mother's thyroid gland. I can confirm that both sides are enlarged and there are nodules as well. To determine the exact situation, we'll need to do an ultrasound scan."
Hearing Chen Cang's words, the young man was montarily stunned, "Then please write a referral for us."
Chen Cang nodded and wrote a referral for a thyroid ultrasound.
The young man suddenly asked, "Doctor, can you also write us a referral for a lung CT? I'm afraid when we go to see Director Qin tomorrow, they won't accept the films from our local hospital."
Chen Cang hesitated for a mont and then asked a sowhat off-topic question, "Does your mother often get x-rayed?"
The young man hesitated for a while before responding hesitantly, "My mom is a teacher and does a lot of desk work, so she's had cervical spine issues for years. Last year, she had quite a few problems and frequently visited the hospital, which ans she's had a lot of cervical spine x-rays, and she's had a persistent cough, not just once or twice, so she's also had several lung examinations."
Listenting to the young man's words, Chen Cang sighed, "How about this, go ahead and get the thyroid ultrasound first. There's no need for a CT right now."
The young man hesitated, "But... we specifically ca here to see Director Qin about the lung disease. Please, just help us this one ti."
Chen Cang replied, "The films from your Wan'an County are sufficient, the equipnt is quite good there, there's no need to have another one taken."
Only then did the young man stand up and leave with his mother.
As Chen Cang watched the two leave, he was still uncertain, but he felt that it was very likely the aunt had thyroid cancer.
Radiation damage is especially deadly to the thyroid gland.
The thyroid, being a relatively fragile glandular tissue, is not surrounded and protected by much, unlike other glands, but rather lies right in the neck.
Thus, during the taking of x-rays and CT scans, these radiative examinations, the gland is more easily damaged by radiation, making it more prone to cancerous changes.
Even now, research has shown that radiation damage has beco one of the highest contributing factors to thyroid cancer.
Chen Cang glanced at the clock as it was nearly ti to finish work and hesitated, but he didn't leave right away.
He decided to wait for these two patients.
Generally speaking, the ultrasound technicians won't directly tell you if you have thyroid cancer, most of them will just tell you to consult a doctor.
Moreover, whether it is specifically thyroid cancer has to be confird by a biopsy result; the ultrasound technician won't make such irresponsible comnts.
The ultrasound room wasn't busy that afternoon and the results were completed relatively quickly.
By around 6:30 p.m., there was hardly anyone in the corridor. The only difference was that the registration desk was now backed up with a long queue, many people were staying up all night waiting for tomorrow's appointnt releases.
There were even so familiar faces.
With nothing else to do, Chen Cang took out his phone and started searching for information on thyroid cancer surgeries.
The difficulty of thyroid surgery isn't high, but it requires precision. The neck has a complex arrangent of tissue, organs, blood vessels, and nerves, and one needs to be extrely careful during surgery.
The demands on the surgeon are high as well.
In terms of difficulty, it tends toward precision, but it is not overly difficult.
At that ti, the aunt and young man ca back from their examination. Noticing the sparse number of people in the corridor and that the doctors had all left for the day, they imdiately beca worried. After all, they couldn't understand the report themselves and could only seek a doctor's opinion, and the ultrasound technician specifically told them to have a doctor review it.
Could I go see Dean Qin tomorrow?
As I was passing by, I suddenly noticed that Chen Cang's clinic door was still open, and my face imdiately lit up with joy!
As the elderly lady ca in, she smiled and said, "Doctor, I'm sorry for making you wait. Thank you so much!"
"But... Doctor, what... what does this say? The doctor who did the exam told I must show it to you."
Chen Cang took the report, looked at the signature, and saw it was from Director Bo.
Ultrasound findings: Bilateral thyroid enlargent, irregular capsule contour, coarsened and heterogeneous parenchymal echoes...
Ultrasound impression:
Thyroid parenchymal echo with coarsening and heterogeneity.
Multiple nodules visible on the right side, T1-RADS-4b category
...
When Chen Cang saw the 4b, his expression changed abruptly. This ant that the likelihood of malignancy was already very high. This was a commonly used index in hospitals; patients couldn't understand it, which avoided unnecessary panic, but doctors generally knew what it ant.
Generally speaking, for thyroid nodule classification, category 1 is a normal thyroid, category 2 is benign nodules, category 3 is likely benign nodules (80% benign), 4a category (5-10% malignant), 4b category (10-80% malignant); category 5: likely malignant nodules (malignancy >80%).
Looking at the 4b, Chen Cang understood that this likely ant a high probability of malignant nodules, that is, a malignant tumor.
Moreover, looking at the report that showed the nodules were irregular, with good blood flow and uneven echoes...
Although an ultrasound couldn't confirm it, Chen Cang felt that a biopsy was all that was missing for a definitive diagnosis!
Next, he had to think about how to communicate with the patient!
Telling her directly about a tumor would certainly cause her to worry and perhaps not be able to accept it.
After much thought, Chen Cang said, "Auntie, you don't need to go to the outpatient departnt tomorrow. Instead, go directly to the inpatient departnt. The thyroid result indicates that the nodules are very likely malignant. What we need next is to perform a biopsy to confirm whether it's benign or malignant, and then complete relevant tests. It's best to have surgery as soon as possible!"
Hearing what Chen Cang said, as expected, both were taken aback.
The elderly lady hesitated, "Doctor... are you talking about cancer?"
In this era where the ntion of cancer changes one's color.
Chen Cang felt it was more troubleso to delay addressing the condition, so he said, "Don't worry. I'm only suggesting the possibility, but whether it is cancer or not needs to be confird by a biopsy. Moreover, don't feel too burdened. The treatnt effectiveness for thyroid cancer now is especially good, with a ten-year survival rate of over 90%. Many patients take dication long-term and it basically has no impact."
Hearing Chen Cang's words, the elderly lady fell silent.
Who would have thought a simple cough would lead to a discovery of thyroid cancer?
Moreover... that was actually lucky.
If she had been in Wan'an County all along, she might never have understood until her death.
Seeing his mother's worried and frightened appearance, the son couldn't help but ask, "Doctor, my mother is usually quite healthy. How could she have developed thyroid issues?"
After so thought, Chen Cang said, "My advice is that when you are having a CT scan in the future, try to shield your neck with sothing, and if possible, opt for MRI over CT for cervical spine imaging, as CT can cause significant harm to the thyroid."
...
ps: The above advice is also for everyone. This disease is becoming more and more common, and it has a lot to do with radiation damage.
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