The five-year survival rate of early gastric cancer can reach over 90% if surgery combined with biological tumor treatment is adopted. In China, most gastric cancer patients are already in the middle and late stages when they are detected, and the survival rate is greatly reduced. Therefore, it is very important to popularize the knowledge of gastric cancer and early diagnosis of gastric cancer.
The early symptoms of gastric cancer are not obvious, and cannot even be distinguished from those of benign ulcerative diseases. So how to achieve early detection and treatment of gastric cancer? This requires screening for asymptomatic people, screening for symptomatic people and gastroscopic screening for precancerous lesions and early gastric cancer, etc.
Screening for asymptomatic people can help improve the early diagnosis rate of gastric cancer, and regular physical examination can help detect some early lesions in the body and reduce the pain caused by symptoms.
Second, screening for symptomatic people is also a screening for high-risk groups.
1. Indigestion and gastroscopy
Indigestion is the main symptom of early gastric cancer. 60%-90% of early gastric cancer patients have indigestion, including heartburn, epigastric pain or epigastric discomfort. Gastroscopy for these dyspepsia patients can improve the detection rate of early gastric cancer and differentiate it from benign lesions.
2. First-degree relatives of patients with atrophic gastritis, post-gastrectomy, and gastric cancer should be cleared of H. pylori infection. For the high-risk group, the removal of H. pylori from the stomach can reduce the risk of cancer by 3.6 times.
III. Precancerous lesions
1.Chronic gastritis and atrophic gastritis
Chronic gastritis is closely related to H. pylori. There is evidence that chronic gastritis with H. pylori infection will eventually develop into chronic atrophic gastritis with continuous destruction of the gland.
Intestinal epithelial metaplasia refers to the replacement of gastric mucosal epithelial cells by intestinal epithelial cells, i.e., epithelial cells in the gastric mucosa that resemble the mucosa of the small or large intestine.
3.Non-invasive neoplasia
Non-invasive neoplastic changes (formerly called atypical hyperplasia) are generally divided into three levels (mild, moderate and severe), and Padova is divided into two levels (mild and severe). Studies have shown that 93.5% (87/93) of chronic atrophic gastritis is associated with atypical hyperplasia, and severe chronic atrophic gastritis is closely related to severe atypical hyperplasia. 50-80% of patients with non-invasive neoplasia eventually develop gastric cancer.
4.Gastric polyps
Hyperplastic polyps are mostly gastric epithelial-like polyps, ranging in size from a few millimeters to several centimeters, and 60% occur in the gastric sinus. There is a 1.5-3% potential for malignant transformation. Adenomatous polyps have a high potential for malignancy.
5.After gastrectomy surgery
The risk of malignancy increases significantly 15-20 years after gastrectomy surgery for benign diseases. The incidence of gastric cancer after gastric ulcer surgery is 4.5 times higher than that of normal population, and the incidence of gastric cancer after duodenal ulcer surgery is 3.7 times higher than that of normal population.
6.Family medical history
The incidence of gastric cancer among first-degree relatives of gastric cancer patients is 3 times higher than that of the normal population. Epidemiological studies have found that 10-15% of gastric cancer patients have a family history. Familial adenomatous polyposis (FAP) also has cancer risk. It is recommended that gastroscopy should be performed every 3-5 years. IV. Gastroscopic screening for early gastric cancer
Regular gastroscopy is recommended for patients over 45 years of age or with atypical hyperplasia. Patients under 45 years old with mild symptoms can be seen according to the doctor’s experience, and there is no hard and fast rule. In areas with high prevalence of H. pylori, the age of screening should be appropriately advanced.
IV. Stomach biopsy operation and surveillance of precancerous lesions
The operation protocol of standard gastric biopsy to detect early gastric cancer is very strict, and a certain number of biopsies are required for abnormalities in any part of the gastric mucosa. Regular gastroscopy for precancerous lesions can help early detection of gastric cancer, and the 5-year survival rate can be increased from 10% to 50%.
In recent years, with the improvement of people’s health awareness and advanced cancer treatment technology, the application of new diagnostic instruments, methods and techniques in clinical practice, and the expansion of screening for high-risk groups, the detection rate of early gastric cancer in China has been improved, and also the mortality rate of gastric cancer has been greatly reduced.