1, more than 70% of early gastric cancer has no obvious symptoms. With the development of the disease, nonspecific symptoms similar to gastritis or gastric ulcer may gradually appear, including fullness and discomfort or dull pain in the upper abdomen, pantothenic acid, belching, nausea, occasional vomiting, anorexia, dyspepsia, melena and so on.
2. The symptoms of advanced gastric cancer (that is, advanced gastric cancer) are pain in the stomach area, frequent biting, which has no obvious relationship with eating, and also has pain similar to peptic ulcer, which can be relieved after eating. Abdominal fullness, heaviness, anorexia, abdominal pain, nausea, vomiting, diarrhea, emaciation, anemia, edema, fever, etc. The main manifestations of cardiac cancer are subaxiphoid discomfort, pain or retrosternal pain, accompanied by eating obstruction or dysphagia; Cancer of the fundus of stomach and lower cardia often has no obvious symptoms, and it does not attract attention until the tumor is huge and necrotic, causing upper gastrointestinal bleeding, or until the tumor infiltrates into the cardia and causes dysphagia. Tumors in the body of stomach are mostly swollen, and pain and discomfort appear later. Ulcer cancer is the most common form of gastric antrum, so the symptoms of upper abdominal pain appear earlier. When the tumor extends to the secluded doorway, it can cause symptoms of pyloric obstruction such as nausea and vomiting. The spread and metastasis of cancer can cause ascites, hepatomegaly, jaundice and metastasis of lung, brain, heart, prostate, ovary and bone marrow, and produce corresponding symptoms.
(2) Signs of patients with gastric cancer
Most patients with gastric cancer have no obvious signs, and some patients have mild tenderness in the upper abdomen. Advanced gastric cancer located in pyloric antrum or stomach body can sometimes be palpated as a lump, which is often nodular and hard. When the tumor infiltrates into adjacent organs or tissues, the mass is often fixed and cannot be pushed. When a female patient palpates a mass in the middle and lower abdomen, it is often suggested that it is Crockenbeier tumor. When gastric cancer has liver metastasis, nodular masses can be touched in the swollen liver. Obstructive jaundice can occur when abdominal metastatic masses compress the common bile duct. In patients with pyloric obstruction, the enlarged stomach type can be seen in the upper abdomen, and the sound of shock can be heard. When the cancer metastasizes through the thoracic duct, the left supraclavicular lymph nodes can be enlarged. When there is pelvic implantation in advanced gastric cancer, rectal digital examination can palpate bladder (uterus) rectal fossa nodules. Ascites can occur when there is peritoneal metastasis. Intestinal stricture caused by small intestine or mesenteric metastasis can lead to partial or complete intestinal obstruction. Diffuse peritonitis caused by cancer perforation can cause symptoms of peritoneal irritation such as plate-like stiffness and abdominal tenderness in supine position, and can also infiltrate organs adjacent to the cavity to form internal fistula. (3) Common complications of gastric cancer
1, combined with gastrointestinal bleeding, dizziness, palpitation, tarry stool and vomiting of brown substances may occur.
2. When the abdominal metastasis of gastric cancer oppresses the common bile duct, jaundice and stool clay color may appear.
3, combined with pyloric obstruction, vomiting may occur, and increased stomach type, odor and shock sound can be seen in the upper abdomen.
4, diffuse peritonitis caused by cancerous perforation, can appear supine plate stiffness, abdominal tenderness and other peritoneal irritation symptoms.
5, the formation of gastrointestinal fistula, see the discharge of indigestible food. Clinical diagnosis method
Gastric cancer should be differentiated from gastric ulcer, simple gastric polyp, benign tumor, sarcoma and chronic gastric inflammation. Sometimes it needs to be differentiated from hypertrophy of gastric folds, giant folds, prolapse of gastric mucosa, hypertrophy of pyloric muscle, severe gastric varices and so on. Differential diagnosis mainly depends on X-ray barium meal radiography, gastroscopy and biopsy.
(a) early suspected gastric cancer, low or lack of free gastric acid, such as hematocrit, hemoglobin, erythrocytopenia, fecal occult blood (+). Low total hemoglobin, white/ball inversion, etc. Laboratory abnormalities such as water-electrolyte disorder and acid-base imbalance.
(2) X-ray findings: Double contrast radiography of gas and barium can clearly show the outline, peristalsis, mucosal morphology, emptying time, filling defect and niche of the stomach. The accuracy of the test is close to 80%.
(3) Fiberoptic endoscopy is the most direct, accurate and effective diagnostic method for gastric cancer.
(4) exfoliative cytology when clinical and X-ray examination suspected gastric cancer, some scholars advocated this examination.
(5) B-ultrasound can know whether the surrounding parenchymal organs have metastasized.
(6) CT examination to understand the invasion of gastric tumor, the relationship with surrounding organs, and the possibility of resection.
Differentiation between gastric cancer and other malignant tumors;
(1) Primary gastric malignant lymphoma: Primary gastric malignant lymphoma accounts for 0.5% ~ 8% of gastric malignant tumors, and it is mostly found in young adults and prone to gastric antrum. Its clinical manifestations are similar to those of gastric cancer. About 30% ~ 50% of Hodgkin's disease patients have persistent or intermittent fever, and the detection rate of X-ray barium meal examination can reach 93% ~ 100. X-ray signs are diffuse gastric mucosal folds with irregular thickening, irregular multiple ulcers, large mucosal folds at the edge of ulcers, and single or multiple circular filling defects, showing "goose egg stone"-like changes. Gastric lymphoma should be considered first when gastroscopy shows huge gastric mucosal folds, single or multiple polypoid nodules, surface ulcers or erosion.
(2) Leiomyosarcoma of stomach: Leiomyosarcoma of stomach accounts for 0.25% ~ 3% of gastric malignant tumors, accounting for 20% of gastric sarcoma. Leiomyosarcoma of stomach is more common in the elderly, and mainly occurs in the stomach floor and body. Tumors are usually > > 10cm, spherical or hemispherical, and large area ulcers may occur after ischemia. According to the location, it can be divided into: ① intragastric type (submucosal type), and the tumor protrudes into the gastric cavity; (2) Extragastric (subserous type), the tumor grows outside the stomach; ③ Gastric wall type (dumbbell type), the tumor grows inside and outside the stomach.
accessory examination
(1) Gastrointestinal X-ray examination
It is the main examination method of gastric cancer, including the projection of different fullness to display mucosal lines, such as the double contrast of pressure projection power, especially the double contrast of barium and air, which is very valuable for detecting gastric wall micro-lesions.
1. The X-ray manifestations of early gastric cancer are under appropriate pressure or double contrast. Uplift type is often characterized by small filling defect, incomplete surface, slightly wider basal part, thickening and disorder of nearby mucosa, which can be distinguished from benign polyps.
Superficial type: the mucosa is flat with granular hyperplasia or slight discoid protrusion on the surface. Some patients can see a small piece of barium accumulation, or a relatively small protrusion when filling. Generally, there is still peristalsis in the lesion site, but the stomach wall is slightly harder than normal.
Depression type: shallow niche shadow can be seen, the bottom is rough, the stomach wall can be slightly harder than normal, but peristalsis and contraction still exist. Under pressure or double contrast, barium can be seen in the depressed area, the shadow is light, the shape is irregular, and the adjacent mucosal lines are often interrupted in a pestle shape.
2. The X-ray manifestations of advanced gastric cancer are mushroom-shaped: it is a filling defect protruding from the gastric cavity, which is generally large, irregular in outline or lobulated, with a wide base, and irregular niches often appear at the filling defect due to ulcers on the surface. The gastric mucosal line around the filling defect is interrupted or disappeared. The stomach wall is slightly hard.
Ulcer type: mainly manifested as niche shadow, irregular ulcer mouth, finger print sign and ring dike sign, and the surrounding folds are nodular hyperplasia, sometimes suddenly interrupted at the ring dike. Mixed patients usually have ulcers, accompanied by hyperplasia and infiltrative changes.
Infiltration type: Localized patients show abnormal thickening or disappearance of mucous membrane line, hard stomach wall and narrow stomach cavity. When taking pictures at the same position at different times, double shadows may appear on the stomach wall, indicating that the normal peristalsis and stiff stomach wall are heavier. Extensive infiltration of mucosal folds flattened or disappeared, the gastric cavity was obviously reduced, the whole gastric wall was stiff, and no peristalsis wave was found.
(2) Endoscopy
It can directly observe all parts of the stomach and has great diagnostic value for gastric cancer, especially early gastric cancer.
1. Prominent early gastric cancer is mainly characterized by local mucosal protrusion, protruding into the gastric cavity, pedicled or wide base, rough surface, some papillary or nodular, and erosion on the surface. The superficial type is characterized by irregular boundary, rough local mucosa, unclear boundary, slight uplift or depression, light or red surface color and erosion, which is the easiest to miss diagnosis. Concave ulcer is obvious, and the depression is more than mucosal layer. The above types can be combined to form mixed early gastric cancer.
2. Advanced gastric cancer often has typical manifestations of gastric cancer, and endoscopic diagnosis is not difficult. Uplift lesions are large in diameter and irregular in shape, showing cauliflower or chrysanthemum shape.
(3) Examination of gastric juice
About half of patients with gastric cancer have gastric acid deficiency. The lactic acid content in basal gastric acid can be higher than the normal value (100μg/ml). However, gastric juice analysis is of little significance in the diagnosis of gastric cancer.
(4) Biological and biochemical examination
Including the immune response of cancer, the determination of Bennett's chemical composition and enzyme reaction. The ratio of serum pepsinogen ⅰ to blood pepsinogen ⅰ/ⅱ; CEA, CA 19-9, CA 125 and other carcinoembryonic antigens and monoclonal antibodies, but these tests have high false positive and false negative, and their specificity is not strong.