I am often asked by patients: Doctor, who has xx cancer in my family, how long is the survival period? When I encounter such questions, I always have a headache because there are so many questions to ask in return, such as: Did you do surgery? Is there metastasis? What is the pathology report? Did you do chemotherapy? What is the patient’s condition now? …… In fact, there are so many factors that determine the survival of a tumor patient. Today, regarding the morbidity and mortality of gastrointestinal tumors, I would like to start with a general overview. The common gastrointestinal tumors in the Department of Oncology, Wangjing Hospital, Chinese Academy of Traditional Chinese Medicine are esophageal cancer, gastric cancer, colorectal cancer, pancreatic cancer and primary liver cancer. Which of these 5 gastrointestinal tumors has the highest incidence rate? In other words, which one, the most common? The latest data comes from the national registry selected in 2010. 2010, the incidence rate of gastrointestinal tract tumors among the national population, in descending order, is stomach cancer, liver cancer, esophageal cancer, colorectal cancer, and pancreatic cancer. Among the urban population in China, the incidence rates in descending order are: stomach cancer, colorectal cancer, liver cancer, esophageal cancer, and pancreatic cancer; among the rural population, they are: stomach cancer, liver cancer, esophageal cancer, colorectal cancer, and pancreatic cancer. It can be seen that the biggest difference is the order of colorectal cancer. The occurrence of colorectal cancer is highly related to high fat and low fiber diet, so there are differences in the living habits and dietary structure of different groups, and the incidence of gastrointestinal tumors also exists. From the statistical data, we can see that whether it is urban population, rural population, or the difference between men and women, stomach cancer is the first tumor in the incidence rate of gastrointestinal tumors. Our country is in the high incidence area of gastric cancer (East Asia, including China, Japan and Korea), and the incidence rate of gastric cancer in China is more than twice of the world average. Why do we have a high incidence rate in China? The answer is: there are no clear findings yet. However, analysis suggests that it is related to ethnicity, dietary habits and advanced ageing. And in fact, as far as the high incidence of stomach cancer is concerned, in fact, in our country, with the improvement of people’s dietary habits and the consolidation of health knowledge, it has dropped a lot from the 1970s. In Japan, which is also a high incidence area for stomach cancer, the incidence rate has not decreased. However, this is a big “but”, Japanese people have long hated stomach cancer to the bone, so they have been spending a lot of efforts to research it, and as early as 10 years ago, their research and treatment of stomach cancer has been second to none in the world. Although the Japanese have not been able to bring down its incidence rate, its mortality rate has been greatly reduced. Reading this, some readers may say: Oh, incidence and mortality are not the same thing! That’s true. Morbidity and genetics, living environment, diet, hobbies, emotions and psychology are all related. There are also many factors affecting mortality rate, such as physical quality, tumor stage, pathological staging, age, gender, etc. The data from the national registry, which was also selected in 2010, showed that the mortality rate of gastrointestinal tumors in the national population in the order from the highest to the lowest is: liver cancer, stomach cancer, esophageal cancer, colorectal cancer, and pancreatic cancer. From the data, there is not much difference in the results of the ranking of the order, both for urban and rural populations, and for men and women. So, how does liver cancer, which is at the back of the incidence rate, win in the mortality column? First of all, liver cancer is not as obvious as stomach cancer in terms of symptoms, and sometimes small liver cancer does not cause any symptoms, so it is also easy to be overlooked. And by the time people have symptoms, small liver cancer will have grown so big that it is difficult to treat. In addition, if liver cancer misses the best time for surgical resection, it is not very sensitive to radiotherapy and chemotherapy, it will rapidly invade the whole abdominal cavity, causing serious complications such as ascites, jaundice and gastrointestinal bleeding, and many times it is powerless to return. Of course, in recent years, with the development of science and technology, the diversification of treatment methods have been improving the situation little by little, and the 5-year survival rate of liver cancer has been improved. Finally, let’s go back to the question we mentioned at the beginning: Doctor, who in my family has xx cancer, how long can you see the survival period? Let’s use stomach cancer as an example. Japan and China both have a high incidence of stomach cancer, but why is the death rate in Japan lower than ours? In other words, why do they have a longer survival period than we do? The Japanese have been promoting gastric cancer screening programs since the 1960s and put H. pylori screening and gastroscopy into their routine medical examinations early on. Because of this, early stage gastric cancer accounts for more than 80% of the total number of gastric cancers detected in Japan. In China, 84% of patients are already in the progressive stage when detected, which greatly increases the mortality rate of gastric cancer patients. The prognosis of gastric cancer is directly related to its stage. The 5-year survival rate of early stage gastric cancer is >95%, while that of progressive stage is 20%-30%, which is also divided into intermediate and advanced stages. In addition, the pathological staging also determines the survival of gastric cancer. The 5-year survival rate of papillary adenocarcinoma is 32.9%, while that of hypofractionated adenocarcinoma is only 19.9%. The survival of gastric cancer patients is also related to the degree of gastric cancer invasion; the deeper the degree of infiltration, the lower the 5-year survival rate. The number and distance of lymph node metastasis is high, and the 5-year survival rate is significantly lower …… There are too many factors that determine the survival of a tumor patient. It is not that a tumor growing in our body is equal to a death sentence, nor is it that the world will be peaceful after we are done with surgery. Human body is a complex whole, tumor can grow and grow in this complex environment and even take away our life, so we naturally cannot underestimate its ability. At present, our people are paying more and more attention to health. With the overall rise of knowledge level and the steady development of national economy, we believe more and more people can realize the importance of tumor screening and self-examination, so as to reduce the morbidity and mortality of tumor in China and improve the quality of life of tumor patients.