Stomach cancer

Introduction to gastric cancer Gastric cancer is one of the most common malignant tumors in China. Its incidence rate ranks first in all kinds of tumors in China. About 170,000 people die of gastric cancer every year, almost 1/4 of the total number of malignant tumor deaths, and there are 2 More than 10,000 new patients with gastric cancer have emerged. Gastric cancer is indeed a disease that seriously threatens the health of the people. Gastric cancer can occur at any age, but it is more common in 40 to 60 years old, more male than female, about 2:1. Gastric cancer can occur in any part of the stomach, but it is more common in the antrum of the stomach, especially on the small curved side of the stomach. The average life expectancy of untreated patients is approximately 13 months. As the disease progresses, the function of the stomach and the general condition of the stomach gradually change. These symptoms are often non-specific, and can be hidden in time and can exist for a long time. Such as abdominal pain, dull pain, dull pain, nausea, loss of appetite, suffocation and weight loss, a small number of ulcerated (IIc and III) early gastric cancer can also have ulcer-like symptoms, rhythmic pain, acid reflux, medical treatment can be relieved . basic knowledge The proportion of sickness: 0.0001%-0.003% Susceptible population: can occur at any age, more common in 40 to 60 years old. Mode of infection: non-infectious Complications: gastrointestinal bleeding, pyloric obstruction

Cause of gastric cancer

Regional environment and dietary factors (30%):

There is a significant regional difference in the incidence of gastric cancer. The incidence of gastric cancer in the northwest and eastern coastal areas of China is significantly higher than that in the southern region. The incidence of distal gastric cancer is high in people who have been eating roasted and salted food for a long time, and it is related to the high content of carcinogens or procarcinogens such as nitrite, mycotoxins and polycyclic aromatic hydrocarbons in food, and the risk of gastric cancer in smokers. 50% higher than non-smokers.

Helicobacter pylori infection (20%):

The Hp infection rate of adults in high-risk areas of gastric cancer in China is above 60%. Helicobacter pylori can promote the conversion of nitrate to nitrite and nitrosamines, causing cancer. Hp infection causes chronic inflammation of gastric mucosa and environmental pathogenic factors accelerate the excessive proliferation of mucosal epithelial cells, leading to distortion and carcinogenesis. The toxic products of Helicobacter pylori CagA and VacA may have a cancer-promoting effect, and the detection rate of anti-CagA antibodies in gastric cancer patients is significantly higher than that of the general population.

Precancerous lesions (20%):

Stomach diseases include gastric polyps, chronic atrophic gastritis, and residual stomach after partial gastric resection. These lesions may be accompanied by varying degrees of chronic inflammatory processes, gastric mucosal intestinal metaplasia or atypical hyperplasia, which may turn into cancer. Precancerous lesions refer to the histopathological changes of gastric mucosa that are prone to canceration, and are borderline pathological changes in the process from benign epithelial tissue to cancer. The dysplasia of gastric mucosal epithelium belongs to precancerous lesions. According to the degree of heterotypic cells, it can be divided into mild, moderate and severe three degrees. Severe dysplasia and early differentiation of early gastric cancer are sometimes difficult to distinguish.

Genetics and genes (10%):

Genetic and molecular biology studies have shown that the incidence of gastric cancer in blood relatives of patients with gastric cancer is four times higher than that of the control group. Carcinogenesis of gastric cancer is a multi-factor, multi-step, multi-stage development process involving changes in oncogenes, tumor suppressor genes, apoptosis-related genes, and metastasis-related genes, and the forms of genetic alterations are diverse.

Precancerous changes

The so-called precancerous changes refer to some lesions with a strong tendency to malignant transformation. If this lesion is not treated, it may develop into gastric cancer. Precancerous changes include precancerous conditions and precancerous lesions. .

1, the precancerous state of the stomach

(1) Chronic atrophic gastritis: Chronic atrophic gastritis has a significant positive correlation with the incidence of gastric cancer;

(2) Pernicious anemia: 10% of patients with malignant anemia develop gastric cancer, and the incidence of gastric cancer is 5 to 10 times that of the normal population;

(3) gastric polyps: adenoma or villus polyps, although the proportion of gastric polyps is not high, the cancer rate is 15% to 40%, the diameter is greater than 2cm, the cancer rate is higher, proliferative polyps are more common, and cancerous The rate is only 1%;

(4) Residual stomach: The cancer of the stomach after the operation of benign gastric lesions is called gastric cancer. After gastric surgery, especially after 10 years after surgery, the incidence is significantly increased;

(5) benign gastric ulcer: gastric ulcer itself is not a precancerous state, and the mucosa of the ulcer edge is prone to intestinal metaplasia and malignant transformation;

(6) Great gastric mucosal folds (Menetrier disease): serum protein is lost through huge gastric mucosal folds, clinically low proteinemia and edema, about 10% can be cancerous.

2, precancerous lesions of the stomach

(1) abnormal hyperplasia and metamorphosis: the former is also known as dysplasia, is a reversible pathological cell proliferation caused by chronic inflammation, in a few cases can not be cancerous, gastric anaplasia is more cancerous opportunities;

(2) intestinal metaplasia: there are two types of small intestine and large intestine, small intestine (complete type) has the characteristics of small intestinal mucosa, well differentiated, large intestine type (incomplete type) and large intestine mucosa similar, can be divided into two Subtype: Type IIa, capable of secreting non-sulfated mucin type IIb can secrete sulfated mucin, which is closely related to gastric cancer.

Pathological change

(1) The site of occurrence of gastric cancer

Gastric cancer can occur in any part of the stomach, more than half of which occurs in the antrum of the stomach, small curvature of the stomach and anterior and posterior walls, and secondly in the cardia, where the corpuscle is relatively small.

(2) Giant morphological typing

1, early gastric cancer

Regardless of the size of the range, the early lesions are limited to the mucosa and submucosa, which can be divided into a bulge type (polyp type), a superficial type (gastritis type) and a concave type (ulcer type), and the type II is divided into IIa (the bulge type is superficial). ), IIb (flat superficial) and IIc (depressed superficial) three subtypes, the above types can have different combinations, such as IIc + IIa, IIc + III, etc., early gastric cancer in the diameter of 5 ~ 10mm It is called small gastric cancer, and the diameter <5mm is called micro gastric cancer.

2, advanced gastric cancer

Also known as progressive gastric cancer, cancerous lesions invade the muscle layer or the whole layer, often with metastasis, there are the following types:

(1) umbrella type (or polypoid type): about 1/4 of advanced gastric cancer, the cancer is limited, mainly to the lumen growth, nodular, polypoid, rough surface such as cauliflower, central erosion, ulcer Also known as the nodular umbrella type, the cancer is disc-shaped, the edge is high, and the central part of the ulcer is called the disc-shaped umbrella type.

There is a mass protruding from the posterior wall of the gastric antrum to the stomach cavity, slightly lobulated, the surface is uneven and granular, and there is erosion, the base of the tumor is slightly narrow, showing a sub-type, and there is no obvious infiltration of the surrounding mucosa.

(2) ulcer type: about 1/4 of advanced gastric cancer, and is divided into localized ulcer type and infiltrating ulcer type. The former is characterized by cancerous limitation, disc-shaped, central necrosis, often large and deep ulcer ulcer The bottom is generally uneven, the edge is bulge-like or crater-like, the cancer is infiltrated into the deep layer, often accompanied by hemorrhage, perforation, and infiltrating ulcer type is characterized by invasive growth of the cancer, often forming a mass that is infiltrated into the surrounding and deep. Central necrosis forms ulcers, often invading the serosa or lymph node metastasis earlier.

(3) Infiltration type: This type is also divided into two types, one is limited infiltration type, the cancer tissue infiltrates the various layers of the stomach wall, mostly limited to the gastric antrum, the infiltrated stomach wall thickens and hardens, the wrinkled wall disappears, and there are no obvious ulcers. And nodules, infiltrates are limited to a part of the stomach, called "limited infiltration type", the other is diffuse infiltration type, also known as leather stomach, cancer tissue spread under the mucosa, invading each layer, a wide range, making the stomach cavity It becomes smaller, the stomach wall is thick and stiff, the mucosa can still exist, and there may be congestion and edema without ulceration.

(4) Hybrid type: two or more types of lesions of the above type coexist.

(5) Multiple cancers: The cancer tissues are multifocal and not connected to each other. For example, gastric cancer that occurs on the basis of atrophic gastritis may belong to this type and is mostly in the upper part of the stomach.

(3) Organizational classification

According to the structure of the tissue can be divided into 4 types, 1 adenocarcinoma: including papillary adenocarcinoma, tubular adenocarcinoma and mucinous adenocarcinoma, according to the degree of differentiation is divided into three types of high differentiation, moderate differentiation and poor differentiation. 2 undifferentiated cancer. 3 mucinous cancer (ie, signet ring cell carcinoma). 4 special types of cancer: including adenosquamous carcinoma, squamous cell carcinoma, carcinoid and so on.

According to the occurrence of tissue can be divided into two types, 1 intestinal type: cancer originated from the epithelium of intestinal metaplasia, cancer tissue differentiation is better, the giant form is mostly scorpion umbrella type. 2 Stomach type: The cancer originates from the intrinsic mucosa of the stomach, including undifferentiated carcinoma and mucinous carcinoma, and the cancer tissue is poorly differentiated. The morphology of the giant body is mostly ulcer type and diffuse infiltration type.

(4) Transfer route

1. Direct dissemination

Invasive gastric cancer can be directly along the mucosa or serosa to the stomach wall, esophagus or duodenum. Once the cancer invades the serosa, it is easy to move to surrounding organs or tissues such as liver, pancreas, spleen, transverse colon, jejunum and diaphragm. Infiltration of the omentum and abdominal wall, cancer cells can also be planted in the abdominal cavity, pelvic cavity, ovary and rectal bladder sag.

2, lymph node metastasis

It accounts for 70% of gastric cancer metastasis. The lower stomach cancer often metastasizes to the pylorus, the lymph nodes under the stomach and the celiac artery, and the upper cancer often metastasizes to the side of the pancreas, next to the cardia, the stomach and other lymph nodes, and the advanced cancer may be transferred to the main The periarterial and supraorbital lymph nodes can be transferred to the left supraclavicular lymph node due to direct communication between the abdominal lymph nodes and the thoracic duct.

3, blood transfer

Some patients can find cancer cells in the peripheral blood, which can be transferred to the liver through the portal vein and reach the lungs, bones, kidneys, brain, meninges, spleen, skin, etc.

Gastric cancer prevention

The etiology of gastric cancer is complex, and the exact pathogenesis is still unclear. In order to reduce the incidence and mortality of gastric cancer, secondary prevention should be carried out. Primary prevention, ie, prevention of the cause, refers to trying to control and avoid known suspected carcinogenic factors. Secondary prevention is the detection of susceptible individuals in the natural population, and regular follow-up examinations, in order to achieve early detection, early diagnosis and early treatment.

1, primary prevention

(1) Pay attention to food hygiene and avoid eating too much irritating diet and smoked products. Control alcohol and tobacco, regular diet, prevent overeating, to reduce the incidence of gastritis and gastric ulcer.

(2) Changing the traditional method of preserving food such as salting or smoking, and widely applying the frozen storage method.

(3) Reduce the intake of salt in food, and control the daily intake below 6g.

(4) Regularly eat fresh vegetables and fruits.

(5) Eat more milk and dairy products.

(6) Increase the content of fresh fish, meat and other proteins in food.

(7) Regular consumption of garlic.

(8) eradication of HP infection in the stomach. Patients with gastric ulcers that are ineffective for long-term treatment or gastric polyps larger than 2 cm should be treated promptly. Patients with atrophic gastritis should be followed up regularly for gastroscopy, which has certain preventive significance.

research shows:

1 Cancer cannot form in a weakly alkaline body.

2 Cancer can only form in acidic bodies.

3 If you have cancer, your body is acidic.

4 Cancer can only spread in an acidic body.

5 If your body becomes weakly alkaline, cancer cannot expand.

6 If you can balance your body's pH and turn your body into a weak alkaline, no matter what cancer you have, you have to change and be cured.

7 No matter how bad your situation is, even if you can only live for 6 months, if you can change your body's pH to weak alkaline, your cancer will not expand, it will be good.

8 Don't worry about your mother, dad or anyone in your family having cancer. As long as your body is weakly alkaline, you won't get it. If you already have it, it will change.

9 Cancer is living in acidic body fluids, nothing else. If your body is acidic, you will get cancer. If it is weak, you won't get cancer. If you have cancer, as long as you can adjust your body's pH to a weak alkaline, cancer will leave you. The secret to preventing cancer is very simple. It is to eat alkaline foods to prevent the accumulation of acidic waste. Because the acidified body fluid environment is a fertile soil for normal cell cancer, adjusting the acid-base balance of body fluids is an effective way to prevent cancer.

A) Develop good habits, stop smoking and limit alcohol. Smoking, the World Health Organization predicts that if people no longer smoke, after five years, the world's cancer will be reduced by 1/3; secondly, no alcohol. Smoke and alcohol are extremely acidic and acidic substances. People who smoke and drink for a long time can easily lead to acidic body.

B) Don't eat too much salty and spicy food, do not eat food that is overheated, too cold, expired and deteriorated; those who are frail or have a certain genetic disease should eat some cancer-preventing foods and high alkali content as appropriate. Alkaline foods maintain a good mental state.

C) Have a good attitude to cope with stress, work and rest, not excessive fatigue. Visible pressure is an important cause of cancer. Chinese medicine believes that stress leads to excessive physical weakness, which leads to decreased immune function, endocrine disorders, metabolic disorders in the body, leading to the deposition of acidic substances in the body. Stress can also lead to mental stress causing qi stagnation and blood stasis. Invagination and so on.

D) Strengthen physical exercise, enhance physical fitness, and exercise more in the sun. Excessive sweating can excrete acidic substances in the body with sweat, avoiding the formation of acidic constitution.

E) People who have regular life and irregular living habits, such as singing karaoke, playing mahjong, and not returning to the night, will have aggravated physical acidification and are prone to cancer. Good habits should be developed to maintain a weak alkaline constitution and keep various cancer diseases away from you.

F) Do not eat contaminated food, such as contaminated water, crops, poultry, eggs, moldy foods, etc., eat some green organic foods, to prevent disease from entering the mouth.

2, secondary prevention

(1) Conducting a population survey in high-risk areas of gastric cancer: This is an important way to find early gastric cancer. The key issue in the prevention of gastric cancer is early detection. The census is an important measure for early detection of gastric cancer, where the age is over 40 years old. Those with a long history of stomach disease, or those with obvious stomach symptoms in recent months, should be included in the census. In Japan, the use of X-ray double contrast angiography gastric cancer screening vehicles in the past 30 years, the census of residents over 40 years old, can reduce the mortality rate of gastric cancer by 27%. Although Japan has made remarkable achievements in the screening of gastric cancer, there are still some problems to be solved. Firstly, the X-ray indirect film double contrast method is used as the primary screening method, and the method of confirming the diagnosis by gastroscope or X-ray precision film examination is not only costly, but also the rate of missed diagnosis of early gastric cancer can be as high as 27 and 2%. Second, because there is still a lack of understanding of the natural history of gastric cancer, it is still difficult to determine how long the two censuses should be separated. China has a large population, its economic level is still not developed enough, and the incidence of gastric cancer is not as high as that of Japan. Obviously, the census method of natural population in Japan should not be widely promoted in China.

In recent years, China has done a lot of work in research and establishment of a screening method for gastric cancer screening suitable for China's national conditions, and has made certain progress. There are two main methods, one is to use the computer as the pattern of medical history and symptoms, and the other is to use a small ball made of various materials to collect fasting gastric juice, and then for occult blood or biochemical examination. The common purpose is to screen high-risk groups and further X-ray or gastroscopy. The detection rate of gastric cancer is generally above 0, 3%, of which early gastric cancer generally accounts for more than 30%, see Table 6. Although this method also has the problem of missed diagnosis, but because of the simple method and low cost, it has certain practical value, and can be promoted and tested in the high-incidence area of gastric cancer, and gradually improved.

(2) Establishing a specialist outpatient clinic for gastric diseases to reduce the missed diagnosis and misdiagnosis of patients attending the hospital is another way to find gastric cancer early. Because early gastric cancer often has no obvious symptoms, the symptoms of advanced gastric cancer are also non-specific, so it is easily misdiagnosed as chronic gastritis such as gastritis or gastric ulcer. Summarizing the cases of confirmed cases of symptomatic gastric cancer in China, only 29% of patients were diagnosed within three months, and 33% of those diagnosed more than one year. Even in Shanghai, where the medical level is high, the average time from the first visit to the diagnosis of gastric cancer is 113 days, and the number of confirmed cases after hospitalization for more than 4 months is 26% and 2%. Therefore, how to improve the early diagnosis rate of patients in hospital and reduce the time of misdiagnosis in hospital is another key to improve the efficacy of gastric cancer. According to foreign experience, after setting up a digestive specialist clinic, the proportion of early gastric cancer can be increased from 1,6% to 10,60%. In hospitals with digestive specialists in China, the proportion of early gastric cancer is 10% to 180%, which is much higher than that of general hospitals, 1% to 2%. Therefore, hospitals with conditions should set up outpatient clinics for stomach diseases, and strengthen the examination of patients who come to the hospital because of stomach symptoms. Especially for cases with a new diagnosis or a long history and a good age, they should be examined by gastroscopy or barium meal. Reduce missed diagnosis and improve the early diagnosis rate of gastric cancer in outpatients.

(3) Follow-up of susceptible cases: Atrophic gastritis, gastric polyps, gastric ulcer, residual stomach, moderate to severe dysplasia, and incomplete colonic intestinal metaplasia are known, and the incidence of gastric cancer is higher. Therefore, active treatment and regular follow-up examination of the pre-cancerous state and precancerous lesions are another way to detect gastric cancer early. Some scholars believe that chronic gas ulcers with long-term unhealed or severe scar formation, multiple polyps of the stomach, single polyps larger than 2 cm in diameter and severe dysplasia can be treated surgically because of the high degree of canceration. For the follow-up of the residual stomach, it is suggested that:

1 Anyone who has been operated before the age of 40, once a year from 20 years after surgery.

2 Those who have undergone surgery after the age of 40, once a year from 10 years after surgery.

3 have chronic bile reflux, once a year from 10 years after surgery.

Gastric cancer complications Complications gastrointestinal bleeding pyloric obstruction

1, when concurrent gastrointestinal bleeding, dizziness, palpitations, tar-like stool, vomiting brown color.

2, gastric cancer abdominal cavity transfer when the common bile duct is compressed, there may be jaundice, stool clay color.

3, combined with pyloric obstruction, vomiting can occur, the upper abdomen see the expansion of the stomach type, smell and sound of water.

4, diffuse peritonitis caused by perforation of cancer, abdominal muscle plate stiffness, abdominal tenderness and other peritoneal irritation.

5, the formation of gastrointestinal fistula, see the discharge of non-digestible food.

Symptoms of gastric cancer Common symptoms Cancer advanced gastrointestinal symptoms Stomach pain Stomach wall thickening Left upper abdominal cystic mass has tenderness Gastric loss protein Acute abdomen nausea constipation Gastric mucosa permeability Increased eating difficulties

Clinical manifestation

Early gastric cancer is mostly asymptomatic or only mild. When the clinical symptoms are obvious, the lesion is already advanced. Therefore, we must be very alert to the early symptoms of gastric cancer, so as not to delay the diagnosis and treatment.

1, symptoms

(1) Early gastric cancer

As the disease progresses, the function of the stomach and the general condition of the stomach gradually change. These symptoms are often non-specific, and can be hidden in time and can exist for a long time. Such as abdominal pain, dull pain, dull pain, nausea, loss of appetite, suffocation and weight loss, a small number of ulcerated (IIc and III) early gastric cancer can also have ulcer-like symptoms, rhythmic pain, acid reflux, medical treatment can be relieved Wait. Some patients have gastric cancer and some benign lesions coexist or on the basis of some benign lesions (such as chronic atrophic gastritis, peptic ulcer, etc.), and the symptoms of these benign gastric diseases have long existed, or repeated attacks, It is easier for patients and doctors to relax their vigilance against gastric cancer and delay the timing of diagnosis. Some early gastric cancers can also be seen with symptoms such as hematemesis, melena, or difficulty swallowing.

1 upper abdominal discomfort: is the most common initial symptoms in gastric cancer, about 80% of patients have this performance, similar to dyspepsia, such as abdominal pain, generally began to be mild, and irregular, can not be relieved after eating, gradually worsening, It can be painful and dull. Some can have rhythmic pain, especially gastric antrum and gastric cancer is more obvious, even eating or taking medicine can be alleviated. The elderly suffer from dullness and mostly complain of abdominal distension. These symptoms are often not taken seriously by patients, and they are easily mistaken for gastritis or ulcer disease when they seek medical treatment. Therefore, middle-aged patients should be given further examination if they have the following conditions: to avoid missed diagnosis: A, no previous history of stomach, but recent unexplained upper abdominal discomfort or pain, treatment is invalid; B, history of gastric ulcer, recently The regularity of abdominal pain changes, and the degree is getting worse. If the symptoms have been alleviated, but there are authors in the short term, the possibility of gastric cancer should also be considered and further examination should be carried out in time.

2 loss of appetite or loss of appetite: loss of appetite and weight loss are the most common symptoms of gastric cancer, nearly 50% of patients with gastric cancer have obvious symptoms of loss of appetite or loss of appetite, some patients are limited by eating too much can cause abdominal distension or abdominal pain of. Unexplained anorexia and weight loss are likely to be the initial symptoms of early gastric cancer and need to be taken seriously. Patients with early gastric cancer generally have no obvious positive signs. Most patients have deep tenderness only in the upper abdomen except for weaker general conditions.

(2) advanced gastric cancer

Gastric cancer lesions range from small to large, from shallow to deep. From no metastasis to metastasis, it is a gradual process. Therefore, there is no obvious boundary between the early stage and the advanced stage. Moreover, the symptoms often overlap between the stages. Some patients have advanced disease, but the symptoms are not obvious. Some of them have early symptoms but some have prominent symptoms. Some patients are treated with symptoms of organ transfer or symptoms of comorbidities. According to the statistics of domestic data, the common symptoms of advanced gastric cancer are as follows:

1 Abdominal pain: When the development of gastric cancer expands, especially when infiltrating through the serosa and invading the pancreatic or transverse mesenteric membrane, persistent severe pain may occur and radiate to the lower back. A very small number of patients with perforated cancerous ulcers may also have signs of severe abdominal pain and peritoneal irritation.

2 loss of appetite and weight loss: the absorption of cancer toxins can make patients increasingly thin, fatigue, anemia, malnutrition, often progressive, and finally manifested as cachexia.

3 nausea and vomiting: is also one of the more common symptoms, can occur early. Symptoms of pyloric obstruction can also occur in gastric antrum cancer.

4 hematemesis and melena: when ulcers form on the surface of the cancer, hematemesis and melena appear. 1/3 of patients with gastric cancer often have a small amount of bleeding, mostly manifested as fecal occult blood positive, some may have intermittent black stools, but there are also a large number of hematemesis patients.

5 diarrhea: may be related to low acidosis, large can be mushy or even five more diarrhea. Late gastric cancer can often cause diarrhea and blood when it involves the colon.

6 difficulty in swallowing: after the cancer grows up, there may be obstructive symptoms, cardia or fundus cancer can cause difficulty in hypopharyngeal, gastric sinus cancer causes pyloric obstruction.

2, signs

Early gastric cancer can be without any signs. Or only the upper abdomen is sore. Most patients with advanced gastric cancer have obvious upper abdominal tenderness. One third of the patients can touch the mass in the abdomen, the quality is hard, the surface is not smooth, there is tenderness, especially in patients with gastric sinus cancer, the mass is more likely to be found. As for the metastatic lesions such as the rectal anterior mass, umbilical mass, supraclavicular lymphadenopathy and ascites, it is evidence of advanced gastric cancer.

Upper abdominal mass, anterior rectal mass, umbilical mass, left supraclavicular lymph node enlargement, left axillary lymph node enlargement, ascites, etc. often suggest distant metastasis. And often due to different transfer sites, the corresponding signs appear, and the clinical performance is very complicated. Such as liver metastases can occur large liver, jaundice, etc., ovarian metastasis can be found ovarian enlargement and a large number of ascites, lung transfer can have difficulty breathing.

In addition, gastric cancer with cancer syndrome can also become important signs, such as thrombophlebitis, dermatomyositis and so on. Late patients may have fever, cachexia and so on.

Gastric cancer examination

(1) Gastrointestinal X-ray examination

The main examination methods for gastric cancer, including the projection of different filling degrees to display mucosal lines, such as double contrast of pressurized projection power, especially the tincture, air double contrast method, is valuable for detecting small lesions of the stomach wall.

1. X-ray findings of early gastric cancer

Under proper pressure or double contrast, the bulge type often shows a small filling defect, the surface is not smooth, the base is slightly wider, the nearby mucosa is thickened, disordered, and can be distinguished from benign polyps.

Superficial type: the mucous membrane is flat, the surface can be seen with granular hyperplasia or slight discoid bulge. In some patients, small pieces of sputum accumulation can be seen, or the filling is relatively slight, and the peristalsis of the lesion is still present, but the stomach wall is slightly stiffer than normal.

Early flat gastric cancer

Depression type: visible shallow shadow, mostly uneven at the bottom, the stomach wall can be slightly stiffer than normal, but the peristalsis and contraction still exist. When the pressure or double contrast is observed, there is a sputum accumulation in the depression area, the shadow is light, and the shape is irregular. Adjacent mucosal lines are often interrupted in a braided shape.

2. X-ray findings of advanced gastric cancer

Umbrella type: It is a filling defect that protrudes in the stomach cavity. It is generally large, irregularly contoured or lobulated, and has a broad base. The surface often has irregular shadows in the filling defect due to ulceration, filling the stomach around the defect. The mucosal pattern was interrupted or disappeared, and the stomach wall was slightly stiff.

Ulcer type: mainly manifested as sputum shadow, irregular ulcer mouth, finger squeezing sign and ring embankment sign, surrounding wrinkles are nodular hyperplasia, sometimes suddenly interrupted to the ring embankment, mixed type is mainly ulcer, with There is hyperplasia, invasive changes.

The antral small curved side of the antrum is irregularly shadowed, surrounded by polypoid hyperplasia, forming finger pressure marks and fissures.

Invasive type: localized manifestations of abnormal thickening or disappearance of mucosal streaks, localized gastric wall stiffness, narrow gastric cavity fixation, filming at different locations in the same position, double shadows on the stomach wall, indicating normal peristaltic stomach wall and stiff stomach wall contour Heavy, extensively infiltrating mucosal folds are flat or disappear, the gastric cavity is significantly reduced, the entire stomach wall is stiff, and there is no peristaltic wave.

(two) endoscopy

It can directly observe various parts of the stomach, and has a great diagnostic value for gastric cancer, especially for early gastric cancer.

1, early gastric cancer

Uplift type: mainly manifested as local mucosal bulge, protruding into the stomach cavity, pedicle or broad-based, rough surface, some papillary or nodular, surface may be erosion, superficial type of boundary is not neat, boundary is not Apparent local mucosal roughness, slightly uplift or depression, surface color faded or reddish, may have erosion, such lesions are most likely to be missed, depressions have more obvious ulcers, depressions more than mucosal layers, the above types can be combined The formation of mixed early gastric cancer.

The central part of the corpus callosum has a semi-spherical polypoid bulge with a smooth surface and a hard surface. The diameter is about 1 and 5 cm, the base is wide, and the mucosa is intact, edema, and no infiltration.

Early gastric cancer (superficial ulcer type): There is a bulge in the posterior pyloric region, some of which are knot-like, pale, with an irregular shallow ulcer in the center and pathologically confirmed adenocarcinoma.

2, advanced gastric cancer

Often with typical manifestations of gastric cancer, endoscopic diagnosis is not difficult, the uplift type lesions are larger in diameter, irregular in shape, cauliflower or chrysanthemum.

(three) gastric juice examination

About half of gastric cancer patients have gastric acid deficiency, and the lactic acid content in basic gastric acid can exceed normal (100 & mug/ml), but gastric juice analysis has little significance for the diagnosis of gastric cancer.

(4) Biological and biochemical examination

Including the immunological reaction of cancer, the determination of specific chemical components and enzyme reaction, blood such as serum pepsinogen I and pepsinogen I / II ratio CEA, CA19-9, CA125 and other carcinoembryonic antigens and monoclonal antibodies The detection, etc., but these tests have higher false positives and false negatives, and the specificity is not strong.

Diagnosis and differentiation of gastric cancer

diagnosis

1, symptoms

Early manifestations of upper abdominal discomfort, about 80% of patients with this performance, nearly 50% of patients with gastric cancer have significant loss of appetite or loss of appetite, late can appear fatigue, low back pain and obstruction after nausea, vomiting, eating difficulties, tumor surface Hematemesis and black stools when ulcerated.

2, signs

There are no special signs in the early stage, and the upper abdominal mass can be seen in the late stage. The rectal examination can reach the mass, the left supraclavicular lymph nodes are enlarged, and the anemia, weight loss, ascites and other dyscrasia are manifested.

3, laboratory inspection

Early suspicious gastric cancer, low or lack of free gastric acid, such as red blood cell pressure, hemoglobin, red blood cell decline, fecal occult blood (+), low total hemoglobin, white / ball inversion, water and electrolyte disorders, acid-base balance disorders and other abnormal tests.

4, X-ray performance

Gastric double contrast can clearly show the contour of the stomach, peristalsis, mucosal morphology, emptying time, presence or absence of filling defects, shadows, etc., the accuracy of inspection is nearly 80%.

5, fiber endoscopy

It is the most direct and accurate diagnosis method for diagnosing gastric cancer.

6, exfoliative cytology

Some scholars advocate this examination when clinical and x-ray examination of suspected gastric cancer.

7, B-ultrasound

Can understand the presence or absence of metastasis of the surrounding organs.

8, CT examination

Understand the invasion of gastric tumors, and the relationship with the surrounding organs, with or without resection.

9. Immunology

CEA, FSA, GCA, YM globulin, etc.

Differential diagnosis

Gastric cancer must be differentiated from gastric ulcer, simple polyps in the stomach, benign tumor, sarcoma, and chronic inflammation in the stomach. There is a need for fashion and stomach fold hypertrophy, huge wrinkles, gastric mucosal prolapse, pyloric muscle hypertrophy and severe fundus vein. The varicose phase identification, differential diagnosis mainly relies on X-ray barium meal angiography, gastroscopy and biopsy.

1, gastric ulcer

Gastric ulcers and ulcerated gastric cancer are often confused and should be carefully identified to avoid delay in treatment.

2, tuberculosis

Stomach tuberculosis is more common in young patients, with a longer course, often accompanied by tuberculosis and cervical lymph node tuberculosis. Gastric pyloric tuberculosis was secondary to lymphatic tuberculosis around the pylorus, and X-ray barium meal examination showed irregular filling defects in the pylorus. The duodenum is also often involved, and the range is wide, and the duodenum is deformed. Multiple gastroscopic ulcers can be seen during fiberoptic endoscopy. The bottom is dark and there are gray nodules around the ulcer. A biopsy should be performed to confirm the diagnosis.

3, pancreatic cancer

The early symptoms of pancreatic cancer are persistent upper abdominal pain or discomfort, the course of disease progresses rapidly, and the late abdominal pain is more dramatic. The average time from symptom onset to visit is 3 to 4 months. Loss of appetite and weight loss are obvious, and the general condition can worsen in a short period of time. Symptoms of gastrointestinal bleeding are less common.

4, gastric malignant lymphoma

The identification of gastric cancer and gastric malignant lymphoma is difficult, but the differential diagnosis is of certain importance. Because the prognosis of gastric malignant lymphoma is better than that of gastric cancer, it should be actively pursued surgical resection. The average age of gastric malignant lymphoma is earlier than that of gastric cancer. The course of disease is longer and the systemic condition is better. The average volume of tumor is generally larger than that of gastric cancer. Pyloric obstruction and anemia are rare. Combined with X-ray, gastroscope and exfoliated cell examination. Help the difference. But in the end, pathological diagnosis is often needed.

5, stomach polyps

Similar to the uplift-type gastric cancer, but its long course, slow development, smooth surface, more pedicle or yati, X-ray examination and gastroscopy are easy to distinguish, but must pay attention to the possibility of polyp cancer, should be judged by tissue biopsy.

6, stomach wrinkles, giant fat syndrome

May be confused with invasive gastric cancer, but its stomach wall is soft. It can be extended, under X-ray or gastroscopy, thick wrinkles can be flattened or thinned when the stomach cavity is full.

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