Smooth muscle sarcoma of the residual stomach

　　First, etiology

　　The occurrence of gastric smooth muscle sarcoma may be related to the following factors.

　　1. Gastrointestinal alkaline reflux:Gastrointestinal alkaline reflux can be seen in various types of gastric resections, especially in Billroth II. Bile and pancreatic juice reflux into the stomach, causing chronic irritation of the residual gastric mucosa, leading to gastric mucosal inflammation and ulcers. Over time, atrophy, intestinal metaplasia, and atypical hyperplastic changes may occur, and these are proportional to the degree of reflux. Pancreatic juice may promote the transformation of precancerous substances in the residual stomach into carcinogens, thereby triggering the occurrence of cancer. Some studies have also shown that taurine bile acid can significantly promote the occurrence of residual gastric cancer induced by nitrosoguanidine.

　　2. Delayed gastric emptying:Postoperative residual gastric atony, loss of grinding function, and intestinal motility disorder often lead to delayed gastric emptying, bacterial proliferation in the residual stomach, and increased opportunities for contact with the residual gastric mucosa, aggravating the injury to the residual gastric mucosa.

　　3, Low acid in the stomach:After a partial gastrectomy, the secretion of residual stomach decreases, and with the reflux of bile and pancreatic juice, the pH value of the gastric juice increases. It is easy for bacteria to grow and the activity of carcinogenic substances to increase.

　　4, Lesions at the anastomosis:Chronic non-physiological stimulation factors can cause gastric mucosal carcinogenesis, which is well known to people. Local stimulation at the anastomosis includes: mismatched anastomosis of different tissue layers, bringing mucosal tissue into the submucosa; local scar tissue bridge formation; direct adjacency of gastric mucosa and small intestinal mucosa, and polypoid lesions around the anastomosis. These factors all contribute to the occurrence of residual gastric cancer.

　　Second, pathogenesis

　　Different from the epithelial cancer of the residual stomach, the smooth muscle sarcoma of the residual stomach grows within the wall first. When the tumor volume increases to a certain extent, it can gradually protrude into the lumen, squeezing the gastric mucosa, and protrude into the peritoneum, appearing as a dumbbell-shaped mass on X-ray. Sometimes the tumor may completely protrude into the gastric lumen, presenting as a pedunculated polyp. Due to compression and ischemia of the mucosa, nearly half of the patients may have central ulcers in the mass, which manifests clinically as gastrointestinal bleeding.

　　In the late stage, the smooth muscle sarcoma of the residual stomach can be palpated as an abdominal mass in the upper abdomen, and its main sites of metastasis are the lungs and liver. Generally, tumors with a diameter less than 5 cm have a better prognosis, while tumors with more than 40% of the dermis are prone to recurrence, but they rarely metastasize. Conversely, about one-third of subcutaneous tumors can metastasize and cause death, and bile and pancreatic juice reflux, etc. may occur.

　　The smooth muscle sarcoma of the residual stomach may be asymptomatic and occasionally detected by endoscopy, X-ray, etc. If there are clinical manifestations, hematemesis and melena are most common, followed by upper abdominal discomfort, oppression or distension, changes in defecation habits, weight loss, etc. In the late stage, an abdominal mass in the upper abdomen can be palpated. The main sites of metastasis of the smooth muscle sarcoma of the residual stomach are the lungs and liver, and metastasis to the supraclavicular lymph nodes is rare.

　　1. Gastrointestinal alkaline reflux:Gastrointestinal alkaline reflux can be seen in various types of gastric resections, especially in Billroth II. Bile and pancreatic juice reflux into the stomach, causing chronic irritation of the residual gastric mucosa, leading to gastric mucosal inflammation and ulcers. Over time, atrophy, intestinal metaplasia, and atypical hyperplastic changes may occur, and these are proportional to the degree of reflux. Pancreatic juice may promote the transformation of precancerous substances in the residual stomach into carcinogens, thereby triggering the occurrence of cancer. Some studies have also shown that taurine bile acid can significantly promote the occurrence of residual gastric cancer induced by nitrosoguanidine.

　　2. Delayed gastric emptying:Postoperative residual gastric atony, loss of grinding function, and intestinal motility disorder often lead to delayed gastric emptying, bacterial proliferation in the residual stomach, and increased opportunities for contact with the residual gastric mucosa, aggravating the injury to the residual gastric mucosa.

　　3, Low acid in the stomach:After a partial gastrectomy, the secretion of residual stomach decreases, and with the reflux of bile and pancreatic juice, the pH value of the gastric juice increases. It is easy for bacteria to grow and the activity of carcinogenic substances to increase.

　　4, Lesions at the anastomosis:Chronic non-physiological stimulation factors can cause gastric mucosal carcinogenesis, which is well known to people. Local stimulation at the anastomosis includes: mismatched anastomosis of different tissue layers, bringing mucosal tissue into the submucosa; local scar tissue bridge formation; direct adjacency of gastric mucosa and small intestinal mucosa, and polypoid lesions around the anastomosis. These factors all contribute to the occurrence of residual gastric cancer.

　　1, X-ray

　　Visible defects in filling, shadowing, such as large, deep, and multiple ulcers, or sinus tracts leading to the cyst cavity of the tumor, other visible mucosal disorder, destruction, with varying degrees of barium through obstruction or abnormal passage.

　　2, Gastroscopy

　　Local ulcers or nodular hyperplastic masses may be found.

　　First, Gastric Cancer Diet Recipe:

　　1, Sugar Cane and Ginger Drink:Appropriate amounts of sugar cane and ginger. Squeeze half a cup of sugar cane juice, mix with one spoon of ginger juice, and simmer. Take twice a week, served warm, it has the effect of harmonizing the middle and strengthening the stomach, suitable for early stages of gastric cancer.

　　2, Brown Sugar Stewed Tofu:100 grams of tofu, 60 grams of brown sugar, 1 bowl of water. Dissolve the brown sugar in water, add tofu, and boil for 10 minutes. Take regularly, it has the effect of harmonizing the stomach and stopping bleeding, suitable for those with obvious hematemesis.

　　3, Dried Tangerine and Date Drink:One piece of tangerine peel, 3 dates. Remove the seeds from the dates and boil with the tangerine peel. Take once a day, this nourishing recipe can promote the flow of qi, strengthen the spleen, relieve nausea and vomiting, and is suitable for虚寒 vomiting.

　　4, Radish Seed Congee:30 grams of radish seeds, an appropriate amount of glutinous rice. Roast the radish seeds first, then cook with glutinous rice to make congee. Take once a day, for breakfast, this recipe can eliminate accumulation and relieve abdominal distension, suitable for those with obvious abdominal distension.

　　5, Dried Tangerine Lean Pork Congee:9 grams of dried tangerine peel, 12 grams of cuttlefish bone, 50 grams of lean pork, and an appropriate amount of glutinous rice. Cook the dried tangerine peel and cuttlefish bone with rice, remove the peel and bone after boiling, add slices of lean pork and cook again, season with a little salt. Take twice a day, for breakfast and dinner, this nourishing porridge can relieve nausea and vomiting, strengthen the spleen and harmonize the qi, and is the first choice for those with abdominal distension.

　　6, Lettuce:250 grams of lettuce, 250 grams of dates, 500 grams of flour. Chop the lettuce, cook the dates until tender and remove the seeds, mix with flour to make a cake. It can be taken as a snack, strengthening the spleen and stomach, drying dampness and promoting diuresis; suitable for diarrhea or loose stools.

　　7, Euryale Ferox Six Treasure Cake:30 grams each of Euryale ferox, Chinese yam, Poria cocos, lotus seed, Job's tears, and mung bean. Mix all these into powder and blend with 500 grams of rice flour. Take 2 to 3 times a day, 6 grams each time, add sugar for taste, and serve with hot water. It can also be used to make cakes. This recipe is good for strengthening the spleen and stopping diarrhea.

　　8, Lychee and Peanut Soup:250 grams of peeled peanuts, 5 dates, 12 grams of lychee meat. Remove the seeds from the dates, cook with peanuts and lychee meat in water until tender. Take once a day, nourishing the blood and spleen, suitable for those with obvious anemia.

　　9. Wumei rice porridge:Wumei (Prunus mume) 20 grams, glutinous rice 100 grams, rock sugar to taste. First, decoct the Wumei to get a concentrated juice and remove the dregs, then cook the glutinous rice into porridge. After the porridge is cooked, add a little rock sugar and cook a little longer. Take once a day, this recipe has the effect of astringing and stopping bleeding.

　　10. Peach kernel rice porridge:Sesame and peach kernels each 20 grams, glutinous rice 80 grams. Cook the porridge with sesame seeds, peach kernels, and glutinous rice together. Take once every other day, this porridge moistens the intestines and relieves constipation.

　　11. Sesame rice porridge:Sesame 6 grams, glutinous rice 30 grams, honey to taste. Roast the sesame seeds and add them to the rice porridge when it is about to be cooked, then add honey to mix well. Take once a day, this medicinal diet nourishes the blood and moistens the intestines.

　　12. Fish maw crispy:Fish maw (the swim bladders of big yellow croaker, carp, yellow-lipped fish, and eel can be used as raw materials), sesame oil. The fish maw is fried until crispy with sesame oil and then crushed. Take 10 grams three times a day, with warm water. This medicinal diet补肾益精, nourishes tendons and vessels, stops bleeding, disperses blood stasis, and reduces swelling.

　　13. Healthy stomach and anti-cancer tea:Safflower stalk or safflower disk 30 grams. Boil the above ingredients into a decoction. Drink the decoction as tea, and long-term drinking has the effects of preventing and treating cancer and inflammation. This diet can be chosen for patients with inflammatory anastomosis after gastric cancer surgery.

　　2. Postoperative dietary requirements:

　　Postoperative fasting until gastrointestinal function is restored, removal of the gastric tube, usually for 5-7 days. On the day of removal of the gastric tube, a small amount of water or rice gruel can be taken. On the second day, a small amount of liquid food can be consumed. On the third day, more liquid food can be consumed. On the fourth day, semi-liquid food is recommended, preferably congee. From the 5th to the 6th day, soft food can be consumed. From the 7th to the 8th day, normal diet can be resumed. There is a kind of medicine, which is actually a nutrient, that can be absorbed directly by the human body without gastrointestinal digestion, thus reducing the burden on the intestines. For example, Ensure, when dissolved in water, can be used as a high-quality liquid diet. Fish soup and meat soup with a little cooked meat residue can be used as good semi-liquid food. During the process of eating, pay attention to whether there is bloating or abdominal pain. If discomfort occurs, reduce the amount of food, temporarily slow down the transition of diet, and continue eating after improvement. For patients with special conditions, dietary issues should be followed according to the doctor's advice.

　　3. Dietary attention:

　　1. Chewing slowly:Food stimulates the secretion of saliva (containing enzymes beneficial for the digestion of carbohydrates) in the mouth, and careful chewing can make the food particles smaller. The saliva is fully mixed with the food, partially replacing the function of the stomach. Slow eating refers to slow swallowing and long intervals between swallows to prevent the syndrome of dizziness and palpitations caused by rapid swallowing of a large amount of food (detailed later).

　　2. Small and frequent meals:The capacity of the residual stomach or the attached intestinal segment after surgery cannot be compared with that before, and the body needs a longer period of time to adapt to this change. Clinical experience shows that it takes at least 8-10 months to recover to a normal three-meal-a-day diet. The initial intake is 5-8 times a day, with each meal containing 50-100 grams, gradually increasing the intake according to the patient's tolerance (good tolerance is indicated by no bloating or discomfort), and reducing the frequency of meals. Due to individual differences, the process of adaptation is different.

　　Third, diversification of diet:The variety of food can be chosen according to the patient's dietary preferences and habits, but attention should be paid to eat as many nutritious and easily digestible high-protein, high-vitamin foods as possible. For example, fish, eggs, fresh vegetables, fruits (it is best to drink them as juice), etc. Iron supplementation should be noted because after the stomach is removed, the stomach acid loses its effect on iron (making trivalent iron into divalent iron), causing malabsorption. Some iron preparations can be taken orally under the guidance of a doctor, and iron pots should be used in daily life. Eat more iron-rich foods such as animal liver, spinach, legume products, etc. Drinking some yogurt is also beneficial.

　　Fourth, posture for eating:Surgical resection of the stomach entrance should prevent food from regurgitating after eating, and maintain a sitting or slope position; surgical resection of the stomach outlet should prevent food from running down quickly after eating, lie down and rest for about 20 minutes first, then adopt a free body position.

　　Fifth, after meals, take some medications as prescribed by the doctor, such as digestive drugs, vitamin B12, folic acid, etc., which help with digestion and absorption and prevent anemia from occurring.

　　Fourth, foods to be restricted:

　　Firstly, foods that are fried, spicy, and刺激性, as well as raw, cold, and hard foods should be avoided. Foods that are too hot, too sweet, or too salty should also be limited appropriately.

　　The diagnostic and treatment measures for smooth muscle sarcoma are increasing, including resection, radiotherapy and chemotherapy, but sometimes these measures fail to alleviate the pain of patients with smooth muscle tumor cells, in fact, because the true cause of recovery has not been found, that is, the body fluid is acidified, and as long as the acidic body fluid is not changed, the mutated cells will not die, which is why cancer cells recede and recur after surgery and chemotherapy.

　　To treat smooth muscle tumor cells, one must start by improving one's own constitution, and starve the tumor cells at the source. Eat more alkaline foods, improve one's own acidic constitution, and at the same time, supplement the necessary organic nutrients for the human body. Only in this way can one starve the tumor cells while restoring one's own immunity.