Ms. Liu, 36, is a housewife who does not smoke or drink alcohol and has healthy living habits.
She always felt a stomachache, and after eating, her stomach was swollen, "as if something was on top of it".
After 3 weeks of delay, she finally decided to go to the hospital for a doctor, and the doctor recommended a painless gastroscopy.
This was her first time undergoing gastroscopy, but the result was like a bolt from the blue - Ms. Liu suffered from gastric signet ring cell carcinoma, which was locally advanced with peripheral lymph node metastasis. The doctor sighed and recommended surgery as soon as possible.
I believe that many people are sympathetic and regretful, but it is also the first time they have heard of such strange names as "leather stomach" and "signet ring cell carcinoma".
How dangerous is this kind of stomach cancer, even doctors sigh? In fact, young people in particular need to take a look.
The term "leather" to describe malignant tumors of the digestive tract was first proposed by United Kingdom surgeon William · Brinton in 1854.
However, leather is not only exclusive to the stomach, but also "leather colon" and "leather rectum", as the name suggests, are as stiff and inelastic as leather.
Leathery stomach is a type of advanced gastric cancer.
This stage is generally in the middle and late stages, and is more common in men than in women.
This cancer does not grow like a "tumor" or form a deep ulcer, but spreads and penetrates into all layers of the stomach wall.
(Bormann classification of gastric cancer, type IV is leather stomach)
The stomach wall thickens and hardens, and gradually becomes as stiff as leather, as if it has cultivated the "incorruptible body of King Kong".
The "little folds" (folds) on the gastric mucosa disappear, and the stomach cavity shrinks, so I can't eat and often has a bloated stomach.
In the late stage, most patients' stomachs have basically lost their peristalsis function, just like a leather bag, so it is also called "leather cyst stomach".
On the pathological biopsy report of the leather stomach, the vast majority of them are written as "poorly differentiated carcinoma", "undifferentiated carcinoma" or "signet ring cell carcinoma", and the degree of malignancy is very high.
To put it simply, this is a histological type of gastric cancer, which is to look at the "appearance of cancer histiocytes" to determine the classification.
Signet ring cell carcinoma is the younger brother of the adenocarcinoma family, and other siblings include papillary, tubular and mucinous adenocarcinoma.
Alongside the adenocarcinoma family, there are adenosquamous cell carcinoma, squamous cell carcinoma and undifferentiated carcinoma.
Because the cells of signet ring cell carcinoma are filled with mucus, the nucleus is squeezed to the side, and it looks like a ring, hence the name.
(Microsmear of signet ring cell carcinoma)
Signet ring cell carcinoma is a special type of gastric cancer with high malignancy, strong aggressiveness, and rapid progression.
Progressive signet ring cell carcinoma often presents with significant fibrosis or sclerosis, and later in detection, the entire stomach may become "leather."
Therefore, signet ring cell carcinoma and "leather stomach" are like a pair of difficult brothers, often appearing at the same time.
Gastric signet ring cell carcinoma also prefers younger people, but it prefers younger women.
This is different from the fact that it is more common in men with leather stomachs.
This may be related to the strong estrogen metabolism in young women, so girls must pay more attention!
Although the "leather stomach" is dangerous, the symptoms are very insidious and not easy to detect at an early stage.
In the early stages, most patients do not even have obvious symptoms, and may just feel that they have eaten less, eat quickly, and so on.
Some patients experience epigastric discomfort, fullness after eating, decreased appetite, nausea, or symptoms similar to ulcer disease.
As the disease progresses, symptoms such as worsening epigastric pain, weight loss, and fatigue appear.
Unfortunately, most people wait until their stomach hurts and their bodies are emaciated, and at this time, it is found that they are already in the middle or late stages, and even lymph node metastasis has occurred.
This is also the reason why there are very few patients in the early stage of "leather stomach".
Yes, that's because the tumor is located in a different location.
For example, people with lesions in the cardia and fundus (both in the upper part of the stomach) may have progressively worsening dysphagia and retrosternal pain;
People with lesions in the pylorus (lower part of the stomach) will have symptoms such as vomiting and lodging (vomiting after a few hours of eating);
If you have persistent stomach pain, supraclavicular lymphadenopathy, ascites, abdominal mass, etc., it may indicate that the cancer has spread, which are all manifestations of advanced stomach cancer.
The examination methods of "leather stomach" are basically gastroenterography, gastroscopy, ultrasound, and CT.
Although many patients are found for the first time after a gastroscopy, sometimes, the results of the gastroscopy and biopsy may also be negative, deceiving the doctor's eyes.
In this case, a combination of other tests, such as barium swallow (double gastrointestinal x-ray), ultrasound, and CT, can help confirm the diagnosis and determine whether the cancer cells have metastasized [1].
Unfortunately, the "leather stomach" often has a short course of disease, rapid development, and poor treatment effect and outcome.
The survival time is generally not more than one year, and most patients only take 3 months to half a year from the time they go to the hospital to die.
Therefore, once the diagnosis is confirmed, surgery should be performed as soon as possible, and radical excision surgery should be done as much as possible.
When part or all of the stomach is removed, doctors connect the remaining ends of the stomach, intestines and esophagus, which is called "rebuilding the digestive tract."
If the primary lesion has metastasized and cannot be removed, palliative surgery should be performed as much as possible, and chemotherapy should be used to improve the patient's symptoms and make the tumor grow more slowly.
Of course, the doctor will treat the patient according to the specific situation. The goal of all treatments is to slow the progression of the disease, improve the patient's quality of life, and prolong survival.
The incidence and mortality rate of gastric cancer in mainland China are among the highest in the world, and there is a trend of younger people, which is related to factors such as genetics and bad lifestyle habits.
If any of the following conditions are present, they may be at high risk of gastric cancer [2]:
In areas with a high incidence of gastric cancer (e.g., northwest region, southeast coastal area)
Parents, siblings and other first-degree relatives have a history of stomach cancer;
have Helicobacter pylori infection;
Previous chronic atrophic gastritis, hypertrophic gastritis, gastric polyps, gastric ulcers, pernicious anemia and other diseases;
Eating heavy (high-salt diet), eating pickled foods for a long time, eating too few vegetables and fruits, smoking, heavy drinking, etc.
For high-risk groups, regular gastroscopy is recommended from the age of 40 onwards.
For low-risk ordinary people, it should not be taken lightly.
If you have symptoms such as epigastric pain, acid reflux, heartburn, nausea, dysphagia, anemia, black stool, and unexplained weight loss, you should go for a gastroscopy as soon as possible!
Only early detection and early treatment can buy you more time to survive.
I would also like to remind all young people here, don't think that you can carry it when you are young!
The crises in the body are accumulated unconsciously.
It is precisely because you are young that you should pay more attention to a healthy diet, stay away from tobacco and alcohol, have a regular work and rest, exercise reasonably, and have regular physical examinations. Only in this way can cancer stay away from you!