Gastrointestinal tumors are the general term for tumors in the esophagus, stomach, colorectal and other parts. They often have no obvious symptoms in the early stage. Therefore, the patients treated are basically advanced tumors with poor treatment effects and poor prognosis. But in fact, most gastrointestinal tumors can be effectively controlled and even cured through preventive screening, early diagnosis and early treatment. Therefore, it is very necessary to actively carry out the prevention and treatment of early cancer of the digestive tract.
Be alert to early symptoms and do a good job of screening
Colorectal cancer, gastric cancer, and esophageal cancer ranked 3rd, 5th and 7th respectively in the global incidence of malignant tumors, which are common causes of cancer deaths. What are their early symptoms?
Early esophageal cancer
of esophageal cancer refers to tumor invasion and early mucosa, and regardless of the presence or absence of lymph node metastasis. During this period, the clinical manifestations are not obvious, and most of them are recurring foreign body sensation or choking sensation when swallowing food, or pain behind the breastbone. Many studies have proven that endoscopic minimally invasive treatment for early esophageal cancer has basically the same clinical efficacy as surgery, and endoscopic diagnosis and treatment has the advantages of shortening hospital stay, improving postoperative quality of life, and reducing pulmonary complications .
At present, endoscopy and pathological biopsy are still important screening methods for early detection of esophageal cancer. The "Chinese Expert Consensus Opinion on Early Esophageal Cancer and Precancerous Lesion Screening (2019, Xinxiang)" recommends that the starting age for esophageal cancer screening is 40 years old, and the screening should be terminated when the age of 75 or life expectancy is less than 5 years. New high-risk factors: hot soup diet, fast eating, air pollution, tooth loss. The use of esophageal cancer screening scores/questionnaires to assess the risk of esophageal cancer can increase the screening rate; at the same time, early esophageal cancer and intraepithelial neoplasia (or dysplasia) should be the main screening targets.
2. early gastric cancer,
gastric cancer refers to early invasive cancer limited to the mucosa and submucosa, with or without lymph node metastasis. According to the unevenness of the gastric mucosa surface tissue, it is divided into uplift, superficial and concave. The superficial type is subdivided into three subtypes: superficial convex, superficial flat and superficial concave. The vast majority of early gastric cancer have no obvious symptoms, or only non-specific symptoms such as upper abdominal discomfort, acid reflux, belching, and loss of appetite. In severe cases, abdominal pain, hematemesis, and melena may also occur. Endoscopic treatment of early gastric cancer has a good prognosis, and the 5-year survival rate can reach more than 90%. Therefore, endoscopy is of great significance for the detection of early gastric cancer.
In addition to gastroscopy and related tumor markers as routine screening methods, the "Expert Consensus Opinions on the Screening Process for Early Gastric Cancer in China (2017, Shanghai)" puts forward the concept of "precise stratification" of the risk of gastric cancer and summarizes the related risks. Table evaluation method. The scale is mainly composed of five variables: gender, age, pepsinogen, gastrin 17 and Helicobacter pylori antibody, and assigned corresponding scores. The sensitivity of the scale for diagnosing gastric cancer is 70.8%, the negative predictive value is 98.8%, and the accuracy rate can reach 75.7%. It can be used as an important tool for gastric cancer screening.
3. Early colorectal cancer
colorectal cancer is early colorectal epithelial tumor of any size is limited to the depth of invasion of mucosa and submucosa, with or without lymph node metastasis. Pathologically, there are two main types: low-grade intraepithelial neoplasia is also called mild and moderate dysplasia, which are benign lesions; high-grade intraepithelial neoplasia is also called severe dysplasia, carcinoma in situ, carcinoma in situ Suspicious infiltration and intramucosal carcinoma are malignant lesions. Colorectal cancer often has no obvious clinical symptoms in the early stage. As the tumor progresses, there may be changes in defecation habits and nature, such as blood in the stool, diarrhea, local abdominal pain, frequent defecation, and incomplete defecation.
Colonoscopy and related tumor markers are important measures for the early diagnosis of colon cancer. According to the "Expert Consensus Opinions on the Screening Process for Early Colorectal Cancer in China (2017, Shanghai)", it is recommended that population screening and opportunistic screening be combined, and screening is recommended The subjects are people between 50 and 75 years old, regardless of whether there are alarm symptoms. The use of colorectal cancer screening scores/questionnaires for colorectal cancer risk assessment can significantly increase the screening rate.
Many diagnosis and treatment methods help early diagnosis and treatment
The occurrence and development of gastrointestinal tumors is a long-term and complex process. Normal epithelium-simple hyperplasia-dysplasia-carcinoma in situ-invasive carcinoma is considered to be the classic process of tumor growth, which takes 10-15 years on average to complete, and some may only take 5 years or less. The so-called "precancerous lesions" refer to the intermediate stage from normal tissues to carcinogenesis. Precancerous lesions of gastrointestinal tumors generally include chronic inflammation, malignant ulcers, polyps, adenomas, adenomatosis, and heterogeneous hyperplasia. At present, the treatment of precancerous lesions and carcinoma in situ is mainly done through endoscopy or surgery.
The first is endoscopic resection. Endoscopic resection of diseased tissue has become a routine treatment because of its advantages such as less trauma, faster recovery and fewer complications. Except for a small number of patients with excessively large diameters, malignant changes under the microscope, and a large number, most of them can be removed by endoscopy treatment. Commonly used endoscopic resections for gastrointestinal polyps include conventional endoscopic polypectomy, endoscopic mucosal resection (EMR), and endoscopic submucosal dissection (ESD).
The second is other endoscopic treatment techniques, including argon ion coagulation, hot electrode therapy, and cold cutting snare. These methods and techniques can only remove small polyps and other minimally diseased tissues, and cannot confirm pathological diagnosis and whether they are cured. Therefore, pathological biopsy of tissue types that tend to become cancerous should be performed before the treatment of minimal changes.
The third is surgical treatment. Carcinoma in situ and precancerous lesions are generally treated with ESD or EMR. However, additional surgical operations are required when the following conditions occur: (1) the lateral and basal margins of the excised specimen are positive; (2) the submucosa is highly infiltrated; (3) the vascular invasion is positive; (4) poorly differentiated adenocarcinoma, undifferentiated Differentiated carcinoma; (5) The budding grade of carcinoma is above G2.
In recent years, through the unremitting efforts of the majority of medical workers, the prevention and treatment of early gastrointestinal cancer has achieved initial results. This is due to the clinical popularization of many testing methods, such as electronic high-definition gastrointestinal endoscopy, carbon 13/carbon 14 breath test, capsule endoscopy, and fecal occult blood test. Of course, the emergence and application of some new methods and technologies, such as fecal DNA methylation detection, magnetic control capsule endoscopy, electronic staining gastrointestinal endoscopy, multidimensional omics research technology and the use of artificial intelligence medical risk models based on biological calculations, These can better improve the detection rate of early gastrointestinal cancer, so as to achieve early detection and early treatment.
In terms of the prevention of early gastrointestinal cancer, long-term intake of tobacco and alcohol, high-fat diet, irregular diet, staying up late and other bad lifestyle habits can lead to a significant increase in the incidence of gastrointestinal tumors. Therefore, these risk factors should be focused on and adjusted in time, such as quitting smoking and limiting alcohol, eating regularly, maintaining adequate sleep, strengthening physical exercise, controlling weight, increasing dietary fiber intake, and reducing red meat intake. In addition, Helicobacter pylori infection is also one of the main carcinogens of early gastrointestinal cancer, so once Helicobacter pylori infection should be eradicated in time. At the same time, for people over 40 years old, people in areas with high incidence of gastrointestinal tumors, and high-risk groups with family history of gastrointestinal tumors and history of gastrointestinal polyps, gastrointestinal endoscopy should be performed every 1 to 2 years.
Expert introduction
Zhang Mingxin First Affiliated Hospital of Xi'an Medical College, medical director, Dr., deputy chief physician, master tutor. Winner of the May 1st Labor Medal of Shaanxi Province, Winner of the May 4th Youth Medal of Shaanxi Province, Outstanding Young Talents in Shaanxi Province, and the first most promising young oncologist of the Chinese Society of Clinical Oncology. Mainly dedicated to the clinical and basic research of gastrointestinal tumors and liver diseases, carrying out endoscopic precision treatment of esophageal and gastric varices (ESVD), endoscopic submucosal dissection (ESD), endoscopic gastric wall resection (EFR), Endoscopic submucosal tunnel tumor resection (STER) and other operations.
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