In clinical work, we encountered many patients who delayed treatment or even missed the best first treatment opportunity because they did not know how to seek medical consultation and treatment, because for digestive tract tumors such as gastric cancer, whether the first diagnosis and treatment is correct or not will basically determine the final treatment effect of the disease. If unfortunately you have stomach cancer, you must not panic and consider the following issues.
First, smoothly pass the psychological barrier.
First of all, gastric cancer is not an incurable disease and the sky is not falling. Nowadays, medical technology, whether it is radical surgery or adjuvant radiotherapy, has improved substantially compared with the previous level. Many patients with gastric cancer can be cured after receiving correct and reasonable treatment. Therefore, after stabilizing your emotion, you should think of how to diagnose and treat next.
Second, how to diagnose?
The diagnosis and treatment of malignant tumors such as gastric cancer must be done by specialist doctors in specialized hospitals. Unlike the treatment of benign diseases such as perforated gastric ulcer and gallbladder removal, the treatment of gastric cancer is not only the removal of part of the stomach, but also should conform to the diagnosis and treatment norms of gastric cancer. Whether the lymph node dissection is reasonable or not determines the risk of recurrence or metastasis after surgery. Many patients’ family members, because they are afraid of the name of oncology hospital, or they don’t want patients to come to oncology hospital knowing it is a tumor, and go to general hospital. I have several friends in this situation, went to another well-known general hospital for general surgery, the treatment was not standardized, soon relapsed, and later found me, only to adjust the chemotherapy regimen, the general direction of disease development unfortunately can not be changed. In addition, before treatment, it is important to characterize and stage the disease. Qualitative is to clarify the nature of the lesion, the type of pathology; staging is to clarify the stage of the lesion, that is, the severity. Different treatment methods are required for different stages.
Then what tests are needed to diagnose gastric cancer?
Gastroscopy and ultrasonic gastroscopy: Gastroscopy is necessary to clarify the location, size and shape of the lesion, and more importantly, biopsy can be taken for pathological examination to clarify the nature of the disease; ultrasonic gastroscopy, that is, the head of gastroscope with ultrasonic probe, can understand the thickness of the lesion invading the stomach wall, that is, T-stage, and at the same time, it can probably understand the perigastric lymph node metastasis.
2, abdominal pelvic enhancement CT: this is also a must-check item. Enhanced CT can understand the lesion invasion of the stomach wall and perigastric organs, the presence of abdominal lymph node metastasis, the presence of liver or abdominal cavity spread, and is a very important staging test. It is an important basis for determining whether surgical resection is possible. Pelvic CT is especially important for female patients, as gastric cancer can metastasize to the ovaries. For male patients, pelvic ultrasound can also be performed instead.
3. Chest X-ray or chest CT examination: a must. To understand the lung condition and whether there are lung metastases.
4.Neck ultrasound: except for lymph node metastasis in the neck. Patients with gastric cancer can have typical left neck lymph node metastasis, and once metastasis, consider advanced stage.
5.Gastrointestinal tumor markers: to know the level of CEA, CA199, CA724. This test is not a basis for confirmation of diagnosis, but a reference basis.
6.PET/CT examination: For malignant tumor, this examination is an important tool to screen out systemic spread of metastasis, which can be detected at the early stage of the disease, but the examination cost is high. Clinical application is limited.
7.Lung function, cardiac ultrasound, vascular ultrasound: It is not a necessary item for diagnostic examination, but a preoperative cardiopulmonary function assessment test.
Third, how to treat?
This is a very important step. There are specialties in the field, especially in cancer treatment. I remember an oncologist once said, “Professionals do professional things. Be sure to consult a specialized doctor specializing in stomach cancer. The treatment of gastric cancer is comprehensive and different according to the stage of the disease.
1. For early stage gastric cancer, endoscopic resection can be considered, but not all early stage is suitable for endoscopic resection, and the indications are decided by specialist doctors.
2. For progressive gastric cancer, whether it should be treated by direct surgery or neoadjuvant chemotherapy first and then surgery should be considered. It also needs to be analyzed on a case-by-case basis.
If the patient has small lesions, lymph node metastasis may not be significant, or if the patient has obstruction, gastrointestinal bleeding, or some elderly patients, direct surgery may be recommended, and postoperative adjuvant therapy and treatment plan will be decided according to pathological results. Patients at risk of bleeding, or with existing bleeding, are likely to have fatal hemorrhage during chemotherapy and should be surgically removed first. Older patients with weaker bodies are weaker after chemotherapy and less able to tolerate surgical blows.
If the patient’s general condition is better and the lesion is larger invading surrounding organs and lymph node metastasis is obvious, 2-4 cycles of neoadjuvant chemotherapy are recommended, and the timing of surgery is decided according to the chemotherapy response, usually about 1 month after the end of chemotherapy.
3.For patients with advanced gastric cancer, surgery is not the best choice. Systemic chemotherapy should be considered first. Only when complications such as obstruction and perforation occur, palliative surgery to improve symptoms should be considered. For patients with resectable liver metastases, there is still a chance of surgical radical treatment after chemotherapy. For patients with advanced gastric cancer with abdominal spread, consider performing abdominal thermal perfusion chemotherapy along with systemic chemotherapy. For some sensitive patients, radical surgical resection can be considered after laparoscopic exploration after chemotherapy and if the peritoneal metastases disappear.
4. Should it be open surgery or laparoscopic minimally invasive treatment?
At present, laparoscopic radical gastric cancer surgery has been widely carried out in China, Japan, Korea and other countries with the highest incidence and treatment level of gastric cancer, which is the trend. Several large international clinical studies have shown that there is no difference in the radicality of tumor and the safety of surgery with traditional open surgery, but at the same time, it has the advantages of less surgical trauma, faster postoperative recovery, less intraoperative blood loss and early bedtime activities. Minimally invasive laparoscopic surgery is exactly the same as open surgery in terms of tumor treatment principles, such as the scope of surgical resection, lymph node clearance, and tumor-free principle, except that during the whole operation, the patient’s abdominal wall is relatively intact, the internal organs are isolated from the outside world, and the intraoperative trauma is small, and at the same time, the magnifying effect of laparoscopy is more suitable for the surgeon’s fine operation without dead space in the field of vision, so as to achieve anatomical-type surgery.
It is also important to understand that open surgery and minimally invasive laparoscopic surgery are not opposites, but simply different surgical options that complement each other. Medicine is constantly advancing, and surgical approaches are constantly being optimized. Whether minimally invasive surgery or open surgery, the best surgical option is the one that is the best choice for the specific patient.