Peritoneal metastasis of gastric cancer?

summary

According to the statistics of Japan in 1966, peritoneal recurrence of gastric cancer accounted for 28%, ranking the second in recurrent cases. However, in Japan, the recurrence rate of peritoneum was 40%, and the most frequent recurrence was peritoneum. According to the data of Japanese Society of surgery in 1981, the recurrence rate of peritoneum was 33.6% ～ 54.7%, ranking the first among the recurrent cases. In short, gastric cancer patients with peritoneal recurrence, dissemination and metastasis are more often, and usually have cancer intestinal adhesion obstruction, prompting short-term death of patients. One group reported 51.7% peritoneal metastasis after operation. 30% of them were complicated with intestinal obstruction. Peritoneal metastasis of gastric cancer? Let's talk about it.

Peritoneal metastasis of gastric cancer?

1. Clinical manifestations: once gastric cancer invades the peritoneum, ascites of different degrees can often appear. In addition, gastrointestinal peristalsis is limited, so the patient first feels abdominal distension, especially after meals. He always feels that food is accumulated in the upper abdomen, so he has loss of appetite, weight loss, general tiredness, anemia and pale complexion. The patients with ovarian metastasis of gastric cancer showed abnormal menstruation, increased blood volume and intermittent vaginal bleeding. Physical examination may have upper abdominal tenderness or palpable mass. Abdominal percussion showed ascites. Anal digital examination, can touch hard, no plastic and fixed nodules or masses, gynecological double diagnosis can touch the enlarged ovary or masses, with tenderness. When accompanied with carcinomatous adhesive ileus, nausea and vomiting may occur, and no defecation and exhaust may occur. Abdominal distension is progressively aggravated, and typical partial or complete ileus may appear. The patient's general condition deteriorated rapidly, showing cachexia.

2. The diagnosis of a small amount of abdominal ascites, sometimes the signs are not obvious. B-mode ultrasound examination can accurately determine whether and how much ascites. Ascites can be aspirated by abdominal puncture. Generally, it is light yellow, and a few cases are bloody ascites. Ascites afternoon cytology is helpful to determine the diagnosis, but often need to repeatedly check to detect cancer cells. In fact, in clinical practice, more patients are diagnosed as intestinal obstruction or ovarian tumor when they are operated again.

3. Treatment and prevention according to the depth of invasion of gastric cancer, whether the serosa is invaded and the area of gastric cancer cells penetrating the serosa, in addition to choosing a reasonable radical operation, we should also use the method of killing free cancer cells during and after the operation to prevent peritoneal recurrence of gastric cancer. In order to improve the therapeutic effect, the patients who have relapsed should be treated with active peritoneal anticancer therapy. Foreign reports: about 50% of patients with gastric serosa involvement relapse even after radical resection, which may be due to the intraperitoneal dissemination of cancer cells during the operation.

matters needing attention

It has been reported that radiotherapy was combined with intraperitoneal anticancer drugs. There were also cases with survival of 3-5. Ovarian metastasis of gastric cancer is only a part of peritoneal metastasis. Surgical resection of metastatic ovarian cancer alone is of little significance, and even accelerates the death of patients.