Cardia cancer
Introduction
Introduction to Cardiac Cancer The incidence of cardiac cancer in high-risk areas of esophageal cancer in China is also very high. According to the statistics of these areas and cancer research institutions, the ratio of esophageal cancer to cardiac cancer is about 2:1. Due to the inconsistent understanding of the scope of Tuen Mun, there are different views on the definition of cardia cancer, so that the statistics are larger and larger. The correct definition of cardiac cancer is adenocarcinoma that occurs in the gastric cardia, which is about 2 cm below the esophagogastric line. It is a special type of gastric cancer and should be distinguished from the lower esophageal cancer. The etiology of cardia cancer is complex. It is generally believed that the living environment and diet are the two main carcinogenic factors of various cancers in the human digestive tract, and may also be related to gastroesophageal reflux and esophageal hiatus hernia. Symptoms of cardia cancer include upper abdominal discomfort, mild postprandial fullness, indigestion, or pain in the heart and socket, etc., which are easily confused with the symptoms of peptic ulcer, which can not attract the attention of patients until the difficulty of swallowing is aggravated. The patient is seeking medical attention. basic knowledge The proportion of sickness: 0.01% Susceptible people: good for the elderly Mode of infection: non-infectious Complications: gastrointestinal cancer metastasis ovarian gastrointestinal cancer skin metastasis
Cause
Causes of cardiac cancer
Cause
As with other tumors, the cause is unknown and may be related to dietary factors, environmental factors, genetic factors, and Helicobacter pylori infection.
Pathogenesis
1, general classification
(1) Progression period: Gastrointestinal tumor classification is generally followed by Borrman classification. The basic classification is sputum, ulcer type I, ulcer type II and invasive type. According to this, Chinese authors have classified type 4 for cardiac cancer.
1 bulge type: The tumor is a lump with a clear edge to the cavity, which is cauliflower, nodular mass or polypoid, and may have shallow ulcer.
2 localized ulcer type: the tumor is a deep ulcer, and the edge tissue is like a ridge-like bulge, and the boundary between the cut surface and the normal tissue is clear.
3 infiltration ulcer type: the edge of the ulcer is not clear, the cut surface and the surrounding tissue are unclear.
4 infiltration type: the tumor infiltrates and grows in the wall of the cardia, the affected area is evenly thickened, and there is no boundary with the surrounding tissue, and the surrounding mucosa often shows radial contraction.
Gross type is related to histological type. Types 1 and 2 are more highly differentiated adenocarcinomas and mucinous adenocarcinomas. Invasive ulcers are more common in poorly differentiated adenocarcinomas and mucinous adenocarcinomas. Invasive types are mostly poorly differentiated. Diffuse adenocarcinoma or mucinous adenocarcinoma, surgical treatment prognosis with the best type of bulging, limited ulcer type second, invasive ulcer type is poor, invasive type is the worst.
There are two main types of histological types of gastric cardia adenocarcinoma: adenocarcinoma and mucinous adenocarcinoma with obvious mucus secretion. These two types are divided into three subtypes of high differentiation, poor differentiation and diffuse according to the degree of differentiation. High and low are closely related to the prognosis of surgery. In addition to adenocarcinoma and mucinous adenocarcinoma, cardia cancer has some rare histological types, such as adenosquamous carcinoma, undifferentiated carcinoma, carcinoid (sinusoidal cell carcinoma) and carcinosarcoma.
(2) Early stage: The general morphology of early cardiac cancer is similar to that of other parts of the stomach and early stage of esophagus, and can be easily divided into three types.
1 Depression type: The mucosa of the cancerous tumor is irregularly mildly depressed, and a few are shallow ulcers. The boundary with the surrounding normal mucosa is not clear, and the differentiation under the microscope is often poor.
2 uplift type: the mucosa of the cancerous part is thick and rough, slightly bulged, and some of them are plaques, nodules or polyps, with highly differentiated adenocarcinomas.
3 concealed type: the mucosa of the lesion is slightly darker in color, slightly thicker in texture, and there is no significant change in the body. It is diagnosed by histological examination and is the earliest form of type 3.
2. The law of spread and metastasis of cardia cancer
(1) Direct infiltration spreads to other parts of the stomach at the lower end of the esophagus, the diaphragmatic muscle, the left lobe of the liver, the liver and stomach ligament, the tail of the pancreas, the spleen, the spleen and other retroperitoneal structures.
(2) lymphatic metastasis: in the wall of the cardia, especially in the submucosa and subserosal layer, there are abundant lymphatic network and esophageal lymphatic network traffic, which are combined into extra-parenchymal lymphatic vessels, which are drained upward to the mediastinum and drained downward to the abdominal cavity. Finally, I entered the thoracic duct, and some authors suggested that the three lymphatic drainage systems of the cardia are:
1 liter dry: along the esophageal wall up to the mediastinum.
2 right stem: from the small curvature of the stomach along the left ventricle of the stomach and the esophageal branch of the cardia to the celiac artery.
3 left stem: to the posterior wall along the large bend to the upper edge of the pancreas and retroperitoneum.
It can also be divided into large curved branches, posterior gastric branches and sacral branches. There are lymph nodes along the system. The first station is next to the cardia (left and right), the lower esophagus and small curved lymph nodes, and the second station has left gastric vessels. Next to the spleen and the omental lymph nodes, the distant side has the celiac artery, the abdominal aorta, the hilar region, the mediastinum and the supraclavicular lymph nodes.
(3) Blood transfer:
1 through the portal vein into the liver, through the inferior vena cava circulation.
2 The intervenous vein path directly enters the systemic circulation, the former is the most common transfer pathway.
(4) Planting: Cancer cells can be detached and planted in the peritoneal omentum, etc., and may be accompanied by bloody ascites.
Prevention
Cardia cancer prevention
There are many factors inducing cardiac cancer, and it is effective in preventing cardia cancer. In daily life, the following points must be noted:
1, no smoking, no alcohol, according to statistics, smoking is one of the main factors in the induction of cardiac cancer, long-term smoking can directly induce cardiac cancer, the relevant data show that the incidence of cancer in patients with cardia cancer is 10 times higher than non-smokers, in addition, alcohol It is very irritating to the mucosa of the cardia, and it is easy to cause mucosal degeneration and necrosis on the surface of the cardia. The alcohol also contains various carcinogens such as nitrosamine and gonadobacter. According to statistics, the incidence of cardia cancer among drinkers is higher than that of non-drinkers. Times, the rate of smoking and drinking is 30 times higher than that of non-smoking and non-drinking patients.
2, do not eat hot and hard food, the relevant experts in the high incidence of Tuen Mun cancer in Henan Province, Yangzhong County, Jiangsu Province and other areas of the investigation showed that the occurrence of cardia cancer and diet overheating, hard, thick, fast, too hot tea, Porridge can cause cancer of the gastric epithelium of the cardia.
3, do not eat mildew pickled food, mildew peanuts, mildew dried vegetables, cured meat, bacon and other foods are often contaminated by fungi such as Aspergillus flavus, Geotrichum candidum, easy to produce nitrosamines, nitrite and other carcinogens, prone to occur after consumption Cardia cancer.
Complication
Cardiac cancer complications Complications, gastrointestinal cancer, metastasis, ovarian gastrointestinal cancer, skin metastasis
Transfer and diffusion
1, direct infiltration: spread and other parts of the stomach at the lower end of the esophagus, such as the diaphragmatic diaphragm, liver left lobe, liver and stomach ligament, pancreatic tail, spleen, spleen and other retroperitoneal structures.
2, lymphatic metastasis: such as metastasis into the wall of the cardia, especially in the submucosal and subserosal layer is rich in lymphatic network and esophageal lymphatic network traffic, pooled into extra-parenchymal lymphatic vessels, upward drainage of the mediastinum, downward drainage of the abdominal cavity, Finally enter the thoracic duct. There are three lymphatic drainage systems proposed by the author: 1 liter of dry, along the esophageal wall to the mediastinum; 2 right stem, from the small curvature of the stomach along the left ventricle of the stomach and the esophageal branch of the cardia to the celiac artery; 3 left stem, backward The wall is bent to the upper edge of the pancreas and the retroperitoneum. It can also be divided into large curved branches, posterior stomach branches and sacral branches. There are lymph nodes along each system. The first stop is the side of the cardia (left and right), the lower esophagus and the small curved lymph nodes of the stomach. The second station has the left side of the stomach, the side of the spleen and the retinal lymph nodes. In the distance, there are abdominal celiac artery, para-aortic aorta, hilar region, mediastinum and lymph nodes.
3, blood transfer: 1 through the portal vein into the liver, through the inferior vena cava into the systemic circulation; 2 through the inter-organ vein path directly into the systemic circulation. The former is the most common transfer pathway.
4, planting: cancer cells can be shed and planted in the peritoneum, omentum, pelvic cavity, etc., may be associated with bloody ascites.
Symptom
Tumor cancer symptoms common symptoms abdominal discomfort swallowing difficulty ascites anemia appearance polyp upper gastrointestinal bleeding tar
Because of the anatomical features of the Tuen Mun, it is like a river entering the sea. The esophagus is the river, and the stomach cavity in the far side of the Tuen Mun is the sea. The Tuen Mun passage is wider and wider. Therefore, it is easy to produce obstruction after the cancer occurs in the esophagus. At the beginning, the volume is small, and it is not easy to cause obstruction. If there is difficulty in swallowing, the cancer must have progressed quite a bit. Therefore, patients with early cardiac cancer lack clear characteristic symptoms. Symptoms of cardiac cancer include upper abdominal discomfort and mild postprandial fullness. Indigestion, or pain in the heart and socket, are easily confused with the symptoms of peptic ulcer, which can not attract the attention of patients, until the difficulty of swallowing is aggravated, and the patient is urged to seek medical treatment.
Another initial symptom of cardia cancer is upper gastrointestinal bleeding, which is characterized by hematemesis or tarmac. Severe bleeding may be associated with collapse or shock, or severe anemia. The incidence of this condition is about 5% of the patient, due to lack of Symptoms of sputum, patients are easily misdiagnosed as peptic ulcer bleeding, and surgery by abdominal surgeons, it is precisely because most departments are emergency surgery, all aspects are not adequately prepared, the incidence of surgical complications and mortality in these patients are Higher, poor efficacy, in addition to dysphagia in advanced cases, there may be persistent pain in the upper abdomen and lower back, indicating that the cancer has involved the retroperitoneal tissue such as the pancreas, which is a contraindication for surgery.
There is no positive sign in patients with early cardiac cancer. Patients with advanced disease can be seen with anemia, hypoproteinemia, weight loss, dehydration or low protein edema. If there is a mass in the abdomen, hepatomegaly, ascites sign, pelvic mass (anal diagnosis) Not suitable for surgical treatment.
Examine
Cardiac cancer examination
1, X-ray barium meal imaging: is the main means of diagnosis of cardiac cancer.
(1) Early: early manifestations of subtle mucosal changes, small ulceration and less obvious and constant filling defects, in early cases, endoscopy, brushing cytology and biopsy pathology must be performed Confirmed diagnosis.
(2) Late stage: The X-ray findings of the advanced cases are clear, including soft tissue shadow, mucosal destruction, ulcer, sputum, filling defect, twisted and narrow stenosis of the cardia, invasion of the lower esophagus, and infiltration of the fundus, size and body. The stomach wall is stiff and the stomach is reduced in size.
2, gastroscopy: visible at the cardia at the mass or erosion, the texture is brittle and hard and easy to hemorrhage, severe tube distortion and stenosis into the lens is difficult, check at the same time multiple biopsy pathological examination.
3, abdominal CT: can understand the relationship between the tumor and the surrounding organs, relative to the CT findings of the esophagus, the positive findings of cardiac cancer are often not sure, CT helps to find liver metastases and whether to judge the invasion of the pancreas and abdominal lymph nodes, there are Conducive to preoperative evaluation of cardiac cancer.
4, exfoliative cytology diagnosis: the positive rate of cardia cancer is lower than esophageal cancer, which is also caused by the conical anatomical features of the cardia caused by the balloon is not easy to contact with the tumor, the diagnosis rate is improved after switching to a larger balloon.
Diagnosis
Diagnosis and diagnosis of cardiac cancer
The diagnosis should be differentiated from the following diseases:
1. Cardiac achalasia: The patient is young and has a long history of dysphagia, but still maintains a moderate health condition. X-ray esophagography shows a symmetrical and smooth stenosis above the cardia and a high degree of dilatation of the proximal esophagus.
2, the lower esophagitis: often accompanied by hiatal hernia and gastric reflux, the patient has a long-term "heartburn", acid history, body weight, short, long-term inflammation caused by scar stenosis, dysphagia, X-ray barium meal performance of the lower esophagus and The stenosis of the cardia, the mucosa may be irregular, esophagoscopy can be seen in the inflammatory granulation and scar, and the naked eye is sometimes difficult to distinguish from cancer. Repeated biopsy can confirm the diagnosis if it has been negative.
3, peptic ulcer: upper abdominal discomfort, mild postprandial fullness, indigestion, or heart pain, etc., are easily confused with cardia cancer, and digestive ulcer bleeding and cardia cancer bleeding is difficult to identify, gastroscopy biopsy diagnosis rate Higher.
The differential diagnosis of cardiac cancer includes sputum sputum (sacral achalasia), stenosis caused by chronic inflammation of the lower esophagus, and digestive ulcers of the cardia. The clinical features of the case of sputum are young, long history, long history of dysphagia, but still able to Maintaining moderate health, X-ray esophagography showed a symmetrically smooth stenosis above the cardia and a high degree of dilatation of the proximal esophagus.
