Stomach cancer is one of the common malignant tumors in China, and the incidence rate is the highest among digestive system tumors. Compared with Europeans and Americans, Chinese people have a higher chance of stomach injury and are more likely to be targeted by stomach cancer. However, gastric cancer is preventable and treatable, and as long as it is detected early and treated early, the cure rate can reach 90%. Recently, Professor Shen Lin, vice president of Peking University Cancer Hospital, pointed out 9 questions about stomach cancer in Life Times, which I think is where many people have misconceptions about stomach cancer or simply do not understand.
1.Is there any difference in ethnicity, geography and age of stomach cancer?
The Global Cancer Report 2014 released by the World Health Organization shows that there are 405,000 new cases of stomach cancer in China, accounting for 42.5% of the new cases in the world. In fact, the ethnic and geographical differences of stomach cancer are more obvious. East Asia is a high incidence area for gastric cancer, and the total number of gastric cancer cases in three countries, China, Japan and Korea, accounts for about 70% of the world. This is related to the genetic predisposition of the people in the region, the high consumption of barbecued and pickled foods in the diet, and the high rate of smoking.
Specifically in mainland China, stomach cancer also “favors” people in coastal areas, the middle and lower reaches of the Yangtze River or relatively poor areas such as Jiangsu, Shandong, Anhui, Henan, Gansu, Inner Mongolia and Northeastern provinces who prefer high salt diets. In terms of age, the average age of onset of stomach cancer is 58 or 59 years old, but patients range from a few years old to over 90 years old.
The youngest patient I encountered was only 9 years old, and the exact cause of the disease is unknown. In the past 10 years, the incidence of gastric cancer in China is in a generally stable and slightly increasing state. It should be noted that the incidence rate of young people is increasing faster than the national level, and most of them belong to diffuse gastric cancer, which is relatively more difficult to treat.
2.Does gastric cancer have precancerous lesions? What are the main symptoms?
Gastric polyps, chronic atrophic gastritis and remnant stomach are the high-risk factors for gastric cancer. The occurrence of gastric cancer is a multi-factor, multi-level and multi-stage development process. In early stage, patients with gastric cancer often have no obvious symptoms, or only epigastric discomfort, atypical epigastric pain, loss of appetite, fullness, belching, and a few may have black stool or vomiting blood. Once the symptoms are more obvious, it often indicates that the gastric cancer has entered into the middle and late stage, which mainly manifests as: unexplained gradual wasting, anemia, hypoproteinemia, swelling, persistent epigastric pain, vomiting blood and black stool, etc.
3.What are the high-risk groups of gastric cancer? How to detect it in early stage?
First, people with family history of tumor. Among two or three generations of relatives who have had digestive system tumor or other tumors, their chances of getting stomach cancer will be higher. The response is to do professional tumor screening about 10 years earlier than the youngest age of cancer members in the family, and gastroscopy should be done for gastric cancer, every 3 years, as recommended by doctors. For example, if the minimum age of cancer members in the family is 55 years old, then the first gastroscopy should be done at the age of 40.
Secondly, people who have bad habits such as long-term smoking, drinking alcohol, and especially love to eat hot food, pickled and barbecued food, and high-salt food. These habits can cause more serious damage to the stomach and should be adjusted in time.
Third, patients with gastric ulcers, chronic gastritis and other gastric diseases. People with these diseases should be actively treated to prevent disease progression and go to the hospital for regular review.
4.If one has chronic gastritis, gastric ulcer and other diseases, will one get gastric cancer?
Some gastric diseases are high-risk factors for stomach cancer and need to be taken seriously, but having gastric diseases does not mean that you will definitely get stomach cancer. Gastric ulcer is clearly associated with gastric cancer, which will increase the risk of cancer. Long-term, severe chronic gastritis, such as those with atrophic changes, intestinal hyperplasia or atypical hyperplasia, must be closely monitored. In life, promptly say goodbye to bad habits, quit smoking and limit alcohol, and eat less fried and high-salt food, etc. In addition, you should see a gastroenterologist regularly every year, and they will give specific advice on gastroscopy and medication depending on your specific situation.
5.How much is H. pylori related to stomach cancer?
H. pylori is the only type of stomach bacteria known to mankind so far, and it has some correlation with certain types of stomach cancer. If H. pylori is found to be positive and combined with chronic gastric diseases, such as chronic gastritis and gastric ulcer, the risk of developing gastric cancer in the future is higher and should be cleared in time. Not only should I clear it, but also my family members should be examined and cleared at the same time.
6.Is it painful to do gastroscopy and is there no other better examination method?
It is true that gastroscopy can be painful if painless measures are not taken. But at present, in order to detect early gastric cancer, you can only do gastroscopy; the gastric cancer that can be detected by other methods is not early, and the stage of gastric cancer directly affects the cure rate.
The great thing about gastroscopy is that it reaches into the stomach with the help of a slim and soft tube, and through the mirror-like probe at the bottom, the doctor can look straight into the stomach and see it clearly without letting go of the slightest change. The early manifestation of gastric cancer is very secretive, which may be the same as a small plaque growing on our hand, only the color of gastric mucosa has changed a little. The current technology such as CT and imaging can scan a certain diameter of gastric lesion, but cannot capture such a small change. Therefore, people who should have gastroscopy should not hesitate.
7.Is there a “gold standard” for gastric cancer diagnosis? What are the methods to treat gastric cancer?
Gastroscopy plus pathological biopsy is the “gold standard” for gastric cancer diagnosis, which is the qualitative diagnosis, followed by staging diagnosis. Surgery, radiotherapy, chemotherapy and supportive therapy are the main means to treat gastric cancer, among which surgery is the main method to cure early gastric cancer, while multidisciplinary comprehensive treatment is the most advanced treatment mode for gastric cancer. It is based on the comprehensive judgment of patient’s physical condition and disease, etc., and relevant multidisciplinary experts, together, formulate a set of treatment plan for patients, which is very necessary for patients with complicated disease. If the patient’s stage and diagnosis are very clear, the treatment can be done according to the relevant norms of gastric cancer.
8.How to seek medical treatment scientifically if I have gastric cancer?
Every time I go out to the clinic, I will encounter some patients who have not received standardized treatment, accounting for about 1/4 of the clinic volume. Whenever I see this situation, it makes me very worried. It is important to know that irregular treatment may stimulate the growth of tumor cells and make the subsequent treatment more difficult.
The first treatment is the most critical for gastric cancer patients. If you have stomach cancer, you must clarify two points: the first step is to seek medical consultation from a digestive tumor specialist; the second step is to wait for the doctor to do sufficient examination and evaluation before making treatment decision. Many patients are so anxious that they want to be diagnosed today and have surgery to remove the cancer tomorrow. Queuing for examination? Can’t wait! Waiting in line for a bed? No! As a result, many patients often go to non-digestive tumor specialists or irregular and unspecialized hospitals to receive irregular treatment as soon as possible.
When gastric cancer is detected by us, it has actually grown for a long time, and there is no hurry for these three to five days, unless there are serious complications such as perforation, bleeding and obstruction, which require immediate surgery. As a matter of fact, some waiting is for better treatment, and the doctor must be given time to fully understand the patient’s physical condition and analyze the tumor, so that a scientific treatment plan can be tailored for you. It is worth noting that the treatment level of gastric cancer in China varies greatly. Patients can also judge whether the doctor is professional by whether he fully understands your physical condition, tolerance and stage of the disease.
9. Is it right to say that 1/3 of cancer patients die of fright?
Obviously, this statement is too exaggerated. In my 30 years of medical experience, I have only met one patient who passed away due to excessive fear. She did not eat or drink every day, and lay in bed for years chanting: “I am dying, I am dying ……”. Any communication with her was ineffective. 12 days later, she passed away.
In fact, cancer is actually not as scary as we think, many people survive with cancer and still live a wonderful life. After suffering from cancer, you must adjust your mentality and communicate more with optimistic patients. For recovering gastric cancer patients, family members and colleagues do not need to protect them as “porcelain dolls” and do not let them do anything, which will easily make them feel that their life is worthless.
Last words.
In China, the average cure rate of stomach cancer is 30%, which is not low among the cure rates of cancer. I often hear people say that a friend is still healthy after having stomach cancer for more than 10 years, because the doctor’s surgery is good; while some friends passed away after six months of diagnosis, because the doctor’s level is not good. In fact, specifically for individuals, the cure rate is directly related to the stage of gastric cancer.
Comparing the survival rate of early stage cancer and late stage cancer is obviously not comparable. Compared with the overall cure rate of stomach cancer in Japan which is 60%, the cure rate of stomach cancer in China is low. The main reason is that Japan requires the first gastroscopy to be started after the age of 50, and its early stage patients account for more than 60%; while in China, most people have not had gastroscopy, and only about 10% are early stage gastric cancer patients. This shows that early diagnosis plays an important role in improving the survival rate of gastric cancer patients.