The media has revealed that 44-year-old former CCTV anchorwoman Fang Jing died in Taiwan due to advanced gastric cancer (liver metastasis) at the age of 44. Fang Jing was born in 1971, a first-class broadcaster, has served as the host of “East Time”, “Focus Interview” and other columns, and was invited to serve as the host of the live broadcast of the Red Square parade in May this year. Cancer again! Stomach cancer, a very common type of cancer! Cancer is indeed already a common disease and a frequent one, and you have to pay attention to it even if you don’t, because it is around every one of us. Instead of fearing cancer, we should take the initiative to learn the knowledge related to cancer prevention and treatment, so as to prevent cancer as much as possible before it happens. Kang Jingbo, Department of Radiation Oncology, Naval General Hospital Many people do not pay much attention to cancer prevention and treatment, and some even avoid talking about “cancer”, as if cancer will not come to them if they do not talk about cancer and do not pay attention to cancer. Since people usually do not pay attention to cancer prevention and treatment, we should take this opportunity to talk about the prevention and treatment of stomach cancer today, so that the celebrity effect may be more effective in arousing people’s attention to health issues. I think we should not be too unfamiliar with stomach cancer, because it is very common. You will understand if you look at the following figures. The incidence rate of stomach cancer ranks fourth in the world and the mortality rate ranks second after lung cancer, while China ranks second in all cancers in terms of incidence rate and mortality rate. Stomach cancer, you need to know! First of all, what is stomach cancer? Stomach cancer, as the name implies, is of course cancer (malignant tumor) occurring in the stomach, but this is actually not a strict term, as we usually refer to malignant tumors originating from gastric mucosal epithelium, such as gastric adenocarcinoma (the most common), gastric squamous cell carcinoma, gastric adenosquamous carcinoma, gastric medullary carcinoma, etc. Primary lymphoma, mesenchymal tumor and smooth muscle sarcoma of the stomach are also malignant tumors occurring in the stomach, but are generally not classified as They are also relatively uncommon and therefore are not included in the scope of this article. Next, you will surely ask, “Why do you get stomach cancer? Who is prone to get stomach cancer? Generally speaking, cancer is caused by the interaction between inherent genetic factors and external environmental factors, which leads to the cancerous transformation of normal cells in the body, but the exact cause of cancer is not fully understood, which is why it is difficult to prevent cancer at the root. However, this does not mean that we can do nothing at all. Through research, many risk factors for the occurrence of cancer have been basically clarified. 1. Age. The risk of gastric cancer increases with age, and most gastric cancers occur after middle age, but in recent years, there is a tendency for gastric cancer to develop at a younger age, which must be taken seriously. 2. Gender. Men have a higher chance of getting stomach cancer than women, about twice as much as women. Therefore, men, especially men above middle age, should pay more attention to it, and of course, women should also pay attention to it. 3. Dietary factors. Stomach is a digestive organ and diet plays an important role in the occurrence of gastric cancer, such as poor eating habits (irregular diet, eating too fast and too full, overeating, etc.), unclean diet, fondness for smoked and fried food, long-term high-salt diet and salted and smoked food (such as pickled fish and salted vegetables), consumption of overnight or moldy food, low intake of fresh vegetables and fruits, imbalance or lack of nutrition, smoking and alcoholism, etc. 4, Helicobacter pylori infection (HP infection). H. pylori infection is very common, more than half of the people in the world have this bacterial infection, and the infection rate in developing countries is higher than that in developed countries. 1994, the World Health Organization has identified it as a human class I carcinogenic factor. 5. Family history of gastric cancer, history of chronic atrophic gastritis, chronic gastric ulcer, gastric polyp or gastric surgery. What people may be most concerned about is the prevention of cancer, how can we prevent cancer? Obviously, in order to prevent stomach cancer, it is necessary to clearly know the cause of its development in order to prevent it fundamentally, but as mentioned earlier, the exact cause of the occurrence of stomach cancer is not fully understood. However, as mentioned earlier, most of the risk factors related to the occurrence of stomach cancer have been clarified, and effective measures can be taken to target these risk factors to effectively reduce the chance of occurrence of stomach cancer. What measures can be taken to help prevent stomach cancer? According to the risk factors related to gastric cancer listed above, the main measures include the following: 1. Eradicate H. pylori infection. It has been clearly established that H. pylori infection can lead to the occurrence of gastric cancer, and the World Health Organization has identified it as a human class I carcinogen, and several studies have confirmed that eradicating H. pylori infection can reduce the risk of gastric cancer. How can I know if I am infected with H. pylori? Is it necessary to eradicate H. pylori infection? It is not necessary to eradicate H. pylori infection, and consultation with a gastroenterologist is recommended. Happily, scientists in mainland China have successfully developed the world’s first and currently the only approved Hp vaccine with fully independent intellectual property rights, and have completed phase III clinical studies, which proved that the oral recombinant H. pylori vaccine has good safety and immunogenicity and can effectively reduce the incidence of gastritis, gastric and duodenal ulcers and gastric cancer caused by H. pylori infection, which is an important step towards the prevention of H. pylori-induced Gastric cancer caused by H. pylori is an important step forward. 2. Chemical prevention. For example, taking non-steroidal anti-inflammatory drugs represented by aspirin, but the evidence in this regard is not yet sufficient, and considering the toxic side effects of the drugs themselves, therefore, it is not advocated for individuals to take them without authorization. 3, change the bad lifestyle and dietary habits. For example, quit smoking and drinking, eat regularly, do not eat too fast and too full, do not overeat, do not eat smoked and pickled and fried and baked food, do not eat too salty, do not eat moldy food, eat more fresh vegetables and fruits, etc.. It is difficult to prevent stomach cancer from the root, so is there any method to detect stomach cancer at an early stage? This is called “cancer screening”, so how to screen for stomach cancer? It takes a long time for cancer to occur, which provides sufficient time for early detection of cancer, and the key is to pay attention to it. The main reason for the high mortality rate of gastric cancer in China is that most people have advanced gastric cancer once they are diagnosed, and there are fewer early cases. The cure rate of early gastric cancer can reach 90% after surgery, while the rate of advanced gastric cancer is only less than 14%, which shows how crucial early detection of gastric cancer is. So how to screen for gastric cancer? At present, the methods used for gastric cancer screening mainly include X-ray gas-barium double contrast imaging, serum pepsinogen (PG) test, gastroscopy, serum tumor marker examination (such as CEA, CA199, CA724), etc., among which gastroscopy is the most accurate screening method. It is recommended to use 40 years old as the starting age for gastric cancer screening. For people without high-risk factors, upper gastrointestinal imaging or direct gastroscopy can be performed every one to two years or so for people over 40 years old depending on the situation. The Japanese experience is that for people over 40 years old, conventional X-ray upper gastrointestinal tract imaging is used as the primary screening method, and for those who are found to have suspicious lesions in the primary screening, further gas-barium double contrast imaging is performed, and for those who are found to have suspicious cases in the gas-barium double contrast imaging, further gastroscopy is performed, and biopsies are taken and sent for pathological examination for final confirmation. For people with high risk of gastric cancer, it is recommended to have gastroscopy once a year, or at least once every two years if not once a year. For all people with abnormal findings on upper gastrointestinal imaging, further gastroscopy should be performed and biopsies sent for pathological examination if necessary. Currently, there are two recommended screening programs for gastric cancer, one is the initial screening with serum pepsinogen (PG) test and risk factor questionnaire, and further gastroscopy for those with positive initial screening results, and the other is direct gastroscopy with corresponding follow-up program based on the screening results. The specific implementation of screening is recommended on a case-by-case basis according to the advice of a specialist. If screening is not performed, and even if screening is missed, is there any remedy for early detection of stomach cancer? Of course there is, that is, don’t miss any clues, so how can we catch the clues of stomach cancer? Most cancers do not have specific manifestations in early stages, and stomach cancer is no exception. Although some gastric cancers may have some manifestations in early stage, such as mild pain and discomfort in the upper abdomen, or a feeling of fullness, or just a loss of appetite, feeling weak, or accompanied by vomiting, vomiting blood, or discomfort in swallowing food, or blood in stool/black stool, etc., these manifestations are not unique to gastric cancer, and it is difficult to distinguish them from benign diseases such as chronic gastritis, gastric ulcer, and gastric prolapse. The purpose of understanding these early manifestations is to raise your awareness of early diagnosis and to go to the hospital promptly for examination if you have any discomfort. What should I do if I am found to have stomach cancer? First of all, the diagnosis must be confirmed. To confirm the diagnosis of cancer, we must rely on pathological examination, that is, to obtain tumor tissues and send them to pathology department for “laboratory test” (pathological examination). How can we get the tissue needed for pathological examination? There are various ways, such as biopsy through gastroscopy or surgical biopsy of lymph nodes suspected of having metastases that can be palpated on the body surface. The next step is to perform staging. Some people ask for treatment as soon as they are diagnosed with cancer, and when the doctor says further examination is needed, they doubt the doctor’s medical ethics. Why do you still need to check? This is a complete misunderstanding. Without staging, there is no proper treatment, because different staging will lead to different treatment and different future outcomes. How to stage? It is to find out whether there are metastases other than the primary site of stomach, such as lymph nodes, lung, liver, bone, brain, etc. through various examinations. Next, the patient’s general condition and physical status should be assessed. For example, what is the nutritional status, what is the physical status, whether there are other comorbidities that may affect the treatment, etc. Otherwise, starting the treatment in a hurry will do more harm than good. Lastly, of course, treatment should be started formally. The treatment should be decided according to the pathological type, stage and physical condition of gastric cancer, and combined with the patient’s/family’s wishes and economic status. The general principle is that surgery alone can be considered for early gastric cancer without lymph node metastasis, and some very early submucosal tumors can even be treated by gastroscopy without surgery; for intermediate stage (locally progressive stage or early gastric cancer with lymph node metastasis), surgery-based comprehensive treatment is adopted, including preoperative neoadjuvant chemotherapy or postoperative adjuvant chemotherapy/radiotherapy; for advanced metastatic gastric cancer, systemic chemotherapy-based comprehensive treatment is adopted. If the patient’s health is too poor to tolerate anti-tumor treatment, only symptomatic treatment can be used, not to prolong life but to relieve pain.