Gastrointestinal carcinoma

　　The study of physiology has confirmed that only about 10% of the degradation products of plasma albumin and globulin are excreted from the intestine. Therefore, it is considered that the loss of gastrointestinal protein in normal physiological conditions can be ignored.

　　The pathogenesis of protein-losing enteropathy mainly includes three aspects:

　　1. Mucosal erosion or ulcers lead to protein exudation or leakage.

　　2. Damage or loss of mucosal cells and widening of intercellular tight junctions lead to increased mucosal permeability and leakage of plasma proteins into the intestinal lumen.

　　3. Intestinal lymphatic obstruction, increased intestinal stromal pressure causes protein-rich intestinal stroma not to remain in the stroma or be absorbed into the blood circulation, but rather to overflow into the intestinal lumen, resulting in the loss of intestinal inflammation. The mechanism of protein-losing enteropathy is not yet clear and may be due to the exudation of extracellular fluid and inflammatory fluid in the inflammatory area.

　　1. The main manifestations are the decrease of plasma albumin and IgG, and in the early stage, there are often symptoms such as fatigue, weight loss, and reduced sexual function. Severe deficiency can cause dry skin, desquamation, hyperpigmentation, and sometimes bedsores. Hair becomes dry and easy to fall out, concentration is poor, memory decreases, and there is a tendency to be excitable and excited, and even indifference. Some patients, especially children, may have growth and development disorders, and even death.

　　Due to the decrease in plasma proteins, especially albumin, leading to a decrease in plasma colloid osmotic pressure, water moves from the vascular space to the interstitial space, and secondary aldosterone secretion increases, resulting in water and sodium retention, which leads to systemic edema. The most common is lower limb edema, and facial, upper limb, or umbilical edema can also be seen, but systemic edema is rare.

　　Colon and rectal cancer present as flesh-colored pedunculated or pendulous nodules, inflammatory carcinoma, clustered vascular nodules, or occasionally as perianal nodules and inflammatory lesions suggesting suppurative hidradenitis, stomach, pancreatic, and gallbladder cancer metastasizing to the skin usually present as nodules and psoriasiform plaques. Clinically, there is a rapid increase in tumor nodules in the short term (6-12 months), distributed in the skin near the primary tumor surgical area or corresponding lymphatic drainage area, and their histopathological morphology is similar to that of the primary tumor.

　　Prognosis: In summary, determining the cause of protein-losing enteropathy using appropriate surgical and (or) dietary intervention can partially or completely alleviate the hypoproteinemia edema and other clinical symptoms in these patients. The prognosis of malignant tumors is poor. Delayed diagnosis and treatment in children can lead to growth and development disorders and even death. Some adult patients may die due to severe malnutrition and secondary infection due to delayed diagnosis and treatment.

　　1. Histopathology:Skin metastatic cancer from the large intestine is mainly secretory mucin-secreting adenocarcinoma, some cases appear as mucin carcinoma, skin metastatic cancer with low differentiation is rare, and occasionally there is a marked metaplasia in skin metastatic cancer, making it difficult to identify its epithelial origin. Skin metastatic cancer from the stomach often presents as an anaplastic infiltrative carcinoma, with a variable number of signet ring cells containing intracellular mucin located in loose or fibrous stroma.

　　2. Special staining and immunohistochemistry: Gastrointestinal adenocarcinoma contains sialomucin including neutral and non-sulfated mucopolysaccharides, PAS positive and resistant to amylase, tumor cells are positive for cytokeratin and carcinoembryonic antigen, but giant cystic fluid protein-15 (GCDFP-15), prostate-specific antigen (PSA) or prostate acid phosphatase (PAP) is negative.

　　Section 1: Gastrointestinal Cancer Diet Remedies

　　1. Tangerine Peel Pork Minced Rice Porridge: 5g of tangerine peel, 25g of lean pork, and 50g of glutinous rice. First cook the tangerine peel and glutinous rice into porridge until cooked, remove the tangerine peel, add the minced pork, and cook until tender. It has the effect of promoting Qi and strengthening the spleen, reducing nausea and vomiting. It is suitable for epigastric pain and belching, but it is not suitable for people with Qi deficiency or Yin deficiency and dry cough.

　　2. Rose Petal Tea: 5g of rose petals, 3g of jasmine flowers, and 3g of Yunnan anti-cancer health tea; put them in a teapot and brew with boiling water, then drink as tea. It has the effect of regulating Qi, relieving depression, soothing the liver and strengthening the spleen, and dispersing blood stasis and relieving pain. However, it should not be consumed during gastrointestinal bleeding.

　　3. Fuling Porridge: 5g of Fuling powder, 100g of flour, and 50g of lean pork; make it into a steamed bun. It has the effect of strengthening the spleen and regulating the stomach, removing dampness and resolving phlegm, and nourishing the heart and calming the mind.

　　4. American Ginseng and Red Jujube Porridge: 2g of American ginseng, 5 red jujubes, and 20g of Job's tears; first remove the seeds from the jujubes and soak them in warm water, then cook the ginseng and Job's tears together until 6/7 cooked, add the jujubes and cook until tender. Add a small amount of starch paste or blend into a smooth paste for consumption. It has the effect of invigorating Qi and generating fluid, strengthening the spleen and promoting diuresis, and nourishing the spleen and defensive Qi.

　　5. Ginseng and Pigeon: Tie the ginseng with gauze and cook it with the pigeon until tender. It has the effect of nourishing both Qi and blood, and invigorating the spleen. Gastrointestinal cancer patients should strictly avoid drinking, smoking, high-sodium salt, preserved foods, pork, spicy and刺激性 food, hard, cold, sour, or hot food, and fried food.

　　Section 2: Foods Beneficial for Gastrointestinal Cancer

　　1, Eat more foods that can enhance immunity and have anti-gastric cancer effects, such as yam, broad bean, Job's tears, water chestnut, chrysanthemum, mushroom, sunflower seeds, kiwi, fig, apple, sardine, honey, pigeon egg, milk, pork liver, sandworm, monkey head fungus, abalone, needlefish, sea cucumber, oyster, octopus, shark, tiger fish, yellow fish bladder, sea horse, turtle, etc.

　　2, Eat more high-nutrition foods to prevent malnutrition, such as black-bone chicken, pigeon, quail, beef, pork, rabbit meat, eggs, duck, soy sauce, tofu, silver carp, grass carp, cutlass fish, mudfish, green fish, yellow fish, cuttlefish, crucian carp, eel, bream, perch, snakehead, sea cucumber, clam, octopus, shark, tiger fish, yellow fish bladder, sea horse, turtle, etc.

　　3, For nausea and vomiting, eat water chestnut, pomelo, orange, loquat, millet, walnut, rose, starfruit, fig, ginger, lotus root, pear, winter vegetables, mango, black plum, lotus seed.

　　4, For anemia, eat conpoy, turtle, shark, shark fin, malan head, chrysanthemum, monkey head fungus, honey, cilantro, banana, olive, black plum, black fungus, sheep's blood, broad bean skin, sesame, persimmon, dregs of tofu, snail, etc.

　　5, For diarrhea, eat shark, broad bean, pear, myrica, taro, chestnut, pomegranate, lotus seed, mung bean, green fish, white hibiscus flower.

　　6, For abdominal pain, eat kumquats, cabbage, flounder, cuttlefish, frogfish, sandworm, sea cucumber, cuttlefish, brussels sprouts, taro flowers.

　　Third, what foods should not be eaten for gastrointestinal cancer

　　1, Avoid moldy or rotten food.

　　2, Avoid high-salt diets.

　　3, Avoid excessively stimulating foods, such as chili and Sichuan pepper.

　　4, Abstain from smoking and drinking.

　　5, Patients after surgery should avoid milk, sugar, and high-carbohydrate diets to prevent倾倒综合征.

　　6, Eat less or no smoked or excessively salted foods and vegetables.

　　7, Avoid spicy and volatile foods, such as coriander, cumin, pepper, chili, scallion, wasabi, garlic, etc.

　　8, Foods that produce phlegm: such as fatty meat, fatty chicken, fatty duck, various sweets (high in sugar content), butter, cheese, etc.

　　Gastrointestinal carcinoids are a group of tumors with pathological morphology similar to malignancy but with a relatively benign biological behavior, with an incidence rate of about 1 in 100,000. Gastrointestinal carcinoids account for 0.05% to 0.20% of all malignant tumors and 0.40% to 1.80% of gastrointestinal malignant tumors. According to their origin, they can be divided into foregut, midgut, and hindgut. In addition to those originating from the foregut such as lung, bronchus, and thyroid carcinoids, the rest occur in the digestive tract, accounting for about 85% to 90% of all carcinoids. Carcinoids have the potential for malignancy and metastasis recurrence, can occur at any age, are most common between 40 to 60 years old, and are a slowly growing tumor with relatively low malignancy. Treatment mainly involves the resection of the primary tumor, and somatostatin analogs such as octreotide can also be used to control diarrhea effectively.

　　First, endoscopic electrocautery resection:

　　Gastric and colorectal carcinoids, with a diameter less than lcm, limited to the mucosal layer, can be treated by local tumor resection or local mucosal resection through gastroscopy or colonoscopy, and further treatment will be decided according to the pathological condition. However, regular endoscopic monitoring and follow-up are required after surgery to prevent recurrence.

　　2. Local resection:

　　For carcinoids in the stomach and middle and lower part of the rectum, with a diameter less than or equal to 2cm, without invasion of the muscular layer, and without lymph node metastasis, local resection of rectal tumors can also be performed through the anus or sacrum, with a margin of 2 to 3cm from the edge of the tumor. However, due to local anatomical limitations, the resection range is often insufficient, and frozen section pathological examination should be performed during surgery to prevent cancer residue.

　　3. Radical resection:

　　Applicable to tumors with a diameter greater than 2cm, invasion of the muscular layer, or regional lymph node metastasis. For carcinoids in the upper part of the rectum and colon, radical surgery is recommended if the diameter exceeds 1cm to avoid secondary surgery; for small intestine carcinoids, due to the difficulty in distinguishing them from other malignant tumors before surgery, and 20% to 45% of cases may experience lymph node metastasis, the resection range should include the corresponding mesentery and lymph nodes.

　　4. Radical resection for carcinoids in special locations:

　　1. Carcinoids located at the esophagogastric junction should be treated according to the requirements for radical surgery for esophagogastric cancer.

　　2. Carcinoids located near the ampulla of the duodenum require pancreaticoduodenectomy.

　　3. Carcinoids located in the horizontal part can undergo resection of the horizontal part of the duodenum and the upper part of the jejunum.

　　4. Resection of the distal ileum and part of the ascending colon should be performed for distal ileal carcinoids.

　　5. Partial resection of the jejunoileum and dissection of mesenteric lymph nodes should be performed for jejunoileal carcinoids.

　　6. Carcinoid of the appendix: If the tumor is 1.5cm or the mesentery of the appendix is involved, or there is local lymph node metastasis, right hemicolectomy should be performed.

　　7. The situation with small intestine carcinoids is opposite, they are highly prone to metastasis, and even if the tumor is less than 1cm, standard extensive intestinal resection and lymph node dissection should be performed. Since 20% to 40% of small intestine carcinoids are multiple, a comprehensive exploration of the small intestine and colon should be performed during surgery. Carcinoid tumors grow slowly, and even if there is metastasis, wide resection should be performed as much as possible.

　　8. All colon carcinoids should undergo the corresponding radical colon cancer surgery. About 2/3 of rectal carcinoids are less than 1cm and can undergo more extensive local resection. Carcinoids measuring 1 to 2cm can be widely resected. If the pathology shows invasion of the muscular layer, anterior resection or abdominoperineal radical surgery should be performed.

　　5. Palliative resection:

　　Carcinoid tumors grow slowly, and even if there is metastasis, wide resection should be performed as much as possible if the patient has no surgical contraindications. The resection of primary and metastatic tumors can extend survival and improve the quality of life. After the resection of liver metastatic foci, the symptoms of carcinoid syndrome can disappear or partially relieve in 80% of patients for up to 5 years.

　　6. Management of liver metastatic foci:

　　The metastasis of carcinoid tumors is often seen in the liver. Since carcinoid tumors grow slowly, if the focus is localized, surgical resection can still be performed to achieve cure. For patients with liver limited metastasis, liver lobectomy can be performed, while for those with multiple foci or large foci that cannot be resected, liver artery catheter chemotherapy, subcutaneous implantation of chemotherapy pumps, or ligation of the hepatic artery or embolization, cryotherapy, or radiofrequency treatment can be tried to alleviate the patient's pain and prolong survival. In addition, there have also been recent reports that liver transplantation has been used as a treatment method for liver metastasis of carcinoid tumors, and has achieved good therapeutic effects.

　　Seven, chemotherapy:

　　has a certain effect. Commonly used adriamycin and fluorouracil (Fu/DOX), streptomycin and fluorouracil (Fu/STZ), carbachol and fluorouracil, calcium folinate (DTIC/Fu

　　combined with chemotherapy, among which the Fu/STZ regimen seems to be better, with an efficacy rate of 16% to 66%. Combination chemotherapy is often used for obvious symptoms (especially those with heart involvement in the carcinoid syndrome), and the excretion of 5-hydroxyindoleacetic acid in urine is above 150mg/24h.

　　Eight, interferon

　　Alpha-interferon 2a 3 million to 5 million U/d can be used for subcutaneous injection, 3-7 times a week, with an efficacy rate of 50%, the effect appears slowly but is long-lasting. It can reduce the excretion of 5-HIAA in urine, and about 15% of patients show regression or stability of the tumor for more than 3 years.

　　Nine, somatostatin derivative treatment:

　　Somatostatin is a polypeptide hormone normally distributed throughout the gastrointestinal tract and pancreas, which can inhibit the release of various gastrointestinal hormones and cell mitosis, and is a regulatory peptide that acts on exocrine, endocrine, paracrine, and autocrine. It exists in the human body in two forms, 14 peptides and 28 peptides, widely distributed and complex in action. Animal experiments have confirmed that somatostatin can not only inhibit the production of hormones by endocrine cells but also inhibit multiple growth and proliferation indexes of tumor cells. Most scholars advocate the use of octreotide, starting with a low dose (100-200μg) twice a day, and gradually increasing the dose to 1500μg/d. 60% of the symptoms of carcinoid syndrome are relieved, and the biochemical reaction (5-HIAA excretion) is reduced by 70%, but only 5% of the tumors are reduced. The use of long-acting preparations only requires monthly injection, and it can significantly improve the quality of life of patients.

　　Ten, other symptomatic treatments:

　　To control the发作 of skin flushing, phenoxybenzamine can be used, 150mg/d; to control diarrhea, para-chlorophenylalanine can also be used, 3-4g/d (not exceeding 1 month); when there is a carcinoid syndrome, somatostatin derivative SM230 can be used, subcutaneous injection can immediately relieve symptoms; to prevent the occurrence of carcinoid crisis during chemotherapy and anesthesia, SM230 subcutaneous injection can be given 24 hours before surgery, and the dosage can be increased for severe cases, and SM230 should be administered intravenously immediately if a crisis occurs.