Gastric cancer surgery is not one for all, there is still recurrence risk, and postpartum follow-up should pay attention

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Gastric cancer surgery is not one for all, there is still recurrence risk, and postpartum follow-up should pay attention

2021-11-28 00:09:59 33 ℃

Lao Zhang did not long ago, after surgery, after surgery, the doctor said, "I found it very timely, I don't have to chemotherapy, and I will check it on the next regular review."

He still has some uneasy, always thinking, "I have a big disease, an operation is over?"

In fact, "Regular Review" is the point that the doctor wants to emphasize.

I. Why is patients with gastric cancer to pay attention to "postoperative follow-up"

Reluletic surgery is the only means of completely cure early and progressive gastric cancer.

However, due to the characteristics of the complexity of gastric cancer surgery, "postoperative follow-up" after the end of the operation, timely understanding of recurrence transfer and postoperative complications.

1. The complexity of gastric cancer surgery

The stomach itself is extremely important to digestive organs, distributed around multiple organs, blood vessels, nerves, etc., can imagine that surgery is extremely difficult, plus some progressive stomach cancer to perform lymph node cleaning (will bring greater trauma), Digestive tract reconstruction is also possible after surgery (that is, connect the remaining stomach and esophagus or intestines).

Such complex surgery will inevitably bring serious complications. For example, gastroesophageal return, bile reflux, disability, dumping syndrome, malnutrition, etc.

2. High probability of post-abbreviation after gastric cancer

From timepowing: about 40% of the recurrent metastatic transfer rate of 40% in the early stomach cancer root treatment, about 23% of the recurrent transfer rate of about 23% in 5 years; about 66% of the progress of the gastrointestinal cancer after 3 years after the gastrointestinal treatment The probability of recurrence transfer is 69.4% in 5 years.

From the type of recurrence transfer: local recurrence (19.3-34%), liver metastasis (30% -43%), peritoneal metastasis (30% -60%), peritoneal metastasis (30% -60%) (Lung, bone, ovaries, etc., the incidence is 24.3% -43%).

As soon as possible, the recurrence transfer is found as soon as possible, and the basic treatment of further treatment, actively treat complications, to ensure the quality of life of patients, is our main purpose of "postoperative follow-up".

Second, how long after gastrointestinal cancer is reviewed?

There are two common follow-up methods: regular follow-up and symptomatic follow-up (ie, uncomfortable and then check).

There is a study showing that no matter which follow-up method, there is no significant effect on the long-term survival of patients with gastric cancer. But the law follow-up helps to find recurrence transfer as soon as possible. The Huaxi Hospital of Sichuan Province has conducted research on 278 patients after gastric cancer root surgery. The results show that the results show that the postoperative regular review can find recurrence transfer as soon as possible, which also leads to this part of patients The 3-year overall survival rate is higher than the symptom leader.

In addition, the four major guidance of the global tumor (American Clinical Oncology Association, the European Tumor Society, Japan Gastric Cancer Society, US National Comprehensive Cancer Network) will follow up the law follow-up as recommended content.

According to "NCCN Gastric Cancer Clinical Practice Guide (2019)", postoperative follow-up is divided into three stages:

1. 1-2 years after surgery

A detailed medical history symptom collection and physical examination is performed every 3-6 months, regarding blood routine, biochemical indicators, nutritional status, tumor markers, imaging and endoscopy;

2. 3 - 5 years after surgery

A detailed medical history symptom collection and physical examination is performed every 6-12 months, regarding blood routine, biochemical indicators, nutritional status, tumor markers, imaging and endoscopy;

3. 5 years after surgery

A detailed medical history symptom collection and physical examination is performed each year, and blood routine, biochemical indicators, nutrients, tumor markers, imaging and endoscopy are performed.

In the practice of clinical follow-up, it is usually checked in each follow-up, blood and CT, endoscopic examination, endoscopic examination, one time after surgery, this will be 3-5 years.

Of course, the period of follow-up of the guide is not used when there is no special case.

Once the patient has a decline in appetite, abdominal pain, hemate blood, and black blood, etc., it is necessary to review the changes in the condition. In reality, we must listen to the doctor's advice, but also timely medical treatment when the condition changes.

Third, after the stomach cancer review, what check items?

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1. Symptoms of medical history, physical examination:

This is an essential item each follow-up. It is the basic situation to the doctor's instructions and the discomfort of the body after surgery. Doctors have a deep inspection of the patient's body (touch, listen to one listening, and kickly). According to the doctor's experience, it can be judged whether a further check is needed.

2. Blood routine and blood biochemical examination (including liver kidney function, blood sugar, blood lipids, coagulation function, etc.):

Blood routine examination can understand the patient's blood cell condition, such as anemia, particularly prone to anemia after full stomach; no bone marrow inhibition after adjuvant chemotherapy (white blood cell reduction, anemia, platelet reduction); there is no infection, etc .;

Blood biochemical examination can understand the general situation of the patient's body, there is no treatment to the poisonous side reaction (liver and kidney damage, coagulation function is abnormal), according to the results of the examination, it is necessary to further treatment.

3. Serum tumor marker examination:

It mainly includes an index of carcinoembryonic antigen (CEA), gastric cancer antigen (CA724), sugar antigen (CA199), glycosyl antigen (CA125) and other indicators.

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· Studies have shown that gastric cancer (CA724), sugar antigen (CA199) is the preferred indicator of predictive recurrence transfer transfer after gastric cancer. · The cancerous epicostrum antigen (CEA) has a monitoring effect on post-abdominal metastasis of gastric cancer.

· Sugar antigen (CA199) is considered to be inspection indicators for liver metastasis of gastric cancer.

CA724, CEA, CA199, and CA125 were used alone, 16.4%, 31.4%, 16.1%, 6.0%, respectively, respectively, and the combined application of more than 85%, respectively.

Studies have also found that the increase in serum tumor markes is often caused by symptoms caused by tumor recurrence transfer stoves, which helps to find a lesion that does not have obvious symptoms.

4. Imaging examination:

Including ultrasound, digestive tract angiography, abdominal flaws CT / MRI, abdominal reinforced CT / MRI, PET-CT, etc.

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Ultrasound and digestive tract angiography are generally not carried out as a regular review project due to non-high specificity.

· CT examination:

Due to the change in local anatomy after the radical surgery, its diagnostic value for local recurrence is limited. Especially for the local recurrence of the invisible gastric cancer, the sensitivity and specificity of lymph node metastasis are not high.

Studies have shown that CT If the stomach wall thickening is 2 cm as a standard diagnosis, the sensitivity is 50%, which is 88%. When the gastric wall thickens 1 cm, the sensitivity is 100%, but the specificity is reduced to 36%. Moreover, CT is only 34% -50% specific for lymph node metastasis.

However, there is a certain diagnosis value for distant metastasis, and the sensitivity of the transfer stove of the liver and peritoneum is high (90% and 86.6%, respectively), so it can still be used as a reliable examination.

· MRI check:

The price is high and sensitive, and the specificity and CT are different, so there is less clinical use during the follow-up phase.

· PET-CT:

In 2015, the First Affiliated Hospital of Suzhou University reported the detection value of PET-CT after stomach cancer, and the results showed that 29 patients occurred in the follow-up of 50 patients with gastric cancer, 17 cases Without any recurrence symptoms, the sensitivity of PET-CT of recurrence cases was 89.7%, and the specificity was 85.7%.

However, due to the less cases, it is not enough to explain the advantages of PET-CT after monitoring the transfer of gastric cancer. Moreover, PET-CT is expensive and is not suitable for use as ordinary people.

5. Gastroscopy:

It is the most effective inspection method that clearly and local recurrence, especially for patients with early gastric cancer under mucosal removal / peeling.

6. Followup of postoperative complications:

Including BMI (body mass index), gastric emptying test, vitamin B12 level, bile reflux condition, etc.

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The purpose is to understand the patient's postoperative nutritional status.

Good nutritional status is to ensure the premise of patient life quality, and when nutrient state is deteriorated, it may be prompted to relapse transfer or complications of the disease.

Summarize

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In summary, in the follow-up after gastric cancer, it is necessary to perform medical history, symptoms, physical examination in the outpatient clinic, blood biopsy, blood, serum tumor markers (CEA, CA724, CA199) , CA125) and CT inspection, gastroscopy 1 time after surgery, this will then follow up every 3-5 years.

Gastric cancer is not terrible, terrible is that we cannot know it correctly and treat it. Maintain a good mentality, actively cooperate with the doctor, correct follow-up, I believe that we must defeat the disease and regain health!