Gastric cancer, which includes malignant tumors of epithelial origin occurring in the lower esophagogastric junction and stomach, is the fourth ranked malignant tumor in the global population. In China, its incidence rate ranks the 2nd among malignant tumors and mortality rate ranks the first among all kinds of cancers. Gastric cancer is prevalent in Asian countries such as Japan, Korea and China, and the incidence rate in Shanghai is about 13.73/100,000 for men (ranked second) and 8.71/100,000 for women (ranked third).
Stomach cancer can occur at any age, mostly between 40 and 69 years old. Due to the rapid progression of gastric cancer, more than 90% of patients will die within one year if they do not undergo surgery after symptoms appear. In recent years, with the improvement of surgical methods and the application of comprehensive treatment, the cure rate of gastric cancer has been improved, but most of the reported 5-year survival rate is 20-30%.
I. Causes of gastric cancer
The exact causes of development are still unclear, and the factors that may be related are
1.Genetic factors: mainly related to blood relationship (such as parents and siblings), in addition to common life history.
2.Stomach disorders: certain diseases of stomach such as gastric polyp, gastric ulcer, chronic atrophic gastritis and intestinal epithelial hyperplasia may be precancerous lesions.
3, dietary habits: residents in areas with high incidence of gastric cancer eat a lot of smoked dried meat, salted fish and other high-salt foods, which have been proven to have a catalytic effect on the occurrence and development of gastric cancer. Preference for hot food, fast food, irregular meals and smoked and salted food may cause damage to the gastric mucosa and become a trigger for the development of gastric cancer.
4.Nitrosamines: As nitrosamines have strong carcinogenicity, they are likely to be one of the causative factors of human gastric cancer. If fresh vegetables are left for a few days, nitrite content will rise sharply; when vegetables are cooked, they do not contain much nitrite, but their content will rise significantly after overnight, especially cabbage, so it is better not to always eat leftovers; in addition, the nitrite content of cooked meat such as bacon is also high.
Which people need to be alert to the risk of stomach cancer
1.Unexplained loss of appetite, epigastric discomfort, wasting especially for middle-aged patients or above.
2.Patients with unexplained vomiting of blood, black stool or positive stool occult blood.
3, the original history of long-term chronic gastric disease, the recent symptoms have significantly aggravated.
4.Middle-aged people with no previous history of gastric disease who have developed gastric symptoms in the short term.
5.Patients who have been diagnosed with gastric ulcer, gastric polyp, atrophic gastritis, should have planned follow-up and regular review. Usually, gastroscopy should be done once every six months to a year.
6.Patients who had a major gastrectomy for benign gastric disease many years ago and have recently developed gastrointestinal symptoms.
7, Those with epigastric pressure, fullness, tension or palpable mass.
8.Supraclavicular fossa lymph node enlargement.
Tips: Patients with the above symptoms should seek medical consultation in time to avoid delaying the disease and losing the treatment opportunity.
Common symptoms of gastric cancer
Most of the gastric cancers have no specific symptoms in the early stage, or there are symptoms similar to gastritis. For example, fullness and vague pain in upper and middle abdomen, increase of acid reflux and belching, decrease of appetite, feeling of obstruction in eating and so on.
As the disease progresses, symptoms such as nausea and vomiting, inability to eat, weakness and emaciation will appear, and when the tumor is bleeding, it will be accompanied by vomiting blood and black stool.
In the advanced stage, systemic symptoms such as ascites, tumor intestinal obstruction and malignant fluid may appear.
Treatment of gastric cancer
At present, the treatment of gastric cancer advocates multidisciplinary comprehensive treatment centering on surgery.
For early gastric cancer, after excluding local lymph nodes or distant metastasis, local lesion resection (EMR, ESD) can be performed under gastroscopy, and laparoscopic surgery can also be chosen for minimally invasive treatment.
For locally progressive gastric cancer, the patient’s systemic condition should be fully evaluated before surgery. If resection is possible, surgery can be performed directly, or neoadjuvant chemotherapy can be administered followed by surgery plus postoperative adjuvant chemotherapy. This perioperative combination chemotherapy treatment model has been proven to be beneficial in extending the overall survival time of patients in overseas clinical studies. If the local lesion cannot be resected, preoperative chemotherapy can be administered and surgery can be obtained after the lesion is reduced.
Surgery is the only treatment means that can achieve the purpose of radical cure. Our department strictly follows the treatment standard and actively performs D2 radical surgery to ensure the adequacy and radicality of the surgery. Currently, more than 400 cases of gastric cancer are treated surgically every year, with an overall survival rate of about 50-60% at 5 years and an overall complication rate of less than 5%. It has been proven to be safe and effective.
After surgery, patients should undergo further chemotherapy or radiotherapy to prevent recurrence of the disease.
For advanced gastric cancer that cannot be surgically resected or cannot be completely resected, or has distant metastases that cannot be surgically operated at the time of consultation, palliative systemic treatment can be performed. Some advanced patients may have a chance to be surgically resected again if their disease is in remission.
V. Prognosis of gastric cancer
The 5-year survival rate of gastric cancer mentioned earlier is usually only 20%-30%, referring to the overall level of all gastric cancers. The five-year survival rate of early-stage gastric cancer (tumor cells only infiltrate to the mucosal layer) can be as high as 90% or more, but these patients usually do not have any symptoms and are extremely difficult to detect. After radical resection of progressive gastric cancer, the five-year survival rate generally ranges from 15% to 50%, depending on the degree of tumor infiltration, malignancy and the effect of radical surgery.
Friendly advice: early detection, early treatment and reasonable and correct treatment are the only guarantee to improve the survival rate of gastric cancer.
What and how to eat if you have stomach cancer
Stomach cancer may cause digestive tract obstruction, which may manifest as inability to eat, vomiting and malnutrition. Generally, nutritional support is given before surgery to correct malnutrition and increase the patient’s tolerance to surgical treatment.
Generally, during gastric cancer surgery, the surgeon will establish a nutritional channel for a short period of time through a nasogastric tube or jejunostomy. After 48 hours after surgery, nutritional support in the intestinal tract can be given, and there are specially formulated enteral nutrition preparations. From 5-7 days after surgery, patients start to gradually resume transoral diet, from soup to porridge, and can be discharged when they feel normal after eating porridge.
After discharge, patients with gastric cancer should still focus on semi-liquid and soft food such as easily digestible porridge and noodles, emphasizing the principle of eating less and more meals, consuming well-cooked food with less residue, with no obvious restrictions on the types of food, and avoiding foods that are not fresh and spicy, etc. If the general family diet cannot be tolerated, enteral nutrition preparations can still be used for support to ensure daily energy supply. In addition, if patients have severe reactions and cannot eat during radiotherapy, intravenous nutritional support should be considered.
Tips: In early postoperative recovery of gastric cancer, if the eating status is poor, oral intake of non-essential anti-tumor drugs, such as Chinese patent medicines and health care products, should be delayed to avoid aggravating the decrease of appetite and increasing the discomfort symptoms of digestive tract.