Is gastroscopy the first choice for gastric cancer screening? Not necessarily. You can do these two tests first!

Author: Wu Qi, Chief Physician, Peking University Cancer Hospital

Reviewer: Shang Zhanmin, Chief Physician, Beijing Chaoyang Hospital (West Campus), Capital Medical University

The incidence and mortality of gastric cancer in China are very high.

In the early stages of gastric cancer, there are very few symptoms. Very early gastric cancer basically has no symptoms, and it is difficult to detect without examination.

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If gastric cancer can be detected in its early stages and the cancer cells have only invaded the mucosal layer and submucosal layer, radical treatment can be given and the person will not die from gastric cancer.

Therefore, early detection of gastric cancer and regular check-ups are crucial.

1. Which groups of people need regular screening for gastric cancer?

First, people in areas with a high incidence of gastric cancer;

Second, there is a family history of digestive tract tumors, and direct relatives within two generations have suffered from gastric cancer;

Third, there is a history of gastric diseases, such as gastric polyps, gastric adenoma, and gastric ulcer;

Fourth, people infected with Helicobacter pylori. Helicobacter pylori parasitizes in the human stomach. There are four subtypes of Helicobacter pylori, two of which are highly pathogenic. It secretes some toxins, which can easily cause inflammatory reactions in the stomach and are directly related to gastric cancer. The World Health Organization defines Helicobacter pylori as a primary pathogenic factor for gastric cancer;

Fifth, people with a high-salt diet often eat pickled foods;

Sixth, people who drink often drink and drink a lot.

Expert consensus and national guidelines recommend that the above-mentioned groups should undergo regular gastric cancer screening at the age of 40-65. If there are no problems in the screening and there is no Helicobacter pylori infection, they can do it again three years later.

2. Is gastroscopy the first choice for screening gastric cancer?

Serum gastrin, pepsinogen, Helicobacter pylori, and gastric cancer are all correlated to a certain extent. To screen for gastric cancer, you can first do a serological test and a Helicobacter pylori test. If the result is positive, then do a gastroscopy. This is what the current guidelines recommend. In the words of ordinary people, it means spending little money to achieve great things.

In China, serum gastrin and pepsinogen are very important and guiding screening indicators.

Gastrin is a substance that promotes gastric secretion and secretion of mucus proteins, which protects the stomach. It is also called gastrin. Gastrin deficiency is prone to gastric damage, so it is considered to have a certain reference value for the diagnosis of gastric cancer.

Pepsinogen is a precursor of gastric protein and is divided into two subtypes: pepsinogen 1, which is secreted by the chief cells of the fundic glands; and pepsinogen 2, which is secreted by the chief cells and the neck mucous cells of the pyloric glands of the gastric antrum. Testing pepsinogen mainly reflects the secretion of the stomach and determines whether the stomach is atrophied and the degree of atrophy.

If gastrin and pepsinogen are abnormal and Helicobacter pylori is positive, further gastroscopy is needed to determine whether there are any lesions in the stomach.

3. Under what circumstances is it necessary to obtain pathological data during gastroscopy screening for gastric cancer?

Gastroscopy is now considered to be the only effective and efficient examination option for early gastric cancer, and to a certain extent it can determine whether it is a very early stage gastric cancer lesion.

When we find a very clear or typical gastric lesion and when we determine that the lesion shows signs of a tumor, we need to take a biopsy and perform further pathological examination.

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Pathological examination is a qualitative diagnosis. Gastric cancer is divided into different types according to the degree of differentiation, and they can be clearly distinguished through pathological examination. Different types of gastric cancer have different treatment plans, so pathological examination is very important in the diagnosis of gastric cancer.

With the development of endoscopic technology, we have discovered many early gastric lesions and many early gastric cancers have been detected.

For gastric cancer that only invades the mucosal layer and the shallow submucosal layer, and has no lymph node metastasis, endoscopic resection or endoscopic mucosal stripping can be performed; if it exceeds the indications for endoscopic treatment, we also have laparoscopy, which can also perform radical resection to achieve the purpose of radical treatment. Compared with open surgery, laparoscopy is relatively less invasive and has a good prognosis. It is also a good treatment option for early gastric cancer.