Why should early diagnosis and treatment of gastric cancer be emphasized?
Because the more early the cancer is, the better the treatment effect is.
Jiangsu is a region with a high incidence of gastric cancer. Although medical technology has made great progress, the overall 5-year survival rate of gastric cancer is still not high.
Japan is also a country with high incidence of gastric cancer, but the 5-year survival rate is significantly higher than ours. The reason is that more than 80% of gastric cancer patients diagnosed in Japan are early stage gastric cancer, so the treatment effect is good, while in our country, on the contrary, more than 80% of gastric cancer patients are found to be late stage gastric cancer, so the treatment effect is naturally not good.
What is early stage gastric cancer?
From the medical point of view, it is a superficial cancer with almost no lymph node metastasis, such a lesion can be cured by local excision without the need of lymph node dissection.
Simply speaking, the stomach wall is like the clothes we wear, it is divided into layers. If the cancer is confined to the first and second layers, that is, the mucosal layer, it is an early stage cancer, which can be cured by local excision.
If the cancer has grown to the third layer, that is, the submucosa layer, there is a 10-15% chance of lymph node metastasis, and surgery is needed to remove it.
When should I suspect that I may have this problem?
Unfortunately, there is no characteristic symptom that allows the doctor to take a look and know that the patient has precancerous lesions or cancer.
There may be some risk factors, such as family history, first-degree relatives of tumor patients (parents, siblings, children) will have higher relative risk; older ones will have higher risk than younger ones; those with H. pylori infection may have higher risk.
How can we find out and determine if there is one?
Gastroscopy + biopsy pathology is the only test that can determine it. Just as some technological tools can help the police to lock up criminals, modern gastroscopy techniques have come a long way, and with the help of special staining, magnification and other features, doctors can show lesions that were not very clear very clearly.
If gastroscopy has confirmed the diagnosis of stomach cancer, how can we know whether it is early or late stage?
The most accurate way to determine is to surgically remove the stomach and make a comprehensive judgment by removing the surrounding lymph nodes and combining with the whole body scan.
Before the surgery, the doctor can make a judgment based on the results of multiple tests. The crudest way is to judge the early and late tumor visually based on the size of the lesion and local mucosal changes under gastroscopy, which is often based on the doctor’s clinical experience and is rather subjective and cannot be used as a basis for choosing treatment later.
On the basis of gastroscopy, ultrasound endoscopy can be checked, which is to do ultrasound directly on the surface of the lesion to determine the depth of tumor growth and whether there are enlarged lymph nodes around the stomach. For early gastric cancer, this is a more effective examination method that can help doctors determine the depth of the lesion more precisely and decide whether endoscopic resection can be done.
Besides, abdominal CT can be done to find out whether there are metastases in the liver, abdominal cavity and lymph nodes, and for patients who have the conditions, whole body scan PET-CT can be done to find out whether there are metastases elsewhere.
It should be emphasized that all these examinations, except for pathology after resection, cannot be 100% accurate, so doctors often need to combine multiple methods to make a comprehensive judgment.
For early gastric cancer, is local excision sufficient?
C No. As it has been repeatedly emphasized before, pathology is the “gold standard” for tumor diagnosis.