What are the main early manifestations of gastric cancer? Most patients will have epigastric pain, some patients will have epigastric stuffiness, epigastric discomfort, loss of appetite, dyspepsia, accompanied by pantothenia, and a few patients will show symptoms such as pantothenia, heartburn, nausea, vomiting, belching or black stool. Very few patients have unexplained weight loss, emaciation and fatigue. What are the diagnosis methods of gastric cancer? 1.Fiber gastroscopy diagnosis: It is the most direct and accurate diagnosis method, which can detect early gastric cancer, differentiate benign and malignant ulcers, determine the type of gastric cancer and the scope of infiltration of lesions, and conduct follow-up examination of precancerous lesions. It is meaningful to conduct regular follow-up gastroscopy and surveillance for patients with precancerous lesions. 2.CT examination: CT examination can show the extent of gastric cancer involving the stomach wall growing into and out of the lumen, the anatomical relationship in the vicinity and the presence of metastasis, etc. 3.Endoscopic ultrasound: endoscopic ultrasound is a relatively new technology, which allows the examiner to directly see all layers of the stomach wall and understand the whole picture of the tumor, which is helpful for the diagnosis of gastric cancer and TNM staging. Pre-cancerous changes of gastric cancer The so-called pre-cancerous changes of gastric cancer refer to certain lesions with strong malignant tendency, which may develop into gastric cancer if left untreated. Pre-cancerous changes include pre-cancerous state and pre-cancerous lesions. 1. Pre-cancerous state of stomach: chronic atrophic gastritis, pernicious anemia, gastric polyp, post-surgical residual stomach, benign gastric ulcer, giant gastric mucosal crepitus. 2. Pre-cancerous lesions of stomach: heterogeneous hyperplasia and interstitial lesions, intestinal metaplasia. What are the manifestations of advanced gastric cancer? The manifestation of advanced gastric cancer mainly depends on the metastasis of gastric cancer, specifically: a lump can be palpated in the upper abdomen, which is hard and moves up and down with breathing. It can also metastasize to liver, lung, brain, bone, skin, ovary, etc. Through blood circulation, enlarged lymph nodes can be found in the left supraclavicular fossa and armpit, or ascites, jaundice, hepatomegaly and swelling in the rectal recess. If there is metastasis of gastric cancer cells implanted in the chest cavity, it may cause pleural fluid. The diagnosis can be confirmed by endoscopy, upper gastrointestinal barium meal or double air-barium imaging, CT, ultrasound and PET-CT, especially PET-CT has a high accuracy rate for advanced gastric cancer. How long can I live with gastric cancer? There are many factors affecting the survival rate of gastric cancer, such as stage of disease, tumor size, location of gastric cancer, histological type, pathological stage and lymph node metastasis, etc. Among them, pathological stage and the presence of lymph node metastasis are more important. The earlier gastric cancer is detected, the better the treatment effect is. The 5-year survival rate of stage I gastric cancer is 100%, stage II is 70% and stage III is 20%. Treatment methods of gastric cancer The basic treatment methods of gastric cancer include surgery, radiotherapy, chemotherapy and biological therapy. Clinically, a combined treatment plan is usually formulated based on a comprehensive analysis of the patient’s tumor site, tumor size, presence or absence of metastasis and stage, as well as the patient’s physical quality and other conditions. Surgical resection is the most important means in the treatment of gastric cancer. As long as the patient’s general condition allows and there is no distant metastasis, caesarean operation should be performed. There are three main surgical methods for gastric cancer, namely, radical resection, palliative resection and short-circuit surgery. Metastatic pathways of gastric cancer 1. Direct dissemination: Infiltrating gastric cancer can develop along the mucosa or plasma membrane directly into the stomach wall, esophagus or duodenum. Once the cancer tumor invades the plasma membrane, it will easily infiltrate to the surrounding adjacent organs or tissues such as liver, pancreas, spleen, transverse colon, jejunum, diaphragm, greater omentum and abdominal wall. When cancer cells are shed, they can also be planted in the abdominal cavity, pelvic cavity, ovaries and rectal and bladder sockets. 2.Lymph node metastasis: it accounts for 70% of gastric cancer metastasis. Lower gastric cancer often metastasizes to lymph nodes such as subpyloric, subgastric and para-abdominal artery, while upper cancer often metastasizes to lymph nodes such as para-pancreatic, para-pancreatic and supragastric. Advanced cancer may metastasize to periaortic and supra-diaphragmatic lymph nodes. Since the abdominal lymph nodes have direct communication with the thoracic duct, it may metastasize to the left supraclavicular lymph node. 3.Bloodstream metastasis: Cancer cells can be found in peripheral blood of some patients and metastasize to liver through portal vein, and reach to lung, bone, kidney, brain, meninges, spleen, skin, etc. 4.Plantation metastasis in peritoneal cavity: It refers to the implantation metastasis formed when gastric cancer cells infiltrate the plasma membrane and are shed to the peritoneal cavity. Implantation lesions can be distributed on the surface of any organ in the abdominal cavity. Metastatic lymph node rupture can also cause implantation, which is called “secondary metastasis”. Metastasis of gastric cancer to ovary is called Krukenberg tumor. What should I pay attention to in my diet after gastric cancer surgery? 1. Fasting after surgery, waiting for the restoration of bowel movement and anal discharge. After removal of gastric tube, drink a small amount of water, 4-5 tablespoons each time, once in 2 hours for 5 days after surgery. 2.If the postoperative recovery is normal, a low-fat semi-liquid diet with normal protein content and very little fiber content can be eaten two weeks after surgery. 3.Patients should eat in order to feel no discomfort to themselves, the diet content should be low residue, mild and easy to digest, eat less and more meals, and avoid too sweet, too salty and too thick diet, if nausea, abdominal distension and other symptoms appear after eating, food should be suspended. 4, 2-3 weeks after surgery, some patients may enter sweet food (such as milk with sugar, etc.) after the symptoms of panic, sweating, dizziness, nausea, epigastric discomfort, etc., generally lasting 15-30 minutes can be relieved by themselves, this syndrome is called “dumping syndrome”. To prevent this situation, if you want to eat sweet food, you should also eat a moderate amount of easily digestible salty food, and to control the speed of eating. 5, the patient can eat soft food after discharge, the main food and side dishes should be chosen nutritious, easy to digest food, avoid eating raw and cold, fried, sour and spicy and other stimulating easy flatulence food. Patients should chew and swallow slowly, eat more fresh vegetables and fruits, not eat high-fat food and pickled products, supplement iron and vitamins in appropriate amounts, prohibit smoking and alcohol, and have a regular diet. After 3-6 months after surgery, patients can gradually resume ordinary diet according to their body condition. 6. Drugs should be used according to medical prescriptions after gastric cancer surgery to prevent anemia. When do gastric cancer patients need adjuvant chemotherapy after surgery? It is generally advocated that postoperative adjuvant chemotherapy should be carried out as soon as the functions of organs are basically restored to normal after surgery, preferably starting around 4 weeks after surgery, and should not exceed 8-12 weeks. It may be difficult to provide survival benefit if longer than 3 months. Since there is no evidence-based medical basis for the duration of treatment, some experts suggest following the experience of colon cancer, with 6 months being appropriate. Do patients with gastric cancer need chemotherapy after surgery? The selection should be based on the pathological stage, surgical method, high-risk factors, physical condition and concomitant diseases of gastric cancer patients. Early gastric cancer generally does not have chemotherapy indications and does not need chemotherapy. Middle and late stage gastric cancer usually needs chemotherapy.