Pre-cancerous lesion is a pathological term referring to certain lesions with obvious risk of cancer, which may be transformed into cancer if not treated in time. The study of precancerous lesions of gastric cancer is important for the early detection of gastric cancer, which not only can understand the process of gastric cancer from the study of precancerous lesions, but also the follow-up of such lesions can detect early gastric cancer in time.
Gastric cancer is one of the common malignant tumors, and its incidence and mortality rate are the first among malignant tumors in China. Like other malignant tumors, the cancer of gastric mucosal epithelial cells is a gradual process, which often goes through years of continuous precancerous stage of gastric cancer, and only a few patients will evolve into gastric cancer. The process of occurrence and development of gastric cancer is as follows: superficial gastritis progresses to atrophic gastritis, then to intestinal epithelial hyperplasia, then to atypical hyperplasia, and finally to gastric cancer.
Atypical hyperplasia is further divided into three stages.
1, mild atypical hyperplasia, moderate atypical hyperplasia and severe atypical hyperplasia; where mild and moderate atypical hyperplasia are also known as low-grade intraepithelial neoplasia, and severe atypical hyperplasia is also known as high-grade intraepithelial neoplasia.
2. Above moderate atypical hyperplasia is irreversible. We call atrophic gastritis, intestinal epithelial hyperplasia and atypical hyperplasia as pre-cancerous state of the stomach.3 We call atrophic gastritis, gastric ulcer, warty gastritis, gastric polyp and remnant stomach, after major gastrectomy, as pre-cancerous lesions of the stomach.
In medical work, we often encounter patients who come to doctors with gastroscopy reports with “chronic atrophic gastritis” written on them. They are nervous and afraid that the lesion will become cancerous. What kind of pre-cancerous lesions are more likely to become cancerous? What kind of precancerous lesions can be treated conservatively by combining Chinese and Western medicine? What kind of precancerous lesions need endoscopic treatment? What kind of precancerous lesions need surgery?
The principles of gastroscopic evidence-based treatment are as follows.
1. If the gastric mucosa is still smooth, light red in color, with vascular permeability under endoscopy, and the pathology is reported as atrophic gastritis, it can often be treated with TCM, and most of the chronic atrophic gastritis can be reversed.
2, if the endoscopic gastric mucosa is rough, white in color, with vascular permeability, and the pathology is reported as atrophic gastritis or intestinal epithelial metaplasia, it can also be treated with TCM herbs, but the reversal rate of atrophic gastritis or intestinal epithelial metaplasia is relatively reduced.
3. if the gastric mucosa is rough, with color changes in different parts and pathology reported as atrophic or intestinal epithelial hyperplasia, it can be treated by TCM herbs for 3-6 months first, and then endoscopic treatment if it cannot be reversed.
4, if the gastric mucosa is rough, with color changes in different parts and pathology report with atypical hyperplasia, endoscopic treatment is often recommended.
5, if the gastric mucosa is rough, there are warty bulges in different parts, and the pathology report is only superficial gastritis, there is no atrophy, intestinal epithelial hyperplasia, then it can be treated with Chinese herbal dialectic, many warty bulges can be reversed.
6, if the gastric mucosa rough, different parts of the warty bulge, and the pathology report pathology report has atrophy, intestinal epithelial hyperplasia, or even atypical hyperplasia, then you should perform endoscopic treatment, otherwise it is difficult to reverse the Chinese herbal medicine.
7, if the gastric mucosa is rough and has extensive warty bulge, and the pathology report pathology report without atrophy, intestinal epithelial hyperplasia, can first Chinese medicine treatment for 3-6 months, can be part of the warty bulge disappeared, did not disappear warty bulge should be endoscopic treatment; if the gastric polyp, pathology report with atrophy or intestinal epithelial hyperplasia, then directly endoscopic treatment;.
8, gastric ulcer combined with intestinal epithelial hyperplasia, mild atypical hyperplasia and other cases can be considered combined Chinese and Western medicine treatment, often with the healing of the ulcer, the majority of the above pathological changes can be reversed.
With the above endoscopic identification, we talk about the following theoretical treatment.
In recent years, we have used the combination of Chinese and Western medicine in the treatment of precancerous lesions, and after protecting the mucosa, improving the blood circulation of gastric mucosa, and increasing the regeneration and repair function of gastric mucosal epithelial cells, we found that chronic atrophic gastritis can be transformed into chronic superficial gastritis or restore normal mucosa; the number of intestinal hyperplasia can also be reduced or completely disappeared; mild atypical hyperplasia can be reversed; however, the chance of reversing or disappearing moderate-to-severe atypical hyperplasia The chance of reversal or disappearance of moderate-to-severe atypical hyperplasia is small. Gastric warty bulges and gastric polyps with atrophy, intestinal epithelial metaplasia or atypical hyperplasia are difficult to be reversed.
For the treatment of precancerous lesions, we can treat them from three aspects.
I. Diet.
Don’t eat pickled products, fried food, smoked food; don’t eat leftover food; eat slowly and chew; insist on drinking two servings of milk every day, those with bloating can drink yogurt, those with excessive stomach acid can drink fresh milk; eat more fresh vegetables and fruits; don’t eat too hot food.
Second, drugs.
1, because 70 to 82% of patients with chronic atrophic gastritis have H. pylori infection, so patients also have to actively treat H. pylori infection. Now the eradication of Helicobacter pylori has the fourth consensus: the Wellspring Consensus, completely abandoned triple therapy, all the use of quadruple therapy, and according to whether the bacteria resistance and adjust the treatment plan, and with Chinese medicine to strengthen the spleen and benefit the qi, clear heat and detoxification, sterilization effect is better.
2.Western medicine should take folic acid, which is the only western medicine that can definitely prevent cancer so far, and the drugs that may have prevented cancer are allicin, and carotene’s cancer prevention effect has been negated.
3, the focus should rely on Chinese medicine to treat pre-cancerous lesions of stomach. The concept of Chinese medicine in treating pre-cancerous lesions of stomach is to activate blood circulation and eliminate blood stasis, eliminate swelling and disperse nodules. There are three types of drugs from weak to strong: blood nourishing and blood stasis, such as angelica, rehmannia, etc.; blood invigorating and blood stasis removing, such as danshen, safflower, curcuma, etc.; blood invigorating and blood stasis removing, such as raw pu huang, perforated nail, etc.; swelling and nodule dispersing drugs, such as dandelion, senghuang, white flowered snake tongue herb, half branch lotus, etc. The reversal rate of precancerous lesions reaches 40-60%.
III. Endoscopic treatment.
For gastric warty bulge with intestinal epithelial hyperplasia and atypical hyperplasia, gastric polyp, macular tumor with precancerous lesions and limited mucosal precancerous lesions (which can be clearly observed under gastroscopy) should be selected for endoscopic treatment, and techniques such as cauterization, removal, mucosal resection and mucosal peeling can be chosen.
At present, mucosal resection and mucosal peeling can be used for early gastric cancer treatment, replacing part of surgical procedures, which is a newly developed sunrise technology with a great future. In Japan, many early gastric cancers are treated endoscopically, avoiding the huge trauma caused by surgical procedures. Of course, endoscopic mucosal dissection requires an endoscopist with rich clinical experience to perform. For extensive lesions or gastric ulcers with moderate to severe atypical hyperplasia, surgical treatment should be considered.