Stay away from the king of gastric cancer: signet ring cell gastric cancer

Cancer Prevention and Control Promotion Week April 15-21, 2024 is the 30th "National Cancer Prevention and Control Promotion Week". The theme of this year's promotion week is "Comprehensive measures for scientific cancer prevention."

Stay away from the king of gastric cancer: "Signet ring cell gastric cancer"

Recently, I consulted a pregnant woman who was 30 weeks pregnant. She had severe back pain. The electrocardiogram and cardiac ultrasound were all normal. After examination, it was suspected that she had gastrointestinal problems. However, she had never done a gastroscopy before pregnancy. Now she is more than 7 months pregnant. Because she was afraid of the bad influence on the baby, there was really no other way but to do a regular gastroscopy. The examination found that the mucosa of the entire stomach cavity was thickened and thickened, and there was a huge ulcer necrosis with bleeding (as shown in the picture), and no matter how much air was sent inside, it could not be opened. It turned out that the cunning disease had already planted seeds under the mucosa, quietly infiltrating until the stomach became smaller, hardened, and unable to shrink. This is what we often call a typical "leather stomach" in medicine.

The family faced the soul-searching question of "save the adult or the child?" Because his family had been a single-son family for three generations, she was determined to save the child.

Later, after a large-scale consultation by experts from our hospital, the patient and her family decided to have surgery. They first had a caesarean section to save the baby. At the same time, they wanted to remove the gastric cancer. Unfortunately, the surgery found that the abdominal cavity had metastasized and could not be treated surgically. Pathology also confirmed that it was poorly differentiated gastric adenocarcinoma, some of which were "signet ring cell carcinomas", and cancer cells were also found in the abdominal cavity.

"Signet ring cell carcinoma" is a special type of poorly differentiated mucinous adenocarcinoma with strong invasive ability. Under the microscope, a large amount of mucus can be seen in the cancer cells, and the cell nucleus is squeezed aside, which looks like a ring, so it is called "signet ring cell carcinoma". Even if the lesion of "signet ring cell carcinoma" is very small, it is still easy to metastasize and progress. It is common in the gastrointestinal tract, breast and other parts, and it is more common in young people. Due to its extremely high malignancy, "signet ring cell gastric cancer" is often called the "king of gastric cancer."

In fact, "signet ring cell gastric cancer" is very good at disguising itself. Patients in the early stage have no symptoms. Even with a gastroscopy, it is difficult to find a small lesion, which may be just a little erosion on the surface. Therefore, it is easy to misdiagnose or miss the diagnosis. Most "signet ring cell cancer" is already in the late stage when it is discovered. Even with active treatment, there is little chance of surviving for five years. This has brought pain to families and society that can never be erased.

The 25-year-old young man also had signet ring cell gastric cancer. He came to have a gastroscopy because of stomach discomfort. The attending doctor was experienced and extremely careful. He found an early "signet ring cell carcinoma" less than 1 cm and immediately performed an endoscopic submucosal resection (ESD) surgery. It is now the 8th year, and he has been in good health every year.

According to the latest data, in 2022, there were 509,000 new cases of gastric cancer and 400,000 deaths from gastric cancer in China, accounting for about half of the world's total. Among them, "signet ring cell carcinoma" accounted for about one-tenth.

In view of the current situation of my country being the country with the largest incidence of gastric cancer, Chinese experts have updated and revised the "Guidelines for Gastric Cancer Screening, Early Diagnosis and Early Treatment (2022 Edition)", "Guidelines for Gastric Cancer Risk Management in the Chinese Population (2023 Edition)" and "Guidelines for the Diagnosis and Treatment of Gastric Cancer (2023 Edition)". Those who meet any of the 1st and 2-6 items should be listed as high-risk groups for gastric cancer and are recommended as subjects for routine screening:

Routine screening subjects for gastric cancer <br /> Age 45 years and above, regardless of gender;

Long-term residence in areas with a high incidence of gastric cancer (Liaodong Peninsula, Shandong Peninsula, Yangtze River Delta, Taihang Mountains, etc.; high-incidence provinces: Liaoning, Fujian, Gansu, Shandong, Jiangsu, etc.);

People infected with Helicobacter pylori (Hp);

Patients with precancerous diseases of the stomach such as chronic atrophic gastritis, gastric ulcer, gastric polyps, residual stomach after surgery, hypertrophic gastritis, pernicious anemia, etc.

First-degree relatives of gastric cancer patients;

The presence of other high-risk factors for gastric cancer (high salt, pickled diet, smoking, heavy drinking, etc.).

In fact, combined with our experience, the first item about the age of 45 is recommended, and the 2019 guidelines recommend 40 years old. In other words, the first gastroscopy should be before the age of 40, especially if there is a family history or genetic tendency, it should be done earlier.

In recent years, more and more people in their teens and twenties have died of cancer, which is a pity. Recently, our team treated an 8-year-old child with gastric cancer. He had no family history and died within a year.

We once again strongly urge that you must have regular physical examinations. You don’t have to wait until you feel unwell to do a gastroscopy. Of course, if you experience belching, stomach pain, bloating, weight loss, blood in the stool and other discomforts, don’t delay and don’t forget to rule out tumors, because the most expensive medicine in the world is the “regret medicine.”

We are all insignificant, and there are too many things we cannot change. Among these uncertainties, the only thing we can do for sure is to have a gastroscopy earlier to give ourselves a different future. Perhaps, a physical examination in winter becomes a story, and a gastroscopy in spring becomes a landscape.

In short, early detection, emphasis on physical examinations, and maintaining a healthy lifestyle can help us stay away from the "king of gastric cancer." Let us work together to keep more people away from the threat of this disease.

Reminder at the end of the article

This article introduces the common knowledge about signet ring cell carcinoma, mainly describing the screening, diagnosis and treatment of early gastric cancer. Readers are reminded that each patient's situation is different, and the specific treatment plan needs to be formulated under the guidance of a doctor.

What is signet ring cell carcinoma?

"Signet ring cell carcinoma" is a special type of poorly differentiated mucinous adenocarcinoma, which is common in the gastrointestinal tract, breast and other parts. It is more common in young people and is called the "king of gastric cancer" because of its high malignancy. It may be asymptomatic, the surface of the lesion is eroded, and it is easy to misdiagnose or miss the diagnosis. Most patients are already in the late stage when they are discovered.

Early Gastric Cancer Screening and Diagnosis

In view of the fact that my country is the world's largest country with gastric cancer, my country has specially updated and revised the "Guidelines for Screening, Early Diagnosis and Treatment of Gastric Cancer (2022 Edition)" and "Guidelines for Diagnosis and Treatment of Gastric Cancer (2023 Edition)", and it is recommended that those who meet any of items 1 and 2 to 6 be listed as high-risk groups for gastric cancer and routinely used as screening subjects. Among them, people over the age of 45 are at high risk of gastric cancer. It is recommended that the first examination be done before the age of 40, and those with a family history and genetic tendency should do it earlier. Especially during pregnancy, many digestive tract symptoms sometimes need to be distinguished from morning sickness and discomfort caused by the uterus lifting and compressing the stomach, and attention should be paid to excluding tumors.

Conclusion

The diagnosis and treatment of gastric cancer involves multiple fields of medicine, such as internal medicine, surgery, radiology, oncology, etc. Early detection and early treatment of gastric cancer are crucial for gastric cancer patients.

It is recommended that people over 30 years old have regular physical examinations to detect diseases as early as possible, receive timely treatment, and try to avoid pain and regret.

Author: Deng Zhenzhong (Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine)

Supervisors: Gu Jianchun, Chen Siyu (Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine); Yang Zhiyong (Chongming Hospital Affiliated to Shanghai Health and Medical College)

Reviewer: Xu Yun, Chief Physician, Department of Oncology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Standing Committee Member and Secretary-General of the Oncology Rehabilitation Committee of the Chinese Rehabilitation Medicine Association

Editor: Jia Jing (Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine)