Stomach cancer, bowel cancer, is it late if diagnosed? Oncologist: These tests may be able to detect in advance

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

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

On April 21, we joined hands with Guangzhou Taihe Cancer Hospital to launch a live broadcast of the theme of "Early Diagnosis and Early Treatment of Gastrointestinal Tumors, Scientific Prevention and Fighting of Diseases". Tan Youchun, a well-known expert in digestive diseases at Guangzhou Taihe Cancer Hospital, chief physician, endoscopy The director of the office, the deputy chief physician Zhou Chaoyang, a well-known expert in endoscopy, and the deputy chief physician Jia Lin, a well-known expert in internal oncology, jointly popularized knowledge about the prevention, screening, diagnosis and treatment of digestive tract tumors, and answered questions from netizens online.

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

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

The most common digestive tract tumors are gastrointestinal tumors and liver tumors. Among them, the incidence rate of gastric cancer is about 40%, and the incidence rate of liver cancer is as high as 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%, and if it develops to the middle or late stage, the 5-year survival rate may not reach 50%. The key to prevention is screening.

Many people may worry that tumor screening is complicated, but in fact, a preliminary diagnosis can be obtained with a simple examination. Director Tan Youchun said that the simplest and non-invasive method for gastrointestinal tumors is to use stool for occult blood test. If there is bleeding in the gastrointestinal tract and the occult blood is found to be positive, further examination can be done.

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

During physical examination, such as examination of liver, gallbladder, pancreas, spleen, and abdominal pain, if a mass is found during abdominal palpation, it indicates that the condition may be serious. During digital rectal examination, if you feel that the lumen is obviously narrowed, you can take color photos, tumor marker examinations, CT, nuclear magnetic resonance or more advanced PET-CT examinations to understand the general situation.

However, the current diagnosis of gastrointestinal tumors mainly relies on colonoscopy for pathological biopsy. If the pathological diagnosis is a tumor, it is necessary to judge the grade of the tumor and the extent to which it has developed.

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

For example, barium meal and barium gas double contrast can check the stiffness of the tumor and the condition of the gastric mucosa to judge the extent of the disease; gastroenteroscopy can also judge the size, but it needs to be judged comprehensively based on the degree of lymph node metastasis.

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

Colon cancer mainly relies on gastrointestinal endoscopy to judge the severity of the disease.

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

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

During the question-and-answer session, netizens in the live broadcast room were puzzled about the common gastrointestinal endoscopy. Is it an inspection method or a surgery? Why both inspection and surgery can be done? Director Zhou Chaoyang also gave detailed science popularization while answering the questions.

Gastrointestinal endoscopy can detect precancerous diseases, such as early lesions and early cancers of the digestive tract, and endoscopic resection can achieve surgical results, so both inspection and surgery can be performed.

A face-to-face consultation is required before the gastrointestinal endoscopy, and the doctor will evaluate whether the patient is suitable for the gastrointestinal endoscopy, and fasting is required for 6-8 hours before the examination.

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

During the examination, a thin and long tube is passed through the mouth and throat to the stomach, and the examination time is about 10 minutes. Colonoscopy is more complicated than gastroscopy. Not only does it require fasting, but also preparations for bowel cleansing. Before the examination, drugs to empty the intestines should be taken. The examination time is 10-20 minutes.

Director Zhou Chaoyang said that gastric cancer is preventable and controllable, and gastroscopy is an effective way to prevent gastric cancer. It is recommended that the general population should have a gastroscopy every 3-5 years; people with chronic atrophic gastritis should have it once a year; those with dysplasia should have it every six months.

2. What are the causes of gastric cancer, colon cancer and rectal cancer? How to treat it? ==========================================================================================

The early symptoms of gastric cancer, colon cancer, and rectal cancer are not very obvious, so they are often overlooked. For example, in the early stage of gastric cancer, there are atypical manifestations such as indigestion, abdominal distension, belching, acid reflux, and nausea.

The early symptoms of colorectal cancer are not very typical. According to Director Jia Lin, the left half and right half of colorectal cancer have different manifestations. Symptoms on the left half appear earlier, the intestine is relatively narrow, and it is closer to the anus. Diarrhea, abdominal pain and other symptoms may occur, and it is prone to obstruction when it develops slowly.

The right intestinal canal is wider and far away from the anus. The tumor is not easy to find. The tumor grows slowly, causing surface damage and absorption of toxins, resulting in poor spirits, fatigue, loss of appetite, pale complexion, etc. People who have changed their bowel habits, it is best to go to the hospital for examination.

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

In addition to habits, genetic factors are getting more and more attention. Director Jia explained this: Genetics broke into everyone's field of vision. It was an article published in the New England Journal of Medicine that studied the incidence of cancer in twins. The results confirmed that 30% of cancers are related to genetics and 70% are related to the environment.

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

So if diagnosed with cancer, how to treat it? I'm afraid this is the most concerned issue of diagnosed patients.

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

If it is in the intestine or stomach wall and invades the surrounding tissues, such as colon cancer liver area, duodenal invasion, gallbladder invasion, and bile duct invasion, they can be resected together. Judging from clinical cases, there are many patients who can not relapse for a long time after surgery. Therefore, if resection is required, it must be performed.

If it develops to distant metastasis, such as colon cancer lung metastasis or liver metastasis, it is best to remove the primary tumor and the lymph nodes of local regional metastasis together.

However, poorly differentiated adenocarcinoma, mucinous carcinoma, undifferentiated carcinoma, and signet ring cell carcinoma are relatively easy to metastasize, and if the operation is larger, radical surgery is required. If the base layer and serosa layer have been invaded, the surgical level will be higher, so early treatment and early surgery are required.

When the tumor is too large to be tolerated by the body, it is best to shrink it first through chemotherapy and targeted drug therapy, which will be easier to remove and have better curative effect. If you can't even do surgery, then you have to take chemotherapy, targeted drugs, and immunotherapy.

Internal medicine treatment has been developed for more than 70 years. Since the emergence of the third generation of chemotherapy drugs, internal medicine treatment has been greatly improved. The effective rate has increased from the original 5% and 10%. The sudden emergence of targeted drugs has also made many patients with advanced stage Patients can achieve a cured state, and targeted drugs, targeted drugs, macromolecular drugs, and small molecule drugs have benefited many people.

When performing medical treatment, pathological staging treatment is the biggest treatment principle. Director Jia Lin introduced that with the development of precision medicine, gene testing and immune testing for precision medicine have become the most important directions. Especially for advanced patients, 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 to coordinate internal medicine, chemotherapy, and radiotherapy with surgery to turn inoperable patients into operable patients, and make uncuttable into curable and radically curable requires the team to discuss and standardize the treatment.

Of course, prevention is always better than cure, and we should consciously do a good job in the daily prevention of gastrointestinal tumors.

The most important thing is to change your living habits, keep exercising, eat more healthy diets, and stay away from pollution and microbial infections caused by adverse factors in the surrounding environment. It is also necessary to carry out microscopic radical treatment of precancerous lesions, including regular reexamination, so that precancerous lesions can be killed 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 for gastric cancer is 40 years old, but for people with a genetic history, it becomes 20 years old. And if someone in the family suffers from stomach cancer or bowel cancer, the screening age should be earlier than the first ten years before the elders got the disease.

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