Based on gastroscopy, gastric cancer is divided into early gastric cancer and progressive gastric cancer
Early gastric cancer: it refers to the cancer limited to the mucous membrane or submucous layer. Gastroscopy reveals small polypoid elevations (also known as cancer foci), of which those with a diameter of less than 1 are called small gastric cancers; those with a diameter of less than 0.5 are called micro gastric cancers.
The cure rate of early gastric cancer is now more than 90%, but once diagnosed, most of the disease is already in the advanced stage, and the 5-year survival rate is at a low level. Especially for patients with metastasis, the treatment is difficult and the prognosis is not favorable.
Progressive gastric cancer, also known as intermediate and advanced gastric cancer, refers to gastric cancer in which the infiltration of cancer tissue exceeds the submucosal layer or infiltrates the whole layer of gastric wall, and it is conceivable that the deeper the infiltration, the worse the prognosis.
For early gastric cancer, surgical treatment is still the main means in medicine, and commonly used surgical methods are as follows:
I. Laparoscopic surgery
Most of the patients can be treated by mucosal resection through gastroscope, which is mostly used for early gastric cancer or part of progressive gastric cancer, and the symptoms of gastric cancer will be accompanied by heaviness, anorexia, abdominal pain, nausea, fever and so on. Patients can be treated by laparoscopy, which is not only less traumatic, but also can carry out radical treatment and get early recovery.
The results of the study showed that the total resection rate of patients treated with endoscopic mucosal resection was about 56%, and we can realize that on the basis of one-time complete resection of the lesion, we can further expand the scope of indications for surgery and maximize the cure rate. Comparing traditional open surgery with endoscopic surgery, the 5-year survival rate of patients with early gastric cancer can reach more than 90% after treatment with this treatment modality.
Second, traditional open surgery
Traditional open surgery is the same as laparoscopic surgery, which is suitable for early gastric cancer or part of progressive gastric cancer, and is more traumatic than laparoscopic surgery.
Third, radical resection surgery
It is generally used in the middle stage of gastric cancer. There are two types of surgery: 1. resection of the concurrent range as well as a part of duodenum and regional lymph nodes with residual cancer cells; 2. resection of the whole stomach or transverse colon, spleen and so on in addition to the range to be resected as mentioned above.
The difference between the two is the scope of gastric resection and the scope of lymph node removal, which should be chosen according to the specific condition of the patient in order to maximize the cure rate of gastric cancer.
Fourth, palliative resection
It is suitable for patients with advanced gastric cancer. When the patient's peritoneum or lymph nodes have been widely metastasized, traditional surgery can not be carried out, and palliative resection can reduce the tumor load of the body well, and improve the survival rate of the patient compared with other non-surgical treatments.
After surgery, patients also need careful postoperative care to reduce the chance of complications and consolidate treatment.
Postoperative precautions for gastric cancer patients:
1. Compared with normal people, postoperative patients have poor digestive function, so it is better to control the amount of food they eat, let them eat more fluid and easy-to-digest diets, eat small amount of meals, increase the intake of proteins, and gradually increase the amount of diet, so as to enhance the immune system of the patients.
Second, to ensure that the dietary care is perfect at the same time, but also let the patient to maintain the correct lying position, deep breathing, turn over, etc., to prevent lung infection, to avoid complications, to be regularly reviewed, to improve the overall quality of life.
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For early gastric cancer, there is a clear definition, that is, gastric cancer confined to with the mucous membrane and submucosal layer, no matter whether lymph node metastasis occurs or not. The incidence of lymph node metastasis in early gastric cancer confined to the mucosa is about 3%, while the incidence of lymph node metastasis in early gastric cancer that has progressed to the submucosa can be up to 20%. Whether or not lymph node metastasis occurs is significantly associated with the prognosis of early gastric cancer, and it also influences the choice of treatment options.
Early gastric cancer generally has a good prognosis, and the 5-year survival rate can reach 95%, and the 5-year survival rate of early gastric cancer confined to the mucosal layer without lymph node metastasis is almost 100%. The treatment of early gastric cancer is divided into endoscopic resection and surgical resection. The 2011 version of China's former Ministry of Health's Gastric Cancer Diagnostic and Treatment Guidelines states that endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) can be used as an alternative to surgery for some early gastric cancers, but it is limited to be carried out in experienced centers. The absolute indications for endoscopic treatment are intramucosal carcinomas less than 2 cm, visible to the naked eye (cT1a), and well-differentiated tissue types such as papillary adenocarcinoma and highly differentiated tubular adenocarcinoma. In the broad type of early gastric cancer, it is limited to the non-ulcerative type. Some expanded indications for endoscopic treatment have been derived on this basis, such as non-ulcerative type of more than 2 cm with well-differentiated tissue types and tumors confined to the mucosa (cT1a), non-ulcerative type of less than 3 cm with well-differentiated tissues, cT1a, and non-ulcerative type of less than 2 cm with undifferentiated cT1a. If there is no vena cava invasion and the metastasis rate of the lymph nodes is low, the indications can be appropriately expanded, but the After expanding the indications, EMR often cannot be completely resected, and ESD is needed to be more stable. If the pathological type of early gastric cancer is confirmed to be poorly differentiated, with vascular invasion and lymph node metastasis, endoscopic resection is no longer safe at this point and surgical treatment is needed. The extent of gastric resection is related to the location of the tumor, on the basis of which effective lymph node dissection is performed.
For the depth of tumor invasion and lymph node metastasis in early gastric cancer, it mainly relies on enhanced CT and ultrasound endoscopy. It has been reported in the literature that the accuracy of CT on the depth of tumor invasion is about 75%-85%, and the accuracy of lymph node metastasis is about 66%. The accuracy of ultrasound endoscopy in determining the depth of tumor invasion is about 75%, and the 8th edition of AJCC/UICC gastric cancer staging recommends ultrasound endoscopy as the main means of T (depth of tumor invasion) staging.
The definition of the term early gastric cancer, in fact, there is still some disagreement. The term early gastric cancer was first defined in 1971 by the Japanese Society of Gastroenterology and Endoscopy: gastric cancer is considered early gastric cancer when the cancer is confined to the mucous membrane and/or submucosa, regardless of the presence of metastases in lymph nodes. This is different from the definition of many other cancers, where the definition of early stage of many cancers means that the tumor is confined to the organ envelope, and once there are lymph node metastases, it is no longer called early stage. In the case of stomach cancer, since Japan is a high incidence area for stomach cancer, Japan has sufficient experience and is more vocal about early diagnosis and treatment of stomach cancer. So for a long time the definition of early gastric cancer was the above expression. Including the textbook we went to school with more than ten years ago, the definition of early gastric cancer was one of the examination points of surgery. The significance of this definition is that it seems to suggest that the most important factor in predicting the outcome of gastric cancer treatment is the depth of tumor invasion. This is of course confirmed by a lot of data. For example, data from a Japanese study showed that patients with gastric cancer limited to mucosal lesions had a 5-year survival rate of 100%, and patients with submucosal invasion had a 5-year survival rate of 90%. Of course, later studies have found that there is actually a correlation between the depth of tumor invasion and the probability of lymph node metastasis. The incidence of lymph node metastasis in gastric cancer confined to the mucosa was 6%, while the incidence of lymph node metastasis in gastric cancer invading the submucosa was 28%. Later studies also found that if more than 3 lymph node metastases were present, then even if the lesions were confined to the mucosa or submucosa, patients had significantly worse outcomes.
So, overall no matter from which definition of early gastric cancer, the treatment effect is better, and the 5-year survival rate is generally up to 90% or more. Of course, the relative therapeutic effect is still different for different depth of invasion and different lymph node metastasis. The shallower the depth of tumor invasion, the better the survival rate of patients without lymph node metastasis. According to the data reported by different scholars, that is, the 5-year survival rate, whether in Japan, China, Europe and the United States, the 5-year survival rate of early gastric cancer is almost always more than 90%. Many people don't understand the term 5-year survival rate very well, 5-year survival, in fact, is not exactly equal to cure, but due to the limitation of energy, most scholars count more 5-year survival time. The survival rate of early gastric cancer is higher, and there are many scholars statistic 10 years survival rate or 15 years survival rate. Most of Japanese scholars' 10-15 years survival rate of gastric cancer is considered to be almost the same as that of normal non-gastric cancer people of the same age, which is basically equivalent to saying that early gastric cancer does not affect survival after treatment. However, the data from Europe and the United States are slightly worse, with the 10-year survival rate for early gastric cancer reported to be between 84% and 92% by different data. In a French long-term follow-up study of patients with early gastric cancer, the 15- and 20-year survival rates dropped to 58 percent and 51 percent, respectively. However, this includes mortality from all causes, not necessarily because of death from gastric cancer, and if a normal average 65 year old dies, he or she is likely to die of other causes over a 15-20 year period as well.
So, instead of looking at the survival data, it is better to look at the recurrence data, and in the Japanese data, it is almost always considered that the chance of recurrence after surgery for early gastric cancer is less than 5%. However, in European and American reports, the recurrence rate after surgery for early gastric cancer is usually higher, with most reports ranging from 5% to 15%. This is a multifactorial result, which may be related to the biological characteristics of gastric cancer in East Asian populations, population genetic factors, and the degree of treatment standardization. In conclusion, it seems that the prognosis of early gastric cancer in East Asians is a bit better than that of Europeans and Americans.
Therefore, compared with the middle and late gastric cancer, the treatment effect of early gastric cancer is obviously very good. Take Japan, where the treatment level of gastric cancer is very high, compared with the 5-year survival rate of early gastric cancer of about 96%, the 5-year survival rate of middle and late gastric cancer is only 50% and 5.7%. Therefore, early diagnosis and treatment of gastric cancer is very important. For people with high risk of developing gastric cancer, they should do gastroscopy regularly in order to detect gastric cancer at an early stage so as to get the best therapeutic effect by early treatment.
Overview
Early gastric cancer (EGC) refers to invasive gastric cancers with invasion depth not exceeding the submucosal layer, with or without lymph node metastasis. These cancers have a significantly better prognosis than progressive gastric cancers (5-year survival rate of about 90%). As many as half of all gastric adenocarcinomas are resected for EGCs in Japan and East Asia, and in Japan, with the introduction of screening programs, the proportion has risen from 15% to as high as 57%.
Early manifestations of gastric cancer
(1) Loss of appetite Early gastric cancer often manifests suddenly with loss of appetite and aversion to grease. This should be distinguished from hepatitis. Hepatitis often has elevated aminotransferases as well as systemic symptoms such as fever and fatigue, yellow urine with strong tea color and jaundice.
(2) epigastric discomfort and fullness There is often a feeling of burning, noisy and fullness in the abdomen, especially after meals, and with the development of the disease, the symptoms are getting worse. These symptoms should be distinguished from indigestion and chronic gastritis. Dyspepsia often has a history of careless eating and overeating, while chronic gastritis often has a history of recurring episodes.
(3) Nausea, warmth, acid reflux and vomiting When the gastric cancer lesion is located in the pylorus at the gastric outlet, nausea is most obvious. If the gastric outlet is completely blocked, it will warm up a sour or egg odor, or there will be vomiting, and the vomit is mostly hangover and gastric fluid.
(4) Hidden pain in epigastric region The pain of early gastric cancer has no fixed time, or manifests as continuous hidden pain, unlike gastric ulcer or duodenal ulcer, which is characterized by more obvious after-meal pain or before-meal pain. If the patient originally thought to have gastric or duodenal ulcer disease, the regularity of pain can be changed suddenly, and the drugs which are effective in treating ulcer disease suddenly become ineffective or the effect is obviously reduced.
(5) Sharp wasting and severe anemia Because cancer is a kind of consumptive disease, and gastric cancer causes maldigestion, malabsorption and gastrointestinal hemorrhage, which aggravates wasting and anemia.
(6) Vomiting blood and black stool If the cancer only destroys small blood vessels, it is often manifested as "occult blood" in stool, i.e., although the appearance of stool is normal, the laboratory test can find that there are blood cells in it. If the cancer only destroys small blood vessels, it usually manifests as "occult blood" in stools, i.e. blood cells can be found in stools though their appearance is normal. The occult blood and black stool of gastric cancer are persistent and stubborn, while the bleeding caused by gastric and duodenal ulcer is intermittent and can be stopped after timely treatment.
(7) Unexplained fatigue, wasting or progressive anemia: patients often feel weak, weight loss gradually, within 2-3 months can fall 3 5 pounds.
(8) the original chronic gastric pain pattern changes: such as the previous abdominal pain or after eating the pain of the regularity of the obvious, the recent regularity disappeared, or the original treatment of effective drugs is now poor.
(9) Signs of early gastric cancer: there are no obvious signs, and most of the patients only have deep epigastric pressure pain or mild muscle tension enhancement.
(10) Paraneoplastic syndromes: Paraneoplastic syndromes can appear before gastric cancer, which mainly include: (1) recurrent thrombophlebitis; (2) acanthosis nigricans, with skin pigmentation, especially in the axillae; (3) dermatomyositis, etc.
(11) Early gastric cancer signs: There are often no obvious signs.
Can early gastric cancer be cured?
Survival rate of early gastric cancer The survival rate is 97.8% at 3 years after operation, 90.9% at 5 years and 61.9% at 10 years. Those whose cancerous tissue infiltration is limited to mucous membrane layer and submucous membrane layer are early gastric cancer. The criterion for judging early gastric cancer is not the size of its area and whether there is local lymph node metastasis, but its depth. Gastric cancer can be said to be one of the major malignant tumors in our country. The high incidence area of gastric cancer has a wide distribution, and its mortality rate accounts for about 24% of all malignant tumors, which is the first place of all kinds of cancer mortality.
High-risk groups
1. Suffering from precancerous lesions: precancerous lesions refer to benign diseases with cancerous tendency, such as: (1) chronic atrophic gastritis, the cancerous rate can be up to 10%; (2) chronic gastric ulcers, the cancerous rate is less than 3%; (3) gastric polyps, the diameter of which is up to > 2cm, the cancerous rate of those who have multiple occurrences and wider base is high; (4) those who have partial resection of the stomach, the cancerous rate of the residual stomach can be up to 0.3%-10%; (5) those who have partial resection of stomach, the cancerous rate of the residual stomach can be up to 0.3%-10%. 0.3%-10%; (5) other precancerous lesions, such as giant gastric mucosal hypertrophy, verrucous gastritis, etc.; (6) gastroscopic biopsy pathology: ① heteromorphic hyperplasia, also known as atypical hyperplasia, caused by chronic inflammation, such as the development of severe atypical hyperplasia can be regarded as a precancerous lesion or even early cancer; ② gastric interstitial changes are more likely to be cancerous; ③ intestinal mesenteric growths of the large intestine have a close relationship with the occurrence of gastric cancer.
2. Poor dietary habits: such as irregular diet, fast food, high salt/hot food, pickled, smoked, dried seafood with high content of carcinogen nitrite, overnight food, barbecued red meat, moldy food, and less fresh vegetables.
3, long-term alcoholism and smoking: Alcohol can make the mucosal cells change and cause cancer. Smoking is also a strong risk factor for stomach cancer, and those who start smoking in adolescence have the greatest risk.
4. Family history of gastric cancer or esophageal cancer: the incidence rate of gastric cancer in patients' family members is 2-3 times higher than that in normal population.
5. Long-term poor psychological state: such as repression, sorrow, longing, loneliness, depression, hatred, aversion, low self-esteem, self-blame, guilt, tension in interpersonal relationship, mental collapse, sulking, etc., the risk of gastric cancer is significantly higher.
6. Certain special occupations: long-term exposure to sulfuric acid dust mist, lead, asbestos, herbicides and metal industry workers, the risk of stomach cancer is obviously elevated.
7, geology, water quality containing harmful substances: geology of volcanic rocks, high peat, there are deep and large faults in the region, the Ca/SO4 ratio in water is small, while nickel, selenium and cobalt content is high. Volcanic rocks contain high levels of 3,4 benzo(a)pyrene, peat organic nitrogen and other nitrosamine precursor content is high, easy to damage the gastric mucosa. Selenium and cobalt can also cause gastric damage, nickel can promote the carcinogenic effect of 3,4 benzo(a)pyrene.
8, Helicobacter pylori (Hp) infection: some studies say that about half of the stomach cancer and Helicobacter pylori infection. About 60% of the national population is infected with this bacteria, but only 0.03% of the population suffers from stomach cancer.
Principles of treatment
The principle of comprehensive treatment should be adopted clinically. That is to say, according to the patient's physical condition, the pathological type of the tumor, the invasion range (disease stage) and the development tendency, the existing treatments should be applied in a planned and reasonable way, so as to eradicate and control the tumor in the most substantial way, increase the cure rate and improve the quality of life of the patients. For patients who are to be treated with radiotherapy and chemotherapy, the treatment of gastric cancer is mainly divided into surgical treatment, radiotherapy and chemotherapy and their related treatments.
The five-year survival rate of early gastric cancer is very high, generally above 80%, which is related to patients' physique and mindset, condition, what kind of cancer i.e. the pathological condition of cancer, whether timely surgery and what kind of surgery, whether postoperative radiotherapy or chemotherapy, whether postoperative complications or recurrence, etc. Certainly, there is always a star of fully recovered cancer fighters, and there are always the cancer patients who have the cancer patients' party in the Cancer Hospital every year. There will always be survivors who have survived for more than five years at the annual gathering of anti-cancer patients in tumor hospitals. Mood and mentality are very important, don't scare yourself, and please consult and communicate with your doctor more often, and actively rest and cooperate with the treatment positively. Pay attention to eat easy to digest food, pay attention to dietary diversity and pay attention to light diet and do not eat pickled food, do not eat fried food, do not eat spicy and stimulating food, pay attention to the stool situation, keep the bowels smooth. In addition, we must relax and have a calm mind, take a walk and walk outdoors as appropriate, sunbathe as appropriate, do yoga or practice Tai Chi if possible, in order to better relax and regulate the body, improve the body and improve the anti-cancer capital to be a star of the anti-cancer industry.
Stomach cancer is still very lucky to be detected in early stage. In our country, the percentage of early gastric cancer is still relatively low, only 20%, and most of them are already in the progressive stage when they are detected, and the overall 5-year survival rate is less than 50%.
Early gastric cancer refers to infiltrative cancer limited to the gastric mucosa or submucosa, but due to the lack of specific symptoms, it is difficult to detect early gastric cancer through one's own senses, and basically it is found when doing gastroscopy screening.
The treatment of early gastric cancer is mainly surgical treatment, either endoscopic resection or surgical resection, the 5-year survival rate can be more than 90%. Take Japan as an example, Japan is a high incidence of gastric cancer, but the cure rate of gastric cancer in Japan is leading the world, reaching 85% in general. It is not that Japan has any miracle cure, but the gastroscopy and rate in Japan is quite high, and the gastric cancer screening has been widely promoted as a routine medical checkup program, so the early detection of gastric cancer means that the chances of getting the root cause of the disease are greatly improved.
In short, the cure rate of early gastric cancer is still very high. 5 years after the operation, the condition is still stable and there is no recurrence and metastasis, which means that it has reached the standard of clinical cure.
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Pathologically, all the cancer cells are limited to the mucous membrane layer and submucous membrane layer, regardless of whether there are blood and lymphatic metastases, they are all early gastric cancer. According to its morphology, early gastric cancer is divided into bulging type, superficial type and depressed type. The prognosis of early gastric cancer is relatively better than that of advanced gastric cancer, and the five-year survival rate of patients can be as high as 90% if detected and treated early. As long as it is cleanly removed by surgery and controlled by chemotherapy drugs, the prognosis of early gastric cancer patients is still optimistic. Progressive stomach cancer can be categorized into myxomatous, ulcerative, infiltrative and superficial types according to its morphology, among which ulcerative type is the most common. The important difference between advanced gastric cancer and early gastric cancer is whether the cancer cells have infiltrated the submucosal layer or not. Progressive gastric cancer with submucosal infiltration often needs radical gastric cancer surgery, and its prognosis is not as good as that of early gastric cancer. Correctly distinguishing between early gastric cancer and advanced gastric cancer is of great significance to the treatment and prognosis of patients. As long as early detection and active cooperation, early stomach cancer can be cured. I wish you good health and all the best!
Stomach cancer is a relatively common malignant tumor. However, the incidence of this malignant disease has a large geographical disparity globally, for example, the incidence of the United States is getting less and less, and it is very common and highly prevalent in Japan, China, Chile and Iceland and other countries. So, what is the condition of stomach cancer? And how should it be treated?
I. What are the risk factors for stomach cancer?
About 95% of stomach cancers are adenocarcinomas, originating from glandular cells in the stomach wall.
Gastric adenocarcinoma often begins in the inflammatory part of the stomach wall, and more and more studies confirm that Helicobacter pylori infection is the cause of most gastric cancers. This feature deserves everyone's vigilance and attention.
In addition, gastric polyps can evolve into cancer and should be removed promptly if detected.
Polyps can become cancerous if they contain glandular tissue, are more than 2 centimeters in diameter, or have multiple polyps.
Certain dietary factors also play a role in the development of gastric cancer, including high salt intake, high carbohydrate intake, and high intake of nitrates used as food preservatives.
These dietary habits should be emphasized in daily life to establish a reasonable dietary structure.
Second, what are the manifestations of stomach cancer?
In fact, early symptoms of stomach cancer are not obvious, so it is easy to be neglected.
Early symptoms are very similar to peptic ulcer disease, accompanied by burning abdominal pain, and unrelieved gastric ulcer symptoms after treatment foretell the possibility of stomach cancer. In addition, patients may notice a feeling of fullness after eating small amounts of food.
Difficulty in eating and malabsorption of vitamins and minerals can cause a decline in the patient's physique and weakness. Even in the absence of other symptoms, gradual loss of small amounts of blood can cause anemia, which manifests as fatigue, weakness and dizziness.
In a few cases, vomiting a large amount of fresh blood or black tar-like stool can occur. When stomach cancer develops further, obvious lumps can be touched in the patient's abdomen at the time of examination.
It should be noted that even in the early stage, small stomach cancer may spread to distant places.
The spread of stomach cancer can cause liver enlargement, jaundice, ascites and skin cancerous nodules.
Third, what is the early cure rate of stomach cancer?
Stomach cancer, like other malignant tumors, focuses on early prevention, early detection, early diagnosis and early treatment for prevention and treatment, in order to get the best treatment effect, to get more survival period, and to reduce patients' pain.
Less than 15% of gastric cancer patients have a survival period of more than 5 years.
The tumor may have metastasized to other parts of the body at a very early stage. If the tumor is confined to the stomach, surgical resection can be as curative as possible.
Removing the entire tumor before it metastasizes is the only hope for a cure. But this early detection and try to cure is only a good wish, often it is not the case, once the tumor is detected, it is in the middle and late stages and has already metastasized.
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Gastric cancer early in the malignant tumor disease in the cure rate is higher, the cure rate depends on the discovery period, the type of tumor and the effect of surgical treatment. The main treatment for gastric cancer is surgical resection, and the three-year survival rate after surgery can reach 97%, and the five-year survival rate is also above 90%.
If the tumor is in situ, the cure rate is higher than that of secondary gastric cancer. But gastric cancer recurrence rate is high, ten-year survival rate after surgery is less than 70%, and the mortality rate accounts for 24% of the number of all malignant tumors.
The early stage of gastric cancer is also prioritized, and the earlier it is found and the more timely the treatment is, the survival rate will be greatly improved. If early untreated not only will not be self-cured, but also will be transformed into middle and late stage, the chance of cure is getting smaller and smaller.
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Survival time after treatment for stomach cancer is relatively long. As long as the treatment program is correct. Patients are optimistic. It can be more than 5 years, such as a patient. Tumor 6.5cm. The hospital asked for surgery. The patient does not agree. He was determined to use Chinese medicine to treat the tumor and got good results. Fifteen years later, he is still alive and well. Television reported.