Disease analysis:
Gastric cancer is one of the common malignant tumors in China, and its incidence ranks first among all kinds of tumors in China. The incidence of gastric cancer in northwest China is the highest, followed by Northeast China and Inner Mongolia, followed by East China and coastal areas, and the lowest in Central South and Southwest China. Every year, about 6.5438+0.7 million people die of gastric cancer, which is almost 6.5438+0/4 of all malignant tumor deaths, and there are more than 20,000 new patients with gastric cancer every year. Gastric cancer is indeed a disease that seriously threatens people's health. Gastric cancer can occur at any age, but it is more common in 40 ~ 60 years old, and the ratio of male to female is about 2: 1. Its pathogenesis is unknown, which may be related to many factors, such as living habits, diet, environmental factors, genetic quality, mental factors, as well as chronic gastritis, gastric polyps, gastric dysplasia, intestinal metaplasia and so on. And long-term helicobacter pylori (HP) infection. Gastric cancer can occur anywhere in the stomach, but it is more common in the antrum of the stomach, especially in the small curvature of the stomach. According to the infiltration depth of cancer tissue, it can be divided into early gastric cancer and late gastric cancer (middle and late gastric cancer). The early symptoms of gastric cancer are often not obvious, such as unpredictable epigastric discomfort, dull pain, belching, pantothenic acid, loss of appetite and so on. Symptoms such as mild anemia are similar to gastroduodenal ulcer or chronic gastritis. Some patients take painkillers, anti-ulcer drugs or diet adjustment to relieve or relieve pain, so they are often ignored without further examination. With the progress of the disease, stomach symptoms gradually turned into obvious epigastric pain, loss of appetite, weight loss and anemia. Cancer metastasis, abdominal mass, left supraclavicular lymph node enlargement, melena, ascites and severe malnutrition often occur in the late stage. Because gastric cancer is very common and harmful in China, related studies believe that its etiology is related to eating habits and stomach diseases, so it is of great significance to understand the basic knowledge about 1 gastric cancer for the prevention and treatment of gastric cancer.
Guiding opinions:
Gastric cancer is the most common malignant tumor in China, and it occurs in any part of the stomach. More than half of it occurs in the antrum, small curvature and anterior and posterior walls of the stomach, followed by the cardia, and the body of the stomach is relatively rare. The treatment of gastric cancer mainly includes surgery, radiotherapy, chemotherapy and traditional Chinese medicine.
Surgery is still the main treatment for gastric cancer in the early stage, and drug therapy is supplemented according to different pathological examination results after operation, but traditional Chinese medicine must be used conservatively in the middle and late stage to alleviate the pain of patients, delay their life expectancy and improve their quality of life.
First, surgical treatment.
Due to the improvement of the diagnosis and treatment level of gastric cancer, the surgical indications have also expanded accordingly. At present, except for patients with huge and fixed primary focus, extensive visceral metastasis, bloody ascites with cachexia, as long as the patient's general situation allows, even if there are supraclavicular lymph nodes and metastatic nodules in the liver, laparotomy should be performed as far as possible to remove the primary focus and relieve symptoms. According to the statistics of domestic 1 1734 cases of gastric cancer surgery, the operation rate was 865,438+0.8%, and the total resection rate was 49.7%. In recent years, the resection rate of cancer has increased to about 75%, mainly for stage II and III gastric cancer.
The types of gastric cancer surgery are:
1. Radical resection: Radical resection includes radical resection and extended radical resection.
(1) The scope of radical resection should include the primary lesion, together with 2/3 or 4/5 of the distal stomach, the whole omentum, the first part of the duodenum and regional lymph nodes, locally infiltrated organs, and there is no residual cancer in the stomach or duodenum.
(2) To expand the scope of radical resection, in addition to the above contents, it is necessary to remove the whole stomach or the adjacent invaded transverse colon, left lobe of liver, spleen, pancreatic tail, left cardia and spleen vessels and adjacent lymph nodes. There is no consensus on the choice of the above two surgical methods, and the main difference lies in the scope of gastrectomy and lymph node dissection.
In order to improve the cure rate of gastric cancer, we should choose the operation method according to the specific condition, and we can't stipulate it rigidly. When the late stage of the disease is accompanied by deep lymph node metastasis or gastric body cancer and diffuse invasive cancer, extended radical surgery should be considered. Although extended radical surgery can improve the curative effect, the operative mortality and postoperative complications are still higher than radical surgery. This kind of operation can't take the place of radical operation.
2. Palliative gastrectomy: When gastric cancer has extensive peritoneal or lymph node metastasis and the primary tumor can be resected, patients can generally tolerate surgery and can undergo palliative gastrectomy. This operation can alleviate the poisoning symptoms of patients and eliminate complications such as obstruction, bleeding or perforation caused by cancer. Postoperative chemotherapy and traditional Chinese medicine treatment can prolong the survival time of patients.
Short-circuit surgery: suitable for patients with advanced gastric cancer who can not be surgically removed and accompanied by obstruction.
For example, patients with pyloric sinus cancer complicated with pyloric obstruction can undergo gastrojejunostomy before or after colon. Patients with cardiac cancer complicated with obstruction can adopt jejunoesophageal side anastomosis, which often requires thoracotomy to complete the operation, and the surgical indications should be stricter than the former. General shortcut surgery can not improve the curative effect, but it can alleviate the pain of patients and improve their quality of life.
Although the tumor can be removed by surgery, there are still cancer residues, regional lymph node metastasis or intravascular tumor thrombus, and the probability of recurrence and metastasis is very high. Long-term postoperative Chinese medicine treatment can prevent recurrence and metastasis.
Second, radiotherapy.
There are many radiation complications, even resulting in partial loss of function; For advanced cancer patients, the effect of radiotherapy is not perfect. At the same time, for patients with poor health and older age, continuing radiotherapy can only lead to life weakness and accelerate the death of patients. The radiosensitivity of gastric adenocarcinoma is low, only 60% of the tumors shrink by more than 50% after radiotherapy alone or combined chemotherapy, and only 65,438+00% of the tumors disappear completely. Therefore, gastric cancer cannot be cured by radiotherapy alone. The role of radiotherapy in the treatment of gastric cancer is mainly auxiliary or palliative. Mostly used for comprehensive treatment. The main forms of radiotherapy are preoperative radiotherapy, intraoperative radiotherapy, postoperative radiotherapy and palliative radiotherapy. According to the literature, preoperative radiotherapy can increase the radical resection rate by about 2% and the 5-year survival rate of advanced gastric cancer by 1% ~ 2.5%.
Thirdly, chemotherapy.
Except for a few patients after gastrectomy, most patients need postoperative chemotherapy. The reason is that there may be residual cancer cells after operation, or some gastric cancer is difficult to be completely removed by surgery, or there are metastatic lesions through lymph or blood system. Practice has proved that the survival time of postoperative chemotherapy for gastric cancer is longer and the recurrence is less. This is why doctors often arrange chemotherapy for patients before surgery.
Fourth, Chinese medicine treatment.
Surgery for advanced gastric cancer is unlikely, and even if it can be operated, it is only palliative local resection. Clinically, the treatment of advanced gastric cancer is mostly combined with radiotherapy and chemotherapy and traditional Chinese medicine, which fully combines the advantages of various treatment methods. Traditional Chinese medicine believes that this disease mostly belongs to the category of "nausea" and "epigastric pain". The pathogenesis is improper diet, excessive anxiety, spleen and stomach damage, transportation disorder and endogenous phlegm and blood stasis.
Life care:
The treatment principles of gastric cancer are: early detection, early diagnosis and early treatment.
Selection of treatment scheme for gastric cancer: ① Stage ⅰ gastric cancer can be regarded as early cancer, and radical surgical resection is the main method. Adjuvant chemotherapy is generally not recommended. ② Stage Ⅱ gastric cancer can be regarded as the middle stage, with radical surgical resection as the main method, followed by conventional chemotherapy and biological therapy. ③ Stage Ⅲ gastric cancer is advanced, and the operation is mainly extended radical operation. After operation, comprehensive therapies such as chemotherapy, radiotherapy and combination of traditional Chinese and western medicine should be emphasized. ④ Stage Ⅳ gastric cancer is advanced, and most cases can no longer be surgically removed.
Disease analysis:
Patient, male, 49 years old, how to treat gastric cancer?
Guiding opinions:
Gastric cancer is one of the most common malignant tumors in China. Even if you have surgery, radiotherapy and chemotherapy, don't take it lightly, because the surgery only removes the tumor visible to the naked eye, but the tiny cancer cells that spread in the blood and lymph can't be removed, and the side effects of radiotherapy and chemotherapy are too great to be carried out indefinitely. After surgery and radiotherapy, there are 1- 1 10,000 cancer cells left in the patient. Once treatment is stopped, the number of cancer cells will be higher than that of normal cells.
Life care:
Pay attention to rest after operation and review in time.
Disease analysis:
Hello, gastric cancer is one of the common malignant tumors in China.
Guiding opinions:
Gastric cancer is the most common malignant tumor in China, and it occurs in any part of the stomach. More than half of it occurs in the antrum, small curvature and anterior and posterior walls of the stomach, followed by the cardia, and the body of the stomach is relatively rare. The treatment of gastric cancer mainly includes surgery, radiotherapy, chemotherapy and traditional Chinese medicine.
Surgery is still the main treatment for gastric cancer in the early stage, and drug therapy is supplemented according to different pathological examination results after operation, but traditional Chinese medicine must be used conservatively in the middle and late stage to alleviate the pain of patients, delay their life expectancy and improve their quality of life.
Life care:
In short, surgery and comprehensive treatment can prolong the survival of patients.
Disease analysis:
You must trust the doctor and relax. A good attitude is the most basic condition for your recovery.
Guiding opinions:
Trust the doctor, this is the best advice I can give you, really. Relax and drink some tea and green tea properly, but please consult your doctor if it conflicts with your medicine. Green tea has inhibitory effect on cancer treatment.
Life care:
I wish you a speedy recovery. Relax and pay attention to your diet. ..
Disease analysis:
Hello, at present, the best treatment for gastric cancer is surgical resection. The earlier it is found, the earlier the operation, and the better the effect. If the operation is found early, it is possible to cure it.
Guiding opinions:
Gastric cancer is the most common malignant tumor in China, and it occurs in any part of the stomach. More than half of it occurs in the antrum, small curvature and anterior and posterior walls of the stomach, followed by the cardia, and the body of the stomach is relatively rare. The treatment of gastric cancer mainly includes surgery, radiotherapy, chemotherapy and traditional Chinese medicine.
Surgery is still the main treatment for gastric cancer in the early stage, and drug therapy is supplemented according to different pathological examination results after operation, but traditional Chinese medicine must be used conservatively in the middle and late stage to alleviate the pain of patients, delay their life expectancy and improve their quality of life.
Life care:
Prognosis of gastric cancer
The prognosis of gastric cancer depends on the location and scope of the tumor, tissue type, depth of gastric wall infiltration, metastasis, host reaction, surgical methods and so on.
The occurrence and development of gastric cancer is a long and complicated biological process, and there are many factors unrelated to treatment besides treatment.
1. It is related to the degree of gastric wall infiltration:
Early gastric cancer has a good prognosis. If it only invades the mucosa, the 5-year survival rate after operation can reach more than 95%.
The 5-year survival rate of patients with superficial muscle invasion is 50%, and that of patients with deep muscle invasion is 25%.
The 5-year survival rate of patients with serosa invasion is only 10%.
2. It is related to lymph node metastasis of gastric cancer:
Lymph node metastasis is the main route of gastric cancer metastasis and an important factor affecting the prognosis of gastric cancer patients. Perigastric lymph node metastasis is significantly related to the survival rate, and the 5-year survival rate is:
No lymph node metastasis 4 1. 1%.
The first stop loss shifts 13.3%.
The transfer rate of the second station is 10. 1%. It has been reported that the 5-year survival rate of patients with distant lymph node metastasis at the second station is 0%.
3. Related to the growth mode of tumor:
The growth mode of gastric cancer is one of the main manifestations of biological behavior of gastric cancer, which has been highly valued by pathologists in recent years. According to the infiltration growth mode of cancer tissue, it can be divided into three types. In China, Zhang Yinchang (1964) divided the growth modes of gastric cancer into:
Quality growth: the best prognosis.
Nested growth: somewhere in between.
Diffuse growth: the worst prognosis
I hope you will make a decision and have an operation as soon as possible, so as not to delay the best treatment opportunity.
Disease analysis:
Gastric cancer can occur at any age, but it is more common in 40 ~ 60 years old, and the ratio of male to female is about 2: 1. The etiology of gastric cancer is unknown, which may be related to many factors, such as living habits, diet, environmental factors, genetic quality, mental factors and so on. And chronic gastritis, gastric polyps, gastric dysplasia and intestinal metaplasia, postoperative gastric stump cancer, long-term Helicobacter pylori (HP) infection, etc. Gastric cancer can occur anywhere in the stomach, but it is more common in the antrum of the stomach, especially in the small curvature of the stomach. According to the infiltration depth of cancer tissue, it can be divided into early gastric cancer and late gastric cancer (middle and late gastric cancer). The early symptoms of gastric cancer are often not obvious, such as unpredictable epigastric discomfort, dull pain, belching, pantothenic acid, loss of appetite and so on. Symptoms such as mild anemia are similar to gastroduodenal ulcer or chronic gastritis. Some patients take painkillers, anti-ulcer drugs or diet adjustment to relieve or relieve pain, so they are often ignored without further examination. With the progress of the disease, stomach symptoms gradually turned into obvious epigastric pain, loss of appetite, weight loss and anemia. Cancer metastasis, abdominal mass, left supraclavicular lymph node enlargement, melena, ascites and severe malnutrition often occur in the late stage. Because gastric cancer is very common and harmful in China, related studies believe that its etiology is related to eating habits and stomach diseases, so it is of great significance to understand the basic knowledge about gastric cancer for its prevention and treatment.
Guiding opinions:
Surgery is still the main treatment for early gastric cancer. After operation, according to different pathological examination results, supplemented by drug treatment. However, conservative treatment of traditional Chinese medicine must be adopted in the middle and late stage to alleviate the pain of patients, delay life expectancy and improve quality of life.
Life care:
(1) Pay attention to food hygiene, eat less smoked food, salt Z, fried food, quit smoking and alcohol, eat more fruits and vegetables rich in vitamin E, store food well and cook properly; (2) Chronic atrophic gastritis, especially intestinal metaplasia and atypical hyperplasia, gastric ulcer, pernicious anemia and gastric polyp. Active treatment and regular follow-up, gastroscopy, timely detection of cancer and treatment.
Disease analysis:
Gastric cancer is indeed a disease that seriously threatens people's health. Gastric cancer can occur at any age, but it is more common in 40 ~ 60 years old, and the ratio of male to female is about 2: 1. Its pathogenesis is unknown, which may be related to many factors, such as living habits, diet, environmental factors, genetic quality, mental factors, as well as chronic gastritis, gastric polyps, gastric dysplasia, intestinal metaplasia and so on. And long-term helicobacter pylori (HP) infection. Gastric cancer can occur anywhere in the stomach, but it is more common in the antrum of the stomach, especially in the small curvature of the stomach. According to the infiltration depth of cancer tissue, it can be divided into early gastric cancer and late gastric cancer (middle and late gastric cancer). The early symptoms of gastric cancer are often not obvious, such as unpredictable epigastric discomfort, dull pain, belching, pantothenic acid, loss of appetite and so on. Symptoms such as mild anemia are similar to gastroduodenal ulcer or chronic gastritis. Some patients take painkillers, anti-ulcer drugs or diet adjustment to relieve or relieve pain, so they are often ignored without further examination. With the progress of the disease, stomach symptoms gradually turned into obvious epigastric pain, loss of appetite, weight loss and anemia. Cancer metastasis, abdominal mass, left supraclavicular lymph node enlargement, melena, ascites and severe malnutrition often occur in the late stage. Because gastric cancer is very common and harmful in China, related studies believe that its etiology is related to eating habits and stomach diseases, so it is of great significance to understand the basic knowledge about 1 gastric cancer for the prevention and treatment of gastric cancer.
Guiding opinions:
Classification of gastric cancer
(1) Gastric cancer can occur in any part of the stomach, and more than half of them occur in the antrum, small curvature and anterior and posterior walls of the stomach, followed by the cardia, with relatively few gastric body areas.
(2) Specific morphological classification
1. Early gastric cancer, regardless of its scope, is limited to mucosa and submucosa. It can be divided into three types: uplift type (polyp type), superficial type (gastritis type) and depression type (ulcer type). Type Ⅱ can be divided into three subtypes: Ⅱ A (uplift type), Ⅱ B (flat type) and Ⅱ C (depression type). Ii c+iii, etc. In early gastric cancer, those with a diameter of 5 ~ 10 mm are called small gastric cancer, and those with a diameter less than 5 mm are called small gastric cancer. Both early gastric cancer and late gastric cancer can have upper gastrointestinal bleeding, often accompanied by melena. A small number of early gastric cancer may have mild upper gastrointestinal bleeding symptoms, that is, black stool or persistent occult blood positive.
2. Advanced gastric cancer is also called progressive gastric cancer. Cancerous lesions invade the muscle layer or the whole muscle layer and often metastasize.
(1) Mushroom-like type (or polypoid type): About 1/4 of advanced gastric cancer. The tumor is localized, mainly growing into the cavity, nodular and polypoid, with rough surface like cauliflower, erosion and ulcer in the center, also known as nodular mushroom-like type. Tumors are discoid with high edges, and those with ulcers in the center are called discoid mushroom-like types.
There is a tumor protruding from the gastric cavity at the back wall of the small curvature of the gastric antrum, which is slightly lobulated, uneven, granular and erosive. The base of the tumor was slightly narrow and pedicled, and no obvious infiltration was found in the surrounding mucosa.
(2) Ulcer type: advanced gastric cancer is about 1/4. It can be divided into localized ulcer type and invasive ulcer type. The former shows localized cancer, discoid central necrosis, and often large and deep ulcers; The bottom of the ulcer is generally uneven, and the edge is raised like a dam or crater. Cancer cells infiltrate deep, often accompanied by bleeding and perforation. Infiltrative ulcer type is characterized by invasive growth of cancer, which often forms a mass to infiltrate around and deep, and the central necrosis forms an ulcer, which often invades serosa earlier or causes lymph node metastasis.
(3) Infiltration type: there are two types, one is localized infiltration type, in which the cancer tissue infiltrates all layers of the stomach wall, mostly confined to the antrum of the stomach, and the infiltrated stomach wall thickens and hardens, and the folds disappear without obvious ulcers and nodules. Infiltration is confined to a part of the stomach, which is called "localized infiltration type". The other is diffuse infiltration type, also called cutaneous stomach, where the cancer tissue spreads under the mucosa and invades all layers.
(4) Mixed type: Two or more lesions of the above types coexist at the same time.
(5) Multiple cancers: The cancer tissues are multifocal and unconnected. For example, gastric cancer, which is mainly atrophic gastritis, may belong to this type, mostly in the upper part of the stomach.
(3) Histological classification can be divided into four types according to organizational structure. ① Adenocarcinoma: including papillary adenocarcinoma, tubular adenocarcinoma and mucinous adenocarcinoma, which can be divided into three types according to their differentiation degree: high differentiation, medium differentiation and low differentiation; ② Undifferentiated carcinoma; ③ Mucinous carcinoma (signet ring cell carcinoma); ④ Special types of cancer: including adenosquamous carcinoma, squamous cell carcinoma, carcinoid, etc.
According to histogenesis, it can be divided into two types: ① intestinal type: cancer originated from metaplasia epithelium of intestinal gland, and the cancer tissue was well differentiated, and the giant body was mostly mushroom umbrella type; ② Gastric type: Cancer originated from the proper mucosa of the stomach, including undifferentiated cancer and mucinous cancer. Cancer tissue differentiation is poor, and macrosomia is mostly ulcer type and diffuse infiltration type.
(4) Transfer route
1. Directly disseminated invasive gastric cancer can directly develop to the stomach wall, esophagus or duodenum along the mucosa or serosa. Once cancer cells invade serosa, they can easily infiltrate into adjacent organs or tissues, such as liver, pancreas, spleen, transverse colon, jejunum, diaphragm, omentum and abdominal wall. When cancer cells fall off, they can also be planted in abdominal cavity, pelvic cavity, ovary and rectal bladder cavity.
2. Lymph node metastasis accounts for 70% of gastric cancer metastasis. Tumors in the lower part of stomach often metastasize to lymph nodes such as pylorus, stomach and celiac artery, while tumors in the upper part often metastasize to lymph nodes such as pancreas, cardia and stomach. Advanced cancer may metastasize to lymph nodes around aorta and above diaphragm. Because the abdominal lymph nodes are directly connected with the thoracic duct, they can be transferred to the left supraclavicular lymph nodes.
3. Metastatic cancer cells can be seen in some patients' peripheral blood, which can be transferred to liver through portal vein and reach lung, bone, kidney, brain, meninges, spleen and skin.
Life care:
First, surgical treatment.
Due to the improvement of the diagnosis and treatment level of gastric cancer, the surgical indications have also expanded accordingly. At present, except for patients with huge and fixed primary focus, extensive visceral metastasis, bloody ascites with cachexia, as long as the patient's general situation allows, even if there are supraclavicular lymph nodes and metastatic nodules in the liver, laparotomy should be performed as far as possible to remove the primary focus and relieve symptoms. According to the statistics of domestic 1 1734 cases of gastric cancer surgery, the operation rate was 865,438+0.8%, and the total resection rate was 49.7%. In recent years, the resection rate of cancer has increased to about 75%, mainly for stage II and III gastric cancer.
The types of gastric cancer surgery are:
1. Radical resection: Radical resection includes radical resection and extended radical resection.
2. Palliative resection
3. Short circuit surgery
Two. Radiotherapy three. Chemotherapy IV. Traditional Chinese Medicine Treatment and Western Medicine Treatment of Gastric Cancer
1) Pay attention to food hygiene, eat less smoked food, salt Z, fried food, quit smoking alcohol, eat more fruits and vegetables rich in vitamin E, store food well, and cook properly; (2) Chronic atrophic gastritis, especially intestinal metaplasia and atypical hyperplasia, gastric ulcer, pernicious anemia and gastric polyp. Active treatment and regular follow-up, gastroscopy, timely detection of cancer and treatment.