The clinical diagnosis of the stomach cancer

Symptom
When small cancer or in early days cancer, clinical up much had no to obviously aware of self symptom, pathological changes development, lump body enlarge, bleed, make stomach function or whole body the appearance was justsubjected to influence to just appear the self-conscious symptom of different degree, but as well non- stomach cancer had especially, its performance often and stomach inflammation, stomach ulcer or the top digest way disease disease likeness, don't do special check, generally all pressed the stomach disease a treatment.When the top digests a symptom to aggravate and ascends belly disease to turn worse after taking a meal, anorexia, anemic and black then, emaciated and tired, then the belly appear a pack of piece, Geng Zu in the You door, lock bone ascend lymphoid knot swollen big, get empty to transfer with stomach etc., all lose effectively an opportunity to cure for good for the later period symptom.According to the local data, now earlier period stomach cancer with carry on the clinical symptom that expects stomach cancer to make a comparison.
The body advertises for
The general stomach cancer all has no obvious body to advertise for, minority of patients have a following circumstance, to diagnosis meaningful:
1)last the belly press a pain:The last belly of parts of patients is partial to right, there is light degree pressing a pain, be pathological changes scope bigger, the ulcer involves in a muscle layer, while straching film or the syrup layer outside the film patient top the stomach refuse press can appear a muscle strain with anti- jump a pain.
2)stomach piece:In up any parts of the belly equal stomach area all can Men and lump, the stomach Dou department cancer to the right top the belly much see.Lump tightly solid, present to knot stanza-like in shape, be lump body to surroundings organization gradually, the movable degree is obviously subjected to a limit, should fight for a surgical operation treatment.Have surrounding lymphoid knot to transfer such as the original hair tumor companion or when the belly cavity lump plant Be canned transfer knot stanza by the Men and the urine bladder or the womb rectum by ass rectum, all is later period, not proper surgical operation cut off.
3)transfer lymphoid knot:In addition to the lump in the stomach side the lymph knot, the lymphoid knot transfers to lead on the left lock bone tallest, can reach to 10% or so, the Yi lymphoid knot transfers to have 2% around.Clinical up and may also see minority of tops in the right lock bone and Qi around transfering a cancer.
4)extensively plant to transfer:The later period of the stomach cancer can take place blood to go sexual liver, lung, bone, kidney and nervous system to transfer;When the tumor infringes upon syrup in addition to film, when the cancer cell sheds off to take place extensive sex peritoneum to plant to transfer can have stomach water, and can check cancer cell.Condition further the depravation then appear emaciated, bleed, anemic;You door or bowel take care of Geng Zu;The quality of the liver swollen big and yellow Dan, stomach water and bad disease.
5)diagnosis with discriminate diagnosis though stomach cancer diagnosis method numerous, all is raising development in form.Nearer in the last years, although the optic fiber stomach mirror is clinical to get an extensive application,the X line checks and still stands first and chooses a position before the Shu, is a kind of simple but effective method.Its purpose:One is definitely have no cancer lump, with meticulous care the check can discover, diagnose in early days in early days and cured in early days;Two after being a certain stomach cancer, can provide to establish a treatment the basis of the project, like pathological changes part, size, scope, gradually depth and pathological changes number etc..
Stomach of the X line dual contrast build a shadow check
This checks agree with stomach cancer of diagnose and discriminate to diagnose very beneficial, its advantage:
1)can observe the variety of the stomach small area, the stomach small ditch, be advantageous to the small pathological changes that discovers that the stomach glues the film wrinkly wall, have already helped to judge pathological changes scope.
2)can take photo wall and Houpi to be like before the stomach respectively, acquire a pathological changes of positive view, and can observe the side wall of all of the curved stomaches in the meantime, observe scope bigger.
3)the agree with stomach upper part is as clearer as the observation of area pathological changes in the Ben door.
4)ask for help of increasing or decreasing of air contrast, can understand the movable degree of stomach wall and stretch sex, agree with stomach wall muscle layer the scope that implicate a circumstance provide a diagnosis reference.
Unite a check to discover a less than 5 mms and small cancer according to the applied dual contrast method of the Laufer1976 annual report way and the stomach mirror, the false feminine gender misdiagnosis of the stomach cancer rate descends from 22% to 6%~7%.Even Gelfand(1976) thinks to have 25% earlier period cancers to only use this method to discover.
The optic fiber stomach mirror checks
This checks about 20 in the last yearses clinical extensively applied in the our country, not only agree with stomach department disease diagnosis method is an epoch-making development;To various type the cancerous earlier period discovered to have a decisive function with accurate diagnosis and still provided a new treatment method in the meantime in early days, its advantage:
1)from lead a bare fiber bunch to constitute, the mirror body is soft, easy to crooked, connecting the thing mirror can curve transformation angle and operate vivid, can keep a view each one inside the stomach glue a film circumstance, pathological changes size, scope, number and state etc..
2)the stomach mirror establish to send spirit, blunt water and attraction stomach a liquid to equip and be advantageous to operation and observation.
3)the exploitation enlarged stomach mirror or glue film dyeing, can observe the variety of the stomach small area, the stomach small ditch, can discover a small cancer and much be taken bad to change.
4)can carry on automatic color to shoot to be like, record image when the stomach mirror checks, movie etc. dynamic state observation, and reserve a record.
5)stomach mirror in addition to raising diagnosis quality, also live check pliers, cell to brushes, flush a machine and inject a machine and super voice wave, Gao repeatedly gives or gets an electric shock Ning, laser, and fluorescence...etc., latest of the stomach mirror technique can make the fluorescence appeared reaction stereo set and contribute to the home position cancer that discovers latent.
Discriminate diagnosis
Stomach cancer symptom and general stomach department the disease is extremely alike, but clinical often easily confuse with the stomach positive ulcer most , have to with meticulous care discriminate, in order to prevent delay treatment.Relevant stomach inflammation, polyp, tubercle, benign tumor, lymphoid lump etc., although each have a characteristic, clinical symptom and stomach ulcer or the cancer basic type together, only passing a X line barium meal, stomach mirror the check then can at last and definitely diagnose.
The clinical pathologic cent expects
Because the stomach is located on inside the belly cavity, check-up can't see, the Men cannot compares with.Stomach cancer the growth scope before Shu, proliferation degree, gradually depth and transfer a circumstance all hard assurance.Therefore, the stomach cancer still has no before the Shu exactitude currently of, reasonable of clinical TNM cent expect.UICC established stomach cancer to expect a method for TNM cent in 1966, after clinical domestic and international scholar practice, rift a little bit greatly, the opinion is hard to unify, owing to stomach cancer cent expects in its prevention and cure and studies in nasty need solution, the our country is national stomach cancer cooperation set comprehensive analyzed to expect the merit and shortcoming of method for various cent, put forward the stomach cancer of our country and expect a method for TNM cent in 1978, emphasized according to the original hair cancer gradually depth, size, lymphoid knot to transfer degree and didn't far separate and transfer but carry on a cent and expect, after more than 10 years of in great quantities clinical verification, our country of the stomach cancer clinical pathologic cent expect the method contain definitely practical meaning.But its weakness is their contents description of writing and drawing to unify, reader hard comprehension, now to the TNM cent of our country stomach cancer cooperation set expect the sketch map slightly make some corrections as follows:Suggest:①The M"the distance transfers a circumstance" should add "dirty machine" two words at the back of the distance and transfer with the N3 far lymphoid knot by benefit mutually distinct.②The Ⅳ expects of the cent set is the T1-4 aNs 3 M0s, the T4 bNs 0-3 M0 T1-4 aNs 0-3 M0 T1-4 aNs 0-3 M1s, show T4 like this, the bs is gradually tumors circumstance rather than far transfer lump(M1), but T4 bs' arranging with M1 is together but physically a M figure 3-3-1-5.Consequently should T4 bs and M1 separate from transfered to move to a tumor column inside the column, the clinical pathology of the agree with stomach cancer divided a period of writing and diagram slightly added a modification, modification empress of Ⅳ period cent set is the T1-4 bNs 0-3 M0s, the T4 bNs 3 M0s, the T4 bNs 0-3 M1s makes of more reasonable, in the meantime text diagram the contents is consistent, clear, be easy to keep a view.
The T 棗 delivered tumor at first.For the sake of the scope and size of easy to estimate tumor, divide the line stomach for up, in, next three area, bends in the stomach size each is divided into three etc.s to be apart from of order, and order the top and bottom corresponding to conjunction, up 13 include Ben door and stomach bottom, in 13 is a stomach body, under 13 include stomach Dou.
T1 tumor in spite of its size, only the one who be limited by to glue a film or glue film bottom layer.
T2 tumors invade and muscle layer, but size not more than a 1s that divides area are 2 areas.
T3 tumors invade and strach a film layer, or although 1 that didn't invade and strach more than one of film layer but pathological changes to divide area 2.But not more than one divides area.
The T4 a tumor invades and straches a film an outside or has more than a cent area.
The T4 b tumor has been already invaded and the surroundings dirty machine.
The N 棗 lymphoid knot transfers a circumstance.Leading stomach to flow lymph to is divided into is three sets of, Group 1(N1) is the shallow set lymphoid knot that sticks in the stomach wall, such as stomach big and small curved, on the You door, bottom, the Ben door waits beside each lymphoid knot.Group 2(N2) is that the deep set that leads to flow shallow lymph is lymphoid to knot, such as Pi door lymphoid knot, Pi, the liver total stomach left artery dry lymphoid knot, Yi 12 bowel empress lymphoid knot.Group 3 includes the belly cavity artery side, stomach aorta beside, the liver door, bowel fasten the lymphoid knot of artery surroundings in film root and colon.Transfer a circumstance but is divided into 4 classes according to part and lymphoid knot of tumor.
The N0 has no lymph to transfer.
The N1 tumor close by part shallow set lymphoid knot transfers, such as the stomach Dou department cancer You door up, descend lymphoid knot to transfer.
The N2 Group 2s lymphoid knot transfers, or the tumor far separate the part shallow set the lymphoid knot transfer.If the stomach Dou department cancer has a Ben door the lymphoid knot transfer beside.
The N3 Group 3s lymphoid knot transfers.
Dirty machine in the M distance transfers.
The M0 has no distance to transfer.
The M1 has the distance the dirty machine to transfer.
According to above classification, can is divided into the period of the disease of stomach cancer 4 period.
The Ⅰ expects T1-2 N0 M0
The Ⅱ expects T1-3 N1 M0, T3 N0 M0
The Ⅲ expects the T1-4 aNs 2 M0s, T4 aN 0-2 M0s
The Ⅳ expects the T4 bNs 3 M0s, the T1-4 bNs 0-3 M0s, T4 bN 0-3 M1s