Updated Guidelines for Screening and Prevention of 20 Malignant Tumors

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Updated Guidelines for Screening and Prevention of 20 Malignant Tumors

Updated Guidelines for Screening and Prevention of 20 Malignant Tumors including colorectal cancer, lung cancer, breast cancer, liver cancer, stomach cancer, and thyroid cancer……..

Since the World Health Organization clearly proposed the “three early” strategy of early detection, early diagnosis, and early treatment of cancer, cancer screening, early diagnosis and early treatment have been recognized as the most effective way to prevent and control cancer.

According to the World Cancer Report issued by the World Health Organization, it is predicted that by 2025, the number of new cancer cases worldwide will increase to 19 million annually, to 22 million by 2030, and to 24 million by 2035.

The three most common cancers in the world in 2018 were lung cancer (2.1 million), breast cancer (2.1 million), and colorectal cancer (1.8 million). The top three cancers with fatality rates were lung cancer, colorectal cancer, and gastric cancer. Approximately 9.6 million people worldwide die of cancer each year.

1. Colorectal cancer

High-risk objects:

1. Asymptomatic people over 45 years old;
2. Two weeks of anorectal symptoms over the age of 40 (refers to any of the following symptoms lasting more than two weeks: changes in stool habits (constipation, diarrhea, etc.); changes in stool shape (feces become thinner); changes in stool properties (hematochezia, mucous stools, etc.) ; People with pain in a fixed part of abdomen);
3. Patients with long-term ulcerative colitis;
4. People after colorectal cancer surgery;
5. People after colorectal adenoma treatment;
6. Immediate relatives with family history of colorectal cancer;
7. An immediate family member of a patient diagnosed with hereditary colorectal cancer (referring to familial adenomatous polyposis (FAP) and hereditary non-polyposis colorectal cancer (HNPCC)) who is over 20 years old.

Screening recommendations

1. “General population” screening that meets 1~5:

(1) Colorectal cancer screening starts at the age of 45, regardless of men and women, fecal occult blood (FOBT) testing is performed once a year, and colonoscopy is performed once every 10 years until the age of 75;
(2) Those who are 76 to 85 years old, who are physically fit and whose life expectancy is more than 10 years, can continue to be screened;
(3) If you are over 85 years old, it is not recommended to continue screening.

2. Screening of immediate family members with “family history of colorectal cancer”:

(1) 1 first-degree relative has clear high-grade adenoma or cancer (onset age less than 60 years old), 2 or more first-degree relatives have clear high-grade adenoma or cancer (any age of onset), starting at 40 years old (Or start 10 years younger than the age of onset of the youngest person in the family) screening, FOBT examination once a year, colonoscopy once every 5 years;
(2) High-risk subjects with a family history of first-degree relatives (only one, and the age of onset is older than 60 years): Start screening at the age of 40, FOBT test once a year, and colonoscopy once every ten years.

3. Screening for family members of “hereditary colorectal cancer” that meets 7: For family members of FAP and HNPCC patients, when the first case gene mutation in the family is clear, gene mutation test is recommended.

(1) Those who have a positive gene mutation test, after the age of 20, undergo colonoscopy once every 1 to 2 years;
(2) Those who have a negative gene mutation test shall be screened according to the general population.

4. Recommendations on screening methods:

(1) FOBT testing + questionnaire survey is the main screening method, with sufficient evidence;
(2) Multi-target genetic testing of blood may help improve the accuracy of screening, which is relatively expensive;
(3) Those who have conditions can combine stool and blood methods for screening.

Prevention advice

1. Exercise can effectively reduce the occurrence of tumors, adhere to physical exercise, and avoid obesity;
2. Healthy diet, increase the intake of crude fiber and fresh fruits, and avoid high-fat and high-protein diets;
3. Non-steroidal anti-inflammatory and analgesics may be effective in preventing bowel cancer. The elderly can try to take low-dose aspirin, which may reduce the risk of cardiovascular and cerebrovascular diseases and bowel cancer. Consult a doctor for specific use;
4. Quit smoking and avoid its long-term toxicity and inflammatory irritation to the digestive tract.

2. Breast cancer

High-risk objects:

1. Patients with past breast duct or lobular dysplasia or lobular carcinoma in situ (LCIS).
2. Received chest radiotherapy before the age of 30.
3. There is an obvious genetic predisposition:

(1) Family (including first- and second-degree relatives. First-degree relatives refer to parents, children, and siblings (same parents); second-degree relatives refer to uncles, uncles, aunts, uncles, aunts, grandparents, and grandparents) with BRCA1 Carriers of /BRCA2 gene mutation;
(2) Those with breast cancer in the family whose age of onset is before 45 years old;
(3) There are 2 breast cancer patients in the family (1 bilateral or 2 unilateral), and the age of onset is 45-50 years old;
(4) There are 2 or more people in the family suffering from breast cancer, or ovarian cancer, or fallopian tube cancer, or primary peritoneal cancer;
(5) There are male breast cancer patients in the family;
(6) Those who have had breast cancer, or ovarian cancer, or fallopian tube cancer, or primary peritoneal cancer.

Screening recommendations:

1. General women

(1) Screening is not recommended before the age of 40;
(2) Start screening at the age of 40, and it is recommended to have mammograms every 1 to 2 years;
(3) It is recommended to combine with B-ultrasound for dense breasts (mammography examination reveals that the glands are type c or type d);
(4) Those who are over 70 years old, physically fit, and have a life expectancy of more than 10 years are recommended to maintain screening, and mammography should be performed every 1 to 2 years.

2. People at high risk of breast cancer

(1) It is recommended to carry out breast cancer screening at 40 years of age or earlier;
(2) Breast x-ray examination once a year;
(3) One breast ultrasound examination every 6-12 months;
(4) One breast examination every 6-12 months;
(5) When necessary, an enhanced MRI of the breast should be performed once a year.

Prevention advice

Develop a healthy lifestyle, stay away from tobacco and alcohol, have reasonable nutrition, maintain a healthy weight, and keep exercising;
Give birth at the right time and breastfeed;
Participate in breast screening and regular physical examination.

3. Cervical cancer

High-risk objects

1. Those who have multiple sexual partners;
2. People who have premature sex;
3. Persons infected with human papillomavirus (HPV);
4. People with weakened immune function;
5. Women with a history of cervical lesions.

Screening recommendations

Women who are married or have a history of sex for 3 years or more are recommended to undergo screening:

1. Cervical cytology is used for 21 to 29 years old, and after 3 years of continuous screening, there is no abnormality, once every 3 years;
2. Cervical cytology is used for 30 to 65 years old, and after continuous screening for 3 years without abnormalities, once every 3 years; or high-risk HPV and cervical cytology combined screening, after continuous screening for 3 years without abnormalities, every 5 years Once a year;
3. Screening end time:> 65 years old and multiple previous tests have been negative, then the screening will be terminated; if a history of high-grade squamous intraepithelial lesion (HSIL) has been diagnosed, the screening will continue for another 20 years, and the frequency of screening Depends on the condition;
4. Women who have undergone total hysterectomy (without cervix) and have not had cervical intraepithelial neoplasia (CIN) 2, CIN3, carcinoma in situ or cancer in the past 20 years, do not need to be checked;
5. For women who have been vaccinated against HPV, follow the age-specific recommendations (same as women who have not been vaccinated).

Prevention advice

1. Get HPV vaccine;
2. Do not smoke or quit smoking;
3. Safe and healthy sex;
4. Timely treatment of reproductive tract infections;
5. Enhance physical fitness.

4. Lung cancer

High-risk objects

Age> 40 years old, with at least one of the following risk factors:

1. Smoking ≥ 20-year pack (annual pack refers to how many packs you smoke per day multiplied by how many years last, for example, 20-year pack refers to 1 pack per day for 20 years or 2 packs per day for 10 years), including smoking cessation less than 15 years;
2. Passive smoking;
3. A history of occupational exposure (persons exposed to asbestos, beryllium, uranium, radon, etc.);
4. Have a history of malignant tumors or a family history of lung cancer;
5. A history of chronic obstructive pulmonary disease or diffuse pulmonary fibrosis.

Screening recommendations

1. For people at high risk of lung cancer, low-dose spiral CT screening is recommended. It is recommended to use 64-slice or more multi-slice spiral CT for lung cancer screening as much as possible. The scan range is from the tip of the lung to the tip of the costophrenic angle. After the baseline CT scan, according to the specific conditions of the lesion (shape, size, boundary and other characteristics), it is recommended to consult a specialist hospital for the specific next diagnosis and treatment plan;
2. If a pulmonary nodule is detected, perform LDCT review according to the different characteristics of the nodules, ground glass, subsolid, solid nodules and multiple nodules;
3. According to the national conditions and effectiveness and the characteristics of the Chinese population, PET/CT is not recommended as a screening method for lung cancer population.

Prevention advice

1. It is recommended to quit smoking;
2. People at risk of occupational exposure should take protective measures;
3. Pay attention to avoid indoor air pollution, such as passive smoking, open flames for heating, exposure to oil fume, etc.;
4. When the atmosphere is severely polluted, avoid going out and exercising;
5. People with respiratory diseases should be treated in a timely and standardized manner.

5. Liver Cancer

High-risk objects

Any of the following groups of people over the age of 35 for men and over 45 for women:
1. Chronic hepatitis B virus (HBV) infection or chronic hepatitis C virus (HCV) infection;
2. Those who have a family history of liver cancer;
3. Patients with liver cirrhosis caused by schistosomiasis, alcohol, primary biliary cirrhosis, etc.;
4. Patients with drug-induced liver damage;
5. Patients with inherited metabolic diseases, including: hemochromatosis, α-1 antitrypsin deficiency, glycogen storage disease, delayed skin porphyria, tyrosinemia, etc.;
6. Patients with autoimmune hepatitis;
7. Non-alcoholic fatty liver (NAFLD) patients.

Screening recommendations

1. People at high risk of liver cancer who are over 35 years old in men and over 45 years old in women should be screened;
2. Combined application of serum alpha-fetoprotein (AFP) and liver B-ultrasound, screening once every 6 months.

Prevention advice

1. Get hepatitis B vaccine;
2. Patients with chronic hepatitis should receive antiviral treatment as soon as possible to control the replication of hepatitis virus;
3. Quit drinking or reduce drinking;
4. Eat a light diet and reduce the intake of greasy food;
5. Avoid the intake of moldy food.

6. Stomach cancer

High-risk objects

Anyone who has one of the following conditions is a high-risk object:

1. Over 60 years old;
2. Moderate and severe atrophic gastritis;
3. Chronic gastric ulcer;
4. Stomach polyps;
5. Huge fold sign of gastric mucosa;
6. Remnant stomach after benign diseases;
7. Remnant stomach after gastric cancer (6-12 months after operation);
8. Helicobacter pylori infection;
9. Clarify the family history of gastric cancer or esophageal cancer;
10. Pernicious anemia;
11. There is a family history of familial adenomatous polyposis (FAP) and hereditary non-polyposis colon cancer (HNPCC).

Screening recommendations

Age> 40 years old have abdominal discomfort, abdominal distension, acid reflux, heartburn and other symptoms of upper abdominal discomfort, and chronic gastritis, gastric mucosal intestinal metaplasia, gastric polyps, remnant stomach, gastric giant folds, chronic gastric ulcer and gastric epithelial abnormalities Hyperplasia and other lesions, as well as objects with a family history of tumors, should undergo regular gastroscopy according to the doctor’s recommendation.

Prevention advice

1. Establish healthy eating habits and diet structure and avoid overeating;
2. Eradication of Helicobacter pylori infection;
3. Reduce the consumption of cold, spicy, overheated, and hard foods and high-salt foods such as smoked and pickled foods;
4. Quit smoking;
5. Drink less or no strong alcohol;
6. Relax and decompress reasonably.

7. Prostate cancer

High-risk objects

Men with the following high-risk factors for prostate cancer need to be vigilant, carry out targeted inspections when necessary, and conduct reasonable follow-up for abnormal results.
1. Males aged> 50 years;
2. Men who are> 45 years old and have a family history of prostate cancer;
3. Men who are> 40 years old and have a baseline PSA> 1 μg/L;

Screening recommendations

1. It is recommended to carry out prostate cancer screening based on PSA testing for men who are in good physical condition and have a life expectancy of more than 10 years, and the risks and benefits of prostate cancer screening should be explained in detail before the screening;
2. Serum PSA test is performed once every 2 years, and the termination time of PSA test is determined according to the patient’s age and physical condition;
3. Screening based on serum PSA test should be carried out as soon as possible for people at high risk of prostate cancer;
4. It is not recommended to conduct population screening for men under 40.

Prevention advice

1. Avoid bad habits such as smoking and drinking;
2. Reduce the intake of foods high in animal fat, because these foods contain more saturated fatty acids and increase the intake of vegetables and fruits;
3. Avoid too spicy food, because these foods will cause excessive congestion of the prostate;
4. Drink plenty of water and urinate frequently in daily life, avoid holding urine and sitting for a long time;
5. It is recommended to exercise moderately.

8. Thyroid cancer

High-risk objects

Anyone with one of the following conditions is a high-risk target for thyroid cancer:

1. History of head and neck radiation exposure or exposure to radiation dust in childhood;
2. Due to other diseases, the head and neck have been treated with radiotherapy;
3. Differentiated thyroid cancer (DTC), medullary thyroid carcinoma or multiple endocrine neoplasia type 2 (MEN2), familial multiple polyposis and certain thyroid cancer syndromes (such as Cowden syndrome, Carney syndrome) History or family history (blood relationship) of symptoms, Werner syndrome, Gardner syndrome, etc.);
4. Thyroid nodules> 1 cm, and the nodules grow rapidly, growing to more than 1 cm within half a year;
5. Thyroid nodules> 1 cm, with persistent hoarseness, dysphonia, dysphagia or dyspnea, and vocal cord lesions (inflammation, polyps, etc.) can be ruled out;
6. Thyroid nodules> 1 cm, with swollen lymph nodes in the neck;
7. Calcitonin is higher than the normal range;
8. Mutations in the RET gene.

Screening recommendations

1. For thyroid screening, functional examination and morphological examination should be carried out at the same time;
2. There are currently no standard tests for early detection or routine screening of thyroid cancer in the general population. Clinical neck physical examination: once every 2~3 years for 20-29 years old, and once a year after 30 years old. Neck ultrasound examination: once a year after 30 years old (including thyroid gland, neck, supraclavicular);
3. Neck ultrasound (including thyroid, neck, and supraclavicular) examinations for people at high risk of thyroid cancer, once a year.
4. Before pregnancy and at the end of breastfeeding period, it is recommended to have a neck ultrasound examination respectively.

Prevention advice

1. Avoid history of exposure to radiation and radioactive dust in the head and neck;
2. Live a healthy life, eat a reasonable diet, and increase exercise;
3. Reasonably channel bad emotions.

9. Lymphoma

High-risk objects

1. Persons with a history of radiation exposure or exposure to radioactive dust;
2. Patients with infection and chronic inflammation;
3. People with low immune function and history of autoimmune disease or organ transplantation.

Screening recommendations

1. Clinical physical examination for the general population, once every 2 to 3 years;
2. Clinical physical examination for high-risk groups, once a year.
3. The above-mentioned clinical examination includes the following items:
(1) Surgical physical examination: palpation of superficial lymph nodes and liver and spleen;
(2) B-ultrasound examination: superficial lymph nodes, liver and spleen and abdominal lymph nodes;
(3) Routine blood examination.

Prevention advice

1. Avoid radiation exposure and radioactive dust contact;
2. Live a healthy life and strengthen physical exercises such as sports;
3. Actively treat autoimmune diseases or chronic inflammation;
4. Reasonably channel bad emotions.

10. Esophageal cancer

High-risk objects

Those who are >40 years old and meet any of the following risk factors:

1. From the high-incidence area of esophageal cancer in many countries;
2. Have symptoms of upper gastrointestinal tract, such as nausea, vomiting, abdominal pain, acid reflux, eating uncomfortable and other symptoms;
3. Have a family history of esophageal cancer;
4. Suffer from precancerous diseases or precancerous lesions of the esophagus;
5. With high risk factors for esophageal cancer, such as smoking, heavy drinking, overweight, hot food, head and neck or respiratory squamous cell carcinoma, etc.;
6. Suffer from gastroesophageal reflux disease (GERD);
7. Human papillomavirus (HPV) infection.

Screening recommendations

High-risk groups of esophageal cancer:
1. Ordinary endoscopy, once every two years;
2. Endoscopy pathology suggests mild dysplasia, endoscopy once a year;
3. The pathology of endoscopy showed moderate dysplasia, and endoscopy should be performed every six months.

Prevention advice

1. Do not smoke or quit smoking;
2. Drinking a little or no alcohol;
3. Eat a reasonable diet and eat more fresh fruits and vegetables;
4. Strengthen exercise and maintain a healthy weight;
5. Do not eat hot food or drink hot water.

11. Skin cancer

High-risk objects

Those who have any of the following high-risk factors are all high-risk subjects for skin cancer:
1. Frequent exposure to the sun and ultraviolet radiation;
2. Long-term exposure to chemical substances, such as asphalt and tar derivatives;
3. Suffering from chronic ulcers, unhealed scars, fistulas, discoid lupus erythematosus, radiation dermatitis, etc.;
4. Have had skin cancer;
5. Birthmarks that continue to grow or have recently grown significantly;
6. Moles on the soles, palms and other areas that are easy to touch and rub.

Screening recommendations

Clinical physical examination, once a year.

For those with high-risk factors, a professional doctor will conduct a skin examination, including moles, birthmarks, or other abnormally pigmented areas, record changes in color, size, shape, or texture, and perform a biopsy if necessary.

Prevention advice

1. Regular skin self-examination (compared with a ruler, take photos for backup);
2. Do physical or chemical sun protection outdoors and avoid exposure to the sun;
3. Do not trim or break your toes or skin spots repeatedly;
4. Eat a reasonable diet and avoid spicy and irritating foods.

12. Pancreatic cancer

High-risk objects

Those who are over 40 years old, especially over 50 years old, are accompanied by any of the following factors (the sixth factor will increase the risk of pancreatic cancer, but screening is generally not performed):

1. Have a family history of pancreatic cancer and diabetes;
2. Long-term smoking, drinking, high-fat and high-protein diet history;
3. Upper middle abdomen with no obvious cause, fullness, discomfort, abdominal pain, loss of appetite, fatigue, diarrhea, weight loss, or back pain;
4. Repeated episodes of chronic pancreatitis, especially chronic pancreatitis with pancreatic duct stones; patients with main pancreatic duct type mucopapilloma, mucinous cystic adenoma, and solid pseudopapilloma have elevated serum CA19-9;
5. A recent sudden onset of diabetes without family history;
6. People with Helicobacter pylori (HP) positive, history of oral periodontitis, P-J syndrome, etc.

Screening recommendations

1. The above-mentioned subjects are screened by the blood test results of CA19-9, CA125, CEA and other tumor markers combined with abdominal CT and MRI, and B-ultrasound can also provide corresponding help;
2. The above population, especially those with family history and those with pancreatic disease, undergo CT or MR examination once a year.

Prevention advice

1. Quit smoking and control alcohol;
2. Promote a light, digestible, low-fat diet;
3. Eat more poultry, fish and shrimp foods, and encourage the consumption of “cross” floral vegetables, such as greens, cabbage, radish, broccoli, etc.;
4. Promote outdoor aerobic activities;
5. In order to prevent the deterioration of benign lesions, patients with pancreatic duct stones, intraductal mucinous papilloma and cystic adenoma or other benign pancreatic lesions should seek medical treatment in time.

13. Gallbladder cancer

High-risk objects

1. Patients with chronic calculous cholecystitis (the larger the stone, the higher the risk);
2. Those who have gallbladder polyps (more than 1 cm in diameter, especially single, broad-pedicle polyps);
3. Porcelain gallbladder or gallbladder atrophy;
4. Patients with abnormal bile duct confluence or congenital bile duct cyst;
5. Patients with gallbladder adenomyosis;
6. People with chronic typhoid fever;
7. People with primary sclerosing cholangitis;
8. People with inflammatory bowel disease;
9. People with diabetes.

Screening recommendations

1. High-risk population: It is recommended to have serum CEA, CA199 and hepatobiliary B-ultrasound every 6 months;
2. General population: It is recommended to take serum CEA, CA199 and hepatobiliary B-ultrasound every year, especially for women.

Prevention advice

1. For patients with gallbladder polyps over 1 cm and gallbladder adenomyosis over 1 cm, cholecystectomy is recommended for limited time; symptomatic chronic calculous cholecystitis, gallbladder atrophy, porcelain gallbladder and gallbladder adenomyosis less than 1 cm For patients, cholecystectomy is recommended as soon as possible.
2. Perform regular physical examinations in accordance with the screening recommendations.

14. Brain tumors

High-risk objects

Ten early signs of brain tumors:

1. Headache, often onset in the morning, severe, gradually relieved or disappeared after waking up with light activities;
2. Jet-like vomiting;
3. Blurred vision, visual impairment;
4. Mental disorders; often exhibits such as excitement, restlessness, depression, depression, forgetting, fiction, etc.;
5. Unilateral limb paresthesias; pain, temperature, vibration decreased or disappeared;
6. Phantom smell;
7. Hemiplegia or staggering or drunken gait;
8. Tinnitus and deafness; often when you are on the phone, you can hear it in one ear but not the other ear;
9. Giant disease;
10. The growth of young children has stopped.

Screening recommendations

Pay attention to the ten early signs of brain tumors, and you need to go to the neurology department or related departments (ophthalmology, otolaryngology, neurosurgery, etc.) for further examination.

Prevention advice

1. Live healthy and avoid staying up late;
2. Increase outdoor exercise and sports to maintain a reasonable weight;
3. Eat a reasonable diet.

15. Malignant melanoma

High-risk objects

1. People with family history;
2. People who have had skin cancer or malignant melanoma;
3. People with pigmented moles or spots in the following areas: between the toes, soles of the feet, palms, scalp, behind the ears, nails and toenails, between the buttocks, and around the genitals;
4. People with huge congenital pigmented nevi;
5. Those who have been exposed to the sun for a long time.

Screening recommendations

1. Pay attention to the pigmented moles and spots on various parts of the skin, and frequently self-examine; discover and continue to observe the new pigmented moles and spots on the skin.
2. Follow the ABCDE guidelines, frequently conduct self-examinations on the changes of existing pigmented moles or spots, make records, and seek medical attention if abnormalities are found.
A. Represents asymmetry. If the mole looks different on both sides, you need to ask a doctor to check it.
B. Represent the boundary. The border around the mole should be smooth and even.
C. Represents color. Some moles are pink or brown. Regardless of the color, each mole should have only one color.
D. Represents the diameter. The diameter of the mole should be less than 6 cm. If the mole suddenly becomes larger or enlarged, please seek medical attention immediately.
E. Represent progress. Moles can change in many ways, including size, color, borders, and appearance of ulceration. Please seek medical attention immediately.
3. Moles on the parts of hands and feet that are prone to rubbing can be removed by preventive surgery to prevent malignant transformation.

Prevention advice

1. Do physical or chemical sun protection outdoors and avoid exposure to the sun;
2. It is particularly important to avoid repeated trimming or breaking of pigmented moles in special parts;
3. It is strictly forbidden to dispose of moles at will, or go to informal hospitals for treatment;
4. Eat a reasonable diet and avoid spicy and irritating foods.

16. Ovarian cancer (including epithelial ovarian cancer, fallopian tube cancer and primary peritoneal cancer)

High-risk objects

1. Patients with hereditary breast cancer-ovarian cancer syndrome (ie BRCA1 or BRCA2 germline pathogenic variants or suspected pathogenic variants);
2. Carry RAD51C or RAD51D or BRIP1 germline pathogenic variants or suspected pathogenic variants;
3. Lynch syndrome (hereditary non-polyposis colorectal cancer syndrome) patients;
4. First-degree relatives who are diagnosed with the above-mentioned hereditary tumor syndromes or carry the above-mentioned genes to cause disease or suspected pathogenic variants, but fail or refuse to be tested;
5. Family history of ovarian cancer, breast cancer, prostate cancer, pancreatic cancer, or family history of endometrial cancer, colorectal cancer, and other Lynch syndrome-related tumors. After genetic counseling and risk assessment, it is recommended to accept genetic testing and fail or refuse testing. By;
6. Have a significant family history of ovarian cancer and related tumors (multiple cases). Although genetic testing has been conducted, no known or suspected disease-causing genes have been detected in family patients (Note: current genetic testing and Data interpretation still has limitations).

Screening recommendations

1. It is not recommended to screen for ovarian cancer in asymptomatic, non-high-risk women.
2. It is recommended that the above-mentioned high-risk women who have not undergone preventive fallopian tube-oophorectomy surgery should be regularly screened for early detection of ovarian cancer. However, there is currently no evidence that ovarian cancer screening can bring clinical benefits to high-risk women.
(1) According to the judgment of clinicians, high-risk women from 30 to 35 years old can consider receiving regular ovarian cancer screening;
(2) Screening items: serum CA-125 examination and transvaginal ultrasound examination;
(3) Screening interval: once every 3 months to once a year.
3. In addition, women who have experienced abdominal distension, abdominal pain, irregular vaginal bleeding and other uncomfortable symptoms are not included in the scope of screening and should seek medical treatment as soon as possible for clinical evaluation.

Prevention advice

1. Individuals who need further genetic testing after genetic counseling and risk assessment should be tested as soon as possible to clarify the risk of cancer;
2. High-risk women who carry pathogenic variants or suspected pathogenic variants that increase the risk of ovarian cancer should preventively remove their ovaries and fallopian tubes at the appropriate age to reduce the risk of ovarian cancer;
3. In theory, any behavior that allows the ovaries to stop ovulating within a period of time can reduce the risk of ovarian cancer, such as birth control pills, pregnancy, and breastfeeding. Therefore encourage timely childbirth and breastfeeding;
4. After genetic counseling, some high-risk women can choose short-term oral contraceptives to reduce the risk of ovarian cancer (long-term use may increase the risk of breast cancer);
5. For high-risk women of childbearing age, discuss possible genetic blockade with tumor genetic counseling doctors and reproductive doctors before giving birth;
6. Maintain good living habits, regular work and rest, a reasonable diet, reduce the consumption of high-fat and high-cholesterol foods, and strengthen physical exercise.

17. Bone Tumors

High-risk objects

Eight early signs of bone tumors:
1. There are harder lumps in the joints of the bones, which cannot disappear at rest and continue to grow;
2. Pain and swelling of bones and adjacent joints, which aggravate at night, and the severity of pain has nothing to do with activities;
3. Fever, weight loss, mainly low-grade fever, and a significant increase in skin temperature at the swollen part, etc.;
4. Unexplained persistent back pain or pain in the spine area, rest can not be relieved, it is difficult to explain with common cervical spondylosis and lumbar spondylopathy;
5. Numbness or stubborn radiating pain at the distal end of the limb, weakness, or even dysfunction;
6. Pathological fracture or limb deformation, or even one or more spontaneous fractures with no obvious cause;
7. Convulsions, muscle cramps, increased blood calcium;
8. When middle-aged and elderly people have unexplained limb pain, low back pain, and a tendency to worsen, they should be alert to the appearance of metastatic bone tumors, especially those with a history of tumors (especially those with late stage lung cancer, Breast cancer, prostate cancer, thyroid cancer, kidney cancer, etc.).

Screening recommendations

Pay attention to the eight early signs of bone tumors, seek medical treatment in time if abnormalities occur, and perform physical examinations and imaging examinations, combined with biopsy when necessary. Especially patients with a history of malignant tumors, such as bone pain, nerve compression, and movement disorders, should go to the Department of Bone and Soft Tissue Oncology and other relevant departments for further examination in time.

Prevention advice

1. Avoid trauma;
2. Increase outdoor exercise and sports to maintain a reasonable weight;
3. A reasonable diet;
4. Avoid contact with radioactive materials;
5. Control emotions and maintain a healthy and optimistic attitude.

18. Bladder cancer

High-risk objects

1. Long-term smokers;
2. Those with a family history of bladder cancer;
3. Persons with a history of occupational exposure to paints, dyes, metals or petroleum products;
4. Those who have received radiotherapy for the pelvic area;
5. Those who have used anti-cancer drugs such as cyclophosphamide or ifosfamide;
6. People who have ever taken Chinese herbal medicines containing aristolochic acid, such as Guangfangji, Qingmuxiang, Tianxianteng, Aristolochia, Xungufeng, Cinnabarum, etc.;
7. Those with high arsenic content in drinking water;
8. Those who drink water treated with chlorine;
9. History of repeated acute and chronic bladder infections, including those with bladder infections caused by schistosomiasis;
10. Those who use urinary catheters for a long time.

Screening recommendations

General risk population: starting from 60 years old, urinary routine, once a year.
High-risk population: starting from the age of 50, urinary routine, hematuria testing combined with urine tumor markers such as NMP22, once a year.

Prevention advice

Reduce environmental and occupational exposure;
Increase the amount of drinking water and pay attention to the quality of drinking water;
Quit smoking;
Avoid drug toxicity caused by long-term use of drugs;
Develop good living and eating habits and improve immunity.

19. Soft tissue sarcoma

High-risk objects

1. High risk factors of soft tissue sarcoma:

(1) Family history of tumor, especially with p53 and rb gene inactivation;
(2) A history of long-term exposure to chemical materials such as asbestos and dioxins;
(3) EB virus, HIV and other infection history;
(4) History of radiation or radiotherapy;

2. Four early signs of soft tissue sarcoma:

(1) Unexplained masses found on the body surface or near large joints and imaging examinations or masses that cannot be resolved for a long time after trauma;
(2) The mass continues to increase and does not relieve with changes in body position;
(3) Pain and joint dysfunction may appear, and gradually worsen;
(4) The local skin temperature of the tumor is often higher than that of the surrounding normal tissues, which may be accompanied by inflammatory manifestations such as redness and swelling.

Screening recommendations

Pay attention to the four early signs of soft tissue sarcoma, and go to the soft tissue tumor specialist in time for medical treatment if abnormalities occur.

1. Physical examination: The tumor is generally qualitatively preliminarily qualitative based on 7 aspects including the location, size, boundary, mobility, tenderness, skin temperature and accompanying symptoms of the tumor.
2. Imaging: B-ultrasound, X-ray, CT, MRI, etc. For extremity soft tissue sarcomas, MRI is preferred over CT. High-risk patients should undergo chest CT to rule out lung metastases. At the same time, the regional lymph nodes should be checked.
3. Biopsy: soft tissue sarcoma biopsy, including needle biopsy and incision biopsy. Fine needle or thick needle puncture, if necessary, CT or B-ultrasound guidance. Difficulty or failure of puncture can be performed by surgical incision biopsy.

Prevention advice

1. Avoid radiation and strong ultraviolet radiation, and increase the intake of β-carotene, carotenoids, vitamin C and E; 2. Reduce exposure to chemical materials, screen for virus infection, and treat the infection in a timely manner;
3. Eat a reasonable diet, enhance physical exercise, and improve immunity.

20. Leukemia

High-risk objects

1. Those with a family history of leukemia;
2. Patients with blood diseases;
3. People who have had a history of exposure to benzene and organic solvents containing benzene;
4. People who have ever been exposed to X-rays, γ-rays and other ionizing radiation environments;
5. People with abnormal autoimmune function;
6. People with bad habits such as smoking, alcohol abuse, drug abuse, irregular work and rest;
7. Those who have no incentive for chronic bleeding, such as skin bruises, nose bleeding, bleeding gums, menorrhagia, etc.;
8. People who are physically exerted, tired and accompanied by bone and joint pain.

Screening recommendations

High-risk population: clinical physical examination, once a year.

The clinical physical examination includes the following items:
(1) Surgical physical examination: palpation of superficial lymph nodes and liver and spleen;
(2) B-ultrasound examination: superficial lymph nodes, liver and spleen and abdominal lymph nodes;
(3) Blood routine.

Prevention advice

1. Avoid environmental contact with benzene and related chemicals and chemical products;
2. Avoid or reduce ionizing radiation such as X-rays and gamma rays, and quit smoking;
3. Regular physical examinations.

(source:internet, reference only)

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