Stomach Cancer

　　Currently, the following groups are considered to be at high risk for gastric cancer:

　　Having precancerous lesions:Precancerous lesions refer to benign diseases with a tendency to become cancerous, such as chronic atrophic gastritis, with a cancerous rate of up to 10%; chronic gastric ulcer, with a cancerous rate lower than 3%; gastric polyps, with a diameter greater than 2 centimeters, multiple and broad-based, have a high cancerous rate; after partial gastrectomy, the residual gastric cancerous rate can reach 0.3% to 10%. Other precancerous lesions include giant gastric mucosal hypertrophy, verrucous gastritis, etc.

　　Poor dietary habits:Unregular diet, eating quickly, preference for high-salt foods, hot and烫 food, preference for preserved, smoked, dried seafood, and leftover dishes with high content of nitrite, red meat grilled, frequent consumption of moldy food, and insufficient intake of fresh vegetables, etc.

　　Long-term heavy drinking and smoking:Alcohol can cause changes in mucosal cells and lead to carcinogenesis. Smoking is also a strong risk factor for gastric cancer, with the risk being the highest for those who start smoking in their youth.

　　Family history of gastric or esophageal cancer:The incidence of gastric cancer in the families of patients is 2 to 3 times higher than that in the general population.

　　Long-term poor psychological state:Conditions such as depression, worry, longing, loneliness, depression, hatred, aversion, inferiority complex, self-reproach, guilt, tension in interpersonal relationships, mental collapse, and being angry in silence can significantly increase the risk of gastric cancer.

　　Certain special occupations:Long-term exposure to sulfuric dust fog, lead, asbestos, herbicides, and workers in the metal industry have a significantly increased risk of gastric cancer.

　　Helicobacter pylori (Hp) infection:Some studies suggest that about half of gastric cancers are related to Helicobacter pylori infection.

　　1. When complicated with gastrointestinal bleeding, it is usually small amount of bleeding, and massive bleeding is rare. About 5% of patients may have massive bleeding, manifested as hematemesis and/or melena, occasionally as the initial symptom. Dizziness, palpitations, tarry stools, and vomiting coffee-colored matter may occur.

　　2. Gastric cancer abdominal metastasis when the common bile duct is compressed, jaundice may occur.

　　3. Combined with pyloric obstruction, more common in gastric cancer originating from the pylorus and cardia. Gastric cancer at the fundus extending to the cardia or esophagus can cause lower esophageal obstruction. Pyloric obstruction is more likely to occur in tumors adjacent to the pylorus. Vomiting, dilated gastric shape in the upper abdomen, and hearing splash water sound may occur.

　　4. Perforation of the tumor causes diffuse peritonitis, which is less common than benign ulcers. It can be seen in ulcerative gastric cancer, mostly occurring in ulcerative cancer at the prepyloric region, without adhesion and covering when perforation occurs, which can cause peritonitis. Abdominal muscle rigidity, abdominal tenderness, and other peritoneal irritation symptoms may occur.

　　5. Formation of gastrointestinal fistula, with the discharge of indigestible food.

　　More than 70% of early gastric cancer patients have no symptoms, and those with symptoms are generally atypical. Mild discomfort in the upper abdomen is the most common initial symptom, similar to dyspepsia or gastritis. The clinical manifestations of advanced gastric cancer patients are as follows.

　　1. No history of gastric disease, but recent onset of unexplained upper abdominal discomfort or pain; or a history of gastric ulcer, with increased frequency and severity of upper abdominal pain in recent days.

　　2. The feeling of fullness in the upper abdomen is often the earliest symptom of advanced gastric cancer in the elderly, sometimes accompanied by belching, acid regurgitation, and vomiting. If the tumor is located at the cardia, it may feel that food is not smooth when eating; if the tumor is located at the pylorus, when obstruction occurs, the patient may vomit up decayed leftover food from the night before.

　　3. Decreased appetite, emaciation and fatigue: According to statistics, about 50% of elderly patients have obvious decreased appetite, gradual weight loss, and fatigue; 40%~60% of patients seek medical attention due to weight loss.

　　4. Gastrointestinal bleeding: hematemesis (10%), melena (35%), and persistent occult blood in stools (60%~80%)(small amount, no blood visible to the naked eye but detectable by testing) positive.

　　1. Eat more fresh foods
　　Use less or do not use foods that are more delicious due to moldiness, such as sauerkraut. Because there are many nitrates in these pickled vegetables, which stimulate the stomach and are carcinogenic. It is necessary to eat more fresh vegetables and fruits, which contain vitamins that can participate in repairing the body's natural barrier and prevent the synthesis of chemical carcinogens in the body.

　　2. Pay attention to developing good eating habits
　　If you have the habit of overeating or eating too fast in the past, please correct it in time. Because this is very stimulating to the stomach, and there is an inevitable relationship with the occurrence of gastric cancer.

　　3. Stay away from carcinogens
　　This point needs to attract the attention of male friends, and it is necessary to not smoke or drink alcohol or to smoke less and drink less alcohol in daily life. Everyone knows that smoking is the main cause of gastric cancer, because its smoke contains many carcinogenic substances; although alcohol itself is not a carcinogen, strong alcohol can stimulate the gastric mucosa, damage the mucosal tissue, and promote the absorption of carcinogenic substances. If drinking and smoking at the same time, the harm is greater, because alcohol can enhance the permeability of the cell membrane, thereby increasing the absorption of carcinogenic substances in the smoke.

　　Gastric cancer patients need to undergo a variety of laboratory tests, including physical examination, laboratory tests, imaging examinations, and endoscopic examinations, etc.

　　1. Physical examination:There may be enlargement of the left supraclavicular lymph nodes, an upper abdominal mass, and rectal examination may find a mass in the pelvic floor (cancer cells fall off and grow in the pelvis).

　　2. Laboratory tests:Early blood tests are usually normal; moderate to advanced stages may have varying degrees of anemia, and the occult blood test in feces may be positive. Currently, there is no tumor marker with strong specificity for the diagnosis of gastric cancer. Continuous monitoring of multiple markers such as CEA, CA50, CA72-4, CA19-9, CA242 has certain value for the diagnosis, treatment, and prognosis judgment of gastric cancer.

　　3. Imaging examinations:Imaging examinations include upper gastrointestinal X-ray barium meal, enhanced CT, MRI (magnetic resonance imaging), PET-CT scan, gastroscopy or laparoscopy with ultrasound, etc.

　　4. Endoscopic examination:Gastroscopy can detect early gastric cancer, differentiate between benign and malignant ulcers, determine the type and lesion range of gastric cancer. If gastric ulcer or atrophic gastritis is found, pathological biopsy is needed to assess the degree of cellular atypical hyperplasia. Those with severe atypical hyperplasia (atypical hyperplasia) need to be treated as early cancer. Laparoscopy, if available in the hospital, can achieve the effect of laparotomy, can understand the situation around the tumor in detail, especially whether there are widespread millet grain metastatic foci in the peritoneum, which are difficult to be found by other examinations.

　　Gastric cancer patients need to adjust the amount and type of food intake, as well as the interval and frequency of eating, according to their tolerance to food and gastrointestinal capacity after surgery. In the early postoperative period, it is generally recommended to provide nutrition through special routes, such as intravenous nutrition or enteral nutrition. After 3-4 days of passing gas and the recovery of gastrointestinal function, gradual eating can be started, usually following the following principles:

　　1. Small meals, frequent eating:Due to the明显缩小 of the space for food intake after surgery, the amount of food per meal cannot be too much, and only small meals can meet the body's nutritional needs. It is recommended to start with 8-10 meals a day, and gradually change to 5-6 meals around 1 month after surgery, and 3-6 months later gradually change to 3-4 meals.

　　2. Increase the intake of protein-rich foods:In the early postoperative period, it is recommended to follow the order of渣free clear liquid diet, low residue liquid diet, semi-liquid diet, soft food, and common food for eating. The liquid diet should include congee, egg soup, vegetable soup, lotus root starch, enteral nutrition preparations, milk, and protein powder; semi-liquid food should be selected with high protein, high calories, high vitamins, low fat, fresh and easily digestible foods. The best source of animal protein is fish, and eggs and yogurt can also be eaten; plant protein is best in tofu. After the common food is consumed, more vegetables and fruits should be eaten.

　　3. Eat less sweet foods and fats:It should be avoided to consume a large amount of overly sweet foods that may cause discomfort. Fat should not exceed 35% of the total energy, and less animal fat should be consumed. It is recommended to eat easily digestible and absorbable fats, such as vegetable oil, butter, and egg yolks.

　　4. Chew slowly and swallow slowly:After surgery, the stomach's grinding function is weakened, and for rough and hard-to-digest foods, it should be chewed slowly and swallowed slowly.

　　Traditional Chinese medicine classifies gastric cancer into Yin Deficiency and Endogenous Heat Type, Spleen and Stomach Weakness Type, Qi Stagnation and Blood Stasis Type, etc. According to different symptoms, dialectical treatment can achieve certain effects.

　　Yin Deficiency and Endogenous Heat Type
　　Treatment Method: Nourish Yin and benefit the stomach, clear heat and moisten dryness.
　　Prescription: Xiyangshen or Taizishen, Maidong, Baibiandou, Shengdi, Yuzhu, Dazao, Jiangbanxia, Maiya, and Zhigancao.
　　Modifications: Add Gouqizi and Nuzhenzi for kidney and liver Yin deficiency; add Xianhecao, Ditu, Sanqi powder, and Dahuang for hemorrhage; add Hemaris, Yuliren, and Guolou for constipation.
　　Usage: Take one dose per day, decocted in water.

　　Spleen and Stomach Weakness Type
　　Treatment Method: Strengthen the spleen and stomach, soften hardness and disperse nodules.
　　Prescription: Danshen or Renshen, Fuling, Baizhu, Chenpi, Qingbanxia, Huangqi, Fupengfang, Quanxie, Wugong, Jiangshi, and Walengzi.
　　Modifications: Add Doushizi, Buguzhi, Nuzhenzi, and Gouqizi for kidney deficiency; add Fuzi and Ganjiang for yang deficiency; add Danggui, Baishao, Shudi, Huangjing, Ejiao, and Zhishou for blood deficiency; for both Qi and Yin deficiency, replace Danshen with Shashen, and add Shihu, Maidong, and Tianhuafen; for phlegm and dampness, add Shanyao, Tuber fleeceflower, and Shengyiren.
　　Usage: Take one dose per day, decocted in water; after symptoms improve and stabilize, take one dose every other day or take medication intermittently.

　　Qi Stagnation and Blood Stasis Type
　　Treatment Method: Regulate Qi and activate blood, harmonize the stomach and detoxify.
　　Prescription: Taoren, Honghua, Shengdi, Shudi, Danggui, Dahuang, Zhishi, Houpu, Zhizhasha, Baihuasheshecao, Qiyeyizhihua, Shengma, Zhigancao, Shengjiang juice, and Jieju juice.
　　Modifications: For purple tongue, large tumors that cannot be completely removed, add Chuanxiong, Didong, Gegan, Sanlie, and Niuxi if the body's vital energy is not deficient; for fixed pain that persists, add Yanhusuo and Wulingzi.
　　Usage: Boil the herbs in water to extract the juice and concentrate it to 300 milliliters, then add ginger and chive juice. Take one dose per day, divided into 6 to 8 servings.