Introduction to gastric cancer:Gastric cancer is one of the most common malignant tumors in our country, in our country the incidence rates
Introduction to gastric cancer:
Gastric cancer is one of the most common malignant tumors in our country, in our country the incidence rates of various tumors, about 170 thousand people died of gastric cancer each year, almost all cancer deaths in 1/4, and every year more than 20 thousand new patients with gastric cancer produced, gastric cancer is indeed a serious threat to people's health disease.
Gastric cancer can occur at any age, but 40 to 60 years of age, more men than women, about 2:1. Its incidence is unknown, and may be a variety of factors, such as diet, living habits, environmental factors, genetic quality, the spirit of the relevant factors, and chronic gastritis, gastric polyps, gastric mucosal dysplasia and intestinal metaplasia, gastric remnant after surgery, as well as long-term Helicobacter pylori (HP) infection have a certain relationship etc.. Gastric cancer can occur in any part of the stomach, but it is more common in the gastric antrum, especially in the stomach. According to the depth of invasion, it was divided into early gastric cancer and advanced gastric cancer. Early gastric cancer often not obvious symptoms, such as abdominal discomfort, pain, unpredictable belching, pantothenic acid, anorexia, mild anemia, stomach ulcer or some similar symptoms of chronic gastritis. Some patients suffer from pain relief, relief, or relief after taking analgesics, anti ulcer drugs or dietary adjustments, which are often ignored without further examination. With the development of the disease, stomach increasingly obvious symptoms appear, upper abdominal pain, loss of appetite, weight loss, weight loss and anemia. Cancer metastasis often late, abdominal mass, left supraclavicular lymph nodes, melena, ascites and severe malnutrition.
How is stomach cancer
Gastric cancer is the most common malignant tumor, which accounts for about 1 / 4 of all kinds of malignant tumors:
(1) environmental and dietary factors
Industrial waste gas, chemical fertilizer, pesticide, certain food additives and moldy fried, salted, smoked foods contain carcinogens. Can promote the occurrence of gastric cancer, especially bad eating habits, often no time to dine, eat excitant food, which can cause gastric mucosa of chronic stimulation, make its function disorder, hyperemia, edema, erosion, increase the chance of gastric cancer.
(2) show that the health status of the body of stomach diseases and a lot of investigation, the incidence of gastric cancer and chronic atrophic gastritis, especially in patients with gastric dysplasia and intestinal metaplasia is closely related. And is related to gastric ulcer, especially the ulcer. In addition, gastric polyps, gastric surgery, gastric bacterial infection, etc.. It is reported that the canceration rate of atrophic gastritis is 6%-10%, the canceration rate of gastric ulcer is 1.96%, and the canceration rate of gastric polyp is about 5%. It has been reported that patients with pernicious anemia are 5 times more likely to develop gastric cancer.
(3) a large number of studies show that mental factors and genetic factors, is relatively high with major trauma and sulk were the incidence of gastric cancer. The risk of being slow, stiff, indifferent or irritable is slightly lower, while the risk of being open, optimistic, and active is the lowest. The occurrence of gastric cancer is related to heredity, and has obvious familial aggregation. Its incidence is unknown, and may be a variety of factors, such as diet, living habits, environmental factors, genetic quality, the spirit of the relevant factors, and chronic gastritis, gastric polyps, gastric mucosal dysplasia and intestinal metaplasia, gastric remnant after surgery, as well as long-term Helicobacter pylori (HP) infection have a certain relationship etc.. Gastric cancer can occur in any part of the stomach, but it is more common in the gastric antrum, especially in the stomach. According to the depth of invasion, it was divided into early gastric cancer and advanced gastric cancer. Early gastric cancer often not obvious symptoms, such as abdominal discomfort, pain, unpredictable belching, pantothenic acid, anorexia, mild anemia, stomach ulcer or some similar symptoms of chronic gastritis. Some patients suffer from pain relief, relief, or relief after taking analgesics, anti ulcer drugs or dietary adjustments, which are often ignored without further examination. With the development of the disease, stomach increasingly obvious symptoms appear, upper abdominal pain, loss of appetite, weight loss, weight loss and anemia. Cancer metastasis often late, abdominal mass, left supraclavicular lymph nodes, melena, ascites and severe malnutrition.
Because gastric cancer is very common in our country, great harm, the study that the causes and eating habits, stomach diseases, so to understand the basic knowledge about gastric cancer is of great significance to the prevention and treatment of gastric cancer.
Early gastric cancer symptoms:
Nearly half of the early gastric cancer patients had no clinical symptoms, only some mild indigestion and other symptoms, such as abdominal discomfort, mild pain, fullness, nausea, belching, and these symptoms are not visible in the gastric cancer endemic, chronic gastritis, ulcer disease, functional dyspepsia, even normal occasionally.
More than 1.80% of patients with upper abdominal pain.
About 2 1/3 with a bulging stomach nausea, abdominal discomfort, loss of appetite, indigestion, pantothenic acid.
3.1/3 patients with no obvious symptoms of digestive system, but may cause unexplained weight loss, weight loss and fatigue.
The 4 part patients showed pantothenic acid, heartburn, belching, nausea, vomiting or black stool and other symptoms
The most common symptoms of early gastric cancer is mild abdominal discomfort, such as stomach pain, swelling of heaviness, sometimes heart aches, at first often diagnosed gastritis or ulcer disease and treatment, symptoms may temporarily relieve. If the lesions occur in the gastric antrum, duodenal function can occur, the occurrence of rhythmic pain, similar to the symptoms of ulcer disease, but also easy to be misdiagnosed as duodenal ulcer and delayed treatment. However, these symptoms will relapse after a period of time. Therefore, those who have symptoms such as epigastric discomfort, and with other high risk factors, or after treatment in cases of recurrent, must be vigilant, do further examination for early detection, early treatment.
Loss of appetite, anorexia, anorexia, nausea and vomiting, bloating after eating, belching, acid reflux symptoms, is a group of common and the lack of early gastric cancer specific signal. Anorexia may be an early symptom of gastric cancer, and do not accompany the symptoms of stomach pain, if with the symptoms of stomach pain at the same time and can rule out hepatitis, especially should pay attention to. Some patients because of abdominal distension, belching and appear after eating automatically limit the daily diet, resulting in weight loss and weight loss and fatigue. The early symptoms of gastric cancer can also be full of satiety after eating with mild nausea. Cardiac tumors can begin to eat, and gradually develop into dysphagia and regurgitation. Further development of gastric antrum cancer may be caused by pyloric obstruction.
The above symptoms are easily misdiagnosed as functional dyspepsia and should be treated as early as possible, gastroscopy and so on, in order to detect gastric cancer at an early stage
Early gastric cancer and advanced gastric cancer can appear upper gastrointestinal bleeding, often black stool. A few early gastric cancer showed symptoms of upper gastrointestinal hemorrhage is slight, melena or persistent positive fecal occult blood test. In polypoid and ulcer like early gastric cancer, or cancer focus for erosion surface invasion of capillaries, causing long-term bleeding caused by, can also be found in early gastric cancer subtypes in the relatively flat. It is not easy to be controlled by drug treatment. Where there is no stomach disease in the elderly, once the black should be more alert to the possibility of gastric cancer. Such as tarry stools, fecal occult blood test remains positive, especially in the general diet or taking drugs after the stomach is not easy to stop, is one of the important signs of early gastric cancer. Therefore the symptoms should be timely to the conditions of the hospital for gastroscopy and upper gastrointestinal barium meal X-ray examination to confirm the diagnosis.
Weight loss, fatigue, lack of energy is a group of common and unexplained lack of gastric cancer specific signal, and progressively increasing. Some are secondary to dyspeptic symptoms, patients with abdominal distension, belching and appear after eating automatically limit the daily diet, resulting in weight loss and weight loss and fatigue. In addition, nausea, vomiting can also be further loss of nutrition, resulting in malnutrition, weight loss. Of course, the later stage of gastric cancer is more obvious.
In addition, it is particularly worth mentioning is the pathology of most gastric cancer occurred in chronic gastritis (especially atrophic gastritis) and Helicobacter pylori (HP) infection, gastritis, gastric polyps, gastric ulcer on the basis, so some patients have long-term chronic gastropathy, abdominal discomfort, digestive adverse symptoms. On this basis, such as short-term pain, epigastric full properties change or degree of increased pain, rhythm changes related to diet, medication or not alleviate, or emaciation, it should alert the occurrence of gastric cancer.
Most of the patients with gastric cancer who suffered from weight loss and fatigue were advanced gastric cancer, and most of them were local or distant metastasis.
Many factors can cause vomiting, such as duodenal ulcer or ulcer scar stenosis, reflux esophagitis, gastric ulcer.
The involvement of the pylorus in gastric cardia cancer or gastric cancer can cause vomiting, including persistent vomiting, gastric juice, and even bloody coffee. Vomiting is a common clinical manifestation of advanced gastric cancer, often accompanied by weight loss.
On the left side of the clavicle, such as soybean or peanut like enlargement of the lymph nodes, painless, hard and fixed, which is more specific signs of gastric cancer, most of the signs of advanced gastric cancer with abdominal and other organ metastasis.
Once found the enlargement of left supraclavicular lymph nodes, do lymph node biopsy or biopsy immediately; gastroscopy and gastric lesions on multi block multi direction forceps biopsy for pathological examination, necessary gastric barium meal radiography, can be immediately diagnosed.
Suffering from stomach of men over the age of 50, such as the recent recurrent upper abdominal pain, but also good and bad, should be vigilant, early related special inspection. At present, the commonly used check gastroscopy and barium meal. Gastroscope examination not only can directly observe the morphology, color and pathological changes of gastric mucosa, but also can be used to remove suspicious cells by gastroscopy. X-ray gas barium double contrast examination, no contraindications and side effects. In addition, gastric examination, fecal occult blood test, can be used as auxiliary diagnostic means.
The younger trend of gastric cancer
The signal of early gastric cancer with abdominal discomfort, stomach fullness pain, loss of appetite, weight loss, acid regurgitation, melena. But young people are easily misdiagnosed in gastric cancer, the most common is misdiagnosed as peptic ulcer disease, followed by chronic superficial gastritis, also misdiagnosed as pyloric obstruction, even misdiagnosed as appendicitis, or because of muscle soreness and misdiagnosed as rheumatic myositis, diagnosis can belong to the middle and late stage, lost cure time. The causes of misdiagnosis, in part because of gastric cancer in young people often above abdominal pain and gastrointestinal bleeding, therefore it is easy to be misdiagnosed as peptic ulcer disease; and the medical staff lack of experience of youth gastric cancer vigilance is not high, explain some symptoms of digestive system of the patient appears often in gastritis, ulcers and other common diseases, neglect the possibility of the occurrence of gastric cancer. In another aspect of youth gastric cancer early symptoms are often hidden, lack of specific performance, easily confused with diseases of digestive system, resulting in the failure to diagnose early, or even found some symptoms did not further detailed examination and diagnosis. In young patients with gastric cancer, gastric antrum and gastric body tumors were more common. Histopathological examination showed that the majority of the patients were poorly differentiated, undifferentiated and mucinous adenocarcinoma, and therefore had a high degree of malignancy, early metastasis, rapid progression, short course of disease and poor prognosis. Visible, young people to be vigilant and early diagnosis of gastric cancer is very important.
To prevent misdiagnosis of young patients with gastric cancer, the medical staff must treat each patient seriously. Gastroscopy is the best way to detect early gastric cancer. The recurrent epigastric bulging pain, melena, anemia, weight loss, regular anti-inflammatory and anti ulcer treatment is invalid or ineffective for young people, as soon as possible by gastroscopy. The patient could not suffer in silence, should closely cooperate with the doctor to check. For suspected patients or a failure to confirm the diagnosis, should be tracked and regular review, in order to facilitate the early detection of possible cancer. At the same time, young people do not think young, do not pay attention to good health care, profligate health, smoking and drinking, eating disorders, living without the law. Once the disease, too late
Method for detecting early gastric cancer
The laboratory examination
The markers of gastric cancer: a variety of substances derived from gastric cancer cell can be detected in the gastric juice, blood and other tissues, gastric cancer can be used as markers used in gastric cancer screening, such as signs of various enzymes and from embryonic.
The cancer gene: it is generally believed that the high expression of p2lras and intestinal type of gastric cancer, but in dysplasia, intestinal metaplasia, tumor near normal mucosa showed high expression, so that this gene plays a role in the earlier stages of gastric carcinogenesis. The deletion mutation of APC gene was also found in the early stage of gastric cancer, and mostly occurred in undifferentiated gastric cancer. In addition, the expression of p53 gene and CD44v6 gene was related to the occurrence of gastric cancer and the biological behavior of gastric carcinoma, and the expression of the gene in gastric mucosal dysplasia, early gastric cancer and advanced gastric cancer was increased. The evolution of gastric cancer is the result of a variety of gene alterations. These genes are of great significance in the early diagnosis of gastric cancer, but the specificity is still to be improved.
Monoclonal antibodies to gastric cancer: the application of monoclonal antibodies in the diagnosis of early gastric cancer. For example, monoclonal antibody MG7 was used in 1090 patients, the positive rate was 41.8%.
The occult blood bead method: gastric cancer showed that the country's more than 23 census, the positive rate of gastric occult blood was 12%, 581 cases were diagnosed as esophageal cancer and gastric cancer, of which 70% patients with pathological examination for early stage cancer. The specificity of this method is not high, but the method is simple, the subjects can be repeated or continuous dynamic observation, in the large-scale population census has greater value.
The screening of gastric cancer: a computer model of probability census, according to the local risk factors of gastric cancer, select significant factors, establish mathematical model, each subject's computer by data input, by regression analysis, positive for high risk population. This method can improve the detection rate of gastric cancer markers.
The radiological examination
Although the majority of lesions can be found, but the rate of missed diagnosis is still high. The imaging examination of stomach includes several kinds of examination methods, such as double contrast image, mucosal image, filling image, compression image and so on. Can be found by comparing the double contrast image and mucosal imaging can clearly show the lesions of the lower stomach, oppression like anterior wall lesions showed especially important, 4 kinds of examination methods can complement each other and confirmed, improve the detection rate of malignant lesions.
With the clinical application of double phase spiral CT and CT, the sensitivity of the imaging method in detecting early gastric cancer was greatly improved. According to the current statistics, the positive coincidence rate of CT in the early diagnosis of gastric cancer can reach more than 70%, and the minimum diameter of mucosal lesions can reach about 1cm. But there is still a high cost of diagnosis, does not apply to the census.
Early gastric cancer does not have specific clinical symptoms, so for those over 40 years of age, there are obvious symptoms of dyspepsia or precancerous lesions, should be routine gastroscopy. Compared with the imaging examination, endoscopy has obvious advantages. It can directly observe the shape of lesions, wide vision, strong resolution, high accuracy biopsy.
The endoscopic ultrasonography
Increase the scope of diagnosis, and shorten the distance between the ultrasonic probe and the target organ. The accuracy rate of ultrasonography in early gastric cancer and advanced gastric cancer was 90%, and the accuracy of judging the type and depth of invasion was up to 70 ~ 80%. Endoscopic ultrasonography may also help to detect the presence of local lymph node metastasis in early gastric cancer.
In short, early detection and early diagnosis of gastric cancer is the foundation of early treatment and the key to reduce the mortality of gastric cancer. With the continuous improvement of diagnostic techniques, it is hopeful to do a good job in the clinical screening of early gastric cancer.
Do you have to have an operation?
For such a problem can not be simply "yes" or "no" to answer, doctors often have to make decisions based on the specific circumstances of patients with gastric cancer. At present, patients with early gastric cancer should be treated with radical resection, which is the only cure for gastric cancer. The cure rate of stage I gastric cancer is about 90%, and II stage gastric cancer can reach about 70%. For advanced gastric cancer is surgery, patients and their families often have more concerns, is afraid of diffusion surgery can cause cancer, but to promote further deterioration. Specifically, such concerns are unnecessary. Even though the advanced gastric cancer, radical surgery can not do, but as long as the main tumor removed, due to the elimination of cancer may cause bleeding, perforation, obstruction and other complications, reduce the adverse effects of cancer toxin produced by human brings, often can rise to reduce the symptoms, improve the quality of life of patients. Prolong survival effect. Especially important after the resection, can lay the foundation for the Chinese and Western medicine treatment after operation, and create favorable conditions. Therefore, gastric cancer was diagnosed, surgical treatment is the first. As long as the general condition of the patients and allow gastric cancer, without extensive metastasis, should actively strive for surgical treatment, the resection.
Of course, we emphasize the importance of surgery, not deny other treatment methods. On the contrary, in order to improve the surgical treatment effect, often need to combine some other treatment methods. The most commonly used before surgery, during and after radiotherapy or chemotherapy. Purpose: the lesion is localized to create conditions for the surgery, in order to improve the resection rate; reduce cancer cell dissemination and surgery as an implant; radical resection after consolidation therapy, eliminate residual disease may exist to prevent recurrence and metastasis; as a non radical palliative therapy after surgery, in order to control the lesion, prolong the survival
Surgical methods for gastric cancer
It is the main method to treat gastric cancer, and the only way to cure advanced gastric cancer. Therefore, the surgical treatment of gastric cancer should take a positive attitude, as long as the patient's general condition allows no clear distant metastasis should be performed laparotomy. Mainly include:
1: radical resection should include primary lesions, and distal gastric 2/3 or 4/5, all the big and small omentum, first portion of the duodenum and the regional lymph nodes and local infiltration of the whole organ resection of gastric or duodenal stump cancer cells without residual cancer. Expand the scope of radical resection in addition to the above content, but also the whole stomach resection or adjacent invasion of the transverse colon, left lobe of liver, spleen, pancreatic tail and spleen and left cardiac vascular adjacent lymph nodes.
2 palliative resection: where has gastric cancer peritoneal or lymph node metastases, the primary tumor can be removed, the general condition of the patients can tolerate surgery, palliative gastrectomy can put qian. This surgery can reduce patient symptoms, eliminate the obstruction caused by cancer, due to complications such as hemorrhage and perforation. Postoperative adjuvant chemotherapy and traditional Chinese medicine treatment can prolong the survival time of patients.
3 short circuit operation: suitable for patients with advanced gastric cancer can not be surgery, while accompanied by yin.
Two, endoscopic treatment
Because the endoscope technology continues to develop, and the awareness of early gastric cancer is deepened, lesions less than 2 cm, the infiltration of early gastric cancer and mucosa only increased significantly, so that certain types of early gastric carcinoma under endoscope for treatment of possible methods used at present has two kinds, one is polypectomy some of the lesions, another method of treatment with laser
Three, laparoscopic radical gastrectomy for gastric cancer
Gastric cancer is a common malignant tumor. Surgical treatment is still the most effective treatment for gastric cancer. However, the traditional open surgery has many problems, such as trauma, postoperative recovery, pain, complications, and so on, so the minimally invasive surgery of gastric cancer has been the unremitting pursuit of gastrointestinal surgeons. Although laparoscopic cholecystectomy has been widely carried out, laparoscopic radical gastrectomy for gastric cancer is still a difficult problem due to its complex anatomical relationship, difficult operation and high technical requirements. According to the characteristics of Chinese people, laparoscopic surgery for gastric cancer was carried out, and a set of effective operation standard of laparoscopic gastric cancer was established.
This set of norms to ensure the scope of treatment, reduce trauma, while the total cost of laparoscopic treatment of patients with gastric cancer and the total cost of open treatment is essentially flat, so that the advanced technology can benefit the majority of patients with gastric cancer.
This technique through the abdominal wall 5 0.5 ~ 10 cm key hole small hole, laparoscopic insertion diameter of 1 cm, the image of the abdominal organs clearly displayed on the TV screen, the doctor while watching the TV screen, while a small hole through the abdominal wall into the small appliance operation, complete the traditional operation need more than 20 cm the incision to complete the operation. Moreover, because of the magnifying effect of laparoscopy, the dissection of gastric lymph nodes can be more thorough, and the resected tissue is finally taken out through a small incision of 3 to 6 cm.
After careful clinical comparison, this surgery has small trauma, less bleeding, gastrointestinal disturbances (basically does not need a blood transfusion), postoperative pain, postoperative patients with the advantages of fast, small incision scar, postoperative complications significantly reduce recovery. In addition, laparoscopic surgery can be avoided in patients with advanced gastric cancer is meaningless or even harmful laparotomy.
Prognosis of gastric cancer
The average survival time of patients without treatment was about one year after the onset of symptoms.
After radical surgery 5 years survival rate depends on the gastric wall invasion depth and growth pattern of lymph node involvement and tumor range. The prognosis of early gastric cancer is good, such as invasion and mucosal layer, the 5 year survival rate can reach more than 95% after surgery, such as the involvement of the submucosa, often with local lymph node metastasis, the survival rate of about 5 years is about 70%. The tumor is a kind of intestinal type and the appearance of mass, the resection rate is high, and the prognosis is better than that of the patients with early metastasis. The prognosis is poor. If the tumor had invaded the muscular layer, but the operation was not found to have lymph node metastasis, postoperative 5 years survival rate is up to 60 to 70%; as has been deep into the muscle or serosal layer and local lymph node metastasis, the prognosis is very poor, 5 year survival rate is only about 20%.
Prevention of gastric cancer
Due to factors of gastric cancer is unknown, the lack of effective prevention methods, it can adopt the following measures:
First, change the food storage methods, less into the pickled, smoked food, prevent high salt diet, quit smoking wine, eat more fresh fruits, vegetables, eat meat dairy.
Two, active treatment and the incidence of gastric cancer related diseases, especially for high-risk groups need regular follow-up.
Three, the establishment of a high incidence of prevention and control network to facilitate early detection and prevention.
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