Gastric cancer is one of the common malignancies of the digestive system. Among the 185 countries in the world, the mainland has the highest incidence and mortality rates of gastric cancer, at about 43.9% and 48.6%, respectively. Recently, the National Cancer Center released the latest national cancer statistics, in which the incidence of gastric cancer ranks 5th among malignant tumors and the mortality rate ranks 3rd.
April 15-21, 2024 is the 30th National Cancer Prevention and Treatment Awareness Week. Professor Li Ping, health ambassador of Fujian Health News and professor of the Department of Gastric Surgery of Union Hospital Affiliated to Fujian Medical University, said that for gastric cancer, it is necessary to adhere to comprehensive measures, scientific cancer prevention, and "stomach" health.
Scientific cancer prevention starts with me
The mechanism of gastric cancer has not been fully elucidated, and it may be caused by a combination of factors, such as genetics, disease states, dietary habits and other factors. Risk factors for stomach cancer include:
(1) Age: The incidence of gastric cancer in mainland > 45-year-old population has increased significantly, and the mortality rate has also increased with age.
(2) Gender: The incidence and mortality rate of gastric cancer in men are higher than those in women.
(3) Life and eating habits: high-salt diet, smoking, drinking, excessive intake of smoked food, low intake of fruits and vegetables.
（4）癌前病变：如上皮内瘤变。
(5) Suffering from the following diseases: HP infection, chronic atrophic gastritis, pernicious anemia, gastric polyps, familial adenomatous polyposis.
(6) History of gastric surgery.
(7) Familial gastric cancer: The incidence of gastric cancer in one family is usually caused by the common living environment, dietary habits or accidental factors, and genetic factors also play an important role in it.
The key to preventing gastric cancer includes: (1) Changing lifestyle habits including low-salt diet, reducing smoking and alcohol intake, avoiding smoking, fried and baked foods, and eating more fresh vegetables and fruits. (2) Eradication of HP. (3) Early screening of high-risk groups. (4) Strengthen cancer prevention science education. (5) Conduct regular physical examinations and genetic testing of family members for familial gastric cancer.
The screening methods for gastric cancer mainly include X-ray barium contrast, endoscopy, serological examination and detection of Helicobacter pylori (HP) infection, and early diagnosis includes endoscopic, pathological and imaging staging diagnosis, among which gastroscopy and biopsy are currently regarded as the gold standard for the diagnosis of gastric cancer, and the target population for gastric cancer screening in mainland China is determined according to the risk factors and epidemiological investigation results of gastric cancer, which >Those who are 45 years old and meet any of the following conditions are recommended to undergo gastric cancer screening: (1) Living in an area with a high incidence of gastric cancer. (2) HP infection. (3) Precancerous diseases of the stomach such as chronic atrophic gastritis, gastric ulcer, gastric polyps, postoperative residual gastritis, hypertrophic gastritis, pernicious anemia, etc. (4) First-degree relatives of gastric cancer patients. (5) There are other risk factors for gastric cancer, such as high salt intake, pickled diet, smoking, heavy alcohol consumption, etc.
Comprehensive measures and precision surgery
(1) Standardized treatment of early gastric cancer
For patients with gastric cancer who have no lymph node metastasis in the early stage, the choice of endoscopic treatment such as EMR and/or ESD or surgical treatment depends on the depth of tumor invasion, and adjuvant chemotherapy or radiotherapy is usually not required after surgery, while for patients with early gastric cancer with lymph node metastasis, surgery is the main treatment, and neoadjuvant chemotherapy can be decided according to the specific situation, and finally the adjuvant treatment regimen (adjuvant chemotherapy or adjuvant chemoradiotherapy) is determined according to the postoperative pathological stage. For patients with early-stage gastric cancer who are not suitable for surgery due to individual factors, chemoradiotherapy is an optional treatment option.
(2) Locally advanced gastric cancer
Locally advanced gastric cancer is characterized by imaging examination, endoscopy, diagnostic laparoscopic exploration, etc., and strives to achieve accurate clinical staging. For locally resectable advanced gastric cancer, the current standard of treatment is D2 surgical resection combined with postoperative adjuvant chemotherapy, and minimally invasive surgery, including laparoscopic and robotic surgery, is gradually widely used in the treatment of advanced gastric cancer.
Assistive technologies represented by fluorescence navigation, 3D laparoscopy, robotics, artificial intelligence, and intraoperative real-time intelligent navigation are profoundly changing the traditional mode of gastric cancer surgery, which is the embodiment of the concept of precision medicine in gastric cancer surgery, and will further improve the precision, visualization, and homogeneity of gastric cancer surgery.
3) Advanced gastric cancer
For locally advanced unresectable gastric cancer, chemoradiotherapy and/or combined immunotherapy or even perioperative targeted immunochemotherapy can be considered.
For patients with gastric cancer without the chance of radical surgical treatment or metastatic gastric cancer, it is now recognized that comprehensive conversion therapy with systemic anti-tumor therapy is adopted, and for some patients, local treatments such as palliative surgery, radiation therapy, and peritoneal infusion can also help to prolong survival and improve quality of life.