The incidence of gastric cancer ranks second in China and the mortality rate ranks third. The incidence rate is higher in the northwest (Qinghai, Gansu, Ningxia) and southeast coast (Jiangsu, Shanghai, Zhejiang, Fujian); while Guangdong, Guangxi and Guizhou are low incidence areas. High incidence age: 40-60 years old; gender: male to female ratio is about 2-3:1 Environmental factors are dominant in the occurrence of gastric cancer, while intrinsic personal factors are subordinate.
Diet: living and eating habits play an important role in the development of gastric cancer. Frequent consumption of high salt, cured foods (containing nitrite), smoked foods are prone to gastric cancer Those who smoke a lot and drink alcohol have high risk of gastric cancer Environmental pollution (soil, water), harmful foods, etc.
Disease factors: chronic atrophic gastritis with intestinal epithelial hyperplasia and atypical hyperplasia, gastric polyps, remnant stomach, gastric ulcer, Helicobacter pylori (HP) infection, etc.
Chronic atrophic gastritis: intestinal epithelial hyperplasia, heterogeneous hyperplasia (cancer rate: 1.2%-7.1%)
Gastric polyps: adenomatous polyps (carcinoma rate: 10%-50%)
Gastric ulcer: chronic lesion repair and regeneration (cancer rate: 1-5%)
Stomach remnant: duodenal fluid reflux aggravates gastric mucosal lesions (cancer rate: 1-5%)
Helicobacter pylori: H. pylori infection (H. pylori) has an important relationship with the development of gastric cancer, but the specific mechanism of action in the complex process of gastric cancer remains unclear. The prevalence of H. pylori infection is also high in countries with a high incidence of gastric cancer and has declined with the prevalence of gastric cancer in developing countries. Some studies have shown that control of H. pylori infection can potentially prevent the occurrence of gastric cancer.
Intrinsic factors: genetic susceptibility of individuals (genetic defects)
Risk factors and high-risk groups.
Those who have the following conditions belong to the high-risk group of gastric cancer
①People who start to have stomach discomfort, pain or loss of appetite after 40 years old;
(ii) Those with chronic atrophic gastritis with Hp infection.
③ Chronic atrophic gastritis with intestinal metaplasia and heterogeneous hyperplasia;
(iv) Those with a history of gastric ulcer and recurring episodes;
(⑤) Those with a history of gastric polyps;
Early symptoms and indications for medical consultation.
Gastric cancer lacks specific clinical symptoms, and early gastric cancer is often asymptomatic. Minor digestive symptoms may appear, such as discomfort, vague pain, fullness and loss of appetite in the stomach and epigastric region, which usually do not attract attention because common indigestion and gastritis will have such manifestations. If the above digestive symptoms do not relieve and disappear for a longer period of time or recur frequently, hospital consultation and appropriate tests (endoscopy, barium x-ray) are recommended.
Clinical manifestations.
In the early stage, there may be mild upper GI symptoms (vague pain, fullness, loss of appetite, nausea and vomiting), which are not disease-specific. With the development of the lesion, the GI symptoms may increase, and vomiting of blood and black stool, anemia, weight loss, etc. may also appear. Late signs include deep pressure pain in the upper abdomen, masses, enlarged left supraclavicular lymph nodes, ascites, etc.
For patients with tumors located in the proximal gastric or cardia-esophageal junction, dysphagia may be present.
Diagnosis and ancillary tests
Focus on those with high-risk factors (previously described) and regular checkups (1-2 times/year). Promptly examine if symptoms of GI discomfort do not easily resolve.
Ancillary examinations: endoscopy + biopsy, upper GI X-ray, CT, blood tumor markers.
Treatment methods and selection principles
The principle of comprehensive treatment should be adopted, that is, according to the pathological type and clinical stage of tumor, combined with the general condition and functional status of patient’s organs, multidisciplinary comprehensive treatment mode should be adopted, and treatment means such as surgery, chemotherapy, radiotherapy and biological targeting should be applied in a planned and reasonable way to achieve radical or maximum control of tumor, improve the quality of life and prolong the survival of patients.
1.For early stage gastric cancer without evidence of lymph node metastasis, endoscopic treatment or surgery can be considered according to the depth of tumor invasion, without adjuvant radiotherapy or chemotherapy after surgery.
2. Early gastric cancer with local progressive stage or lymph node metastasis should be treated with comprehensive treatment mainly by surgery. According to the condition of tumor, radical surgery can be performed directly or chemotherapy can be administered before surgery and then radical surgery. After surgery, adjuvant treatment plan (adjuvant chemotherapy or adjuvant chemoradiotherapy) should be decided according to the pathological stage.
3.Recurrent/metastatic gastric cancer should be treated with comprehensive treatment mainly by drug therapy, and local treatment such as palliative surgery, radiotherapy, interventional therapy, radiofrequency therapy should be given at the right time, and the best supportive treatment such as pain relief, stent placement and nutritional support should also be actively given.
Surgical treatment
Surgical resection is the main treatment for gastric cancer and the only way to cure gastric cancer at present. Gastric cancer surgery is divided into radical surgery and palliative surgery, and radical resection should be strived for.
Palliative surgery: It is only applicable to those who have distant metastasis or tumor invading important organs that cannot be removed and combined with bleeding, perforation, obstruction and other conditions. Palliative surgery is aimed at relieving symptoms and improving quality of life.
Radiation therapy
Radiotherapy or radiotherapy for gastric cancer: including preoperative or postoperative adjuvant therapy and palliative therapy.
The indications for postoperative radiotherapy are mainly for T3-4 or N+ (lymph node positive) gastric cancer; the indications for preoperative radiotherapy are mainly for inoperable locally advanced or progressive gastric cancer; the indications for palliative radiotherapy are local recurrence and/or distant metastasis.
Chemotherapy
It is divided into palliative chemotherapy, adjuvant chemotherapy and neoadjuvant chemotherapy.
1. Palliative chemotherapy is administered to patients with advanced inoperable disease, with the aim of relieving tumor symptoms, improving quality of life and prolonging survival.
2. Adjuvant chemotherapy is administered to post-operative patients with the aim of killing the remaining tumor cells and achieving a curative effect. It is usually started 3-4 weeks after surgery, and the combined chemotherapy is completed within 6 months, and the single drug chemotherapy should not exceed 1 year.
3. Neoadjuvant chemotherapy (pre-surgical chemotherapy) is recommended for gastric cancer that is difficult to be cured by locally advanced surgery, and pre-surgical chemotherapy aims to make the tumor retreat and create the opportunity for radical surgery.
Dietary arrangement for post-surgical gastric cancer patients (to compensate for the loss of gastric function)
1.Choose foods that are easy to digest and rich in nutrition.
2.Chew more after food entry – chew and swallow slowly.
3.Eat less and more meals (6-8 meals/day) and appropriately supplement digestive enzymes and vitamins.
4.Avoid eating spicy and irritating food, avoid smoking and alcohol.
Prevention of gastric cancer
Primary prevention: appropriate prevention according to environmental pathogenic factors
1.Avoid bad living habits, do not smoke, limit alcohol;
2.Limit the consumption of pickled and smoked foods; avoid high-salt diet;
3, eat more fruits, vegetables (garlic, leeks), cereals and legumes, drink green tea.
4.Treat Helicobacter pylori (Hp) infection.
5.Pre-cancerous diseases (chronic atrophic gastritis, gastric ulcer, gastric polyp) should be prevented.
Secondary prevention: early detection and early treatment.
Key examination (gastroscopy) should be conducted for those with the following risk factors.
(1) Stomach discomfort, pain or loss of appetite starting after the age of 40.
(2) Chronic atrophic gastritis with intestinal metaplasia and heterotypic hyperplasia, Hp infection.
(3) Gastric ulcer with unrelieved symptoms after treatment or persistent positive fecal occult blood.
(4) Gastric polyps, especially multiple polyps.
Summary
1.Gastric cancer is a malignant tumor of digestive system with high incidence and mortality rate in China, which should be paid attention to;
2.Environmental factors dominate the causes (dietary habits, environmental factors, disease conditions), and appropriate intervention measures can reduce or prevent the occurrence of gastric cancer;
3.Gastric cancer lacks specific clinical symptoms, if the upper gastrointestinal symptoms cannot be relieved for a long time, it is recommended to go to hospital for consultation and corresponding examination in order to obtain early diagnosis;
4.After the discovery of gastric cancer, it should be treated actively. Doctors will apply surgery, chemotherapy, radiotherapy and biological targeting in a planned and reasonable way to achieve radical cure as far as possible.