Introduction of gastric cancer.
Stomach cancer is one of the most common malignant tumors in China, and its incidence rate ranks first among all types of tumors in China, with about 170,000 people dying from stomach cancer every year, almost close to 1/4 of all malignant tumor deaths, and more than 20,000 new stomach cancer patients arise out every year, stomach cancer is indeed a disease that seriously threatens people’s health.
Gastric cancer can occur at any age, but it is more common in 40-60 years old, and more men than women, about 2:1. Its causes are unknown and may be related to many factors, such as living habits, diet, environmental factors, genetic quality, mental factors, etc. It is also related to chronic gastritis, gastric polyps, heterogeneous hyperplasia of gastric mucosa and intestinal epithelial hyperplasia, post-surgical residual stomach, and long-term pylorus cancer. It is also related to chronic gastritis, gastric polyps, gastric mucosal anomalous hyperplasia and intestinal epithelial growth, post-surgical residual stomach, and long-term Helicobacter pylori (HP) infection. Gastric cancer can occur in any part of the stomach, but it is mostly found in the gastric sinus, especially on the side of the gastric malleolus. According to the depth of cancer tissue infiltration, it is divided into early gastric cancer and progressive gastric cancer (middle and advanced gastric cancer). Early symptoms of gastric cancer are often not obvious, such as elusive upper abdominal discomfort, vague pain, belching, acidity, loss of appetite, mild anemia, etc. Some of them are similar to symptoms of gastroduodenal ulcer or chronic gastritis. In some patients, the pain is reduced or relieved after taking painkillers, anti-ulcer drugs or diet modification, and thus is often ignored without further examination. As the disease progresses, the symptoms of stomach gradually become obvious, such as epigastric pain, loss of appetite, emaciation, weight loss and anemia. At the later stage, the cancer often metastasizes, resulting in abdominal mass, enlarged left supraclavicular lymph node, black stool, ascites and severe malnutrition.
How to get stomach cancer
Gastric cancer is the most common malignant tumor, accounting for about 1/4 of many malignant tumors, and its occurrence is related to the following factors.
(1) Environmental factors and dietary factors
Industrial waste gas, chemical fertilizers, pesticides, certain food additives, and moldy fried, salted and smoked foods all contain carcinogenic substances. These can cause chronic stimulation of gastric mucosa, which can lead to dysfunction, congestion, edema, erosion and increase the chance of gastric mucosa carcinogenesis, especially bad dietary habits, often untimely meals and irritating foods.
(2) Stomach disorders and general health condition
A large number of surveys show that the occurrence of gastric cancer is closely related to chronic atrophic gastritis, especially those with heterogeneous hyperplasia of gastric mucosa and intestinal epithelial metaplasia. It is also related to gastric ulcer, especially the ulcer that does not heal for a long time. It is also associated with gastric polyps, post-surgical gastric surgery, and bacterial infections of the stomach. The cancer rate of atrophic gastritis is reported to be 6% – 10%, that of gastric ulcer is 1. 96%, and that of gastric polyp is about 5%. It has also been reported that patients with pernicious anemia have 5 times higher chance of developing gastric cancer than the average.
(3) Psychoneurological factors and genetic factors
Numerous studies have proved that the incidence of gastric cancer is relatively higher in people who have suffered from major trauma and sulking. Those who are sluggish, dull, indifferent or impatient have a slightly lower risk, while those who are cheerful, optimistic and lively have the lowest risk. The occurrence of gastric cancer is genetically related, and there is an obvious family aggregation phenomenon. The cause of its development is unknown and may be related to various factors, such as living habits, dietary types, environmental factors, genetic quality, mental factors, etc. It is also related to chronic gastritis, gastric polyps, heterogeneous hyperplasia of gastric mucosa and intestinal epithelial hyperplasia, post-surgical residual stomach, and long-term Helicobacter pylori (HP) infection. Gastric cancer can occur in any part of the stomach, but it is mostly found in the sinus region, especially on the side of the gastric lesser curvature. According to the depth of cancer tissue infiltration, it is divided into early gastric cancer and progressive gastric cancer (middle and advanced gastric cancer). Early symptoms of gastric cancer are often not obvious, such as elusive upper abdominal discomfort, vague pain, belching, acidity, loss of appetite, mild anemia, etc. Some of them are similar to symptoms of gastroduodenal ulcer or chronic gastritis. In some patients, the pain is reduced or relieved after taking painkillers, anti-ulcer drugs or diet modification, and thus is often ignored without further examination. As the disease progresses, the symptoms of stomach gradually become obvious, such as epigastric pain, loss of appetite, emaciation, weight loss and anemia. At the later stage, the cancer often metastasizes, resulting in abdominal mass, enlarged left supraclavicular lymph node, black stool, ascites and severe malnutrition.
Since gastric cancer is extremely common and harmful in China, and relevant researches believe that its causes are related to dietary habits and stomach diseases, it is very important to understand the basic knowledge about gastric cancer for its prevention and treatment.
Early symptoms of stomach cancer.
Nearly half of early gastric cancer patients have no clinical symptoms, and only some of them have symptoms such as mild indigestion, such as hidden pain and discomfort in upper abdomen, slight fullness, pain, nausea, belching, etc. These symptoms are not unique to gastric cancer, but can be seen in chronic gastritis, ulcer disease, functional dyspepsia, and even normal people may appear occasionally.
1.More than 80% of patients present with epigastric pain.
2.About 1/3 of patients present with stuffy stomach, epigastric discomfort, loss of appetite, indigestion, accompanied by panic acid.
3.1/3 of patients may have unexplained weight loss, emaciation and fatigue, although they have no obvious digestive symptoms.
4.Some patients show symptoms such as acidity, heartburn, nausea, vomiting, belching or black stool
The more common symptoms of early gastric cancer are upper abdominal discomfort, such as mild stomach pain, swelling and heaviness, and sometimes vague pain in the heart fossa, which are often diagnosed as gastritis or ulcer disease and treated at first, and the symptoms may be temporarily relieved. If the lesion occurs in the gastric sinus, changes in duodenal function may occur, with rhythmic pain, similar to the symptoms of ulcer disease, which is also easily misdiagnosed as duodenal ulcer and delayed treatment. However, all these symptoms can recur after a period of time. Therefore, anyone with symptoms of epigastric discomfort, if accompanied by other high-risk factors, or with recurrent recurrences after treatment, must be vigilant and undergo further investigations with a view to early detection and early treatment.
Indigestion symptoms such as loss of appetite, anorexia and poor appetite, nausea and vomiting, bloating after eating, belching and acid reflux are also a group of common but non-specific early signs of gastric cancer. Loss of appetite may be an early symptom of gastric cancer and is not accompanied by symptoms of stomach pain, especially if it occurs simultaneously with stomach pain and hepatitis can be excluded. Some patients automatically restrict their daily diet because of bloating and belching after eating, resulting in weight loss, emaciation and weakness. Early symptoms of gastric cancer may also include a feeling of fullness after eating and mild nausea. Tumor of cardia may start with unpleasant eating and gradually develop into difficulty in swallowing and food reflux. Further development of sinus cancer may lead to vomiting due to pyloric obstruction.
The above symptoms may be misdiagnosed as functional dyspepsia, so you should seek early medical attention and undergo gastroscopy and other examinations to detect gastric cancer at an early stage.
Both early gastric cancer and progressive gastric cancer can present with upper gastrointestinal bleeding, often in the form of black stools. A small number of early gastric cancers may show mild upper gastrointestinal bleeding symptoms, i.e. black stool or persistent positive occult blood in stool. It is mostly seen in polyp-like and ulcer-like early gastric cancer, which is caused by surface erosion of the lesion or invasion of capillaries by the cancer, resulting in long-term small amount of bleeding. It is not easily controlled by drug therapy. Elderly people without stomach diseases should be more alert to the possibility of gastric cancer once black stool appears. If the stool is tarry and the stool occult blood test is persistently positive, especially when it is not easily stopped even after general diet control or gastric medicine, it is one of the important early gastric cancer symptoms. Therefore, those who have such symptoms should go to hospitals with such conditions for gastroscopy and upper gastrointestinal tract barium meal X-ray in time to make a clear diagnosis.
Unexplained emaciation, weakness and mental depression are also common but unspecific signs of gastric cancer, and they are progressively getting worse. Some of them are secondary to indigestion symptoms, and patients automatically restrict their daily diet due to bloating and belching after eating, resulting in weight loss, wasting and weakness. In addition, nausea and vomiting can further lose nutrition, causing malnutrition and aggravating the symptoms of emaciation and weakness. Of course, in the late stage of progressive gastric cancer, the wasting and weakness will be more obvious.
In addition, it is especially worth mentioning that pathologically most gastric cancers occur on the basis of chronic gastritis (especially atrophic gastritis), Helicobacter pylori (HP) infection, residual gastritis, gastric polyps, gastric ulcer, etc. Therefore, some patients have a long-term history of chronic gastric disease with symptoms such as epigastric discomfort and indigestion. On this basis, if the nature of pain, epigastric fullness, etc. has changed or the degree has increased recently, the rhythm of pain related to diet has changed, or cannot be relieved after taking medicine, or there is wasting and weakness, then it is more important to be alert to the occurrence of gastric cancer.
Most of the gastric cancer patients with emaciation and weakness are in the progressive stage of gastric cancer, and most of them have local or distant metastasis, and often have anemia. Most of the causes can cause vomiting, such as common duodenal bulb ulcer or post-ulcerative scar stenosis, reflux esophagitis, pancreatic ulcer, etc.
Vomiting is often caused by pancreatic or gastric cancer involving the pylorus, and vomit includes decaying food, gastric juice or even coffee-like bloody fluid. Vomiting is usually a clinical manifestation of progressive gastric cancer and is often accompanied by weight loss. The painless, hard and fixed swollen lymph node like soybean or peanut on the left clavicle is a more specific sign of gastric cancer, which is mostly a sign of progressive gastric cancer with metastasis to abdominal cavity and other organs. Once the enlarged left supraclavicular lymph node is found, lymph node biopsy or cytological aspiration should be done immediately; gastroscopy and biopsy of gastric cancer lesions in multiple pieces and directions should be taken for pathological examination, supplemented by barium gastric X-ray if necessary, which can make a clear diagnosis immediately.
Men over 50 years old who suffer from gastric disease should be alerted and have relevant special examinations as early as possible if they have recurrent epigastric pains recently, but they are good and bad at times. Currently, the commonly used tests are fiberoptic gastroscopy and barium X-ray fluoroscopy. Gastroscopy can not only directly observe the morphology, color and lesion of gastric mucosa, but also remove suspicious cellular tissues for pathological examination by gastroscopic forceps. x-ray barium meal gas-barium double contrast imaging examination has no contraindications and side effects. In addition, gastric fluid examination and fecal occult blood test can be used as auxiliary diagnostic tools.
Young trend of gastric cancer
Signs of early gastric cancer include epigastric discomfort, stuffy and painful stomach, loss of appetite, acid reflux, lethargy, black stool, etc. However, gastric cancer in young people is easily misdiagnosed, among which the most common is misdiagnosed as ulcer disease, followed by chronic superficial gastritis, and also misdiagnosed as incomplete pyloric obstruction, or even misdiagnosed as appendicitis, or misdiagnosed as rheumatic myositis due to muscle pain, etc. When diagnosed, most of them are already in the middle and late stages, losing the time for radical treatment. The reason for misdiagnosis is that, on the one hand, young people’s stomach cancer is often misdiagnosed as ulcer disease because of upper abdominal pain and gastrointestinal bleeding; on the other hand, medical personnel lack experience and are not highly alert to young people’s stomach cancer, and often explain some digestive system symptoms as common diseases such as gastritis and ulcer, ignoring the possibility of stomach cancer. On the other hand, early symptoms of gastric cancer in young people are often insidious and lack of specific performance, so it is easy to be confused with general digestive system diseases, resulting in failure to diagnose early, or even if some relevant symptoms are found, they are not further examined and missed. Gastric cancer in young people is mostly found in the sinus and body of the stomach, and the pathological histological examination is dominated by low-differentiated, undifferentiated and mucinous adenocarcinoma, so it has high malignancy, early metastasis, rapid progress, short course and poor prognosis. Therefore, it is very important to be vigilant and diagnose gastric cancer in young people at an early stage.
To prevent misdiagnosis of gastric cancer in young people, medical personnel must treat each patient seriously. Gastroscopy is the best means to detect early gastric cancer. Gastroscopy should be used as early as possible for young people with recurrent upper abdominal pain, black stool, anemia and emaciation, and whose conventional anti-inflammatory and anti-ulcer treatments are ineffective or have poor effects. Patients should not avoid the disease and should cooperate closely with the doctor for a good examination. For suspected patients or those who cannot be diagnosed in one examination, they should be followed up and reviewed regularly to facilitate early detection of possible cancerous changes. At the same time, young people should not think that they are young and in good health, so that they do not pay attention to health care, squander their health arbitrarily, drink and smoke, eat in excess and live irregularly. Once the lesion occurs, it will be too late to regret.
Methods to detect early gastric cancer
(1) Laboratory examination
Gastric cancer markers: many substances produced by gastric cancer cells can be detected in gastric juice, blood and other tissues, which can be used as gastric cancer markers for gastric cancer screening and census, such as various enzymes and embryonic-derived markers.
Oncogenes: It is generally believed that high expression of p2lras is associated with intestinal gastric cancer, but it is highly expressed in dysplasia, intestinal metaplasia, and normal mucosa near the tumor, so it is believed that this gene plays a role in the early stage of gastric carcinogenesis. deletion mutations of APC gene are also mostly seen in the early stage of gastric cancer, and mostly occur in undifferentiated gastric cancer. In addition, p53 gene and CD44v6 gene expression were associated with gastric carcinogenesis and biological behavior of gastric cancer, and their expression increased sequentially in specimens with highly dysplastic gastric mucosa, early gastric cancer, and progressive gastric cancer. The evolution of gastric cancer is the result of multiple genetic alterations, and these above gastric cancer-related oncogenes are important for the genetic diagnosis of early gastric cancer, but the specificity is yet to be improved.
Monoclonal antibodies for gastric cancer: the application of monoclonal antibodies to diagnose early gastric cancer is a major topic in current gastric cancer research. For example, monoclonal antibody MG7 was applied to 1090 patients, and the positive rate was 41.8%.
Gastric cancer occult blood bead method: The national census of more than 230,000 people showed that the positive rate of gastric fluid occult blood was 12%, 581 cases were diagnosed as esophageal cancer and gastric cancer, among which 70% of the patients’ pathological examination was early and middle stage cancer. The specificity of this method is not high, but the method is simple and can be repeated several times or continuously and dynamically observed by the patient, so it is of great value in large-scale population screening.
Probabilistic computer model screening of gastric cancer: During the screening, according to the local risk factors of gastric cancer, meaningful factors are selected and a probabilistic mathematical model is established, and the data of each examinees are input into the computer, and after regression analysis, those with positive results are considered as high-risk group. This method can improve the detection rate if combined with gastric cancer marker method.
(2) Radiological examination
Although most of the lesions can be detected, the malignant underdiagnosis rate is still high. Stomach imaging includes double contrast images, mucosal images, filling images, compression images and other examination methods. Through comparison, it can be found that the double contrast image and mucosal image can clearly show the lesion, and the compression image is especially important to show the lesion in the lower anterior wall of the stomach, and the four examination methods can complement each other to confirm and improve the detection rate of malignant lesions.
With the clinical application of duplex spiral CT and CT simulated gastroscopy, the sensitivity of imaging methods to detect early gastric cancer has been greatly improved. According to current statistics, the positive compliance rate of CT simulated gastroscopy for early gastric cancer diagnosis can reach over 70%, and the smallest mucosal lesion can be shown to be about 1cm in diameter. However, there is still a problem of high diagnostic cost, which is not suitable for screening.
Endoscopic examination method
Early gastric cancer does not have specific clinical symptoms, so patients over 40 years old with obvious indigestion symptoms or precancerous lesions should be routinely examined by gastroscopy. Compared with imaging examination, endoscopy has significant advantages. It can directly observe the morphology of lesions, with wide field of view, strong resolution and high accuracy of biopsy.
(3) Ultrasound endoscopy
It increases the diagnostic range of endoscopy and shortens the distance between the ultrasound probe and the target organ, resulting in higher ultrasound resolution. The accuracy rate of ultrasonic gastroscopy for early gastric cancer and progressive gastric cancer is 90%, and the accuracy rate for determining the type of cancer and the depth of infiltration can reach 70–80%. Ultrasound endoscopy also helps to detect whether there is local lymph node metastasis in early gastric cancer.
In conclusion, early detection and early diagnosis of gastric cancer is the foundation of early treatment and a key part of reducing the mortality rate of gastric cancer. Nowadays, with the continuous improvement of diagnostic technology, there is every hope to do a good job in clinical screening of early gastric cancer.
Must gastric cancer be operated?
Doctors often have to make decisions based on the specific conditions of gastric cancer patients. At present, there is no disagreement that early stage gastric cancer patients should undergo radical resection surgery, which is the only treatment with the possibility of curing gastric cancer; the cure rate of stage I gastric cancer is about 90%, and stage II gastric cancer can reach about 70%. Patients and family members often have more concerns about whether to perform surgery for more advanced gastric cancer, mainly because they are afraid that surgery will cause the cancer to spread and further deteriorate the disease. To be precise, such concern is unnecessary. Even for advanced gastric cancer, although radical surgery is not possible, as long as the main cancer is removed, it can often reduce the patient’s symptoms, improve the patient’s quality of life and prolong the survival period by eliminating complications such as bleeding, perforation and obstruction that may be caused by the cancer and reducing the adverse effects of toxins produced by the cancer on the human body. Especially, after removing the main cancer, it can lay the foundation and create favorable conditions for post-surgical Chinese and Western medicine treatment. Therefore, once gastric cancer is diagnosed, surgical treatment is the first priority. As long as the general condition of gastric cancer patients allows and there is no extensive distant metastasis, they should actively strive for surgical treatment to remove the cancer.
Of course, we emphasize the importance of surgery, not to deny other treatment methods. Quite the contrary, in order to improve the therapeutic effect of surgery, it is often necessary to combine some other treatments. The most common is to combine radiation therapy or chemotherapy before, during and after surgery.
The purpose is to.
① to confine the lesion and create conditions for surgery in order to improve the surgical resection rate.
② To reduce the spread and implantation of cancer cells during surgery.
③ as consolidation treatment after radical resection to eliminate possible residual lesions to prevent recurrence and metastasis.
④ as palliative treatment after non-radical surgery to control lesions and prolong survival
Surgical methods of gastric cancer
I. Surgical treatment
Surgery is the main treatment method for gastric cancer and the only possible means to cure progressive gastric cancer. Therefore, surgery for gastric cancer should be taken as a positive treatment, and as long as the patient’s general condition allows without clear distant metastasis, caesarean operation should be performed. Mainly include
1. Radical resection.
The scope should include the primary lesion, together with the distal 2/3 or 4/5 of the stomach, all the large and small omentum, the first part of the duodenum and regional lymph nodes as well as locally infiltrated organs, and no cancer cells remaining in the stomach or duodenum. In addition to the above, the whole stomach or adjacent invaded transverse colon, left lobe of liver, spleen, tail of pancreatic body and left side of cardia, lymph nodes next to splenic vasculature, etc. should also be removed to expand the scope of radical resection.
2.Palliative resection.
When gastric cancer has extensive metastasis in peritoneum or lymph nodes, but the primary tumor can be removed and the patient can tolerate surgery in general, palliative gastrectomy can be performed. This surgery can alleviate the patient’s toxic symptoms and eliminate complications such as obstruction, bleeding or perforation caused by cancer tumors. After surgery, it is supplemented with chemotherapy and herbal medicine, which can prolong the survival of patients.
3.Short-circuit surgery.
It is suitable for patients with advanced gastric cancer that cannot be surgically resected and accompanied with infarct yin.
II. Endoscopic treatment
Due to the continuous development of endoscopic technology and the deepening of people’s understanding of early gastric cancer, the number of early gastric cancers with lesions less than 2 cm and infiltration only reaching the mucosa has increased significantly, making it possible to treat certain types of early gastric cancers under endoscopy.
Laparoscopic radical surgery for gastric cancer
Gastric cancer is a common malignant tumor, and surgery is still the most effective treatment for gastric cancer. However, traditional open surgery has such shortcomings as large trauma, slow postoperative recovery, obvious pain and more complications, so minimally invasive surgery for gastric cancer has been the unremitting pursuit of gastrointestinal surgeons. Although laparoscopic cholecystectomy has been widely performed, laparoscopic radical surgery for gastric cancer has been a difficult problem due to its complex anatomical relationship, high surgical difficulty and high technical requirements. According to the characteristics of Chinese people, our hospital has carried out laparoscopic radical gastric cancer surgery and established a set of effective operation specification for laparoscopic gastric cancer surgery.
While ensuring the scope of radical treatment and reducing trauma, this set of standard has made the total cost of laparoscopic treatment for gastric cancer patients basically equal to the total cost of open treatment, so that this advanced technology can benefit the majority of gastric cancer patients.
This technique is performed by making five small 0.5-10 cm keyhole-like holes in the abdominal wall and inserting a 1 cm diameter laparoscope to clearly display the images of the abdominal organs on the TV screen, and the doctor can look at the TV screen while inserting tiny instruments through the small holes in the abdominal wall to complete the surgery that requires more than 20 cm incision to complete. to complete the operation. Moreover, due to the video magnification of the laparoscope, the gastric lymph nodes can be cleared more thoroughly and the removed tissue is finally removed through a small incision of 3 – 6 cm.
After careful clinical comparison, this surgery has the advantages of less trauma, less disturbance of the gastrointestinal tract, less bleeding (basically no blood transfusion is needed), less postoperative pain, faster postoperative patient recovery, smaller incisional scar, and significantly fewer postoperative complications. In addition, laparoscopic surgery can avoid meaningless or even harmful dissection for patients with advanced gastric cancer.
Prognosis of gastric cancer
The average survival of untreated patients is about one year since the onset of symptoms.
The 5-year survival rate after radical surgery depends on the depth of invasion of the gastric wall, the extent of lymph node involvement and the tumor growth pattern. The prognosis of early gastric cancer is good, if only the mucosal layer is invaded, the 5-year survival rate after surgery can be more than 95%, if the submucosal layer is involved, there is often local lymph node metastasis, the 5-year survival rate is about 70%. If the tumor is of intestinal type and appears in the form of mass, the resection rate is high and the prognosis is better than that of the infiltrative type with early metastasis. The prognosis of leathery stomach is very poor. If the tumor has invaded the muscular layer but no lymph node metastasis is found at the time of surgery, the 5-year survival rate can still reach 60-70% after surgery; if the tumor has reached the muscular layer or plasma layer and there is local lymph node metastasis, the prognosis is very poor and the 5-year survival rate is only about 20%.
Prevention of gastric cancer
Since the factors of gastric cancer are not yet known, there is no effective prevention method, and the following measures can be adopted
1.Changing food storage methods, reducing pickled and smoked foods, preventing high-salt diet, quitting smoking and drinking, eating more fresh fruits and vegetables, and eating more meat and dairy products.
2.Actively treat diseases related to the development of gastric cancer, especially for high-risk groups, regular follow-up is needed.
3.Establish prevention and treatment network in high incidence areas to facilitate early detection and timely prevention.