Gastric cancer is one of the most common malignant tumors in China, and although there is a trend of decrease in recent years, it still ranks first in the incidence of various malignant tumors. After more than 60 years of efforts since then, gastric cancer, once an unparalleled malignant tumor, has been gradually recognized comprehensively, and the 5-year survival rate after radical surgery has exceeded 50%, which can be said to be a rather promising result in terms of treatment effect. This means that routinely for a gastric cancer patient after a clear diagnosis is no longer a passive waiting for death or crazy consumption, he has at least 50% possibility to persist for more than 5 years or even be cured.
There are obvious regional differences in the division of gastric cancer. The high incidence area coastal areas and the interior of Ningxia Gansu Shanxi Shaanxi, and the southern provinces, especially the two provinces of Yunnan, Guizhou and Sichuan are the low incidence areas.
Gender difference of gastric cancer incidence: more men than women, 1.5:1 to 2.5:1
Time trend: the incidence rate of gastric cancer worldwide is decreasing significantly year by year. The mortality rate of gastric cancer in the first generation of Japanese immigrants to Hawaii is comparable to that in Japan, while the mortality rate in the second generation is significantly lower than that in Japan, between Japanese and natives, a phenomenon suggesting that environmental factors are more closely related to gastric cancer incidence than genetic factors. The development of gastric cancer may be related to dietary factors. This phenomenon suggests that the development of gastric cancer may be related to dietary factors, especially the nitrite group.
Clinical manifestations of gastric cancer.
Symptoms of gastric cancer . There are often no specific symptoms in the early stage. As the development of tumor affects the function of stomach only then similar symptoms such as gastritis gastric ulcer will appear, and further development may show obstruction, lump, bleeding or metastatic lesions with enlarged lymph nodes are found before starting to consult a doctor clearly. Therefore, it is recommended that gastroscopy is necessary when there are atypical symptoms such as vague pain in the upper abdomen, discomfort, acid reflux and belching.
1. Stomach pain: It is a common symptom and the most easily ignored symptom. Now it is not recommended to perform gastroscopy and other further examinations until there is “pain without rhythm”, “can not be relieved by eating” or even poor effect of symptomatic treatment with internal medicine.
2.Loss of appetite, emaciation and weakness: this is another group of non-specific symptoms of gastric cancer, which should be alerted when it exists together with epigastric vague pain!
Bleeding and black stool: this symptom may appear in the early stage of the disease (20% of early gastric cancer), elderly patients with history of gastric disease should first think of gastric cancer when this symptom appears.
4.Nausea and vomiting: In the early stage, there may be only sometimes discomfort of fullness and mild nausea, which are caused by tumor obstruction and gastric dysfunction.
5.Other symptoms: A few patients show diarrhea, constipation and lower abdominal discomfort, and also fever. Abnormal masses or even ovarian masses found on the body surface may be metastatic lesions of gastric cancer.
Stomach precancerous lesions and precancerous diseases
1.What is precancerous lesion: precancerous lesion refers to the pathological changes of gastric mucosal epithelium that can be easily transformed into cancer. At this stage, the most concerned is heterogeneous hyperplasia or atypical hyperplasia of gastric mucosa, especially moderate and severe atypical hyperplasia should be closely observed, and when it is difficult to differentiate severe atypical hyperplasia from cancer, surgical treatment should be appropriate. Incomplete colorectal type intestinal epithelial hyperplasia is also closely related to gastric cancer and should be followed up closely.
2.Pre-cancerous disease: This is a clinical concept, which generally includes chronic atrophic gastritis, chronic gastric ulcer, gastric polyp, remnant stomach, pernicious anemia, etc.
(1) Chronic atrophic gastritis: 10-20 years later・10% of gastric cancer occurred.
(2) Chronic gastric ulcer: associated with cancer is controversial, less than 3%.
(3) Gastric polyp is rare, gastroscopy 2-3%: It is a general and vague designation for any tumor from the gastric mucosa or neoplastic protrusion into the gastric lumen. It is classified as neoplastic, inflammatory, regenerative or misshapen polyp according to pathological features. The recognized ones are proliferative adenomatous polyps, papillary adenomas, inflammatory fibrous polyps, familial polyposis and Peutz-Jeghers syndrome, among which proliferative adenomatous polyps and papillary adenomas are the most common, and their malignant tendency is the most debated issue among clinicians and pathologists. The clinical manifestations are: chronic epigastric pain and discomfort caused by low or lack of gastric acid; nausea, anorexia and dyspepsia caused by tumor obstruction or gastric dysfunction; intermittent vomiting of blood and black stool caused by tumor erosion and ulceration; a few symptoms such as obstruction due to tumor embedded in the pylorus.
(4) Residual gastric cancer: follow-up is recommended for those who have undergone major gastric resection for more than 10 years.
Diagnosis of gastric cancer
At present, the key techniques for gastric cancer diagnosis are gastroscopy and X-ray examination.
1.Gastric double contrast imaging: this method has gradually replaced simple barium meal imaging, and it has unique value for the diagnosis of gastric cancer, especially early gastric cancer.
2.CT examination: CT examination can show the relationship between extra-cavity invasion and neighboring organs, whether the neighboring organs are involved, and even determine whether there is obvious metastasis; CT examination can also show the situation of perigastric lymph nodes, and often determine whether there is metastasis of lymph nodes from the size of lymph nodes for clinical reference; CT examination can often show the images of other organs in the abdominal cavity, such as liver, ovaries, adrenal glands, etc., to understand whether there are metastatic lesions in these organs. CT examination can often show images of other organs in the abdominal cavity such as liver, ovaries, adrenal glands, etc., to understand whether there are metastatic lesions in these organs.
3. Gastroscopic diagnosis: It can visually describe the shape and size of the tumor lesion and take pathological material. 1) Biopsy: The selection of the sampling site is the key to the positive result. 2) Cytological examination: The last step to confirm and clarify the diagnosis. It is the reliable basis for surgical treatment.
4. Ultrasonic diagnosis of gastric cancer. Ultrasonic endoscopic examination carried out in recent years is very helpful for the diagnosis of gastric cancer, which can be used for preoperative staging assessment, understanding the depth and extent of infiltration and providing more reliable information for surgery.
Treatment of gastric cancer
1.Surgical treatment.
Surgery is the main means to treat gastric cancer and the only means to completely cure gastric cancer at present. The efficacy of gastric cancer surgery is very closely related to the stage of gastric cancer. The survival rate of early gastric cancer can reach over 90% in 5 years and over 80% in 10 years after surgery. However, in China, only 15% of early gastric cancers are treated by surgery, and most of those who come to hospital are progressive gastric cancers. There are more factors affecting the surgical effect of specific progressive stage.
(1) Pathological staging of the tumor, generally speaking, the higher the degree of differentiation, the better the prognosis; mucinous adenocarcinoma and indolent cell carcinoma have the worst surgical outcome, and few survive for more than one year after surgery.
(2) The presence of distant metastases: In the past, it was thought that once distant metastases were found, radical surgery for gastric cancer should not be performed, but now it is thought that as long as the physical condition is good, there is still an indication for surgery, at least for tumor reduction and removal of tumor immune paralysis.
(3) Lymph node metastasis: the most likely and common metastatic pathway of gastric cancer is the lymph nodes around the tumor. Therefore, the most technical aspect of radical surgery for gastric cancer is not whether the tumor on the stomach can be removed, but how to achieve the scientific and complete clearance of the relevant lymph nodes. At present, D2 radical surgery is internationally recognized and promoted.
(4) Whether there is infiltration of surrounding organs and whether the infiltrated area can be resected. From the bulk of reports and our practical experience, it is not terrible whether there is infiltration of organs or not, but the key is whether they can be removed together. As long as it is cleanly excised, it does not affect postoperative survival.
2. Gastric cancer surgery.
Before 2007, open surgery was routinely performed, and standard D2 radical surgery was generally performed; after 2007, with the progress and development of laparoscopic surgery, we started to try laparoscopic radical surgery for gastric cancer, and after continuous learning and exploration, we have fully mastered laparoscopic radical surgery for gastric cancer in the past 3 years, and laparoscopic radical surgery for gastric cancer has become a routine surgery and has been carried out on a large scale. At present, there are nearly dozens of cases in total, and the surgical procedures are all very smooth and clear, with good and fast postoperative recovery and no complications in any case. The development of this new technology has been recognized by the hospital, the society and, more importantly, the patients.
3.Adjuvant treatment of gastric cancer surgery.
Most gastric cancers, except for stage 1 gastric cancer with early lesions, need postoperative chemotherapy to consolidate the efficacy, but there is still no mature adjuvant treatment method.