How long can gastric cancer live in the middle stage?

Health News (Reporter Liu correspondent) The chief physician of the Department of Gastrointestinal Oncology of Tianjin Cancer Hospital, under the guidance of a famous oncologist professor, took the lead in carrying out the "clinical study of intraperitoneal chemotherapy with activated carbon adsorbing mitomycin" in China. This new method is effective in treating advanced gastric cancer and preventing postoperative abdominal recurrence. Mitomycin is an antibiotic anti-tumor preparation, which is quickly cleared from plasma after intravenous injection and excreted within 2 hours. The main toxicity is long-term bone marrow suppression, which shows a serious decrease in the number of white blood cells and platelets. A new intraperitoneal chemotherapy method of activated carbon adsorbing mitomycin, which was developed by Chief Physician Han Liang, was applied to the treatment of advanced gastric cancer, which solved the problems of absorption, slow release and toxic and side effects of chemotherapy drugs in abdominal cavity. The novelty of this therapy lies in the clever use of the physical adsorption of activated carbon. Firstly, activated carbon is allowed to adsorb a super-large dose of mitomycin, an anticancer drug. Secondly, as a foreign body, activated carbon adsorbed with anticancer drugs is quickly absorbed by lymphatic tissues around the remnant stomach and concentrated in lymph nodes (the metastasis of cancer cells in abdominal cavity only occurs in lymphatic tissues and gaps). At the same time, it can provide high-concentration anticancer drugs in peritoneal fluid, portal vein and liver for 24 hours, so that cancer cells implanted in abdominal cavity and residual tiny cancer focus during gastric cancer surgery can be directly soaked in high-concentration anticancer drug solution to kill cancer cells. For the patients found that the tumor has invaded the gastric serosa during operation, after radical operation, before closing the abdominal cavity, a super-large dose of mitomycin was placed in the abdominal cavity to eliminate the subclinical cancer cells. Han Liang and others treated more than 50 patients with advanced gastric cancer with this method. Compared with traditional chemotherapy, this intraperitoneal chemotherapy is safe, reliable, simple and easy, and can improve the 3-year survival rate of patients with advanced gastric cancer from 22% to 76%. What should I pay attention to in my diet? 1. Protect the gastric mucosa, avoid high salt, high hardness, overheating and overeating, eat less and eat more meals, regularly and quantitatively, and eat a digestible diet. 2. The food should be fresh, eat more fresh fruits and vegetables, and increase the intake of high-quality protein. 3. Patients with gastric cancer often have symptoms such as fullness and pain in the upper abdomen, and should eat more digestible food; Common symptoms such as nausea, vomiting, loss of appetite, etc. , should eat light food to stimulate appetite and reduce adverse reactions. 4. Diet conditioning after gastric cancer surgery should choose foods with high nutrition and less stimulation. The staple food is the variety of patients' daily habits, and adding barley porridge and glutinous rice porridge is beneficial. Non-staple food should be fresh meat, eggs, vegetables and fruits. After operation, the patients ate 3 ~ 5 meals a day, and their appetite gradually increased. Many patients can recover their preoperative appetite after half a year. If you have nausea and vomiting after a meal, don't worry, you can sit for a while or walk slowly to relieve the symptoms. You can also take10g ginger soup frequently. 5. Most patients with advanced gastric cancer are in a state of general failure, difficulty in eating and loss of appetite. They should eat more fresh pomegranate, fresh dark plum and fresh hawthorn, or decoct with tangerine peel, pepper, ginger, rock sugar and chicken gizzards. Cachexia patients should supply more foods from protein, such as milk, eggs, goose meat, goose blood, lean pork, beef, fresh vegetables and fruits. Glutinous rice porridge needs cooking. 6. Pay attention to the prevention of dumping syndrome and hypoglycemia syndrome after gastric cancer surgery. The main performance of dumping comprehensive tablets is to eat sweet liquid, such as sweetened milk. /kloc-After 0/0 ~ 20 minutes, you will feel epigastric discomfort, abdominal distension and pain, nausea, vomiting, bowel sounds, diarrhea, general fatigue, dizziness, sweating, palpitation, facial flushing and even collapse. This syndrome can be controlled by diet. If the symptoms are severe and recurrent, the author should eat foods with high protein, high fat and low carbohydrate, pour them into a small amount of meals, and avoid drinking liquid foods such as liquids when eating. It is best to lie flat for 30 minutes after meals, and drink a small amount of sugar-free liquid at 1 hour half an hour after meals. After this adjustment, the emptying speed and capacity of gastric thermal power plant can be effectively slowed down. 1~2 years later, the symptoms can be gradually relieved and no longer attack. Postoperative hypoglycemia syndrome is mainly manifested as palpitation, sweating, fatigue, dizziness, hand shaking, hunger, drowsiness or collapse 2-4 hours after eating. The reason is that food is discharged into jejunum too fast, glucose is absorbed too fast, and blood sugar rises temporarily, which stimulates pancreas to secrete too much insulin and then causes reactive hypoglycemia. The way to control this comprehensive tablet through diet adjustment is: eat less and eat more meals, eat a diet with high protein, high fat and low carbohydrate, and avoid a liquid diet that is too sweet and overheated. Lie on your back 10~20 minutes after meals, and prepare sweets for oral administration to correct hypoglycemia. After this adjustment, most patients can gradually heal themselves from 6 months to 1 year. 7. Dietary chemotherapy during chemotherapy often causes digestive tract symptoms such as nausea, vomiting, loss of appetite, abdominal distension and diarrhea. In order to ensure the smooth progress of chemotherapy, we should pay attention to the following points: ① Deal with the relationship between diet and the peak time of chemotherapy drugs and avoid eating at the peak time of drugs. For example, intravenous injection, preferably on an empty stomach, can reduce nausea and vomiting. If it is an oral drug, it is best to take it after meals, because the drug is absorbed back into the blood after 2 to 3 hours. When its concentration reaches the highest, even if there is digestive tract reaction, it will be fasted and the symptoms will be alleviated. ② During chemotherapy, the number of meals should be more than usual, and the food should be soft and easy to digest, rich in protein, vitamins and sufficient heat energy. Even if you vomit, you should keep eating, and if necessary, you can replenish energy through infusion. 8. During radiotherapy, dietary radiotherapy may cause nausea, loss of appetite, vomiting and other symptoms. Abdominal pain and diarrhea, decreased hemogram, decreased immune function, etc. May occur in the late stage of radiotherapy. At this time, adequate nutrition and rich vitamins must be given to invigorate qi and generate blood. Those who belong to yin deficiency should be supplemented. Commonly used foods include yam, longan, lotus seeds, fungus, mushrooms, lilies, crystal sugar, lotus root, tofu, honey, mung beans, ducks, turtles, mussels, milk, coix seed, jujube, glutinous rice and so on. Diet should correspond to physique: people who are usually plump should not eat greasy food, but should eat more light food; Thin patients should not eat fragrant and dry food, but should eat more food that nourishes yin and promotes fluid production. No matter what kind of physique, you should eat more vegetables, fruits, mushrooms, beans, foods rich in trace elements such as selenium and molybdenum, and foods rich in allicin (such as garlic and onions) on weekdays. Don't eat moldy, smoked or pickled food. Cancer is not equal to death! Timely treatment and high survival rate! Summary of gastric cancer Gastric cancer is a malignant tumor originating from gastric mucosal epithelial cells. It accounts for 95% of gastric malignant tumors. The incidence of gastric cancer is very high in China, and the mortality rate ranks first among malignant tumors. The average mortality rate of gastric cancer in China is as high as 20/65438+ 10,000, which is higher in men than in women, and the ratio of male to female is about 3∶ 1. The peak age of onset is 50 ~ 60 years old. The global annual incidence of gastric cancer is 17.6/65438+ 10,000. Japan, Denmark and other countries have high incidence rates, while the United States and Australia have low incidence rates. In China, Shandong, Zhejiang, Shanghai, Fujian and other coastal areas are high incidence areas. The early symptom of diagnosis (1) is epigastric discomfort, and about 80% of patients have this symptom, and nearly 50% of patients with gastric cancer have obvious loss of appetite or anorexia. In the late stage, fatigue, low back pain, nausea, vomiting, eating difficulties and other symptoms may occur. Hematemesis and melena appear when the tumor surface ulcers. (2) Signs There were no special signs in the early stage, but a mass in the upper abdomen could be seen in the late stage, which could be reached by rectal digital examination, and the left supraclavicular lymph nodes were enlarged. At the same time, cachexia manifestations such as anemia, emaciation and ascites were found. (3) Early suspected gastric cancer, low or lack of free gastric acid, such as hematocrit, hemoglobin and erythrocytopenia, fecal occult blood (+). Low total hemoglobin, white/ball inversion, etc. Laboratory abnormalities such as water-electrolyte disorder and acid-base imbalance. (4) X-ray manifestations: Double contrast radiography of gas and barium can clearly show the outline, peristalsis, mucosal morphology, emptying time, filling defects and niches of the stomach. The accuracy of the test is close to 80%. (5) Fiberoptic endoscopy is the most direct, accurate and effective diagnostic method for gastric cancer. (6) exfoliated cytology when clinical and X-ray examination suspected gastric cancer, some scholars advocated this examination. (7) B-ultrasound can know whether there is metastasis in the surrounding parenchymal organs. (8) CT examination to understand the invasion of gastric tumors, the relationship with surrounding organs, and the possibility of resection. (Immunological examination of CEA, FSA, GCA and YM globulin. Treatment measures The treatment of gastric cancer is the same as other malignant tumors. Surgical treatment is the first choice, combined with chemotherapy, radiotherapy, traditional Chinese medicine, immunotherapy and other comprehensive treatments according to the situation. According to TNM staging, comprehensive treatment scheme is currently adopted, which is roughly as follows. Stage ⅰ gastric cancer belongs to early gastric cancer, and surgical resection is the main method. Some patients with type Ⅱ A-X Ⅱ C submucosal infiltration and lymph node metastasis should be given chemotherapy. Stage ⅱ gastric cancer belongs to middle stage gastric cancer, and surgical resection is the main method. Some are adjuvant chemotherapy or immunotherapy. Stage ⅲ gastric cancer often invades surrounding tissues and has extensive lymph node metastasis. Although surgical resection is the main method, chemotherapy, radiotherapy, immunotherapy and traditional Chinese medicine should be combined. Stage ⅳ gastric cancer is advanced. Non-surgical treatment is usually used. Those who are suitable for surgery should try to remove the primary focus and metastatic focus, and cooperate with chemotherapy, radiotherapy, immunization and comprehensive treatment of traditional Chinese medicine. (1) Surgical treatment can be divided into radical surgery, palliative surgery and short-circuit surgery. 1. Radical surgical resection: This concept is relative, which means that the tumor has been removed subjectively and can achieve therapeutic effect, but in fact only part of it can be cured. 2. Palliative resection: it means that the tumor can not be completely removed subjectively, but the main tumor mass can be removed. Resection of tumor can relieve symptoms, prolong life and create conditions for further comprehensive treatment. 3. Short-circuit surgery: mainly used for cases where pyloric obstruction cannot be surgically removed. Gastrojejunostomy can relieve obstruction. (2) radiotherapy 1. Preoperative radiotherapy: refers to preoperative local irradiation of some clinically palpable advanced gastric cancer to improve the resection rate. 200cGY each time, 5 times a week, ***4 weeks, totaling 4000cGY. After stopping radiotherapy, lo- 14d operation was performed. It can increase the local resection rate, but does not affect the degree of lymph node metastasis. It takes six weeks before the operation. Therefore, it is difficult to estimate the impact on the five-year survival rate. 2. Intraoperative radiotherapy: It means that after tumor resection and before the establishment of gastrointestinal anastomosis, a large dose of radiation, preferably 3000 ~ 3500 CGY, is given to the operating field centered on the celiac artery. It can improve the 5-year survival rate of advanced gastric cancer by about 10%. During the operation, ensure that the intestine is isolated in the irradiation field to prevent radiation complications. 3. Postoperative radiotherapy: most scholars think it is ineffective. (3) Early gastric cancer can be treated without chemotherapy, and other advanced gastric cancer should be treated with appropriate chemotherapy. 1. Systemic chemotherapy: Clinical decision of chemotherapy regimen. Firstly, consider the pathological type, location, disease stage and other factors of the tumor. Gastric cancer is mostly adenocarcinoma, and drugs such as 5-FM, MMC, ADM and MeCCNu are commonly used. In the first year after operation, you should take three courses of treatment, each course of treatment is about 2 months, and then take the second course of treatment after 2 months' rest. There are two courses of treatment every year in the second and third years, and one course of treatment every year in the fourth and fifth years. After five years, chemotherapy will be unnecessary. Common chemotherapy regimen:1) fam: 5-fu 500mg iv d1d8d15adm 30-50mg iv d1mmc4-10mg iv d1day is a cycle. 2. Abdominal chemotherapy: After the operation, we can put a catheter or a chemotherapy pump in the abdominal cavity to intubate chemotherapy. Increase the local concentration. (4) Immunotherapy The combination of immunotherapy and chemotherapy can prolong the life of patients. Interferon, IL-2, BCG and other commonly used drugs. 5) TCM treatment focuses on strengthening the body resistance. It can resist the side effects of radiotherapy, increase white blood cells and platelets, regulate gastrointestinal function and improve the body's resistance. At present, the etiology believes that the following factors are related to the occurrence of gastric cancer: (1) The obvious difference of incidence in different countries and regions indicates that it is related to environmental factors, among which diet is the most important. Salt may be one of the inducing factors of exogenous gastric cancer, and the incidence of gastric cancer is also high in countries with high salt intake. Nitrosamines have successfully induced gastric cancer in animals. Smoked fish contains more 3,4-benzopyrene; Moldy food contains more mycotoxins; After processing, the surface of rice is covered with talcum powder, and its chemical properties and structure are similar to those of asbestos fiber. All the above substances are considered to be carcinogenic. (2) Genetic factors The incidence of gastric cancer is higher in some families. Some data show that there are more people with type A blood than those with type O blood. 3) Due to immune factors, people with low immune function have a higher incidence of gastric cancer, and their immune function may be damaged, which has certain significance in the occurrence of gastric cancer. 4) Precancerous lesions The so-called precancerous lesions refer to some lesions with strong malignant tendency, which may develop into gastric cancer if not treated in time. Precancerous lesions include precancerous state and precancerous lesions. 1. Pregastric cancer state (1) Chronic atrophic gastritis: There is a significant positive correlation between chronic atrophic gastritis and the incidence of gastric cancer. /2) pernicious anemia: 10% of patients with pernicious anemia develop gastric cancer, and the incidence of gastric cancer is 5 ~ 10 times that of normal people. (3) Gastric polyp: Although the proportion of adenomatous polyp or villous polyp in gastric polyp is not high, the canceration rate is 15% ~ 40%. The canceration rate is higher when the diameter is more than 2cm. Hyperplastic polyp is common, but the canceration rate is only 65438 0%. 4) Gastric stump cancer: Gastric stump cancer after benign lesion surgery is called gastric stump cancer. After gastric surgery, especially after 10 years, the incidence rate increased significantly. (5) Benign gastric ulcer: Gastric ulcer itself is not a precancerous state. The mucosa at the edge of ulcer is prone to intestinal metaplasia and malignant transformation. (6) Giant gastric mucosal folds (Menetrier's disease): Serum protein is lost through giant gastric mucosal folds, and there are hypoproteinemia and edema in clinic, of which about 65,438+00% can become cancerous. 2. Gastric precancerous lesions (1) dysplasia and anaplasia: The former is also called atypical hyperplasia, which is reversible pathological cell proliferation caused by chronic inflammation, and canceration cannot occur in a few cases. Intermittent change has more chances of cancer. (2) Intestinal metaplasia: there are two types: small intestine type and large intestine type. Small intestinal type (complete type) has the characteristics of small intestinal mucosa and is well differentiated. Large intestine type (incomplete type) is similar to large intestine mucosa and can be divided into two subtypes: type IIA, which can secrete non-sulfated mucin; Type Ⅱ B can secrete sulfated mucin, which is closely related to the occurrence of gastric cancer. Pathological changes (1) The site of gastric cancer can occur in any part of the stomach, more than half of which occur in the antrum, small curvature and the front and rear walls of the stomach, followed by the cardia, with relatively few gastric body areas. (2) Macromorphological classification 1. Regardless of the extent of early gastric cancer, early lesions are 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 is further divided into three subtypes: Ⅱ A (uplift superficial type), Ⅱ B (flat superficial type) and Ⅱ C (depression superficial type). There can be different combinations of the above types. Such as ⅱc+ⅱa, ⅱc+ⅲ, etc. (figure 1). 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. Fig. 1 schematic diagram of early gastric cancer classification 2. Advanced gastric cancer is also called progressive gastric cancer. Cancerous lesions invade the muscle layer or the whole layer and often metastasize. There are the following types (Figure 2): Figure 2 Classification diagram of advanced gastric cancer (1) Mushroom type (or polyp type): it accounts for about 1/4 of advanced gastric cancer, and 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 type (color cancer) 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, with uneven surface, granular and erosive. The tumor base is slightly narrow and pedicled, and there is no obvious infiltration of surrounding mucosa. (2) Ulcer type: about 1/4 of advanced gastric cancer. It is also divided into localized ulcer type and invasive ulcer type. The former showed localized carcinoma, discoid and central necrosis. There are often large and deep ulcers; The bottom of the ulcer is generally uneven, and the edge uplift is dike-like or crater-like, with deep cancer infiltration, often accompanied by bleeding and perforation. Infiltrative ulcer type is characterized by invasive growth of cancer, which often forms a deep mass that obviously infiltrates around, and the central necrosis forms an ulcer, which often invades serosa earlier or causes lymph node metastasis. (3) Infiltration type: This type can also be divided into two types. One type is localized infiltration type, in which 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 shriveled wall disappears without obvious ulcers and nodules. Infiltration is limited to a part of the stomach, which is called "localized infiltration type". The other is diffuse infiltration type, also called skin stomach. The cancer tissue spreads under the mucosa and invades all layers, which makes the stomach cavity smaller, the stomach wall thick and hard, the mucosa still exists, congestion and edema, and no ulcer. (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, and it is mostly in the upper part of the stomach. (3) Tissue typing 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 and carcinoid. According to histogenesis, it can be divided into two types. ① Intestinal type: The cancer originated from metaplasia epithelium of intestinal gland, and the cancer tissue was well differentiated, and the giant body was mostly mushroom type; ② Gastric type: Cancer originated from the proper mucosa of the stomach, including undifferentiated cancer and mucinous cancer. The differentiation of cancer tissue is poor, and most of the giant bodies are ulcer type and diffuse infiltration type. (4) Transfer route 1. Directly disseminated invasive gastric cancer can develop directly to the stomach wall, esophagus or duodenum along mucosa or serosa. Once cancer invades serosa, it is easy to infiltrate into adjacent organs or tissues, such as liver, pancreas, spleen, transverse colon, jejunum, diaphragm, omentum and abdominal wall. Cancer cells can also be planted in abdominal cavity, pelvic cavity, ovary, rectum and bladder fossa when they fall off. 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 node is directly connected with the thoracic duct, it can be transferred to the left supraclavicular lymph node. 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. There are obvious differences in the incidence and mortality of gastric cancer in different countries and regions, and the ratio of high to low can reach 10 times. Japan, Chile, Iceland, Austria, Finland, Hungary and other countries are high-incidence areas; North America, India, Indonesia, Malaysia, Egypt and other countries have low incidence rates. The incidence of gastric cancer in China is also high, especially in Hexi Corridor of Gansu, Jiaodong Peninsula and coastal areas of Jiangxi. The incidence rate in different areas of the same country can be obviously different, with low incidence rate in high-incidence areas and high incidence rate in low-incidence areas. Epidemiological investigation is of great significance for studying the etiology and pathogenesis of gastric cancer. Early gastric cancer with clinical manifestations (1) of more than 70% can be asymptomatic. According to the pathogenesis, the symptoms of advanced gastric cancer can be divided into four aspects. 1. Energy consumption and metabolic disorder caused by cancer proliferation lead to low resistance, malnutrition and vitamin deficiency. , manifested as fatigue, loss of appetite, nausea, emaciation, anemia, edema, fever, constipation, dry skin and alopecia. 2. Gastric cancer ulcer causes epigastric pain, gastrointestinal bleeding, perforation, etc. The pain of gastric cancer is often biting pain, which is not clearly related to eating or aggravated after eating. Some pains like peptic ulcer can be relieved by eating or antacids, which can last for a long time, and then the pain will gradually worsen and last. Cancer bleeding is characterized by positive stool occult blood test, hematemesis or black stool, and 5% patients have massive bleeding, and some even seek medical treatment for the first time because of bleeding or perforation of gastric cancer. 3. Symptoms caused by mechanical effects of gastric cancer, such as fullness and heaviness caused by poor stomach filling, as well as tasteless, anorexia, pain, nausea and vomiting. Gastric cancer located near cardia can invade esophagus, causing cough and dysphagia, and located near pylorus can cause pyloric obstruction. 4. Symptoms caused by the spread and metastasis of cancer, such as ascites, hepatomegaly, jaundice and metastasis of lung, brain, heart, prostate, ovary and bone marrow, cause corresponding symptoms. (2) Signs Early gastric cancer may have no signs, and upper abdominal tenderness is the most common sign in late cancer. 13 patients can palpate the upper abdominal mass, which is firm and irregular and may have tenderness. Whether the abdominal mass can be found is related to the location and size of the tumor and the thickness of the patient's abdominal wall. Gastric antrum cancer can reach abdominal masses. Other signs are mostly caused by advanced or metastatic gastric cancer, such as enlargement, irregular liver, jaundice, ascites, left supraclavicular and left axillary lymph node enlargement. Male patients can palpate a lump in the upper part of the prostate during rectal digital examination, and female patients can palpate ovarian enlargement during vaginal examination. Other rare signs are white line nodules of skin and abdomen, swollen inguinal lymph nodes and late fever, mostly cachexia. In addition, paraneoplastic syndromes of gastric cancer include thrombophlebitis, acanthosis nigricans and dermatomyositis.