There was this 62-year-old man who started to have recurrent abdominal pain a year ago. He had a gastroscopy at the local hospital and was found to have a gastric ulcer, so the doctor prescribed him a drug for gastric ulcer triple therapy, and he took the drug carefully according to the doctor’s instructions, only that it seemed to have some effect at first, but the symptoms still recurred, and after 3 months of continuous eating, it still did not heal. The old man thought that ulcer disease was just like that and didn’t pay much attention to it. However, after a few months, the abdominal pain started to increase and he became thin, but his stomach became bigger and bigger. The abdominal CT showed that the tumor had metastasized extensively in the abdominal cavity with a large amount of ascites, which was inoperable, and then he died due to incurable disease. This is a typical case of mistaking gastric cancer ulcer as a common gastric ulcer, in fact, there are many such deplorable cases. We should be alert to the possibility of gastric cancer ulcers, especially the stubborn gastric ulcer, which is one of the stubborn elements, especially the middle-aged and elderly patients with high incidence of gastric cancer. If a gastric ulcer cannot be cured, be careful of gastric cancer. Our normal stomach is composed of mucosa on the surface, muscle layer in the middle and plasma membrane on the outside, if for various reasons the gastric mucosa is locally defective, deep to the mucosal muscle layer, it is called gastric ulcer. Gastric ulcer may sound commonplace now, but 20 years ago it was a disease that was talked about, often associated with the horror of gastrectomy, because of poor drug treatment, often progressing to bleeding and perforation. Stenosis and other serious complications, and only partial removal of the stomach. In recent years, with the development of proton pump inhibiting drugs and the clarification of the relationship between Helicobacter pylori (HP) and the pathogenesis of gastritis and gastric ulcers, the treatment of gastric ulcers. Nowadays, the standard internal medicine “triple therapy”, i.e. one acid suppressant or colloidal bismuth + 2 anti-HP antibiotics, has been able to cure most peptic ulcers and reduce the chance of ulcer recurrence significantly, which has become a milestone in the treatment of ulcer disease. After such internal treatment, the average ulcer patient can be cured in 4 to 8 weeks. However, the above-mentioned are only common gastric ulcers, there are some ulcers that are “stubborn” and even the “triple therapy” can’t do anything about it. If there is no obvious effect by conventional treatment, and the symptoms still recur during the maintenance period, and even complications such as bleeding and perforation occur, they are called “refractory ulcers”. Those that are particularly stubborn, do not heal after 12 weeks of regular medical treatment, or recur repeatedly after healing, are called “intractable ulcers”. There are many reasons for “stubborn”, such as the cause of the disease has not been removed (anxiety, tension and other mental factors), poor diet, improper treatment or with gastrinoma, pyloric obstruction and other diseases, but for middle-aged and elderly patients, we should pay particular attention to the possibility of cancerous ulcers, because they are essentially different from ordinary ulcers, and it is certainly not possible to treat them as ordinary ulcers. Ulcer or cancer, who came first? Every patient with gastric cancer ulcer has the so-called “chicken or egg first” question, that is, whether the ulcer comes first or the cancer comes first? One is due to genetics, diet, long-term chronic atrophic gastritis (cancer rate is about 1%-3%) and other causative factors, and gastric cancer has already occurred. The other is that the original ulcer is not healed for a long time, and the cells around the ulcer are stimulated by various factors such as inflammation for a long time, so they mutate and become cancer cells, which is what we generally call “malignant transformation” of the ulcer. Although the formation process of these two types of gastric cancer ulcers is very different, the treatment and prognosis are the same, and there is no need to distinguish them clinically. The prognosis of common gastric ulcer and gastric cancer ulcer is very different, and we should understand this point without explanation. On the other hand, gastric cancer is so fierce and aggressive that the best time for treatment will be missed if you are not careful. According to the statistics of more than 2600 cases of gastric cancer in Sun Yat-sen University Cancer Hospital, nearly 80% of the patients are basically in advanced stage when they come to the hospital, which is a very tragic fact, because the cure rate of gastric cancer is very low when it develops to late stage, less than 30%. In terms of treatment, except for a very small number of early gastric cancer that can be removed endoscopically, surgery and/or adjuvant radiotherapy are generally required. Early detection of gastric cancer ulcer is not terrible. Once gastric ulcer is found to be gastric cancer, don’t be disheartened and think that it is hopeless, but should be treated with surgery or chemotherapy as early as possible to improve the prognosis as much as possible. Especially for early stage (I and II) gastric cancer, the treatment effect is still quite good nowadays, and the cure rate can even reach over 70% to 80%. Therefore, the most important thing is to achieve “three early stages” – early detection, early diagnosis and early treatment, which, of course, requires the use of the powerful tool in our hands – gastroscopy. Gastroscopy usually biopsies gastric ulcers, but due to factors such as location and size of ulcers and biopsy sampling, there is a certain false-negative rate and cancerous tissues may not be found. Therefore, it is necessary to review gastroscopy and biopsy several times for suspicious patients. In general, considering the possibility of gastric cancer, patients with gastric ulcer, especially those with recalcitrant gastric ulcer, should review gastroscopy in time after their symptoms improve, usually once a year. ”For example, there was a patient with recurrent gastric ulcers who had been relatively “obedient” and went to the hospital once a year for review, but during a gastroscopy review, a biopsy was routinely done and unexpectedly found During a gastroscopy review, a routine biopsy was done, but unexpectedly cancer was found around the ulcer, so a partial gastrectomy was performed in time, and he recovered well after the surgery. The pathological results later showed that it was a very early gastric cancer, and the cancer cells were only “latent” in the gastric mucosa and had not “escaped” to the deeper layers of the stomach wall or other organs. The quality of life after surgery is relatively high, and eating and daily life are basically as usual. The purpose of reviewing gastroscopy is to achieve early diagnosis in order to kill gastric cancer at an early stage. It would be better if early prevention can be achieved, and the only way to achieve early prevention of stomach cancer is to start from daily life and improve lifestyle. Regular diet and living, long-term exercise and avoiding overexertion are most important to maintain normal immunity and fight against various disease factors. You should also quit smoking and drinking, avoid overheated diet, and eat less pickled, barbecued and fried food. Try to consume sufficient amount of fruits and vegetables to replenish vitamin B and C, which can be antioxidant and improve immunity. Carrots, garlic and shiitake mushrooms can be made into delicacies with good color and flavor, and they are also rich in anti-cancer substances such as beta-carotene, allicin and mushroom polysaccharide, which have certain anti-cancer effects and can be appropriately increased in normal life.