Stomach and bowel cancer, is it diagnosed at an advanced stage? Oncologists: These tests may be able to detect early

April 15-21 is the 28th National Cancer Prevention Awareness Week. The National Cancer Center previously released the latest cancer report in China. The data shows that in 2016, there were about 4.06 million new cases of cancer in China, which is equivalent to 8 people diagnosed with cancer every minute.

Among them, digestive tract tumors still have a high incidence in China, including gastric cancer, colorectal cancer, esophageal cancer, pancreatic cancer and other digestive system tumors, accounting for nearly 50% of the total cancer incidence. In this regard, screening is a very important means of preventing cancer.

On April 21st, we and Guangzhou Taihe Cancer Hospital jointly launched the theme live broadcast of "Early Diagnosis and Treatment of Digestive Tract Tumors, Scientific Anti-cancer and Anti-disease". The director of the laboratory and the deputy chief physician Zhou Chaoyang, a well-known expert in endoscopy, and the deputy chief physician Jia Lin, a well-known expert in oncology, jointly popularized the knowledge of prevention, screening, diagnosis and treatment of gastrointestinal tumors, and answered questions from netizens online.

Friends who missed the live broadcast can directly click the video link in the comment area to watch the live broadcast. Xiaojiu also compiled the essence of the live broadcast and shared it with everyone.

1. How to screen for gastrointestinal tumors and what screening methods are there? ==================================================================================

The most common gastrointestinal tumors are gastrointestinal tumors and liver tumors. Among them, the incidence of gastric cancer is about 40%, and the incidence of liver cancer is 39%, and the number of people is increasing every year. The situation is very serious, so early diagnosis and early treatment are needed.

The 5-year survival rate of early treatment can reach more than 90%. If it develops to the middle or late stage, the 5-year survival rate may be less than 50%. The key to prevention is screening.

Many people may worry that tumor screening is complicated, but in fact, a simple test can lead to an initial diagnosis. Director Tan Youchun said that the easiest and non-invasive method for digestive tract tumors is to do occult blood test with stool.

The doctor will also make a preliminary judgment on the patient's condition through personal medical history, such as abdominal pain, blood in the stool, weight loss, night sweats, fatigue and other symptoms.

During physical examination, such as liver, gallbladder, pancreas, spleen, and abdominal pain, if a mass is found on abdominal palpation, it indicates that the condition may be severe. During digital rectal examination, if the lumen is obviously narrowed, further color photos, tumor marker examinations, CT, MRI or more advanced PET-CT examinations can be performed to understand the general condition.

However, at present, the diagnosis of gastrointestinal tumors mainly relies on colonoscopy for pathological biopsy. If a tumor is diagnosed by pathology, it is necessary to judge the stage and development of the tumor in many aspects.

Different types of gastrointestinal tumors require different screening methods to determine the severity of the disease.

For example, barium meal and gas barium double angiography can check the stiffness of the tumor and the condition of the gastric mucosa to judge the degree of the disease; gastrointestinal endoscopy can also judge the size, but it needs to be comprehensively judged according to the degree of lymph node metastasis.

Tumor size and lymph node metastasis have guiding significance for staging, and to judge whether severe metastasis, CT, MRI, and PET-CT should be used for comprehensive judgment.

Colon cancer mainly relies on gastroenteroscopy to determine the severity of the disease.

Regarding the screening of tumor markers that have frequently appeared in people's field of view in recent years, Director Zhou Chaoyang also made a more detailed supplement: tumor markers are produced by gene expression of tumor cells, or produced in response to human tumor cells. Substances that reflect the existence and growth of tumors, including carcinoembryonic antigens, enzymes, hormones, oncogenes, glycoproteins, cell tumor protein antigens, etc.

Like the tumor marker carcinoembryonic antigen CEA, which is common in digestive tract tumors; CEA, CA19-9, and CA125 are common in pancreatic cancer; CA125 is common in gynecological tumors; alpha-fetoprotein is common in liver cancer; prostate specific antigen PSA.

In the question and answer session, netizens in the live broadcast room were puzzled about the common gastroenteroscopy. Is it an inspection method or an operation? Why is it possible to have both an examination and an operation? Director Zhou Chaoyang also made detailed popular science while answering the questions.

Gastrointestinal endoscopy can detect precancerous diseases, such as early lesions and early cancers of the digestive tract, and can be removed by endoscopy to achieve surgical results, so it can be checked or operated.

A face-to-face consultation is required before gastroenteroscopy, and the doctor will assess whether the patient is suitable for gastroenteroscopy. Fasting for 6-8 hours is required before the examination.

Half an hour before the examination, two drugs need to be taken, one to anesthetize the throat, and the other to dissolve and remove gastric mucus, so that the field of vision during the examination is clear to avoid missing small lesions.

During the examination, a thin and long tube is used to pass through the mouth and throat to the stomach, and the examination time is about 10 minutes. Colonoscopy is more complicated than gastroscopy. It requires not only fasting but also bowel preparation. Before the examination, medicine to empty the bowel is taken. The examination time is 10-20 minutes.

Director Zhou Chaoyang said that gastric cancer is preventable and controllable, and gastroscope is an effective way to prevent gastric cancer. It is recommended that the general population do a gastroscopy every 3-5 years; people with chronic atrophic gastritis need to do it once a year; if it is atypical hyperplasia, it needs to be done every six months.

2. What are the causes of gastric cancer, colon cancer and rectal cancer? How should it be treated? ===================================================================================================

The early symptoms of gastric cancer, colon cancer and rectal cancer are not very obvious, so they are often overlooked. Such as indigestion, abdominal distension, belching, acid regurgitation, nausea and other atypical manifestations in the early stage of gastric cancer.

The early symptoms of colorectal cancer are not very typical. Director Jia Lin introduced that there are differences in the performance of the left and right sides of colorectal cancer. The symptoms of the left half appear earlier, the bowel is relatively narrow, and it is close to the anus. Diarrhea, abdominal pain and other symptoms may occur, and it is easy to cause obstruction if it develops slowly.

The right hemi-intestinal canal is wide and far from the anus, so the mass is not easy to find, the tumor grows slowly, surface damage will occur, toxin absorption will occur, resulting in poor spirit, fatigue, loss of appetite, pale complexion, etc., especially if there is a family history, People who have changed bowel habits, it is best to go to the hospital for examination.

When referring to the causes of the disease, Director Jia Lin said that the formation of tumors is the result of a combination of factors, such as Helicobacter pylori, bad eating habits (often eating overnight vegetables, moldy foods, high-salt foods, salted fish and other preserved foods) ), staying up late for a long time, etc. Family history, precancerous lesions are also high risk factors, and gastric stump may also develop into gastric cancer several years later.

In addition to habits, genetic factors are also increasingly valued. Director Jia explained: Genetics has entered everyone's field of vision. It was an article published in the New England Journal of Medicine. It studied the incidence of cancer in twins. The results confirmed that 30% of cancers are genetically related, and 70% are related to the environment.

So slowly established a theory, the occurrence of cancer is a multi-factor and multi-stage process of heredity and external environment. Among them, heredity is a susceptibility factor, which may induce cancer after ten or twenty years. Some studies have also shown that if there are susceptible genes in the body, coupled with bad living habits, drinking and staying up late, eating unhealthy food, it is also easy to induce under the interaction.

So if you are diagnosed with cancer, how should you treat it? I am afraid this is the most concerned issue of the diagnosed patients.

Director Tan Youchun said that surgery is the only cure for early gastric cancer or intestinal cancer. If the tumor has not invaded the stomach and intestines, then the mucosal layer can be removed through gastroscopy, especially for adenocarcinoma, which can achieve good results.

If it is in the bowel or the stomach wall, it invades the surrounding tissues, such as the liver area of ​​colorectal cancer, the invasion of the duodenum, the invasion of the gallbladder, and the invasion of the bile duct, which can be removed together. Judging from clinical cases, there are many patients who can not relapse for a long time after surgery, so resection must be performed if resection is required.

If it develops to distant metastases, such as colorectal cancer lung metastases and liver metastases, it is best to excise the primary tumor and lymph nodes with local regional metastasis.

And like poorly differentiated adenocarcinoma, mucinous carcinoma, undifferentiated carcinoma, signet ring cell carcinoma, it is relatively easy to metastasize, and the operation is bigger, and radical surgery is required. If the primary and serosa layers have been invaded, the level of surgery will be greater, so early treatment and early surgery are required.

When the tumor is too large for the body to tolerate, it is best to shrink it first through chemotherapy and targeted drug therapy, which will make it easier to remove and have a better curative effect. If surgery cannot be done, then chemotherapy, targeted drugs, and immunotherapy must be used.

Medical treatment has been developed for more than 70 years. Since the emergence of the third generation of chemotherapy drugs, medical treatment has greatly improved. The effective rate has increased from the original 5% and 10%. The sudden emergence of targeted drugs has also caused many advanced diseases. Patients can reach a state of cure, and targeted drugs, targeted drugs, macromolecular drugs, and small molecule drugs have benefited many people.

In medical treatment, pathological staging is the biggest principle of treatment. Director Jia Lin introduced that with the development of precision medicine, genetic testing and immune testing for precision medicine have become the most important directions. Especially for patients with advanced stage, the treatment plan will be comprehensively selected according to genotype, molecular typing and immune typing.

At the same time, multidisciplinary participation in treatment is also important. How internal medicine, chemotherapy, and radiotherapy cooperate with surgery to turn inoperable patients into operable patients, and make inoperable patients incisable and radically curable, requires team discussion and standardized treatment.

Of course, prevention is always greater than cure, and daily prevention of gastrointestinal tumors should be done consciously.

The most important thing is to change your living habits, keep exercising, eat a healthy diet, and stay away from the pollution and microbial infection of adverse factors in the surrounding environment. It is also necessary to perform microscopic radical treatment of precancerous lesions, including regular re-examination, so that precancerous lesions can be strangled in the cradle.

At the same time, we should also pay attention to the screening of family history and genetic history. This group of people is not screened according to the conventional age. For example, the routine screening age for colorectal cancer is 50 years old, and the age for gastric cancer is 40 years old, but for people with a genetic history, it becomes 20 years old. If someone in the family has stomach or bowel cancer, the screening age should be earlier than the first ten years before the elder gets the disease.

In general, cancer prevention and treatment requires early action, early detection, early diagnosis, and early treatment, in order to make cancer invisible.