At present, 1/4 of the causes of death in the country are cancer, and 1/4 of the causes of cancer deaths are stomach cancer. Gastric cancer originates from mucosal epithelial cells in the most superficial layer of the stomach wall and can occur in various parts of the stomach (cardia, gastric body, and sinus). If the cancer is confined to the intra-mucosal or sub-mucosal layer, it is called early gastric cancer; if it invades deep into the muscular layer or metastasizes to areas outside the stomach, it is called progressive gastric cancer. There are many types of cancer cells, such as adenocarcinoma (about 90%, including papillary, tubular, mucinous, and indolent cell carcinoma), adenosquamous, squamous cell, undifferentiated, and carcinoid carcinoma, when observed by microscopic magnification.
The efficacy of gastric cancer is closely related to the early and late stages of the disease and the methods and means of diagnosis and treatment. 90% of patients with early stage gastric cancer can survive for more than 5 years or be cured after regular treatment, while the 5-year survival rate of patients with middle and late stage gastric cancer is only 20-30% after treatment. Therefore, early diagnosis is the key to improve the survival rate. Unfortunately, only less than 10% of gastric cancer patients in China are in early stage when diagnosed, compared with about 60% in Japan, which is quite a big gap; mainly because Japan insists on regular gastroscopy, while most patients in China visit the doctor for discomfort, and most gastric cancer patients have symptoms only in the middle and late stages. Therefore, regular gastroscopy and other examinations for people at high risk of gastric cancer are effective means to detect early gastric cancer.
The so-called high-risk group refers to those who have a higher risk of developing stomach cancer.
At present, those who are more definitely belong to the high-risk group of gastric cancer are
(1) Having precancerous lesions: Precancerous lesions refer to benign diseases that have the tendency to become cancerous, such as
(1) chronic atrophic gastritis, with a cancer rate of up to 10%.
(2) Chronic gastric ulcer, with a cancer rate of less than 3%.
(3) gastric polyps with a diameter of >2 cm and a high cancer rate in multiple cases with a wide base
(4) Partial gastrectomy, the cancer rate of residual stomach can be 0.3-10%.
(5) Other precancerous lesions, such as giant gastric mucosal hypertrophy, warty gastritis, etc.
(6) Gastroscopic biopsy pathological types.
(i) heterogeneous hyperplasia, also known as atypical hyperplasia, caused by chronic inflammation; if it develops into severe atypical hyperplasia, it can be considered as precancerous lesions or even considered as early cancer.
(ii) interstitial gastric metaplasia has more chances of carcinogenesis.
③ colonic type intestinal metaplasia is closely related to the occurrence of gastric cancer.
2.Bad dietary habits.
Such as irregular diet, fast eating, high salt/hot food, pickled, smoked, dried seafood, overnight vegetables with high content of carcinogenic substances nitrite, red meat with barbecue, frequent consumption of moldy food, less fresh vegetables, etc.
3.Long-term alcohol abuse and smoking.
Alcohol can change the mucous membrane cells and cause cancer. Smoking is also a strong risk factor for gastric cancer, and those who start smoking in adolescence are at the greatest risk.
4. Family history of gastric cancer or esophageal cancer.
The incidence of gastric cancer among patients’ family members is 2-3 times higher than that of normal population.
5.Long-term poor psychological condition.
Such as depression, sorrow, homesickness, loneliness, depression, hatred, disgust, low self-esteem, self-blame, guilt, interpersonal tension, mental breakdown, sulking, etc., the risk of stomach cancer is significantly higher.
6.Some special occupations.
Those who are exposed to sulfuric acid dust mist, lead, asbestos, herbicides and metal industry workers for a long time have significantly higher risk of stomach cancer.
7. Helicobacter pylori (Hp) infection.
Some studies claim that about half of gastric cancers are related to H. pylori infection. About 60% of the national population is infected with the bacteria, but only 0.03% of the population suffers from stomach cancer.
Symptoms of gastric cancer.
1.More than 70% of patients with early gastric cancer have no symptoms.
2.Sense of fullness in the upper abdomen is often the earliest symptom of progressive gastric cancer, sometimes there are belching, acid reflux and vomiting.
3.It is similar to indigestion or gastritis.
4.If the cancer focus is located in cardia, the patient may feel uncomfortable in eating; if the cancer focus is located in pylorus, the patient may vomit the rotten overnight food when obstruction occurs.
5.50% of the elderly patients have obvious loss of appetite, increasing wasting and weakness, and 40%-60% of the patients seek medical treatment for wasting.
Diagnosis of gastric cancer.
1.Laboratory examination.
At present, there is no tumor marker with strong specificity for gastric cancer diagnosis. Continuous monitoring of several markers such as CEA, CA50, CA72-4, CA19-9, CA242, etc. is of certain value for the diagnosis and prognosis of gastric cancer.
2.Device examination.
(1) Gastroscopy can identify benign and malignant ulcers and determine the type and lesion scope of gastric cancer. Gastric ulcer or atrophic gastritis can be detected and pathological biopsy can be performed to diagnose the histological typing of gastric cancer. However, it is sometimes difficult to distinguish the early and late stages of gastric cancer by gastroscopy.
(2) CT abdomen (plain scan + enhancement) can show the extent of gastric cancer involving the stomach wall, lymph node metastasis, relationship with surrounding tissues, and whether there are large abdominopelvic metastases.
(3) PET-CT scan (a combination of positron emission tomography and computerized tomography) is more than 80% accurate in determining whether it is gastric cancer (about 50% accuracy for indolent cell carcinoma and mucinous adenocarcinoma), and can understand whether there are metastases throughout the body without pain, but is expensive. It is a reliable way to track the recurrence of gastric cancer after the operation of preoperative imaging.