The well-known pathologist Professor Ji Xiaolong said in a health program: "It is rare to find a stomach cancer in the West, and it occurs every day in China!"
Image source: Tencent Video "Health in 90 Seconds"
At the end of 2018, the official journal of the American Cancer Society published the report "Global Cancer Statistics 2018", which evaluated the incidence and mortality of 185 cancers in 36 countries. According to the report, gastric cancer ranked among the cancer incidence rates in China in 2018 The third place, second only to lung cancer and breast cancer, is an absolute high-incidence cancer in China.
The hospital where the author is located is not very large. In the endoscopy center, several cases or even a dozen cases of gastric cancer are diagnosed almost every month, and 80% of them are in the middle and advanced stages.
According to the latest data from the China Cancer Center, there are about 120 million new gastric cancer cases worldwide each year, and China accounts for about 50.
The proportion of early gastric cancer in China is very low, only about 15-20%. Most of them are already in the advanced stage when they are discovered, and the 5-year overall survival rate is less than 50% (less than 30% in the advanced stage).
Each year, 40 gastric cancer patients are newly discovered in China, accounting for 42% of the world's gastric cancer incidence, 4-8 times that of developed countries in Europe and America.
2015 data show that 49.8 people die from stomach cancer each year.
Why is there such a high morbidity and mortality?
There are two main reasons for inferring:
Not paying attention to the inspection and eradication of Helicobacter pylori;
Do not pay attention to gastroscopy.
The former can effectively prevent gastric cancer,
The latter can be found in early or even precancerous state.
European and American countries have done a lot of work on the control of Helicobacter pylori and gastroscopy screening; some are also listed as statutory physical examination and medical insurance items;
Even our neighbors, Japan and South Korea, although the incidence rate is high, but the cure rate is also high, because 60-80% of their gastric cancer is early cancer.
For example, Japan implemented the "Stomach Cancer Elimination Program" a few years ago. Helicobacter pylori must be detected and eradicated for people over 12 years old; the first gastroscopy must be done at 40 years old and included in the medical insurance plan.This makes them have a high morbidity rate, but their mortality rate is far lower than in China, and the early cancer detection rate is higher than 70%.
China has become a major country of Helicobacter pylori infection due to its special dietary habits; coupled with indifference or misunderstanding of gastroscopy, gastric cancer is ruthlessly rampant.
Therefore, as long as you do these two things in time, you can effectively prevent gastric cancer, and even if it becomes cancerous, it can be cured.
Helicobacter pylori infection is the main cause of gastric cancer in China
Helicobacter pylori is famous because it not only produced a Nobel Prize, but more importantly, opened a window for the treatment of gastric diseases.Prior to this, people had not figured out the exact cause of peptic ulcer, certain gastritis, and gastric cancer for a long time. Therefore, more than a decade ago, gastric ulcer was still an incurable disease.
According to a report issued by the Helicobacter pylori and Peptic Ulcer Group of the Chinese Society of Digestive Diseases, about 7 to 8 million Chinese people have been infected with this bacterium called Helicobacter pylori.
Image source: Tencent News
China’s “Expert Consensus on Helicobacter Pylori Eradication and Gastric Cancer Prevention and Control in China” released in April 2019 stated:
1. Hp infection is the main cause of gastric cancer in China
The low incidence of gastric cancer in European and American countries may be related to their meal sharing system;
China’s eating habits may have aggravated the spread of Helicobacter pylori. The current infection rate has reached 50-56%, and about 7 million people have been infected.
Peptic ulcer occurs in 15%-20% of patients with Hp infection,
Hp-related dyspepsia occurs in 5%-10%,
1% of gastric malignancies (Gastric cancer, MALT lymphoma);
Most infected people have no symptoms or complications, but all infected people have chronic active gastritis, that is, Hp gastritis.
Hp infection is the most important factor in the environmental factors of gastric cancer;
Intestinal gastric cancer (accounting for the vast majority of gastric cancer) occurs in the normal gastric mucosa→superficial gastritis→atrophic gastritis→intestinal metaplasia→dysplasia→gastric cancer, which has been recognized; Hp infection can cause chronic active gastritis. It also plays an important role in the occurrence and development of gastric mucosal atrophy and intestinal metaplasia. Therefore, Hp infection plays a key role in the occurrence of intestinal gastric cancer.
2. Eradication of HP can effectively prevent the occurrence of gastric cancer
A large number of studies have confirmed that eradication of Helicobacter pylori can effectively prevent gastric cancer:
The results of Professor Ji Jiafu’s team show that the attack rate can be reduced by 39%;
Academician Li Zhaoshen once said: Timely eradication of Helicobacter pylori can almost 100% prevent intestinal gastric cancer, and the earlier eradication, the greater the benefit;
Other studies have shown that about 90% of non-cardia gastric cancers are related to Hp infection;
The overall role of environmental factors in the occurrence of gastric cancer is weaker than that of Hp infection;
Genetic factors only play a decisive role in the occurrence of 1%-3% of hereditary diffuse gastric cancer;
A large study in South Korea showed that eradication can reduce the incidence of metachronous gastric cancer by 60%. . . . .
It can be seen that the main culprit of gastric cancer in the history of HP infection, eradication of Helicobacter pylori, is essential for the prevention of gastric cancer.
3. How do you know if you are infected?
The most commonly used methods are carbon 13 and carbon 14 breath tests, which are simple, convenient, accurate and non-invasive.
Also, when doing a gastroscope, the doctor takes out a bit of living tissue for testing.
The first two are the most commonly used; however, it should be noted that carbon 2 cannot be used for children under 14 years of age, pregnant women and lactating women.
4. Treatment and review
The fifth China consensus on Helicobacter pylori recommended a quadruple therapy containing bismuth twice a day for 10-14 days.
Most gastroenterologists believe (including myself of course) that once adults are found to be infected, no matter whether they have symptoms or not, as long as there are no countermeasures, they recommend eradication treatment;
For children under 12 and pregnant women, testing and treatment are not recommended.
4 weeks after stopping the drug, review the breath test. If it is negative, congratulations, it has been cleared.
5. Will there be repeated infections after eradication?
Yes, but very low.The 5-year re-infection rate in China is 5-8%, so after eradication, you should also pay attention to food hygiene.
However, according to Nobel Prize winner Professor Marshall, Chinese people's usual eating habits do not significantly increase the risk of reinfection.
But for patients with chronic atrophic gastritis, especially those with intestinal metaplasia or dysplasia, even if they are eradicated, they must be reviewed every year. Once they are infected, they must be eradicated.Because at these stages, HP often acts as a catalyst.
Gastroscope is a powerful tool for detecting early cancer
HP is the main cause of gastric cancer, but it is not the only cause. The occurrence of gastric cancer is the result of multi-factor participation and long-term evolution.
In other words, if you are infected with HP, you may not get stomach cancer;
If you don’t get Hp, you don’t necessarily get gastric cancer.
Therefore, timely gastroscopy is necessary.
Through gastroscopy, we can not only find some common gastric diseases, such as gastritis, ulcers, polyps, general lesions of the esophagus and duodenum, but also early cancer.
Today's gastroscopy has a very powerful technology. There are 4 to 5 rigorously trained endoscopists in China. The technical level of not only routine examinations, but even some endoscopic surgery, does not lag behind Western countries.
Such a small early cancer can also be found
Endoscopy can detect very early cancers and precancerous states. At this time, they can be treated or removed under gastroscopy without surgery. The cure rate can be said to be almost 100%.
Above, endoscopic staining and magnification
Another example is endoscopy. After suspicious lesions are found in routine gastroscopy, magnifying endoscopy, staining endoscopy, electronic staining endoscopy, etc. are performed to make the lesion observation more detailed, so as to determine whether the cancer is cancerous and the lateral direction of the cancer The extent of infiltration, the depth of vertical infiltration, the degree of differentiation, and whether there are indications for microscopic treatment, etc.
So who needs gastroscopy?
According to the National Gastric Cancer Diagnosis and Treatment Regulations released in 2018, the following people need gastroscopy;
Those who meet any of the following items 1 and 2 to 6 should be listed as high-risk groups for gastric cancer and are recommended as screening targets:
①Age over 40 years old, no gender limit;
②People in areas with high incidence of gastric cancer;
③Persons infected with Helicobacter pylori;
④Past gastric precancerous diseases such as chronic atrophic gastritis, gastric ulcer, gastric polyps, postoperative remnant stomach, hypertrophic gastritis, pernicious anemia, etc.;
⑤First-degree relatives of gastric cancer patients;
⑥There are other high-risk factors for gastric cancer (high salt, salted diet, smoking, heavy drinking, etc.).
Screening method (see picture below):
Preventing gastric cancer must start from lifestyle
Except for the two most effective measures mentioned above, to be honest, Lao Du has no special methods.
The most important thing is to develop a good lifestyle, such as regular diet, regular work and rest, and regular physical examinations.
If you have the following 4 conditions, you should seek medical attention as soon as possible without delay.
Discomfort in the upper abdomen, dull pain in the heart, fullness after eating;
Loss of appetite, weight loss, fatigue;
Frequent vomiting overnight overnight meals and bile-free gastric juice;
The stool is black or bloody.
In addition, there are some risk factors that increase the risk of stomach cancer:
Frequent consumption of salted or smoked foods, chronic stomach inflammation or adenomatous polyps
Smoking and drinking
Anxiety and stress
1. Barbecue and smoked food
The well-known barbecue and fried foods can induce cancer.It is reported that more than half of gastric cancer patients aged 30 to 40 love to eat barbecue or spicy tang.
Especially people in some areas have a strong taste and like to eat barbecue, but after the food is barbecued or smoked, it is easy to produce substances such as 3-4 benzopyrene and cyclic aromatic hydrocarbons, which are clear carcinogens.
2. High salt, pickled food
In addition to barbecue, high-salt diet is also closely related to the occurrence of gastric cancer.The World Health Organization stipulates that the daily salt intake per person is 6 grams, exceeding this amount will cause harm to health.
The high osmotic pressure of table salt can cause direct damage to the gastric mucosa, causing a series of pathological changes such as congestion, edema, erosion, ulcer, necrosis, and bleeding. It can also reduce the secretion of gastric acid and make the gastric mucosa vulnerable to attack.
The most important thing is that high-salt food contains a lot of nitrate, which is converted into nitrite by reducing bacteria in the stomach, and then combines with the amine in the food to form nitrite amine, which is highly carcinogenic and listed by the World Health Organization. It is a primary carcinogen.
According to the recommendations of the World Health Organization, in order to meet the needs of the human body and not increase the risk of gastric cancer, people should not consume more than 5g of salt per day—the amount just filled with a beer bottle cap.
3. Drinking and smoking
Drinking alcohol hurts the stomach and can easily cause stomach bleeding.And there is no such thing as "drinking pleasure." In August 2018, the world's top medical journal "The Lancet" published an article that: drinking directly caused the death of 8 million people worldwide. Any dose of alcohol is not safe, and the safest amount of drinking is 280!
Most patients with gastric cancer are men. Many people have a history of smoking for many years. In addition to gastric cancer, the nicotine, nitrosamines and other carcinogens contained in cigarettes may also induce lung cancer, bladder cancer, oral cancer and other cancers.
4. Staying up late, anxiety and stress, and mental stress are also triggers
Generally speaking, the older the age, the higher the proportion of gastric cancer.However, the number of young patients has increased significantly in recent years.Staying up late, as the "new drug" of contemporary young people, is one of the causes of illness.
Studies have shown that staying up late can cause disorders of the endocrine system and immune system. Irregular work schedules will also affect their diet. Many people who love to stay up late have the habit of eating supper. Suppers are mostly greasy and stimulating foods. Without rest, it stimulates the secretion of large amounts of gastric juice, which over time causes gastric mucosal ulcers and even gradually becomes cancerous.
When a person is nervous, annoyed, or angry, his bad emotions can spread to the limbic system through the cerebral cortex, affecting the function of the autonomic nervous system, directly causing the gastrointestinal to secrete too much gastric acid and pepsin, causing gastric vasoconstriction, pyloric spasm, Emptying obstacles, damage to the protective layer of the gastric mucosa, and eventually ulcers.
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