Because of being responsible for the clinical treatment of gastrointestinal tumor treatment group, every time when we communicate with patients or their family members about their condition and surgical talk, the anxiety of patients and their family members can not be overstated because of the concern of hoping the patient’s condition, wanting to know more about the treatment plan, treatment effect, long-term survival, and even the economic burden of treatment. This anxiety can even continue throughout the patient’s treatment. How to address this issue has prompted me to write this text in the hope that it will be helpful to patients and their families. At the same time, considering the reading comprehension ability of different people, I avoid using too much jargon as much as possible and use expressions such as “analogy” to describe the situation under the premise of expressing the relevant knowledge clearly. Before understanding the specific treatment plan of gastrointestinal tumor, we should understand several basic concepts: tumor lesions are divided into clinical lesions and subclinical lesions; several metastatic pathways of tumor. Tumor lesions are divided into clinical lesions and subclinical lesions. The so-called clinical lesions refer to the dominant lesions that can be seen by human eyes (including those that can be distinguished by the naked eye through endoscopy) and can be touched, and can show positive results through imaging examinations such as ultrasound and CT. Subclinical lesions, on the other hand, are objectively present, cellular-level tumor lesions. Because subclinical lesions are very small and cannot be identified by the above mentioned methods, they cannot be removed surgically and can only be controlled by radiotherapy. There are four major ways of metastasis, namely: hematogenous metastasis, lymphatic system metastasis, implantation metastasis and direct infiltration metastasis. 1. Hematogenous metastasis: It refers to the process of tumor cell growth, in which tumor cells invade and break through the blood vessel wall, enter the blood and then transfer to other places with the systemic circulation of blood to form new metastatic lesions. In tumor of gastrointestinal system, according to the blood return route: intestinal tube or stomach – through superior and inferior mesenteric veins and splenic portal vein – liver – inferior vena cava – heart – lung. Hematogenous metastasis is one of the main metastatic routes of tumors. Tumor organ metastasis is mostly seen in the liver and lung. This is also one of the reasons for postoperative systemic chemotherapy with intravenous vascular drugs. 2.Lymphatic system metastasis: lymphatic system includes lymphocytes, lymphatic vascular network and lymph nodes. It is an important component of human cellular immunity. In the submucosa of digestive tract, capillary lymphatic network and capillary network exist widely in parallel. When tumor cells break through and invade the lymphatic network, they can spread and metastasize along the lymphatic flow pathway and grow in the lymph nodes to form metastatic cancer. Regional lymph node metastasis usually occurs on the same side of the primary tumor, but may occasionally reach the opposite side. Tumors located in the midline of the body may metastasize to one or both lymph nodes. 3.Implantation metastasis: When the tumor invades to the plasma membrane layer of the tissue and breaks through it, the tumor cells on the surface of the cancer mass are shed and planted on other suitable growing plasma membrane surfaces in the abdominal cavity to form new implantation metastases, and may cause hemorrhagic effusion and adhesions. This situation is somewhat similar to the fruit of a fruit tree, after the fruit is ripe, the fruit falls in the suitable growing soil and the seed germinates and grows to form a new sapling. 4.Infiltrative metastasis: i.e. tumor cells proliferate and grow. Cancer cells often continuously invade and destroy adjacent normal organs or tissues along tissue interstices, lymphatic vessels, blood vessels or nerve bundles, and continue to grow. For example, tumor in the sinus of stomach can invade the left lobe of liver upward, gallbladder upward to the right, and pancreas downward; rectal cancer is easy to form bladder infiltration metastasis and pelvic metastasis (if it is female, it is easy to form uterine adnexal metastasis, etc.) The treatment of tumor patients mainly includes the following aspects: surgery, radiotherapy, immune support therapy, Chinese medicine conditioning, nutritional support, physical exercise and psychological adjustment, etc. 7 major aspects. 1.Surgical treatment is the main and preferred treatment for clinical lesions of tumor in China, especially for early stage cancer lesions that have not yet formed extensive metastasis. Surgery is mainly for clinically manifest lesions, and what we call radical surgery is also mainly for clinically manifest lesions. According to the actual situation of the primary cancer lesion, surgery is divided into the following ways: i. If the cancer is early, the tumor is relatively limited and has not spread and metastasized elsewhere, the primary lesion can be radically excised during surgery, and the lymph nodes can be cleared according to the principle of radical surgery; ii. If the tumor lesion spreads and infiltrates the surrounding tissues and organs, there is still a chance of radical excision, but the condition requires expanding the scope of surgical excision, i.e. joint organ The tumor may still have the chance of radical resection, but the condition needs to expand the scope of surgical resection, that is, combined organ resection. For example, if gastric cancer infiltrates the left lobe of liver, the left lobe of liver should be removed during surgery; if gastric cancer infiltrates and adheres to gallbladder, the gallbladder should be removed during surgery; if female rectal cancer infiltrates the uterus, the uterine adnexa should be removed during surgery. If the tumor has formed extensive infiltration, there is no possibility of radical surgical resection, but considering that gastrointestinal tumor often causes gastrointestinal obstruction, which leads to the patient’s inability to eat normally and often leads to poor nutrition due to insufficient nutritional intake and accelerates the patient’s death. If the patient’s organism condition and economic condition allow, we still recommend the patient to be treated surgically. By removing the primary tumor lesion and completing the treatment of tumor reduction surgery, we can win valuable opportunities and treatment time for later chemotherapy and immune support; or through palliative rerouting surgery, we can solve the problem of digestive tract obstruction and maintain their digestive tract access, so as to maintain relatively normal oral feeding and nutritional support before the tumor causes progressive failure of multiple organs and death of the patient, which prolongs the patient’s survival time with tumor. This prolongs the survival time of patients with tumors. In practice, we often do not stick to the use of a single surgical approach, but adopt a more reasonable combination of treatments according to the actual condition of the patient to achieve a more ideal surgical treatment effect. For example, for single lesion of recurrent or metastatic liver cancer, intraoperative combined or postoperative ultrasound (or CT) guided puncture microwave ablation treatment can be considered. Current surgical oncology treatment is developing toward the goal of rational, functional and radical treatment. The basic concept of surgical treatment of cancer has undergone a major transformation, and its development trend is undergoing a shift from “anatomical surgery” to “functionally protected anatomical surgery”, and this shift has tended to reduce the scope of surgery from simply pursuing the expansion of the scope of surgery to the reduction of the scope of surgery for The development trend of metastasis is changing from “anatomical surgery” to “function-preserving anatomical surgery”, and the trend of metastasis is changing from expanding the scope of surgery to narrowing the scope of surgery, preserving the organs that are not invaded, and emphasizing the preservation of the body’s function and immune response. 2. Chemotherapy, which mainly targets subclinical tumor cell lesions. Chemotherapy is a kind of treatment that uses the cytotoxicity of chemical drugs to kill tumor cells, inhibit the growth and reproduction of tumor cells, and promote the differentiation of tumor cells, which is a systemic treatment for primary foci, metastases and subclinical metastases. The proliferation of tumor cells is controlled by chemical drugs, and even apoptosis is induced to control the recurrence and metastasis of tumor to the maximum extent. Therefore, patients with gastrointestinal tumors often need chemotherapy with drugs. Through chemical drugs to control the proliferation of tumor cells and even induce apoptosis of tumor cells, the recurrence and metastasis of tumor can be controlled to the maximum. Therefore, patients with gastrointestinal tumors often need chemotherapy. Chemotherapy is divided into perioperative curative chemotherapy and post-rehabilitation consolidation chemotherapy (such as CHOP chemotherapy for malignant lymphoma). There are four main types of chemotherapy: intravenous systemic chemotherapy, intraperitoneal infusion chemotherapy, vascular interventional tumor supply artery drug infusion chemotherapy and oral drug chemotherapy. Since most of the tumors in the gastrointestinal tract are adenocarcinoma, 5-fluorouracil intraperitoneal hot instillation chemotherapy can be used before surgery. After the operation, the abdominal cavity was routinely flushed with a large amount of warm distilled water (>3000ml), and then 500ml of warm saline + 5-fluorouracil 1g was used to administer chemotherapy or 5-fluorouracil slow-release pellets to spread the tumor bed and surgical wound before closing the abdomen. Postoperatively, the drug regimen and route of administration were selected based on the routine pathology of the specimen and its immunohistochemistry to understand the malignancy degree of tumor cells and their tendency to infiltrate and metastasize. If the tumor cells tend to metastasize bloodstream, the drug administration mode is intravenous systemic chemotherapy; and if the tumor cells tend to metastasize lymphatic system, then for patients with gastrointestinal tumor, if they have good postoperative recovery, they prefer intraperitoneal thermal perfusion chemotherapy. For patients with long tumor history, large size of cancer foci and forming invasion of surrounding tissues and organs, who are expected to have difficulty in stage I radical surgical resection, it is suggested that preoperative vascular intervention of tumor blood supply vessels with drug regional perfusion chemotherapy is recommended to reduce the clinical stage of tumor and strive for maximum chance for radical resection of tumor. 3.Radiotherapy is to irradiate cancer tissues with X-rays, γ-rays, electron rays, etc. Due to the biological effect of radiation, it can kill cancer tissues in the largest amount, destroy them and make them shrink. Radiotherapy can shrink tumors or eliminate potential local metastatic lesions, improve the cure rate, and reduce recurrence and metastasis. The key target of radiation to kill cancer cells is DNA (deoxyribonucleic acid) in the cell nucleus. The division, proliferation and growth of tumors are all determined by DNA replication. Because tumor cells are more sensitive to radiation than normal tissue cells, tumor cells lose their ability to regenerate and proliferate until they are killed by a certain dose of radiation therapy, while normal cells can be completely restored by sublethal dose of radiation, which is a reversible change. Clinically, this kind of normal cell population has low sensitivity to radiation, high tolerance and high repair ability, while tumor tissue is the opposite, so that radiation has a certain selective effect between normal cell population and tumor cell population, which is one of the important factors for the effectiveness of radiation therapy for malignant tumors. Radiotherapy is divided into internal radiotherapy and external radiotherapy. External radiotherapy is mainly applied to postoperative radiotherapy for sinus cancer, thyroid cancer and breast cancer. Internal radiotherapy is suitable for those who do not tolerate external radiotherapy, as well as for single lung cancer nodules, pancreatic cancer, gastric cancer with liver metastasis, and pelvic implantation of internal radiotherapy during rectal cancer surgery. For gastrointestinal tumors with surrounding tissues and lymphatic metastases, since all the tumor tissues cannot be removed radically, in order to control the cancer cells that may remain in the cancer bed, in practice we often combine intraoperative cancer bed implantation of radioactive I125 particles with continuous internal radiotherapy treatment. I125 particle implantation internal radiotherapy is the clinical treatment purpose of killing tumor by destroying the DNA double strand of tumor cells with r-radiation, so that the tumor cells lose the ability to proliferate. 5.Nutritional support, according to the different conditions of patients, should be appropriate dietary allocation, promote appetite, improve the nutritional status, is an important part of rehabilitation, improve survival rate and quality of life. Reasonable nutrition and appropriate increase of various essential nutrients can effectively prevent weight loss, enhance the body’s ability to resist disease, accelerate physical recovery and consolidate the therapeutic effect, so it is said that “medicine is better than food”, that is, nutritional diet should never be ignored. The general requirement of diet is to supply sufficient calories and high quality protein, maintain the nitrogen balance of the body, vitamin-rich food (i.e. high protein, high calories, high vitamin), in order to light and delicious, rich in nutrition and easy to digest as the principle. In gastrointestinal surgery, especially for gastric cancer surgery patients, perioperative feeding needs to pay attention to the method of feeding. We emphasize: firstly, liquid diet, and secondly, less and more meals. In the early postoperative period, because the mucosa at the gastrointestinal anastomosis is still in the state of edema, if semi-liquid (such as thin rice, meat porridge, etc.) or even regular ordinary meals are eaten too early, the postoperative recovery effect can be affected by anastomitis and even anastomotic ulcer formation due to rough food friction. Even the formation of anastomosis and anastomotic ulcers may cause long-term abdominal pain and affect the quality of life. Therefore, it is necessary to eat non-slag food (such as rice paste, soup, etc.) at this time to give the mucosa at the anastomosis ample time to heal. Secondly, less food and more meals, less food is to avoid overfilling the digestive tract especially the stomach cavity after gastric cancer surgery and the uncomfortable symptoms such as abdominal distension caused by poor food digestion; more meals are to ensure the supply of oral nutrients and calories by increasing the number of meals, so that the body can recover smoothly. 6. Physical exercise, “life is not decaying when it moves, and happiness is longevity”. It has a double meaning for cancer patients in recovery to take scientific and appropriate physical exercise. On the one hand, through interpersonal interaction, such as mutual sympathy and encouragement among patients, and various positive information (such as successful experience, regular life system and good exercise environment, etc.) obtained when participating in exercise, patients will have positive influence on their emotions. Various exercise programs have a specific psychological impact on the patient, which is actually a kind of intentional transfer method to relax the nervous, bitter and lonely psychology, so as to gather the confidence to overcome the disease, establish a healthier psychological state and eliminate pessimism. On the other hand, suitable exercise can significantly improve physical fitness, restore physical strength, strengthen the body’s resistance, improve the disease, can be improved from both physical and mental aspects, to consolidate the effect of treatment, to promote physical recovery has a positive significance. 7.Psychological counseling, almost all tumor patients without exception have more or less certain psychological disorders, which are diversified according to their personality, cultural cultivation and severity of illness before falling ill. 70% of cancer patients have symptoms of anxiety and depression; 30% have symptoms of terror, depression, anger and despair, etc. These subjective fears and anxieties are often the catalysts of cancer. Generally speaking, cancer has different psychological reactions at different stages, some of which are normal and adaptive, while others may be abnormal and maladaptive. According to the data, nearly 80% of advanced cancer patients are “scared” to death because of their excessive fear of the disease. On the contrary, patients who are able to deal with advanced tumors openly and actively cooperate with the battle against cancer can not only prolong their lives, but also face death mostly calmly and peacefully. When a person suffers from cancer, he or she is often the most mentally fragile time. The goal of psychological counseling for oncology patients is to improve patients’ fighting spirit to overcome the disease, enhance self-esteem, improve coping ability, reduce confusion brought by the disease as well as increase patients’ sense of control to fight with the disease and help patients better solve the problems they actually encounter. Due to the malignant tumor itself and its treatment and the resulting changes in somatic function, body image, social status, economic status, family relationships, etc., patients will have different degrees of adverse psychosomatic reactions. Through psycho-behavioral counseling, it can help patients improve their psychosomatic tension, alleviate the side effects brought about by various treatments, and improve their own immune function, etc. Chinese medicine, as surgeons in the new era, we do not reject Chinese medicine, the treasure of Chinese civilization, but we are happy to apply Chinese medicine in the treatment of tumor disease control. In the treatment of tumor, TCM focuses on eliminating the evil and helping the righteous at the same time. Through TCM tonics, the patient’s qi, blood and internal organs are harmonized and the yin and yang are balanced, so as to improve the patient’s own immunity and anti-tumor ability, and improve the patient’s survival quality of “living with tumor”. The application of Chinese medicine in tumor patients is mainly divided into the following ways: 1. Early cooperation with surgery: Before surgery, Chinese medicine is used to improve the function of patients’ organs such as liver function and heart function, so as to improve their physical condition and enhance their ability to tolerate surgery; after surgery, Chinese medicine is consulted by the Chinese medicine department and corresponding Chinese medicine tonics are formulated according to the patients’ pulse, so as to improve the patients’ digestive and absorption ability while supporting the root and nourishing the spleen and benefiting the qi. After the surgery, we will consult with the Chinese medicine department and prepare herbal soup according to the patient’s pulse. During the recovery period, regular intake can improve the physical constitution, enhance the immune anti-tumor function, avoid or reduce the recurrence and metastasis of tumor, and improve the long-term efficacy. 2.Application in radiotherapy and chemotherapy patients: giving Chinese medicine in the process of radiotherapy and chemotherapy can effectively prevent or reduce its toxic side effects, such as: reduction of blood cells; gastrointestinal reactions such as nausea and vomiting, abdominal distension and numbness; liver, kidney and heart damage; nerve damage of numbness of hands and feet; fever and so on. 3, usually lose the opportunity of surgery, the patient is relatively weak, and a series of symptoms, then should be based on Chinese medicine to support the righteousness and eliminate evil, enhance the body’s righteousness, so that the body has the ability to do to expel external evil, improve the symptoms, but also with appropriate radiotherapy, in order to achieve the best results of treatment; 4, late stage: late stage patients mainly to the righteousness of the weakness of the main, and a variety of late complications. Surgery and radiotherapy are inappropriate. At this time, Chinese medicine is mainly used to support and supplement the deficiency, improve the body’s positive energy and remove the evil, so as to maximize the patient’s quality of life and prolong life expectancy. The treatment of tumor patients emphasizes the implementation of comprehensive treatment rather than single treatment measures, that is, through the integration of multiple treatment modalities to achieve a relatively ideal treatment purpose, and then achieve the clinical treatment purpose of ensuring patient safety, maximizing the overall survival of patients (including tumor-free survival and survival with tumor), and improving the quality of patients’ survival. Many families ask the same question: How long is the patient expected to live? Every time, it is difficult for me to give a direct answer to families who are eager to get an optimistic answer from me. I hope the family can understand that the doctor’s role is not to judge when the patient will die, not to give the patient a death sentence! The role of doctors is to use their professional knowledge and clinical experience to comprehensively analyze the patient’s disease and related examination results, and then judge the actual condition of the patient, and thus formulate a most suitable treatment plan for the patient, hoping to control the evolution of the patient’s condition to the greatest extent, and then achieve a better clinical treatment effect. As for the diagnosis and treatment of gastrointestinal tumor patients, especially those with middle and late stage and high malignancy of the primary tumor, this hope of infinite living is actually a kind of kind and beautiful lie! This situation. Our principle is: to the patient’s own right to know the condition, we coax as much as we can, conceal as much as we can, and conceal the condition to the maximum extent to avoid the cruelty of the actual condition from having a fatal impact on the patient’s mental state. Because the majority of the general public in our country, not many people can accept the despair of living without hope that they are in the advanced stage of cancer! (This view may not be shared by all, because it deprives the patients themselves of the right to know about their condition to a certain extent.) I often tell the patient’s family that even if the patient is going to die tomorrow due to his or her deteriorating condition, there is still the hope that he or she will be allowed to enter a peaceful sleep tonight with infinite hope! Isn’t a kind and beautiful lie the best parting gift for the patient at such times? And to the family, we will tell the truth about the condition. Only after knowing the real situation, understanding and accepting the cruelest reality, and surviving the hardest tormenting spiritual purgatory, can the family stand up strongly and actively participate in the care of the patient! I sincerely hope that through the efforts of the business staff, the patient’s family and the patient together to overcome the cancer. For the record, the above text is a general description summarized by my experience in daily clinical work for the reference of patients and their families, hoping to bring some help to patients in the process of seeking medical treatment. It is not to be used as the basis for the actual work of the professional staff in the clinical profession.