Gastric cancer is one of the malignant tumors that seriously endanger human life. There are 1.09 million new cases worldwide every year, while there are as many as 410,000 new cases in China every year, which means that about 1,300 people are diagnosed with gastric cancer in China every day. The survival rate of gastric cancer patients is closely related to the degree of progress of gastric cancer. The cure rate of early gastric cancer can reach 90% or even be completely cured, the cure rate of middle gastric cancer is between 60% and 70%, while the cure rate of advanced gastric cancer is only about 30%, so the detection of early gastric cancer and early treatment is the key to reduce the mortality rate of gastric cancer. Fortunately, with the improvement of endoscopic technology, early gastric cancer screening has been widely carried out in China in recent years, so the detection rate of early gastric cancer has been greatly improved, so what is early gastric cancer? How can early gastric cancer be detected? How to treat it?
I. What is early gastric cancer?
Clinically, early gastric cancer mainly refers to early lesions, limited lesions and no obvious symptoms. Early gastric cancer is mainly diagnosed by gastroscopic biopsy pathology. Pathologically, early gastric cancer refers to cancer cells confined to the mucosal layer and submucosal layer, and regardless of the size of the cancer and whether there are lymph node metastases, it is considered early gastric cancer. In recent years, severe heterogeneous hyperplasia and high-grade intraepithelial neoplasia are also classified as early gastric cancer.
Early gastric cancer is classified according to the size of the tumor: small gastric cancer: the diameter of the cancer lesion is 6-10 mm. Microscopic gastric cancer: the diameter of cancer foci is ≤5 mm. Punctate carcinoma: the gastric mucosa biopsy is cancerous, but no cancerous tissue can be found in the surgical resection specimen series sampling.
Endoscopically, early gastric cancer is further divided into: Type I (polyp-like type): those with cancer mass protruding about 5 mm or more. Type II (superficial type): cancerous masses with elevation or depression of less than 5 mm. Type III (ulcer type): cancer mass with depression depth more than 5 mm, but not exceeding the submucosa layer.
II. What are the symptoms of early gastric cancer?
Most early gastric cancer does not have any special symptoms, that is to say, the early symptoms of gastric cancer are no symptoms. Those so-called early signs of stomach cancer circulating on the internet are actually not early signs. It is difficult for both doctors and patients themselves to judge from the symptoms and signs. Some people may have some non-specific symptoms, mainly manifested as indigestion, such as abdominal pain, bloating, feeling of early satiety, loss of appetite, acid reflux, heartburn, belching, burping, etc. These symptoms are very similar to common stomach diseases, so they often do not attract much attention. Therefore, for people over 40 years old, if they have obvious indigestion symptoms, they should go to hospital for medical treatment and gastroscopy if necessary, so as not to miss the best time to detect early gastric cancer.
III. How to detect early gastric cancer
In recent years, medical experts in China, combined with the actual situation in China, have formulated the Expert Consensus Opinions on Early Stomach Cancer Screening Process in China, which will play a great role in improving the diagnosis and cure rate of early stomach cancer.
Early gastric cancer screening mainly targets some high-risk patients, such as patients with Helicobacter pylori infection, patients with family history of gastric cancer, patients over 35 years old, long-term smokers and those who like to eat pickled food.
The primary screening modality is mainly through serological examination, i.e. through gastric function and H. pylori antibody testing, to identify the high-risk group for gastric cancer. Then, the high-risk group identified during the initial screening process is subjected to fine gastroscopy, with magnification, staining, biopsy and other means to make the lesion observation more detailed, so as to determine whether the lesion is cancerous and whether it can be treated microscopically.
Of course, it is also a better way to detect early gastric cancer in healthy people by including gastroscopy into routine medical checkups by means of health checkups.
IV. What is gastric function test and gastric cancer screening scoring system
Gastric function test is to test the content of pepsinogen I (PGI), pepsinogen II (PGII), proteasome ratio (PGR, PGI/PGII) and gastrin 17 (G-17) in serum, while gastric cancer screening scoring system is a method to determine the risk of gastric cancer based on the results of gastric function test, combined with the comprehensive score of H. pylori antibody, age and gender, etc. The The scoring method is shown in the table below. Through the gastric cancer screening scoring system, people with medium and high risk of gastric cancer can be screened out.
Note: High risk group of gastric cancer (17-23 points), medium risk group of gastric cancer (12-16 points), low risk group of gastric cancer (0-11 points)
For the middle and high risk group, endoscopic fine examination and follow-up will be conducted, and the high risk group will be examined at least once a year, and the middle risk group will be examined at least once every 2 years. Those who are really found to be early cancer can be treated with endoscopic surgery. This can not only improve the early detection rate of gastric cancer, but also reduce the unnecessary endoscopy for the low-risk group.
V. What is gastroscopy
In simple terms, gastroscopy is to perform endoscopic morphological analysis on the suspicious lesions found in addition to routine gastroscopy, including general white light endoscopy, staining endoscopy, magnifying endoscopy, confocal endoscopy, etc., to roughly determine whether the lesions are benign or suspicious malignant, and then perform biopsy on the suspicious malignant lesions, and finally confirm the diagnosis through pathology. This can determine whether the lesion is cancerous, the extent of lateral infiltration, the depth of vertical infiltration, the degree of differentiation, and whether there are indications for microscopic treatment.
Compared with general gastroscopy, gastroscopy is performed under painless conditions, allowing patients to relax completely and safely during a short sleep. Gastroscopy requires high requirements for personnel, which must be endoscopists who are trained and experienced in early cancer screening to conduct more detailed examinations, so as to better detect lesions and make reasonable examinations and judgments.
Gastroscopy requires high equipment requirements, especially gastroscopy equipment with image enhancement technologies such as pigmented endoscopy/electronic stained endoscopy or magnified endoscopy. It also needs to be combined with ultrasound gastroscopy if necessary.
Treatment methods of early gastric cancer
1.Endoscopic resection
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.
Currently, the commonly used endoscopic resections are mainly endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD). ESD is developed from EMR and is a new technique developed to avoid the limitations of EMR in terms of tumor infiltration and area size. single-channel endoscopy of ESD can achieve one-time total resection of lesions deep to the intrinsic muscular layer, and also provide accurate pathologic staging to minimize late recurrence.
It should be noted that endoscopic resection is a minimally invasive procedure, but there is still a high incidence of complications, mainly including bleeding, perforation, stenosis, abdominal pain, and infection, depending on the equipment and instruments, operator experience, technical approach, and patient’s general condition. Therefore, patients must actively cooperate with doctors for postoperative care, recuperation, and review in order to recover as soon as possible.
2.Laparoscopy for surgery
For patients with early gastric cancer who cannot be resected endoscopically, laparoscopic surgery can be considered. Laparoscopic surgery is to open tiny channels in the patient’s abdomen, place laparoscopes and operating instruments through these channels which are less harmful to the patient, transmit the image data in the abdominal cavity to the display screen through the laparoscope, and complete gastric cancer surgery under the guidance of the laparoscope. Laparoscopic surgery can complete the operations of traditional open surgery, such as large or total gastric resection and removal of suspicious lymph nodes, with less bleeding, less damage, smaller postoperative incision scar, less pain and faster recovery of gastrointestinal function after surgery.
3.Open surgery
Since 5%-6% of intramucosal gastric cancer and 15%-20% of submucosal gastric cancer have perigastric lymph node metastasis, especially undifferentiated adenocarcinoma in young women, traditional open surgery can be considered for radical resection and lymph node dissection.
Summary: Although gastric cancer is very harmful, it is not terrible. As long as prevention awareness is raised, it can be detected in time at the early stage of gastric cancer and treated early, it is possible to achieve complete cure. Therefore, it is recommended that after the age of 40, high-risk people should receive early screening for gastric cancer regardless of whether they have digestive discomfort or not, or gastroscopy should be added to normal physical examination to detect one case of early cancer, save a life and make a family happy.