I. Ranking of gastric cancer in the incidence of malignant tumors.
The top ten malignant tumors in male incidence are: lung cancer, stomach cancer, liver cancer, colon/rectum cancer, esophageal cancer, bladder cancer, pancreatic cancer, leukemia, lymphoma, and brain tumor.
The top ten malignant tumors in women are: breast cancer, lung cancer, stomach cancer, colon/rectum cancer, liver cancer, ovarian cancer, pancreatic cancer, esophageal cancer, uterine cancer, and brain tumor.
Therefore, the incidence rate of gastric cancer in China is ranked second and third among malignant tumors.
II. Incidence of gastric cancer in China.
Stomach cancer is one of the most common malignant tumors. The incidence rate of gastric cancer takes the first place (17.2%) among various malignant tumors. The ratio of men to women is about 2:1; the gender difference increases with age; the average age of death is 61.62 years, among which 61.11 years for men and 62.59 years for women.
III. Clinical staging of gastric cancer.
Gastric cancer can be divided into stage I, II, III and IV. Stage I is the earliest and stage IV is the latest. The early gastric cancer we often hear refers to stage I only, and the rest are called middle and late gastric cancer (also called progressive gastric cancer).
IV. Staging of gastric cancer in China at the time of diagnosis.
Stage I accounts for 4.1%, stage II accounts for 21.8%, stage III accounts for 31.7%, and stage IV accounts for 42.4%.
From this ratio, we can see that the diagnosis of early gastric cancer in China is extremely low. It is a far cry from the neighboring Japan. In Japan, gastroscopy and colonoscopy were introduced as health checkups as early as the 1990s, and each of the three age groups of 40, 50, and 60 must be examined once for stomach and colonoscopy. Therefore, the detection rate of early gastric cancer and intestinal cancer in Japan is significantly higher than that in China, and naturally the treatment effect of these two types of tumors is also better than that in China.
V. The average number of days to confirm the diagnosis of gastric cancer in China.
The average time required from first diagnosis to diagnosis of gastric cancer is 113.5 days, of which 96.8% is determined by consultation in general hospitals.
From this data, we can see that stomach cancer is not well diagnosed. Why is it so? In fact, the diagnosis of gastric cancer is very simple: one only needs to do a gastroscopy to take a piece of stomach tissue for pathological section, and then a definite diagnosis can be made. Why is a very simple problem difficult? The reasons are twofold: 1) not paying attention to it, always treating it as a stomach disease and taking medicine without further examination; 2) delaying the examination because of the fear of painful gastroscopy, resulting in delayed diagnosis. Our neighboring country Japan takes gastroscopy as a screening test for gastric cancer, so their early gastric cancer diagnosis rate is high and treatment effect is better than ours.
Sixth, five-year survival rate of gastric cancer.
In China, the five-year survival rate of gastric cancer in general general hospitals is 30% on average, while it can be as high as 50% in some specialized hospitals; and then look at the five-year survival rates of various clinical stages: 83.3% for stage I, 59.3% for stage II, 22.1% for stage III and 1.8% for stage IV. From this set of data, the treatment effect of early gastric cancer (i.e. stage I) is obviously better than other stages, however, stage I gastric cancer only accounts for 4.1% at the time of diagnosis.
VII. Regional differences in the incidence of gastric cancer.
In China, stomach cancer is highest in northwestern provinces of Qinghai, Ningxia and Gansu, followed by southeastern coastal provinces of Jiangsu, Zhejiang, Fujian and Shanghai, and lowest in southern provinces of Yunnan, Guizhou, Guangdong and Guangxi.
VIII. Relationship between gastric cancer and environment and diet.
The incidence of gastric cancer has a certain relationship with environmental factors. The incidence rate of gastric cancer is higher in high latitude areas. The incidence rate of residents living in peat soil areas is also higher than those living in sandy or clay soils. Residents living in coal or asbestos mining areas have a significantly higher incidence of stomach cancer. The ratio of zinc to copper content in the soil is also related to the incidence of stomach cancer. The incidence of stomach cancer in the northern and southeastern coastal provinces of China is also much higher than the incidence in the southern or southwestern provinces. Smoked, salted and fungal contaminated foods are related to the occurrence of gastric cancer.
Relationship between stomach cancer and heredity.
Stomach cancer is not contagious and there is no direct evidence of heredity, but there is a gathering phenomenon of stomach cancer in a few families (not due to contagion, but because of the same or similar living and eating habits in the family). There is a relationship between stomach cancer and blood type: the risk of stomach cancer in people with blood type A is 20-30% higher than other blood types. All these indicate that heredity is related to gastric cancer. However, most scholars are cautious and believe that the evidence is insufficient.
X. High-risk groups of gastric cancer.
It should be said that the exact cause of gastric cancer is not very clear. However, it is known that gastric cancer is related to some benign diseases of the stomach, such as gastric ulcer, atrophic gastritis, gastric polyp, residual stomach (i.e., the stomach remaining after surgery for benign lesions of the stomach), and the gastric cancer occurring in the residual stomach is called residual gastric cancer. Gastric cancer is also related to some precancerous lesions of the stomach such as heterogeneous hyperplasia (also called atypical hyperplasia), intestinal chemosis, etc.; Helicobacter pylori (Hp) infection has a certain relationship with the occurrence of gastric cancer.
Early diagnosis of gastric cancer is the key to improve the efficacy of gastric cancer. However, according to domestic data, only 1/5 of patients with gastric cancer are diagnosed within three months after symptoms appear, and about 1/4 of patients are diagnosed more than one year after symptoms appear. Therefore, only about 15% of patients with stage I and II gastric cancer are hospitalized for gastric cancer treatment.
Therefore, patients with the following conditions should be on high alert: (1) those over 40 years of age with discomfort or pain in the upper and middle abdomen without obvious rhythm and accompanied by obvious loss of appetite and wasting; (2) those with gastric ulcer whose symptoms do not improve after strict medical treatment; (3) those with chronic ginger constrictive gastritis with intestinal epithelial hyperplasia and atypical hyperplasia, which are ineffective after medical treatment; (4) those with gastric polyps >2 cm on X-ray; (5) those over middle age Patients with unexplained anemia, wasting and persistent positive fecal occult blood.
XI. Diagnostic methods of gastric cancer.
Gastroscopy is preferred: gastroscopy plus biopsy is the most reliable method to diagnose gastric cancer and is an effective method for early diagnosis of gastric cancer. The combined application of cytological examination and pathological examination can greatly improve the positivity rate of diagnosis.
2.Secondary barium meal: painless and easily accepted by patients; “gas and barium” double contrast imaging can make qualitative and quantitative diagnosis of gastric cancer; it is one of the main means of gastric cancer diagnosis; the confirmation rate is 86.2%. However, it is difficult to detect early gastric cancer.
3.Abdominal CT/Ultrasound: It cannot be used as a method of early diagnosis, but it can determine the extragastric invasion and lymph node metastasis of gastric cancer, which can provide a basis for surgery.
Treatment of gastric cancer.
①Surgery is the main treatment method for gastric cancer and the only possible means to cure the progressive gastric cancer. Therefore, surgery for gastric cancer should be taken as a positive treatment: as long as the patient’s general condition permits and there is no clear distant metastasis, caesarean operation should be performed.
For middle and advanced gastric cancer, because of the high recurrence and metastasis, it must be actively supplemented with comprehensive treatment measures such as preoperative and postoperative chemotherapy radiotherapy and immunotherapy to improve the efficacy.
③If radical resection is not possible due to late stage of disease or serious comorbidities of major organs, palliative surgery with resection of primary foci should be pursued according to specific circumstances to facilitate comprehensive treatment.
④For unresectable advanced gastric cancer, comprehensive treatment should be actively used to improve symptoms and prolong life.
To sum up, people who suffer from “stomach disease” must go for gastroscopy. Nowadays, gastroscopy can also be done with anesthesia, which is called painless gastroscopy, that is, a small amount of intravenous anesthetic is used to make you unconscious during the whole examination, which can avoid the discomfort caused by gastroscopy and dispel the fear of doing gastroscopy. However, because pain is the body’s protective response, the loss of this protection results in a corresponding increase in complications from gastroscopy. There are advantages and disadvantages. Do not blindly pursue painless gastroscopy.
Of course, having gastric disease does not necessarily mean that you will get gastric cancer. With regular gastroscopy, it is possible to avoid the appearance of advanced gastric cancer and to relieve unnecessary psychological burden.