PET-CT scan showing probable tumour needing further confirmation

What about incidental findings of 'disease' detected during imaging scans of other medical conditions a.k.a 'incidentaloma' ? In such cases, it is best to discuss with the specialist to assess the significance of that finding whether that is clinically significant or whether it can lead to actual disease.

PATIENT A Healthy lady in 30’s - has no real medical reasons for thyroid ultrasound screening scan. So happened bought medical screening package which included a thyroid ultrasound screening scan. Scan done -showed single asymptomatic thyroid nodule about 3mm, non-cancerous looking. Also no risk factor for thyroid cancer. No sampling done. (then scan pic not available, only report was disclosed) Later in a few months’ down, decided to buy medical insurance’. ‘Obliged’ to disclose all prior medical tests - including the above ultrasound thyroid report As expected, insurance underwriter exluded insurance coverage for thyroid-related disorder. Patient A unhappy. Decided not to buy the insurance policy. Then came for second opinion few months later to my clinic. Seen for the first time in my clinic. Repeat ultrasound scan showed perfectly normal thyroid, previous small nodule had disappeared. Decided to appeal against the insurance exclusion on thyroid disorders. Since i felt a worthwhile case to fight for. GOOD NEWS: exclusion retracted. Patient proceeded to purchase the poilcy and all went smoothly. Patient A now happy, so was the doctor

PATIENT B A foreign national. for undisclosed reason, did an ultrasound scan at another centre. Scan done -showed single asymptomatic thyroid nodule 5mm, non- cancerous looking. Also no risk factor for thyroid cancer. By international consensus guideline, she surely did nto fit the critieria for the population to be screened. Ultrasound-guided sampling then showed Papillary Cancer of the thyroid gland, the commonest cancer type. Patient B anxious now. Then came for second opinion few months later to my clinic. Seen for the first time in my clinic. Repeat ultrasound scan showed the same thyroid nodule. BAD NEWS: Ultrasound-guided sampling i did for her also confirmed Papillary Cancer of the thyroid gland. (scan as below) Patient B decided to return to home country for treatment.

More real case studies:

One of the international consensus guideline on thyroid screeening,

thyroid

head & neck

ear, nose & throat (ENT)

What is MEDICAL SCREENING ? Another concept of well-being being practised widely nowadays is SCREENING. It means subjecting a normal person without signs or symptoms to look for a particular disease. From a medical perspective, there are recommended criteria to screen any commmmunity/population for any particular disease. There are sound epidemiological and health economics principles behind each recommendation by any medical bodies. However in the real world, many would voluntarily have themselves screened either by a blood test or imaging (eg ultrasound, CT scan, angiogram etc). Besides a patient's right to decide, there are many other personal and industrial factors at play. In our community, these 2 organs are commonly included in the screening patients voluntarily do at other 3rd party centres. - THYROID ULTRASOUND STUDIES - NASOPHARYNGEAL CANCER EBV STUDIES So to screen or not to screen ? While we do not have a routine head and neck cancer screening package in place as part of our clinical practice for individuals without symptoms (in complying with universally advocated sound, ethical and rational medical practice), we are open to anyone who wants such screening upon request. Especially if they have a lot of anxiety and fear, now that everyone can read and write anything on the Internet and social media. After all, assessment, biopsies and treatment are something we do on a daily basis and the tools are readily available in the clinic/hospital. However, the patient has to be aware of the pre-screening counselling and implication as follow. Pros Vs Cons:

POINT 1: Early cancer may not have have symptoms. in head and neck cancers, by the time the patient presents with visible and palpable lymph nodes, that usually means the cancer has spread beyond its primary source to the neighbouring lymph nodes before travelling further to involve distant organs like the brain, bone and live. So early checkups may ACTUALLY detect the cancer in its early stage before it even produces symptoms. Early diagnosis = early treatment = Good results = good cure rate POINT 2: Addresses the patient/family's concern. As mentioned, due to the advent of information and literally the 'knowledge is at our fingertips' (whoever poet that came up with that proverb wouldnt have foreseen how we are so attached to our smartphone and screens today), everyone can read and write anything on the Internet and social media, good, bad or ugly ! Either way the results of the screening turns out to be, it hopefully lay to rest the patient/family's anxiety, concern and the search for answers.

POINT 1: More tests means more cost and time spent. Not to mention there can be more unrelated and non-disease causing incidental findings noted on any test. The medical community call that ‘incidentaloma’. After all, all medical test has to be interpreted in relevance to the individual's patient condition. Not all 'apparently abnormal' findings can cause disease. POINT 2: Also despite all the negative findings, there is no guarantee that the patient can be completely reassured ! Especially the super- anxious or hypochondriac type ! POINT 3: Before purchase of any medical insurance, by the rules and regulations, the patient is ‘obliged’ to disclose any examination/ preexisting disease to the best of his/her knowledge. So any positive findings on screening test, whether clinically significant (can cause real disease), ‘incidentaloma’ or not, has to be disclosed for your insurance underwriters to assess. So this will place you at ‘precarious’ position ! (See real case study below) POINT 4: The example case of thyroid cancer overscreening resulting in overdiagnosis or papillary thyroid cancer in a particular Asian country (controversial as this may be)

Back to Part 2

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