Whenever I talk about cancer
Because we can't beat it yet
So it's always full of fear and uneasiness
If only it could have been discovered earlier
Maybe it will make it come at a slower pace
Precancerous lesions, alarm bells for the body
If you can correctly understand and treat it at this stage
Maybe it can make the cancer cells in the body invisible
This is also the meaning of precancerous lesions
Today, we take stomach cancer as an example to talk about this matter.
From normal gastric mucosa to gastric cancer, there is a precancerous stage [1,2]:
In 1971, the World Health Organization first proposed the concept of gastric precancerous lesions.
Several pathological conditions that are at greater risk of potential cancer than normal tissues have been identified, including atrophy, intestinal metaplasia, and dysplasia [3].
Precancerous lesions
What does the word mean?
Does that mean it's cancer?
Can it be cured?
How long will the cancer come?
Normal gastric mucosa, composed of epithelial cells and glands, the epithelial cells on the surface can secrete mucus, forming a protective barrier, and the glands below secrete digestive enzymes, stomach acid, etc. [4] for digesting food.
When the flower bed of the gastric mucosa is invaded by "insect pests" such as Helicobacter pylori for a long time, the local inflammation is not healed for a long time, the mucus layer is thinned, and the glands are reduced or disappeared [5], which is an atrophic lesion.
Just when the stomach mucosa is seriously injured and the guard is empty, there is a group of "weeds" who are the intestinal epithelial cells that originally grew in the intestine, but covet the "superior" environment in the stomach.
Now was the perfect time for them to attack the city and plunder the land, and they rushed up, and the doves occupied the magpie's nest, replacing the original glands of the stomach with intestinal glands, which is the intestinal epithelial metaplasia [5].
The intestinal glands multiply and grow at an uncontrolled rate.
The limited space of the flowerbed becomes more and more crowded, and the weeds grow backwards and forwards, and some even have deformed growths, which is often referred to as dysplasia, or intraepithelial neoplasia [5].
If dysplasia develops further and genetic mutations occur inside the cell, causing the cell to have unrestricted growth, invasiveness, metastasis, etc., it will truly develop into cancer [5].
The early stages of stomach cancer are very confusing, and the vast majority of early gastric cancers have no obvious symptoms or only innocuous symptoms, such as abdominal discomfort, acid reflux, loss of appetite, and so on [6].
Don't think that the symptoms are not serious and despise it, even if the body does not have any symptoms, friends who meet the following conditions are also recommended to do a stomach cancer screening [7]:
1. Age ≥ 40 years
2. Comply with any of the following
People in areas with a high incidence of gastric cancer
People infected with Helicobacter pylori
He has suffered from chronic atrophic gastritis, gastric ulcers, gastric polyps, postoperative stomach residue, hypertrophic gastritis, pernicious anemia and other diseases
First-degree relatives of patients with gastric cancer
Presence of other risk factors for stomach cancer (e.g., high salt, pickled diet, smoking, heavy alcohol consumption, etc.)
1. The source of all evil, remove the "worms"
Helicobacter pylori infection plays an important role in the atrophy of the gastric mucosa and the development of intestinal metaplasia, and it is infected by it and must be eradicated, not careless!
Removing it can reduce stomach inflammation and stomach atrophy may improve;
Blocks low-grade gastric endothelial tumors from progressing to high-grade intraepithelial neoplasias or gastric cancers [1].
2. Prevention in life is also important [3]:
Eat less salt and pickled foods.
Keep away from cigarettes. Friends who already have precancerous lesions, just 4 words: must quit.
Avoid bile reflux: bedridden immediately after eating; reduce factors that cause increased intra-abdominal pressure, such as constipation and belts; and reduce consumption of certain foods that may cause reflux, such as chocolate, strong tea, and greasy foods.
3. Reasonable "herbicide" – drug application
Folic acid and antioxidant vitamins have the effect of delaying the progression of atrophic gastritis, and gastric mucosal protectors can improve the gastric mucosal barrier and promote erosion healing [1,3].
4. Cutting grass and removing roots - endoscopic surgical treatment
If it has progressed to endothelial neoplasia or has developed into early gastric cancer, the best way to do it is to have endoscopic surgery to remove the lesion and cut the grass and remove the roots.
The development of gastric cancer is a relatively long process, and before it develops to dysplasia, it can be considered that the lesion is likely to be reversed.
After dysplasia, it can be cured by endoscopic minimally invasive surgery in the early stage, and drug therapy can only play a role in controlling the disease and delaying the progression.
The study found that:
The annual incidence of gastric cancer due to gastric mucosal atrophy is 0.1%, the annual incidence of gastric cancer caused by atrophy and intestinal metaplasia is 0.25%, and the annual incidence of gastric cancer is 0.6% in patients with low- and middle-grade intraepithelial neoplasia [1].
Therefore, while carrying out corresponding treatment, we must also pay attention to regular monitoring and review of precancerous lesions, and promptly kill the signs of cancer [1].
Precancerous lesions are not the "death knell"
It's the body that gives you a wake-up call
Only by facing it positively can we kill cancer in the cradle
Special Author: Xiao Xueyan
Doctoral student of Tongji Medical College, Huazhong University of Science and Technology
bibliography
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[4] Li Ji, Zeng Yuanshan. Histology and Embryology[M].People's Medical Publishing House, 2018. 137–138.
[5] Yakirevich E, Resnick MB. Pathology of gastric cancer and its precursor lesions. Gastroenterol Clin North Am. 2013;42(2):261-284. doi:10.1016/j.gtc.2013.01.004
[6] Smyth EC, Nilsson M, Grabsch HI, van Grieken NC, Lordick F. Gastric cancer. Lancet. 2020;396(10251):635-648. doi:10.1016/S0140-6736(20)31288-5
[7] Du Yiqi,Cai Quancai,Liao Zhuan,Fang Jun,Zhu Chunping. Expert Consensus Opinion on Early Gastric Cancer Screening Process in China (Draft) (2017, Shanghai)[J].Gastroenterology,2018,23(02):92-97.
Editors: Guo Qian, Wu Wei, Wang Yan
Painter: Kishi Chi | Proofreading: Wu Yihe | Typesetting: Li Yongmin
Operation: Han Ningning | Coordinator: Wu Wei