Stomach cancer is a malignant tumor that seriously endangers the health of our people, with about 680,000 new cases and 480,000 deaths every year. There are no obvious symptoms in early stage of gastric cancer or only some mild symptoms, and most of the patients have basically developed to advanced stage when they arrive at the hospital. The 5-year survival rate of advanced gastric cancer is less than 30%, while the 5-year survival rate after treatment of early gastric cancer can exceed 90% or even reach the effect of cure. Therefore, early detection, early diagnosis and early treatment of gastric cancer are very important.
What is the tertiary prevention of gastric cancer
Primary prevention: prevention of the cause of disease, or prevention before the disease. It is to remove the causes that may lead to stomach cancer in advance to prevent stomach cancer from occurring at the source, that is, to treat the disease before it happens.
Although the occurrence of gastric cancer is affected by many factors, such as genetics, environment and dietary habits, there are two factors that we can completely control, one is H. pylori and the other is nitrite.
H. pylori infection is the main cause of gastric cancer in China, and about 75% of gastric cancers are caused by H. pylori infection. Therefore, to prevent gastric cancer, we should first prevent and eradicate H. pylori infection and advocate meal sharing system.
Nitrite is mainly found in pickled foods, high-salt foods, and overnight vegetables, so it is important to eat less or no pickles. Eat less or no smoked and fried foods. Do not eat moldy foods. Eat more fresh vegetables and fruits.
Secondary prevention: It is to have the disease to prevent change. That is, early detection, early diagnosis and early treatment.
Before the occurrence of gastric cancer, but precancerous disease or precancerous lesion has already occurred, if it can be detected and treated in advance, the survival rate and cure rate can be improved.
The known precancerous lesions of gastric cancer include: atrophic gastritis, adenomatous polyp, gastric ulcer, moderate to severe heterogeneous hyperplasia, incomplete colonic type intestinal epithelial hyperplasia, hypertrophic gastritis and so on. If these lesions can be detected in time, effective intervention can be made to prevent the evolution into gastric cancer.
Tertiary prevention: In fact, it can no longer be considered as prevention, which is to mend the situation after sheep are lost.
It means to prevent the deterioration of the diagnosed gastric cancer, prevent the disease from causing disability, try to restore the function, promote the recovery, prolong the life span, improve the quality of life and even return to the society.
Because it is impossible to achieve primary prevention of stomach cancer, that is, to cut off the occurrence of stomach cancer from its cause, so secondary prevention, that is, disease prevention, early stomach cancer screening is the most effective way to prevent stomach cancer.
What is early screening for gastric cancer?
According to the Expert Consensus Opinion on Early Stomach Cancer Screening Process in China, all those who are above 40 years old and belong to the risk group of gastric cancer are recommended to have gastric function serological test. Gastric function tests include pepsinogen I, II, and pepsin I and II ratio, gastrin, H. pylori antibody, or breath test for H. pylori. Based on the results of gastric function tests, the new gastric cancer screening scoring system is used to identify high-risk, intermediate-risk and low-risk groups for gastric cancer. Gastroscopy will be performed once a year for high-risk group, once every 2 years for medium-risk group and once every 3 years for low-risk group.
How to perform early gastric cancer screening
The first step is serum gastric function test and H. pylori test
Serum gastric function test is a method to determine gastrin 17 (G-17) and pepsinogen I and II (PG I and II) by taking 2-3ml of venous blood and analyzing them to assist in the diagnosis of gastric mucosal diseases, which is a non-invasive, painless, safe and economical method to detect gastric diseases.
H. pylori infection detection: H. pylori infection can be determined by serum H. pylori antibody test or urea breath test.
The second step is to determine the risk of gastric cancer by scoring with a new scoring system
The system contains 5 variables, mainly gender, age, H. pylori infection, pepsinogen ratio and gastrin content, and the score is based on the assigned values of the 5 variables, with a total score of 0~23.
1.People with high risk of gastric cancer (17~23 points), with extremely high risk of gastric cancer.
2.People with medium risk of gastric cancer (12~16 points), with certain risk of gastric cancer.
3.People with low risk of gastric cancer (0~11 points) have average risk of gastric cancer.
Step 3 Gastroscopy screening for high-risk group
Gastroscopy and its biopsy are the current gold standard for diagnosing gastric cancer. Plain endoscopy is suitable for detecting progressive gastric cancer, and the detection rate of early gastric cancer is low. The detection of early gastric cancer is more dependent on the examiner’s experience in endoscopic operation, electronic or chemical staining and magnifying endoscopic equipment. Therefore, it is a more feasible screening strategy to first screen out people with high risk of gastric cancer by non-invasive diagnostic methods, followed by purposeful endoscopic precision examination.
What is early gastric cancer?
Early gastric cancer refers to tumor confined to the mucosal layer or submucosal layer. And regardless of the size of the tumor and whether there is lymph node metastasis, it is considered early gastric cancer. Since most patients with early stage gastric cancer do not have obvious clinical symptoms, doctors cannot diagnose early stage gastric cancer based on the clinical manifestations of patients, but mainly rely on gastroscopy and biopsy under gastroscopy to determine whether it is early stage gastric cancer.
Early gastric cancer is divided into small gastric cancer, micro gastric cancer and punctate cancer according to the size of the tumor.
Endoscopically, early gastric cancer is further divided into: Type I (polyp-like type) Type II (superficial type) Type III (ulcerated type).
Since early gastric cancer has no specific symptoms, the patient’s consultation rate is low, therefore, carrying out early screening of gastric cancer can improve the diagnosis rate of early gastric cancer.
Once early gastric cancer is diagnosed, endoscopic resection is preferred. Compared with traditional surgery, endoscopic resection has the advantages of less trauma, fewer complications, faster recovery and lower cost, and their efficacy is basically equivalent. Therefore, endoscopic resection is recommended as the first choice of treatment for early gastric cancer both at home and abroad.
What conditions require timely gastroscopy
1.Unexplained wasting and poor appetite
If you have a normal appetite and normal weight, but suddenly you lose weight for no reason and have no appetite, you should undergo gastroscopy to rule out gastric cancer and precancerous diseases.
2. Frequent stomach symptoms
There are upper gastrointestinal symptoms, including upper abdominal discomfort, abdominal pain, bloating, heartburn and acid reflux, swallowing discomfort, belching, erratic, etc. Since there is no specific symptom of stomach cancer, if there are frequent stomach symptoms, gastroscopy should be done.
3.Vomiting blood and black stool
The appearance of vomiting blood and black stool indicates bleeding in the upper gastrointestinal tract. No matter what the cause of bleeding is, gastroscopy should be done in time to clarify the diagnosis for treatment.
4.Other tests reveal abnormalities
If abnormalities are found in blood tests, ultrasound or CT examinations, they indicate the possibility of stomach disease, such as elevated tumor markers in blood tests and positive occult blood in stool tests. For example, elevated tumor markers in blood test, positive fecal test and occult blood, thickening of stomach wall and gastric occupying lesions in ultrasound or CT examination, then gastroscopy is needed in time.
5.Patients with regular review
Those who have had gastroscopy before and found to have chronic atrophic gastritis, gastric ulcer, gastric polyp, warty gastritis and other diseases, which are pre-cancerous diseases of stomach, should receive gastroscopy regularly every six months to a year.