Standard treatment is the prerequisite for recovery of stomach cancer patients
What should we do when we have stomach cancer? Surgery is dangerous, chemotherapy is painful, the patient is old, we believe in TCM and simply take Chinese medicine, is it okay? We often encounter such questions from patients and family members, the main issue involved here is the principle of gastric cancer treatment, as tumor treatment is a discipline, so it needs to follow two principles, one is the past experience of our treatment, which is the evidence-based medicine we often hear nowadays, and the second principle is the specific situation of each patient, that is, individualized situation. The second principle is the specific situation of each patient, that is, the individualized situation, and the organic combination of the two principles is the treatment method needed by the patient. After the surgery and radiotherapy are over, is it cured? Of course not, except for a few early patients with low metastasis recurrence rate in 5 years, 50-60% of patients will have recurrence and metastasis in 2-3 years, so of course we can’t only wait, continue the follow-up maintenance treatment, of which Chinese medicine is a good choice for maintenance treatment, of course, we need to go to the regular Chinese medicine tumor specialist department for consultation and treatment. Li Jie, Department of Oncology, Guang’anmen Hospital, Chinese Academy of Traditional Chinese Medicine
Active prevention and treatment of post-surgical complications is the first step of patient’s recovery
Surgery is currently the preferred treatment method to cure gastric cancer. In addition to common complications such as infection and bleeding, postoperative gastric cancer will also cause emptying disorder, bile reflux, dumping syndrome, biliopancreatic disorders and distant malnutrition, which often bring a lot of pain and troubles to patients, therefore, reasonable treatment and care after gastric cancer surgery play a key role in preventing its complications. In order to fundamentally prevent the emergence of postoperative complications of gastric cancer, one should first understand and master what are the possible complications after gastric cancer surgery, which are mainly manifested as anastomotic leakage, gastric bleeding, gastroparesis, intestinal obstruction and dumping syndrome, etc. The prevention of postoperative complications of gastric cancer is mainly manifested in the following aspects.
1. Prevention and treatment of postoperative abdominal distension and diarrhea
The etiology of postoperative bloating and diarrhea after gastric cancer is mainly that the vagus nerve stem is cut off during surgery, which leads to the reduction of secretion function of liver, bile, pancreas and intestine, the decrease of contraction function of gallbladder, the obstacle of emptying, the lack of various digestive juices in intestine, the lack of various digestive enzymes, and the weakening of intestinal peristalsis, which makes the digestion and absorption of protein and fat incomplete, and causes bloating and diarrhea. In addition, due to the influence of cancer-related factors, the intestinal motor function is also impaired and causes intestinal mechanical motility disorders, digestive malabsorption and accelerated power, resulting in increased stool frequency and diarrhea. Therefore, it is crucial to provide good dietary guidance for patients after gastric cancer surgery. First of all, choose easy to digest, high protein, low sugar and moderate fat, adhere to small amount and multiple meals to avoid excessive gastrointestinal accumulation, so as not to cause indigestion, separate dry and thin, enter liquid food after 0.5~1 hour of dry meal, and lie down for 20-30 minutes after meal if necessary, which can prevent or reduce symptoms. The principle of eating mild food, to achieve a reasonable mix, balanced nutrition, avoid irritating, allergic, hypertonic food and too cold and too hot gas-producing food, such as: ice cream, fried, sweet milk, soy milk and spicy and sour stimulating food. It has been proven that diarrhea can be positively and effectively controlled by proper dietary treatment and patient’s self-diet regulation. In addition, planned and gradual local or systemic activities in the early postoperative period can significantly promote the recovery of intestinal motility. In addition, in addition to improving the tolerance of the body, the postoperative exercise in the right amount also plays a role in mental and psychological care, so that the physical and mental activities can promote each other, forming a virtuous cycle during the recovery period and promoting the recovery of the functions of the whole body systems.
In addition, Chinese medicine is also a very important treatment method, such as diarrhea with a weak spleen and stomach, oral administration of Ginseng and Atractylodes has a good effect.
2, the prevention and treatment of bile reflux gastritis
Gastric surgery removed the pylorus or vagus nerve trunk cut so that the pylorus lost innervation, the chance of duodenal contents back into the stomach increased significantly. The bile acid in it can dissolve lipoproteins and destroy the barrier effect of gastric mucosa, and H+ then enters the gastric lumen. The H+ entering into the gastric mucosa can in turn stimulate the release of histamine from mast cells. The latter then stimulates the secretion of gastric acid and pepsin, which in turn aggravates the damage to the gastric mucosa and produces inflammation, erosion and ulceration. The damage to the gastric mucosa is even more synergistic between the pancreatic juice and bile acids in the duodenal fluid. In addition, after gastric surgery, especially Bishop II surgery, the secretion of gastrin, which strengthens the gastric mucosal barrier and resists the reverse diffusion of H+, is reduced, weakening the barrier function of the gastric mucosa, which is also a factor in the development of reflux gastritis. It usually occurs a few months to a few years after surgery. Its incidence accounts for 3-10% of post-surgical cases of gastric cancer. Its clinical manifestations are: burning pain in the stomach and epigastric region, aggravated after eating, accompanied by dullness and little food, dry mouth and bitterness, nausea and vomiting, yellow or yellow-green secretions, or food residues, abdominal distension, red tongue, thin white and yellow coating, and thin pulse. Western medicine for the treatment of bile reflux gastritis mostly use gastric power drugs and gastric mucosa protective agents, gastric power drugs can increase the peristalsis of the gastrointestinal tract, inhibit the reflux of bile into the stomach, commonly used are: morpholine, mosapride. Gastric mucosal protectors: aluminum thioglycollate, which can complex with mucin of gastric mucosa to form a protective film to protect gastric mucosa from bile damage; gastrin, which can form a film in the stomach to cover gastric mucosa to reduce the stimulation of gastric mucosa by refluxed bile and gastric acid.
Chinese medicine believes that the cause of bile reflux gastritis is the imbalance of spleen and stomach, spleen qi when ascending but not ascending, stomach qi when descending but not descending, liver does not ascend with spleen, bile and stomach do not harmonize, bile qi upward rebellion and see bile reflux into the stomach, bile reflux gastritis and liver and gallbladder have a very close relationship. In the treatment of bile reflux gastritis, the principle is to calm the liver and stomach, regulate the qi and relieve depression, clear the liver and gallbladder, and relieve pain in the stomach, and can choose Xiao Chai Hu Tang plus or minus. Some scholars suggest that you can also take Chen Pi Yin Chen Dazao Soup orally, by taking 10 grams of Chen Pi, 50 grams of Yin Chen and 10 jujubes, and decocting them with water for drinking. Eat more spleen and stomach-healthy medicinal congee, such as yam barley porridge, the practice is to use 20 grams of yam, 20 grams of coix seeds, 100 grams of japonica rice, coix seeds and japonica rice half cooked, add yam boiled. The coix seeds in this meal not only have the effect of strengthening the spleen and replenishing qi, but also have anti-cancer effect, which can improve the immunity of patients. Chinese herbal medicine for bile reflux gastritis has a therapeutic and conditioning double-layer effect. The natural ingredients of Chinese medicine are rich in nutrients, so they can repair the broken gastric mucosa and eliminate the root cause of recurrent bile reflux gastritis, resulting in a low recurrence rate and a long-lasting effect. The key to patients choosing Chinese medicine for bile reflux gastritis is continuous treatment.
Diet regimen: the diet should be light, not greasy food, so as not to stimulate increased bile secretion, aggravating reflux and the condition. You should chew and swallow slowly, avoid overeating. Avoid drinking strong tea, strong wine, strong coffee and eating spicy, too cold, too hot and rough food. Remove certain aggravating factors, including quitting smoking and alcohol, avoiding mental tension, keeping a relaxed mood, and not taking or cautiously taking drugs that are irritating to the gastric mucosa, such as aspirin, anti-inflammatory pain, painkillers and pau d’arco.
3, dumping syndrome prevention and treatment
Dumping syndrome refers to a series of symptoms caused by the sudden dumping of gastric chyme into the duodenum or jejunum after gastrectomy and gastrointestinal anastomosis due to the loss of the normal physiological function of the pylorus or stomach. The clinical manifestations of dumping syndrome mostly occur from the first week to the third week after gastrectomy when the patient resumes eating, and rarely it can be seen only a few years after the operation. Most patients experience dizziness, vertigo, weakness, even trembling, syncope, redness or pallor of the face, tachycardia, and in severe cases, a drop in blood pressure. If the patient lies down for a few moments after a meal, the symptoms can be eliminated quickly or the attack can be avoided, if the attack occurs during a meal, the patient should stop eating immediately and the symptoms usually disappear within one hour. Chinese medicine identifies the symptoms as spleen deficiency and qi weakness, and stomach loss and descent. The treatment is to strengthen the spleen, benefit the qi, harmonize the stomach and lower the rebellion. In terms of diet, patients should eat less and more meals, more dry food, less soup, limit carbohydrates, especially sugar, it is advisable to eat a high protein, high fat and low carbohydrate diet, and need to lie down for about half an hour after a meal. Develop the habit of drinking water between meals or on an empty stomach, take anticholinergic drugs (such as atropine, belladonna or probenecid) 20-30 minutes before meals to stop excessive gastrointestinal motility, and take methylsulfonylurea (D860) 0.5-1.0g orally to shorten the duration of hyperglycemia. After the above treatment, those who do not have it can prevent it from happening, and the majority of mild and moderate cases can have their symptoms reduced or disappear within a few months or years.
Reasonable diet to reduce the toxic side effects of chemotherapy is the second step of tumor recovery
Gastric cancer patients often have more serious toxic reactions during chemotherapy, such as gastrointestinal reactions, abnormal blood, liver and kidney functions, which bring great pain to patients and even affect the normal progress of chemotherapy. In addition to the necessary drug prevention, dietary treatment is a very important aspect in clinical practice.
1.Dietary regulation for declining blood picture
Chemotherapy for gastric cancer can cause poor bone marrow regeneration, especially the decline of white blood cells, which is the most obvious. In order to effectively prevent the decline of blood image, patients should supplement high protein diet during chemotherapy, such as milk, soybeans, lean meat, pig’s feet, sea cucumber, fish and red dates, peanuts, walnuts, black fungus, carrots, adzuki beans, etc. River crab, black fish, beef, animal boiled gum peptones such as donkey skin gum (Agaricus blazei) and pig skin gum (Pork skin peptones) can also help to raise white blood cells. Chinese medicine attaches the most importance to supplementing dirty with dirty, so you can also increase animal bone marrow in moderation during chemotherapy, such as bone marrow stew of cow, kind and pig. You can also eat more five black foods, such as black sesame, black rice, black beans, black dates, etc. Chinese medicine believes that “black can enter the kidney”, five black food can fill the marrow of the kidney, help improve the blood picture.
2.Dietary regulation for toxic reaction of digestive tract
Chemotherapy of gastric cancer can cause oral mucositis, which is manifested as mucosal congestion, edema, ulcer and pain. At this time, it is necessary to keep the oral cavity clean, brush teeth after eating, and supplement high nutritious liquid or office liquid diet, such as lotus seed soup, snow ear soup, milk, soybean milk, carp soup and so on. Avoid overheating, acidity and stimulating diet when eating, acute inflammation can contain ice fast to reduce inflammatory exudation, ulcers can be used 20 ml of honey with 0.1 grams of crushed vitamin C, oral, 2-4 times a day.
Chemotherapy damage to the gastrointestinal tract mucosa, nausea, vomiting, epigastric pain, poor nausea, etc.. At this time, you can eat appetizing food, such as hawthorn, lentils, yam, white radish, mushrooms, etc. At the same time, eat less and more meals to avoid the feeling of satiety. Eat to chew slowly, do not lie down 1 hour after the meal, you can spread, do not eat water 1 hour before chemotherapy, eat such as nausea and vomiting can be taken orally fresh ginger juice 3 ~ 5 ml.
3, dietary conditioning and prevention of liver and kidney injury
Some chemotherapy drugs can cause liver damage and elevated transaminases. At this time, you should eat more bitter melon, mung bean sprouts, tea, shiitake mushrooms, wood ear, monkey mushrooms and other mushroom foods, and eat more vitamin-rich fruits, such as kiwi, peach, apple, grapes, etc. If the liver function is seriously damaged, you can use 20 grams of Wu Wei Zi and 20 grams of Chinese wolfberry to stew carp soup. Some chemotherapy drugs can also cause kidney damage, such as cisplatin. Clinically, drink more water and eat more fresh vegetables and fruits (alkaline food) when using such drugs. Once kidney damage occurs, protein intake should be limited, and combined with edema, salt should be reduced, and water-rich and diuretic foods such as watermelon, cucumber, winter melon and loofah should be eaten.
Regular examination and persistent treatment are the keys to recovery of gastric cancer patients
Surgery, radiotherapy and chemotherapy are the three important means of gastric cancer treatment, so what should a patient who has undergone radical resection of gastric cancer and systematic radiotherapy after surgery do? Should we simply wait? Therefore, the first thing we need to do is to conduct regular check-ups. In the first year after surgery, a comprehensive check-up will be conducted once in 3-6 months, and every 6 months in 2-3 years after surgery. The examination items should include blood routine, stool routine + occult blood, tumor markers (CEA, Ca724, Ca199, etc.), chest X-ray, abdominal ultrasound, bone scan, etc.
In addition to regular checkups, another aspect is to adhere to treatment. A lot of clinical practice has made us realize that adherence to treatment is very important for long-term survival of patients. Adherence to treatment is similar to the maintenance treatment proposed by Western medicine in recent years, and Chinese medicine plays an important role. We once had a patient with gastric cancer, who was already in the middle and late stage at the time of surgical resection and failed to undergo systematic chemotherapy due to poor bone marrow function. The patient did not give up because of this, but immediately started to seek treatment with TCM, and after a period of TCM evidence-based treatment, the blood picture was normalized and the patient’s confidence became stronger, and he has been regularly hospitalized in our hospital for 2-3 years after surgery, and intermittent hospitalization for 3-5 years with oral TCM plus The patient did not give up the treatment for 5 years after surgery, and has been taking oral Chinese medicine in our hospital outpatient clinic until now, and now the patient has been tumor-free for 9 years. From this patient’s example, we can feel the effect of long-term persistence on the patient’s recovery.
Cultivate the body and return to the society
After the disease, cancer patients have undergone great psychological and physiological changes, so they need to re-establish a good life routine and develop good living habits, and change their old habits of smoking, drinking alcohol and working overnight. For patients living in the city, take time to be in the natural environment as much as possible to breathe fresh air and reduce the impact of city exhaust, noise and other adverse factors on the body. At the end of the treatment, when the physical strength has recovered to a certain extent, to seek the doctor’s advice, you can properly resume work, which will help to re-establish the routine of life, the psychological and personality will go to form a positive impact on the body’s recovery.
Conclusion
We believe that as long as early detection, early intervention, systematic and standardized treatment and reasonable conditioning, the recovery level of gastric cancer patients in China will definitely reach a newer level.