My sister was diagnosed with gastric cancer on the last day of September, 217. The preoperative gastroscopy pathology was poorly differentiated adenocarcinoma of the gastric body, and the postoperative pathological stage was T2N1M (27 peripheral lymph nodes were taken).

My sister's whole treatment process went smoothly.

radical surgery was performed in wuhan union hospital on October 11th, 217, in which 2/3 of the stomach was removed, and the operation mode was laparoscopic plus laparotomy (laparoscopic was talked about before operation, but laparotomy was changed during operation).

After the operation, I recovered in Hubei for 2 weeks and hurried back to Shenzhen to start the long road of chemotherapy. On November 1, 217, he received chemotherapy at the Cancer Center of Shenzhen Hospital of the University of Hong Kong. The scheme is the internationally accepted FLOX (intravenous oxaliplatin, capecitabine orally), with 8 courses of treatment, once every 21 days, lasting about 5 months. Eight times of chemotherapy, the first six times were completed on time and in quantity, the seventh time was delayed for a week because of severe bone marrow suppression, and the eighth time of chemotherapy was reduced to 75% because of severe bone marrow suppression and hand-foot syndrome.

On April 17, 218, my sister finished her last chemotherapy and pulled out PICC. Our family hugged and cried, which was distressing and even more gratifying!

On April 24th, 218, my sister suffered from unbearable back pain, and we returned to Hubei again. I found Professor Chen Yanchang in Hubei Cancer Hospital and started another treatment-Chinese medicine!

Up to now, my sister has taken Chinese medicine every morning and evening, checked tumor markers every three months, made enhanced CT of chest and abdomen every six months, and made gastroscope every year.

This year is the fourth year after my sister's operation. I hope my sister will survive this life disaster, and the next ten, twenty, thirty and forty years will be safe and smooth. I also wish you a speedy recovery.

If anyone is unfortunately suffering from gastric cancer, you need to choose the most appropriate treatment method according to your physical condition and tumor stage.

However, if there is an opportunity for surgery, then we still recommend surgery as the first choice. After all, surgery is the most fundamental way to cure early gastric cancer, and it is also one of the most important ways to fundamentally control the condition of gastric cancer with late stage.

If the gastric cancer is very early, and the tumor is located at the surface of the gastric mucosa, and there is no lymph node metastasis, you can choose to resect it under the gastroscope. This is a very small operation, and you only need to resect the focus of the stomach, and you don't need to resect the stomach. After the operation, you recover very quickly, and the treatment effect is quite good. After the operation, you don't need radiotherapy and chemotherapy.

second, middle-stage gastric cancer:

if lymph node metastasis or tumor invades the muscle layer of the stomach is not found in the early stage, it is middle-stage gastric cancer. If you don't want to drive, and because you are relatively old, such as over 85 years old, your physical condition is very poor and you can't tolerate surgery, you can consider not having surgery, and you can do radiotherapy and chemotherapy first.

Third, advanced gastric cancer:

If the patient has developed cancerous ascites, omentum, abdominal implantation metastasis, liver metastasis, etc., it is generally impossible to perform surgery, and only radiotherapy and chemotherapy can be done first. If HER-2 is positive, targeted therapy can be added to minimize their own pain and prolong their life.

Now let's talk about it in detail:

1. Chemotherapy is one of the most important ways to treat gastric cancer:

Compared with lung cancer and breast cancer, the progress of gastric cancer in recent years is relatively slow. So far, chemotherapy is still the most important way to treat gastric cancer. Therefore, if there is no chance for surgery, systemic chemotherapy is the first choice, and the effect of some patients is still good.

some patients with Her-2 positive can be treated with anti-Her-2 targeted therapy, and the side effects are relatively small, and the effect is not bad. However, after all, the proportion of patients with Her-2 positive is low in all gastric cancers, so there are not many patients with this targeted therapy opportunity.

Third, Chinese herbal medicine treatment:

In the absence of a better treatment, Chinese herbal medicine treatment is still one of the options that can be tried in the treatment of gastric cancer. Many targeted drugs for the treatment of gastric cancer are still in clinical trials, but not many of them have really achieved positive results. We expect more new drugs or new treatments to come out.

The treatment of gastric cancer is summarized as local treatment, and there are two kinds of systemic treatment.

Local treatment includes endoscopic resection, surgical resection (laparotomy or laparoscopy) and radiotherapy.

Systemic treatment includes chemotherapy, targeted therapy and immunotherapy.

Gastric cancer treatment can form different combinations according to different tumor stages of each patient.

Early gastric cancer can be removed under endoscope.

. Chemotherapy-surgery-postoperative chemotherapy can also be used < P > If lymph node dissection is not enough or the margin is positive, postoperative radiotherapy is needed < P > Chemotherapy, targeted therapy and immunotherapy are the main methods for stage IV gastric cancer. If the tumor shrinks significantly after treatment and there is a chance of radical treatment, surgery can be performed; If the patient has ascites, he can also do intraperitoneal hyperthermic perfusion chemotherapy, etc. < P > For digestive tract tumors such as gastric cancer, whether the first diagnosis and treatment are correct will basically determine the final treatment effect of the disease. Then, if you have stomach cancer, the correct way to treat it is to see a stomach cancer expert in a regular cancer specialist hospital or a general hospital in time.

how to treat

this is a very important step. There are professions, especially the treatment of cancer, and professional people do professional things. Be sure to consult a professional doctor of gastric cancer first. The treatment of gastric cancer is comprehensive, and the corresponding treatment schemes are different according to the different stages of treatment.

Endoscopic resection can be considered for early gastric cancer, but not all early gastric cancers are suitable for endoscopic resection, and the indications are decided by specialists. Endoscopic treatment of early gastric cancer must be cautious, and the radical treatment of tumor should not be sacrificed in pursuit of so-called minimally invasive endoscopic resection. Appropriate is the best. Before endoscopic treatment, we must strictly grasp the indications of endoscopic resection, and the staging examination must be perfect and accurate.

For advanced gastric cancer, whether to treat it directly by surgery or do neoadjuvant chemotherapy first, then consider surgical treatment. It is also necessary to analyze the specific situation.

If the local progress of the patient's lesion is not obvious, the lymph node metastasis is not fused or involves blood vessels, and it is judged that radical surgical resection can be performed before operation, direct surgical treatment can be suggested, and the adjuvant treatment and treatment scheme can be decided according to the pathological results after operation.

Patients who are at risk of bleeding or have already had bleeding are likely to have fatal massive bleeding during chemotherapy, and should be surgically removed first.

If the patient's general condition is good, the lesion has invaded the surrounding organs, and the lymph node metastasis is obviously fused, it is suggested that neoadjuvant chemotherapy should be used for 2-4 cycles, and the operation opportunity should be decided according to the chemotherapy response. Generally, the operation should be performed about 1 month after chemotherapy.

For patients with advanced gastric cancer, surgery is not the best choice. Consider systemic chemotherapy first. Only when complications such as obstruction and perforation occur, palliative surgery to improve symptoms should be considered. For patients with resectable liver metastasis, there is still a chance of radical surgery after chemotherapy. For patients with advanced gastric cancer with abdominal cavity spread, intraperitoneal hyperthermic perfusion chemotherapy should be considered at the same time as systemic chemotherapy. For some sensitive patients, laparoscopic exploration should be performed after chemotherapy, and radical surgical resection can be considered if peritoneal metastases disappear.

Is the operation method open surgery or laparoscopic minimally invasive treatment?

A number of international large-scale clinical studies show that laparoscopic radical gastrectomy for middle and early gastric cancer is no different from traditional open surgery in terms of tumor radical effect and surgical safety, but it also has the advantages of less surgical trauma, faster postoperative recovery, less blood loss during operation and early ambulation. Laparoscopic minimally invasive surgery is exactly the same as open surgery in terms of tumor treatment principles, such as surgical resection range, lymph node dissection range, tumor-free principle, etc., but in the whole operation process, the patient's abdominal wall is relatively intact, the internal organs are isolated from the outside world, and the intraoperative trauma is small. At the same time, the magnifying effect of laparoscopy is more suitable for the surgeon's fine operation, and there is no dead angle of view, so as to achieve anatomical surgery.

It should be emphasized that open surgery and laparoscopic minimally invasive surgery are not antagonistic, but different surgical options and cooperate with each other. Regardless of minimally invasive surgery or open surgery, as long as it is the best choice for the specific patient's condition, it is the best surgery.

@ Dr. Liu Yongyi's number WD512

The stomach is located in the upper left of our abdomen, with the esophagus at the entrance (cardia doorway) and the duodenum at the exit (secluded doorway). It has a contraction, peristalsis and crescent-shaped pouch, and its main function is to "grind" food and accept all kinds of hard, spicy, sour, roasted and pickled food. Under the stimulation of external environment for a long time, gastric mucosal epithelial cells will gradually degenerate and form cancer cells, and then gastric cancer will occur. What should we do when gastric cancer occurs?

Don't panic. You can't make a hasty decision on how to treat it. First, do a comprehensive examination, clinical physical examination, routine blood biochemistry, gastroscopy, pathology, chest, abdomen, pelvic enhanced CT and so on in order to more accurately stage TNM. Only on the basis of objective and accurate staging, according to the existing medical guidelines and knowledge, the most suitable treatment scheme is selected.

Surgical resection is the main treatment for gastric cancer. Radical surgical resection can be considered when there is no distant metastasis, including distant lymph node metastasis, and the resection margin is more than 5cm away from the tumor. Therefore, proximal gastrectomy or total gastrectomy is performed for gastric cardia cancer, distal gastrectomy or total gastrectomy for gastric antrum cancer and total gastrectomy for gastric body cancer, so partial gastrectomy will probably remove about 2/3 of the stomach. There is no need for adjuvant therapy in the first stage, and postoperative adjuvant chemotherapy is needed in the second and third stages. In the third stage, preoperative neoadjuvant chemotherapy can be selected according to the situation to help reduce the stage and improve the resection rate and therapeutic effect.

in general, drug therapy is the main treatment for stage ⅳ gastric cancer. Unless palliative surgery is considered for bleeding, obstruction and perforation, tumor reduction surgery is generally not performed. Chemotherapy is the most important thing, and it can be treated with anti-angiogenesis targeted drugs if conditions permit. At present, immune checkpoint inhibitors have not been used for clinical treatment in our country, and will be available in the future.

Chinese medicine is a part of the comprehensive treatment of gastric cancer, and it is an aid, and it cannot be used alone, especially when it is operable. This conclusion comes from all medical guidelines and knowledge. This is not a dispute between traditional Chinese and western medicine, but learning from each other's strengths and complementary advantages, considering the patient's survival time.

I'm Dr. @ Liu Yongyi, thank you for reading!

The vast majority of malignant tumors occurring in the stomach are malignant tumors originating from the epithelial tissue of gastric mucosa, which is usually called gastric cancer. It is difficult to find early gastric cancer without obvious symptoms. When the condition continues to worsen, there will be more serious symptoms such as indigestion, epigastric pain, mass, vomiting and melena. Once gastric cancer occurs, surgery, chemotherapy, radiotherapy and molecular targeted drugs should be selected according to the patient's physical condition and pathological stages, among which surgery is the most important method to treat gastric cancer.

1. stage I gastric cancer: it belongs to early gastric cancer. surgical resection is the main treatment method, and different surgical methods are selected according to the location and size of the lesion. The tumor is 2cm in diameter, and endoscopic mucosal resection can be used when there is no lymph node metastasis. However, the depth, histological type and size of tumor infiltration into gastric wall should be accurately evaluated before operation, and regional lymph node dissection should be carried out at the same time as routine radical surgery. Patients with lymph node metastasis and tumor invading muscle layer should be treated with chemotherapy or radiotherapy after operation to consolidate the curative effect.

2. stage ⅱ gastric cancer: according to the size and location of the tumor, choose the standard surgical method of subtotal or total gastrectomy for treatment. At the same time, regional lymph node dissection was performed, but splenectomy was not needed. Adjuvant chemotherapy or radiotherapy is needed after operation.

stage 3. ⅲ gastric cancer: the relative surgical method is selected according to different stages and lymph node metastasis. Patients who have not found extensive lymph node metastasis during surgical exploration can undergo radical resection. Adjuvant chemotherapy or radiotherapy is needed after operation.

stage 4. ⅳ gastric cancer: when there is no distant metastasis, radical surgery should be performed as far as possible, followed by adjuvant radiotherapy. Palliative chemotherapy can be performed when there is distant metastasis and the patient is generally in good condition. Patients with cardiac or pyloric obstruction can be treated with endoscopic laser therapy or implanted with endoluminal stent to relieve obstruction. Palliative radiotherapy can alleviate the complications such as bleeding, pain and obstruction caused by tumor. Palliative surgery can also be considered when patients with gastric cancer are accompanied by persistent bleeding or obstruction caused by tumors.

5. targeted drug therapy: for patients with gastric cancer whose HER2 gene is positive, chemotherapy can be combined with molecular targeted drug therapy.

6. treatment of recurrent gastric cancer: usually palliative chemotherapy is given together with glutathione and granulocyte stimulating factor. People with obstructive symptoms can be treated by endoscopic laser therapy and electrocautery. In addition, palliative radiotherapy can also relieve bleeding, pain and obstruction caused by tumor.

thank you for reading!

Gastric cancer refers to the malignant tumor originating from gastric mucosal epithelial cells, mainly gastric adenocarcinoma, which accounts for more than 95% of gastric malignant tumors. Gastric cancer is still the most common malignant tumor in China, with the morbidity and mortality of men higher than that of women, and the high incidence age is 55-7 years old.

So, how to treat gastric cancer?

When there is no lymphatic metastasis in early gastric cancer, endoscopic treatment can be adopted. Advanced gastric cancer can be treated by surgery when there is no systemic metastasis. After tumor resection, Helicobacter pylori (Hp) infection in the residual stomach should be removed as much as possible.

first, endoscopic treatment, early gastric cancer, especially mucosal cancer, can be treated by endoscopic mucosal resection or endoscopic submucosal dissection, which is suitable for patients with high or moderate differentiation, no ulcer, diameter less than 2cm and no lymphatic metastasis. Pathological examination should be carried out for the resected cancerous tissue. If it is found that the cancerous or superficial cancer invades the submucosa, additional surgery must be performed.

second, surgical treatment, early gastric cancer, can take partial gastrectomy, advanced gastric cancer if there is no distant metastasis, as far as possible radical resection; Palliative resection with distant metastasis is feasible, and surgical resection plus regional lymph node dissection is the main means to treat advanced gastric cancer.

third, chemotherapy, early gastric cancer without metastasis, generally do not need chemotherapy after surgery. Gastric cancer is not sensitive to chemotherapy, but chemotherapy still has a certain effect, which can shrink the tumor and increase the chances of radical surgery and cure. Postoperative chemotherapy mainly includes intravenous chemotherapy, intraperitoneal chemotherapy, continuous intraperitoneal warm perfusion and targeted chemotherapy.

Fourth, other treatments, somatostatin analogues and COX-2 inhibitors can inhibit the growth of gastric cancer and improve the quality of life of patients.