Gastrointestinal common disease (gastric quiz series of gastric stromal tumor of duodenal stasis disease of duodenal diverticulum)

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61 what are the types and stages of gastric cancer?(1) from the depth and shape of the tumor invasion, it can be divided into early gastric

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61 what are the types and stages of gastric cancer?

(1) from the depth and shape of the tumor invasion, it can be divided into early gastric cancer and advanced gastric cancer: (1) early gastric cancer refers to the size of the lesion, early lesions are limited to the mucosa and submucosa. It can be divided into three types: uplift type (polypoid type), superficial phenotype (gastritis type) and sunken type (ulcer type). Type II (II) was divided into three subtypes (a, c) (II) (b) (II) (II). The above types can have different combinations. C+ II A, II c+ III (see figure below). Early gastric cancer in diameter of 5 ~ 10mm, said the small stomach cancer, diameter of 5mm called small gastric cancer.

Schematic diagram of early gastric cancer

(2) advanced gastric cancer is also referred to as advanced gastric cancer, and the invasion of the lesion or muscular layer or the whole layer of the cancer is often accompanied by metastasis. There are several types (see below):

Sketch map of middle late gastric cancer

The mushroom type (or polypoid type): about 1/4 of advanced gastric cancer, limited to the cavity growth, nodular, polypoid, rough surface such as cauliflower, central erosion, ulcer, or nodules of mushroom type. The tumor is discoid, high margin, central ulcer called discoid fungating type. Ulcerative type: about 1/4 of advanced gastric cancer. Is divided into limited ulcerative and infiltrative ulcer type, the characteristics of the cancer limitation is discoid, central necrosis. Often large and deep ulcer ulcer; the bottom edge of the uplift is uneven, levee or volcano shaped, deep infiltration to cancer, often with bleeding and perforation. The characteristics of infiltrative ulcer type for cancer infiltrative growth, often forming obvious infiltration to the surrounding and deep mass with central necrosis and ulceration, often early and serosal invasion or lymph node metastasis. The infiltration type: this type is also divided into two kinds, one is limited infiltration, gastric carcinoma tissues of each layer, mostly confined to the gastric antrum, infiltration of gastric wall thickening hardened, wrinkled wall disappeared, no obvious ulcer and nodular. A part of the stomach that is confined to the stomach is called "limited infiltration". The other is a diffuse infiltrative gastric carcinoma, also known as leather, tissue expansion in the submucosal invasion of each layer, a wide range of gastric cavity becomes small, thick and stiff stomach, mucosa hyperemia and edema can still exist without ulcer. The mixed type: both of these types of two or more than two kinds of lesions. The multiple cancer: cancer tissue showed multifocal, not connected with each other. Such as the occurrence of gastric cancer on the basis of atrophic gastritis may belong to this type, and more in the upper body of the stomach.

Arrow refers to the gastric ulcer area

(two) from the organization type can be divided into 4 types (pathological type): adenocarcinoma: including papillary adenocarcinoma, tubular adenocarcinoma and mucinous adenocarcinoma, according to the degree of differentiation into high differentiation, differentiation and low differentiation 3; the undifferentiated carcinoma; the mucinous carcinoma (i.e., India ring cell carcinoma); the specific types of cancer including adenosquamous carcinoma, squamous cell carcinoma, carcinoid etc.. According to the histogenesis, it can be divided into two types. The intestinal type cancer originated in the intestinal metaplasia of epithelial cancer, well differentiated tissue, body shape is the giant mushroom type; gastric cancer: originated in the stomach mucosa inherent, including undifferentiated carcinoma and mucinous carcinoma, poorly differentiated carcinoma, giant body shape is ulcer type and diffuse infiltrative type.

There are more detailed staging and typing according to tumor size, nature, depth of invasion, lymph node metastasis and distant metastasis.

62 gastric cancer which transfer way?

(1): infiltrative gastric carcinoma can be disseminated directly along the mucosal or serosal directly to the esophagus or duodenal intramural, development. Once the tumor invaded the serosa, which is easy to nearby organs or tissues such as liver, spleen, pancreas, colon and jejunum, diaphragm, omental and abdominal wall infiltration. Exfoliated cancer cells can be grown in the abdominal cavity, pelvic cavity, ovarian and rectal bladder lacuna etc.. (2) in metastatic lymph nodes metastasis of gastric cancer accounted for 70%, lower stomach cancer often metastasize to the pylorus, stomach and abdominal artery beside the lymph nodes, and the upper part of cancer often metastasize to the pancreas, stomach and cardia adjacent side upper lymph node. Advanced carcinoma may be transferred to the aorta and superior phrenic lymph nodes. Due to the direct communication between the celiac lymph nodes and the thoracic duct, it can be transferred to the left supraclavicular lymph nodes. (3) hematogenous metastasis: the cancer cells can be found in the peripheral blood of some patients, and can be transferred to the liver through the portal vein, and can reach the lung, bone, kidney, brain, meninges, spleen, skin and so on.

63 what are the treatment of gastric cancer?

The treatment of gastric cancer is similar to that of other malignant tumors, and surgical treatment should be considered as the first choice.

According to the staging of gastric cancer, the current comprehensive treatment program, roughly as follows. I stage gastric cancer belongs to early gastric cancer. For individuals with type II a ten type II invasion of the submucosa and lymph node metastasis, chemotherapy should be combined with C. The second stage gastric cancer belongs to the middle stage of gastric cancer, and the surgical resection is the main method. Some adjuvant chemotherapy or immunotherapy. Stage III gastric cancer invasion and surrounding tissue and more extensive lymph node metastasis, although surgical resection, but should be combined with chemotherapy, radiotherapy, immunotherapy and treatment of traditional Chinese medicine. Stage IV gastric cancer is advanced, the use of non surgical treatment, surgery is suitable for patients with primary and metastatic lesions as far as possible, with chemotherapy, radiotherapy, immunization, Chinese medicine combined therapy.

Surgical treatment is divided into radical operation, palliative operation and short circuit operation. (1) radical surgical resection: this concept is relative, referring to the subjective judgment from the doctor that the tumor has been cut, can achieve the effect of treatment, in fact, only a part of the cure. (2) palliative resection: the subjective judgment of the tumor is impossible to completely remove the tumor, but the main tumor can be removed, removal of the tumor can relieve symptoms, prolong life, to create conditions for further comprehensive treatment. (3) short circuit operation: mainly used in the cases of pylorus obstruction which is impossible to be resected.

(two) radiation therapy: preoperative, intraoperative and postoperative radiotherapy.

(three) chemotherapy: early gastric cancer without chemotherapy, other advanced gastric cancer should be appropriate chemotherapy. Chemotherapy including systemic chemotherapy and intraperitoneal chemotherapy, intraperitoneal chemotherapy refers to the postoperative intraperitoneal catheter or intraperitoneal chemotherapy and intubation chemotherapy, increase local concentration. Specific chemotherapy protocols should follow the doctor's advice.

(four) immunotherapy: immunotherapy combined with chemotherapy may prolong patient life. Commonly used interferon, IL-2, BCG and other drugs.

(five) traditional Chinese medicine: the main treatment of righting. Can resist the side effects of radiotherapy, improve the white blood cells, platelets, adjust gastrointestinal function, improve the body resistance.

64 what is neoadjuvant chemotherapy for gastric cancer? What are the benefits?

Neoadjuvant chemotherapy for gastric cancer is a new concept in recent years. The so-called neoadjuvant chemotherapy for gastric cancer, also known as preoperative chemotherapy, its main purpose is to reduce the tumor, improve the radical resection rate, improve the therapeutic effect. In the past, it has been used in practice, but it has been abandoned because of poor effect. In recent years, because of the emergence of new chemotherapeutic drugs, neoadjuvant chemotherapy has become a hot spot of research and treatment of advanced gastric cancer. Neoadjuvant chemotherapy for gastric cancer has the following advantages: (1) to prevent postoperative tumor blood supply changes affect the chemotherapy effect; (2) to prevent the resection of the primary tumor stimulation of residual tumor growth; (3) the tumor downstaging, improve the resection rate; (4) to reduce intraoperative spread, eliminate potential micrometastasis. To reduce postoperative recurrence and metastasis; (5) chemosensitivity test, to understand the sensitivity of tumors to chemotherapy, reasonable selection of sensitive drugs; (6) excluding inoperable patients.

65 which patients are suitable for neoadjuvant chemotherapy for gastric cancer? What problems should be paid attention to in the neoadjuvant chemotherapy of gastric cancer?

It is generally believed that it is more appropriate to select patients with locally advanced gastric cancer. Patients with distant organ metastasis and extensive abdominal metastasis may not be treated as an indication for surgery, but patients with earlier lesions are likely to lose the best chance of surgery because of chemotherapy failure. So, neoadjuvant chemotherapy of gastric cancer in the general application of advanced pathology (UICC and TNM stage II and III, III, IV A B M0) of the patients with gastric cancer, objectively measurable lesions for evaluation of the effect of other organs of the patient can tolerate chemotherapy, and to obtain informed consent of patients the.

Neoadjuvant chemotherapy to master several principles, one is not the blind pursuit of chemotherapy effectively and delay the timing of surgery, surgical resection is still the best means; two chemotherapeutic drugs for gastric cancer is a dynamic choice, there is no gold standard. Because of the many chemotherapeutic drugs on gastric cancer is relatively insensitive, only in the hope of neoadjuvant chemotherapy for gastric cancer new chemotherapy drugs, including paclitaxel, docetaxel, oxaliplatin and CPT211, especially the clinical application of molecular targeted drugs.

66 how to prevent gastric cancer?

Because the etiology of gastric cancer is not clear, there is no special prevention method. In addition to pay attention to food hygiene, avoid or reduce intake of possible carcinogens, can eat more vitamin C rich vegetables, fruits, etc.. The so-called precancerous lesions, to be closely followed, in order to detect changes early, timely treatment.

67 what is a gastric stromal tumor? What is its treatment and therapeutic effect?

Gastric non epithelial tumors, the most common malignant lymphoma, followed by smooth muscle tumor, nerve fiber or nerve sheath tumors, tumor of striated muscle. With the pathological research, especially the application of immunohistochemistry and electron microscopy, found that the original is called a lot of smooth muscle tumors were lack of immunohistochemical and ultrastructural features of the previous classification and naming that is clearly not enough scientific and rigorous. In 1990s, some scholars proposed the concept of gastric stromal tumors (gastric stromal tumor, GST), to emphasize the uncertainty of the occurrence of such tumors. The current concept of gastric stromal tumor is composed of a large class of gastric lymphoma except outside the primary non epithelial tumor, produced by organ wall layer cells, due to variability of differentiation pathways often leads to the confusion of understanding. At present, the lack of differentiation or both to smooth muscle and the neural differentiation of the tumor called gastric stromal tumor, there is clear evidence for differentiation can still use leiomyoma (sarcoma) or schwannoma terms.

At present, surgery is the first choice for the treatment of gastric stromal tumors. Local excision of the lesion can be achieved with a similar effect as regular gastrectomy, as long as it can completely remove the tumor. Some people think that even if there is no residue on the edge of the microscope, it will not affect the survival time. Because most of these tumors are in the shape of the growth of the stomach, the cutting edge is far less positive than the tumor cells scattered into the abdominal cavity. Surgical resection should be performed even if the tumor invades adjacent organs or peritoneal dissemination. If all visible tumors can be removed without damage, they can still achieve the same effect as the localized lesions. Because the lymph node metastasis of this disease is rare, it is not necessary to perform extensive or regional lymph node dissection. Although the overall prognosis of gastric stromal tumors is better than that of gastric cancer, the patient's 5 year survival rate is only about 50%, indicating that it is still a relatively poor prognosis of the tumor, but also proved that the efficacy of simple surgery is still limited. In particular, the high level of gastric stromal tumors, although a "curative resection", but the recurrence rate is still high, should be carried out effective multi adjuvant therapy.

68 duodenal stasis is going on?

Duodenal stasis disease (duodenal stasis) refers to the various causes of duodenal obstruction, duodenal obstruction, so that the expansion of the proximal end parts of the resulting chyme stasis syndrome. Duodenal stasis disease caused by many reasons, the superior mesenteric artery of duodenal stasis formed the majority (50%), also known as the superior mesenteric artery syndrome (superior mesenteric artery syndrome). There are other reasons: the congenital anomalies such as congenital peritoneal band oppression pulling and blocking the distal duodenum duodenum; congenital stenosis or occlusion of annular pancreas duodenum compression of the duodenum; adverse development of megaduodenum, due to congenital variation and duodenal and severe ptosis, closed fold bend and the angle of duodenum and jejunum, and produce stasis disease. The tumor of duodenum: benign and malignant tumors; retroperitoneal tumors such as renal tumor, pancreatic cancer, lymphoma, metastatic carcinoma of the duodenum;, adjacent lymphadenopathy (metastasis), mesenteric cyst or duodenal compression of abdominal aortic aneurysm. The distal duodenum or jejunum of invasive disease and inflammation; such as systemic sclerosis, Crohn's disease and diverticulitis of adhesions or compression caused by constriction etc.. The gallbladder and stomach after surgery adhesions pull duodenum; jejunum anastomosis after gastric ulcer, stricture or adhesion, afferent loop syndrome. The other congenital malformations: duodenal inversion and gallbladder duodenal bands caused by colonic duodenal obstruction; duodenal ampulla of Vater Qianmen venous malformation; abnormal position (common bile duct openings in the third portion of the duodenum) etc..

The superior mesenteric artery of duodenal stasis formation as an example, cross section located in the retroperitoneal duodenum from left to right across the third lumbar and abdominal aorta, the front is in the mesenteric root of superior mesenteric vessels and nerves across the beam (see below). If the angle between the two is too small, duodenal compression. The superior mesenteric artery was generally treated at the first lumbar level, with an angle of 30 degrees to 42 degrees. In addition, the following 5 factors are causes of mechanical obstruction: superior mesenteric artery is too long, too short; the superior mesenteric artery variation from the abdominal aorta from the site is too low or the separation angle of stenosis; abnormal large veins in the duodenum in front of the horizontal pressure; the gap of lordosis deformity makes duodenal share reduction; the slender or visceral ptosis bowel mesentery root weight traction.

Schematic diagram of mesenteric vascular anatomy

69 duodenal stasis performance? How to treat duodenal stasis disease?

Acute duodenal obstruction is usually caused by acute gastric dilatation caused by immobilization or traction of the trunk. Chronic obstruction is the most common clinical types, the hiccups, nausea and vomiting is a common symptom in meal, vomit containing bile, the symptoms can be alleviated by the change of posture, such as lateral and prone, knee chest position can reduce the symptoms. If can not alleviate, long-term attack, can cause weight loss, dehydration and systemic malnutrition.

No obvious symptoms may not have to deal with. Fat emulsion for intravenous nutrition including acute exacerbation, decompression of the nasogastric tube and anti spasticity drugs in the treatment of acute gastric dilatation. Usually advised to eat small meals, after meals half an hour to strengthen the knee chest position, abdominal exercises. Such as internal medicine conservative treatment is not obvious, can be treated with surgery. The operation method can be used as follows: free duodenal ligament; duodenum jejunum anastomosis.

70 duodenal diverticulum common? Patients with duodenal diverticulum what show?

The exact incidence of duodenal diverticulum is difficult to statistics, because many diverticula does not produce clinical symptoms, not easy to find. There are reports of gastrointestinal barium meal examination when duodenal diverticulum was found in 1%, and autopsy the duodenal diverticulum found rate can be as high as 22%. 90% of the diverticulum is a single, 80% in the second portion of the duodenum, especially the inner wall or concave. Duodenal diverticulum occurred in 40 ~ 60 years old patients under the age of 30 is rare. There was no difference in the incidence of the disease.

Duodenal diverticulum no typical clinical manifestations, the symptoms are caused by complications. Upper abdominal fullness is a common symptom, is caused by diverticulitis. Belching and pain. There is no regularity of pain, and it is not easy to make acid medicine. When the food is full of diverticulum expansion, compression and partial duodenal obstruction symptoms, vomit early gastric contents, followed by bile, and even can be mixed with blood, and vomiting symptoms. Diverticulum with ulcers or bleeding, symptoms were hematochezia or similar ulcer disease. The opening pressure of common bile duct or pancreatic duct diverticulum, can cause cholangitis, pancreatitis or obstructive jaundice. After showing symptoms of perforation, peritonitis.

 

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