abdominal tumor
Introduction
Abdominal tumor introduction Abdominal tumors mainly include abdominal wall tumors, gastric cancer, colon cancer, small intestine tumor, liver cancer, biliary tumor, pancreatic tumor, spleen tumor, peritoneal and retroperitoneal tumor, gastrointestinal pancreatic neuroendocrine system tumor. basic knowledge The proportion of sickness: 0.6% - 0.8% Susceptible people: no specific people Mode of infection: non-infectious Complications: intestinal obstruction peritonitis
Cause
Abdominal tumor cause
Abdominal tumors are divided into:
1. Abdominal wall tumors: benign tumors of the abdominal wall include fibroids, fibroids, neurofibromas, hemangioma, papilloma, and dermoid cysts. Malignant tumors include fibrosarcoma, dermatofibrosarcoma, melanoma, skin cancer, and metastatic cancer. Select the main person to describe it later.
2, gastric cancer: gastric cancer is a malignant disease of gastric mucosal epithelial carcinogenesis, is one of the most common malignant tumors.
3, colorectal cancer: colorectal cancer is the general term for colon cancer and rectal cancer. Colorectal cancer refers to the malignant lesions of the large intestinal mucosa epithelium under the influence of various carcinogenic factors such as environment or genetics. The prognosis is poor, the mortality is high, and it is common malignant. One of the tumors.
4, small intestine tumor: small intestine tumor refers to the tumor from the duodenum to the small intestine tube of the ileocecal valve. The small intestine accounts for 75% of the total length of the gastrointestinal tract, and its mucosal surface area accounts for more than 90% of the surface area of the gastrointestinal tract. However, the incidence of small intestine tumors accounts for only about 5% of gastrointestinal tumors, and small intestinal malignant tumors are rare. About 1% of gastrointestinal malignancies. The exact cause of small bowel tumors is currently unclear. The clinical manifestations of small intestine tumors are very atypical, generally related to the type, location, size, nature of the tumor and whether there is obstruction, hemorrhage and metastasis.
Carcinogenic factors and mechanisms:
(1) Chemical carcinogenic factors
1) Indirect chemical carcinogens: polycyclic aromatic hydrocarbons, aromatic amines and amino azo dyes, nitrosamines, mycotoxins.
2) Directly acting chemical carcinogens: These carcinogens can cause cancer without activation in the body, such as alkylating agents and acylating agents.
(1) Nitrosamines, a class of chemical carcinogens that are highly carcinogenic and cause a variety of cancers in animals. It is high in degraded vegetables and foods, and can cause tumors of various organs such as the digestive system and kidney.
(2) Polycyclic aromatic hydrocarbons. These carcinogens are represented by benzopyrene, which is applied to the skin of animals to cause skin cancer. Subcutaneous injection can induce sarcoma. The content of car exhaust, soot, cigarettes and smoked foods is high, especially the burnt portion of meat barbecued foods, which contains a large amount of benzopyrene.
(3) alkylating agents, such as mustard gas, cyclophosphamide, etc., can cause leukemia, lung cancer, breast cancer and the like.
(4) Vinyl chloride, the most widely used plastic polyvinyl chloride, is formed by polymerizing vinyl chloride monomer. Can induce tumors in the lungs, skin and bones. It has been confirmed by epidemiological investigations of plastic factory workers that vinyl chloride can cause hepatic angiosarcoma, and the incubation period is generally more than 15 years.
(5) Certain metals, such as chromium, nickel, and arsenic, can also cause cancer.
The mechanism of action of chemical carcinogens on human tumors is complex. A small number of carcinogens can directly induce tumors when they enter the human body. This substance is called a direct carcinogen. Most chemical carcinogens need to undergo metabolic activation or biotransformation in the body to become the ultimate carcinogen with carcinogenic activity. Causes tumorigenesis, a substance called indirect carcinogen. Tumors caused by radiation include thyroid tumors, lung cancer, bone tumors, skin cancer, multiple myeloma, and lymphoma.
(2) Physical carcinogenic factors
Ionizing radiation causes various cancers. Long-term heat radiation also has a certain carcinogenic effect. Metal elements such as nickel, chromium, cadmium and barium have carcinogenic effects on humans. Some clinical tumors are also related to trauma. Patients with osteosarcoma, testicular sarcoma, and brain tumors often have a history of trauma. Another type of tumor-related foreign body is a parasite.
(3) Cancer and bacterial carcinogenesis
1) RNA oncogenic virus: The genetic material is integrated into the host cell DNA by transduction and insertion mutation, and the host cell is transformed. There are two mechanisms for carcinogenesis: 1 acute transformation of the virus 2 chronic transformation of the virus.
2) DNA oncogenic viruses: The common human papillomavirus (HPV) is closely related to the occurrence of squamous cell carcinoma in human epithelial tumors, especially in the cervix and anal genital area. Epstein?barr virus (EBV) is closely associated with Burkitt's lymphoma and nasopharyngeal carcinoma. Epidemiological investigation of hepatitis B is closely related to hepatocellular carcinoma. Chronic gastritis caused by Helicobacter pylori is associated with the development of low-grade malignant B-cell lymphoma.
3. Intrinsic factors affecting tumorigenesis and development and its mechanism of action.
(1) genetic factors
1) Neuroblasts that are autosomal dominant, such as retinoblastoma, nephroblastoma, adrenal gland or ganglion neuroblastoma. Some precancerous diseases, such as multiple adenomatous polyposis of the colon, neurofibromatosis, etc. are not malignant diseases themselves, but the rate of malignant transformation is high. These tumors and precancerous lesions belong to single gene inheritance and appear in the law of autosomal dominant inheritance. Its pathogenesis is characterized by early onset (childhood), multiple tumors, often involving bilateral organs.
2) Genetic syndromes with autosomal recessive inheritance such as Bloom syndrome are prone to leukemia and other malignant tumors; patients with telangiectasia ataxia are prone to acute leukemia and lymphoma; patients with pigmented dry skin disease are exposed to ultraviolet light Prone to skin basal cell carcinoma and squamous cell carcinoma or melanoma. These people with high tumor susceptibility are often accompanied by some genetic defects, and the above three genetic syndromes involve DNA repair genes.
3) Genetic factors and environmental factors play a synergistic role in tumorigenesis, and environmental factors are more important. The genetic factors that determine this tumor are polygenic. Many tumors have been found to have a family history, such as breast cancer, gastrointestinal cancer, esophageal cancer, liver cancer, and nasopharyngeal cancer.
(2) host response to tumors - tumor immunity
CD8+ cytotoxic T cells play an important role in cellular immunity
1) Tumor antigens can be divided into two categories: 1 tumor-specific antigen present in tumor cells and not present with normal cells. 2 There are tumor-associated antigens with tumor cells and certain normal cells.
2) Anti-tumor immune effect mechanism. Tumor immunity is mainly based on cellular immunity, supplemented by humoral immunity. The effector cells participating in cellular immunity are mainly (CTL), natural killer cells (NK) and macrophages.
3) Immune surveillance. The strongest evidence of immune surveillance in the anti-tumor mechanism is that the incidence of malignant tumors is significantly increased in immunodeficiency patients and patients receiving immunosuppressive therapy.
(3) Other factors related to the onset of cancer.
Prevention
Abdominal tumor prevention
1, diet Chinese medicine
1) 90 grams of fragrant fresh mushrooms, with a small amount of vegetable oil, a little salt fried, add boiled water into soup. Can be used for gastric cancer, cervical cancer.
2) Pleurotus ostreatus is appropriate, decoction, cooking, or powdered clothes.
3) Lingshi Xianling real 20-30, add water to the right amount, simmer into a thick soup, 2-3 times serving. It has a certain effect on gastric cancer and cervical cancer.
4) Oolong tea often drinks oolong tea has a certain anti-cancer effect.
5) Bee milk adheres to food, can enhance human immunity, and has anti-cancer effect.
6) Chlorophyll in bean sprouts can prevent rectal cancer and other cancers.
7) Other milk or goat milk, not only rich in vitamins, but also contains certain anti-cancer substances; fresh vegetables such as radish, cabbage, pumpkin, peas, lettuce, etc., have a certain effect on offsetting nitrosamines in food; carrot Spinach, tomato, seaweed, etc., are rich in vitamin A, which has a certain anti-cancer effect.
2, medicated compound
1) Cooked grass mushroom monkey head fresh grass mushroom 60 grams, fresh monkey head mushroom 60 grams, slice; fry the food, add a little salt, put the two, stir-fry and add water to cook. This side is mainly used for digestive tract tumors.
2) 60 grams of Hericium erinaceus, Hericium erinaceus, 60 grams of Hedyotis diffusa, 60 grams of vine root, and water decoction. For gastric cancer, esophageal cancer, cardiac cancer and liver cancer.
3) 30 grams of glutinous rice dumplings, 30 grams of water chestnut, 30 grams of Scutellaria barbata, add water decoction, 2 times a day, take long-term use. Can be used for gastric cancer, cervical cancer, etc.
4) 20 grams of barley porridge, 30 grams of glutinous rice or glutinous rice, and half a spoon of white sugar. Pour the coix seed and rice into the small steel pan, add about 1000 ml of cold water, cook for about half an hour on medium heat, and leave the fire. 1 time a day, for breakfast or snacks. Regular consumption of this porridge is ideal for preventing gastric cancer from becoming cancerous; for patients with gastric cancer who have undergone surgical resection, food can also reduce the chance of recurrence.
5) 15 grams of dried bamboo leaves, bamboo leaves, half a cup of boiling water, covered, can drink after five minutes. The bamboo leaves contain polysaccharide substances, so they have a wide range of anti-cancer and detoxification effects.
6) Licor, green bean soup, licorice 15 grams, mung bean 30 grams, 1 spoon of sugar. First fry the comfrey, fry the mung bean with comfrey juice, and simmer for about 3 minutes after the small fire, until the mung bean has not blossomed, leave the fire, filter out the soup, leave the mung bean, and leave the remaining juice. Pour the comfrey juice into the mung bean pot and burn the mung bean. If the water is insufficient, add water. Leave the fire when it is about 500 ml left. Food method: comfrey green bean juice, add a little sugar, drink twice; burn green mung bean soup, add 1 spoon of sugar, eat as a snack. This side has a certain effect on the prevention of women's chorionic epithelial cancer.
7) Turtle Decoction Soup Turtle 1 , Bupleurum 9 g, Peach Kernel 9 g, Atractylodes 15 g, Hedyotis diffusa 30 g, the turtle will be cured, other drugs decoction to the residue, after the turtle is cooked, eat turtle Drink soup. 1 dose in 2-3 days, often served. This side can be used as an auxiliary therapeutic side for nasopharyngeal carcinoma.
8) Fish , 3, rice wine amount, yellow croaker with frying fry, crushed to the end, 5 grams each time, together with Tianqi end with yellow wine blunt. 1 dose per day, and even take 15-20 doses for a course of treatment. This prescription can be used for blood stasis in patients with esophageal cancer.
9) Mushroom wild grape root mushroom 30 grams, wild grape root 60 grams, honey amount, the first two flavors of decoction, honey seasoning clothes. 1 dose per day, regular clothes. This prescription can be used as an auxiliary therapeutic side for lung cancer patients.
10) Haimashan Fangjia hippocampus 10 grams, 6 grams of sputum, 10 grams of gunwood, rice wine, the amount of rice, a total of research and mixing. Each time 3 grams, 3 times a day, rice wine rushed, and even served 15-20 days for a course of treatment. This prescription can be used for breast cancer patients.
11) Wuweidai tea drinking grass river car 30 grams, Hedyotis diffusa 30 grams, 30 grams of armor, peach kernel 9 grams, safflower 6 grams, sucrose amount, the first five flavors of decoction to slag, plus sugarcane flavored tea 1 dose per day. This party can be used as a regular service for patients with liver cancer.
Complication
Abdominal tumor complications Complications, intestinal obstruction, peritonitis
1. Intestinal obstruction: 1/3 of patients may have intestinal obstruction, usually chronic incomplete intestinal obstruction, vomiting and abdominal distension are not very significant, which is characterized by recurrent episodes of intestinal obstruction and self-remission.
2. Intestinal perforation: The incidence rate is 8.4% to 18.3%, which occurs on the basis of intestinal obstruction. In other cases, ulcers, necrosis and infection cause intestinal perforation due to tumor invasion of the intestinal wall.
3. Peritonitis: Acute perforation causes diffuse peritonitis, and the mortality rate is extremely high. Chronic perforation may occur in intestinal fistula adhesion, inflammatory mass, abscess and intestinal fistula.
Symptom
Abdominal tumor symptoms Common symptoms Abdominal pain with nausea, vomiting, abdominal mass, abdominal wall, outer mass... Lymph node swelling
Abdominal wall tumors: benign tumors of the abdominal wall include fibroids, fibroids, neurofibromas, hemangioma, papilloma, and dermoid cysts. Malignant tumors include fibrosarcoma, dermatofibrosarcoma, melanoma, skin cancer, and metastatic cancer. Select the main person to describe it later.
Clinically, it is a painless oval lumps in the abdominal wall, with a hard texture and slow growth. In most patients, tumors are found when the diameter is several centimeters. When the abdominal muscles contract, the contour of the tumor can still be clearly seen and can be differentiated from the intra-abdominal tumor. A small number of patients who were delayed in the treatment showed a flaky infiltrative growth around the tumor, and the large abdominal wall was stiff, with a diameter of up to 10 cm.
Most of the tumors originate from the rectus abdominis, extra-abdominal oblique muscles, intra-abdominal oblique muscles, or the muscle sheath or aponeurosis of the transverse abdominis muscles, which are infiltrating into the muscles. The tumor has no capsule, irregular edges, and is crab-footed; the texture is tough as rubber; the cut surface is grayish white, and it is interlaced. Under the microscope, the tumor is composed of abundant collagen fibers and less fibroblasts, which are arranged in parallel; the cells have no atypia and mitotic phase; at the edge of the tumor, the striated muscle tissue surrounded by the tumor is often seen. Tumor tissue morphology is benign, but it is very easy to relapse. The disease is more common in young adults. Tumors usually occur in the dermis and are convex. Microscopically, the tumor is composed of spindle cells. The cells are short, fat and thin, and are mostly arranged in a striate or spiral shape. Some cells may have a significant outlier, and the mitotic phase is rare. It is a low-grade malignant tumor. .
Gastric cancer: Gastric cancer is a malignant disease of gastric mucosal epithelium, and it is one of the most common malignant tumors. The main symptoms are stomach discomfort, abdominal distension, abdominal pain, loss of appetite, nausea and vomiting, weight loss, abdominal mass, black stool, abdominal block and so on. Gastric cancer occurs in the pyloric region of the stomach, followed by the small curvature of the stomach and the cardia. China is a high incidence area of gastric cancer. The ratio of male to female incidence is 2.3 to 3.6:1. It can happen at any age, but most of it happens after middle age. It is the most common in 50 to 60 years old and less common before the age of 30. Gastric cancer belongs to the category of "stomach pain", "anti-gastric" and "hoarding" of traditional Chinese medicine.
Gastric cancer: 1. Early stage may have unexplained weight loss, fatigue, loss of appetite, stomach cramps full of discomfort or dull pain, aversion to meat food, pancreatic vomiting, blood in the stool; late manifestations of abdominal mass, lymphadenopathy, cachexia.
2. X-ray examination of gastrointestinal barium meal has local filling defect, cancerous shadow, stenosis or obstruction.
3. Gastroscopic examination can directly observe the morphology of cancer.
4. Histopathological examination, such as finding cancer cells can be diagnosed.
5. Exploratory laparotomy can confirm the diagnosis.
Colorectal cancer:
Colorectal cancer atlas The colorectal cancer is a general term for colon cancer and rectal cancer. Colorectal cancer refers to the malignant lesions of the large intestinal mucosa under the action of various carcinogenic factors such as environment or heredity. The prognosis is poor, and the mortality is high. It is a common malignant tumor. one.
More asymptomatic in the early stage. As the tumor grows and the condition continues to progress, the symptoms are revealed. In patients who have actually developed symptoms in the clinic, their local lesions have often become severe and even advanced.
Once the colorectal cancer enters the advanced stage, more obvious symptoms may occur, but some symptoms are not specific and are related to the location of the cancer.
1, right colon cancer mainly manifested as indigestion, fatigue, loss of appetite, diarrhea, constipation, or constipation, diarrhea alternately, abdominal distension, abdominal pain, abdominal tenderness, abdominal mass, progressive anemia. The position of the mass varies with the location of the lesion. The cecal cancer mass is located in the right lower abdomen, the ascending colon mass is located in the right abdomen, the colonic hepatic mass is located in the right upper abdomen, and the transverse colon mass is located near the umbilicus. In addition, there may be fever, weight loss, and complications such as perforation and localized abscess. At this time, the lesion has entered the most advanced stage.
2, left colon cancer due to the narrow sigmoid colon lumen, and an acute angle with the rectum, it is prone to stenosis and progressive intestinal obstruction, more intractable constipation, but also increased the number of defecation. Because the obstruction is mostly in the lower part of the sigmoid colon, vomiting is mild or absent, while abdominal distension, abdominal pain, bowel sounds and intestinal type are obvious. When the cancer is ruptured, the stool can be stained with blood or mucus. Obstruction of the proximal intestine can cause ulceration due to persistent swelling, ischemia, and hypoxia, and even cause perforation. A large amount of blood and abdominal abscess can also occur.
3, rectal cancer is mainly manifested in increased frequency of stools, feces fine, with blood or mucus, accompanied by urgency and heavy. Because cancer can invade the sacral nerve, severe pain can occur. If the bladder is involved, there may be symptoms such as frequent urination, dysuria, urgency, and blood in the urine. The cancer invades the bladder and forms a bladder rectal fistula. Rectal cancer can also cause intestinal obstruction.
4, anal canal cancer is mainly manifested as blood in the stool and pain. The pain is exacerbated during defecation. When a cancer invades the anal sphincter, there may be fecal incontinence. Anal canal cancer can be transferred to the inguinal lymph nodes, so it can reach swollen and hard lymph nodes in the groin.
Small intestine tumor
Small intestine tumor refers to a tumor that occurs in the small intestine intestine from the duodenum to the ileocecal valve. The small intestine accounts for 75% of the total length of the gastrointestinal tract, and its mucosal surface area accounts for more than 90% of the surface area of the gastrointestinal tract. However, the incidence of small intestine tumors accounts for only about 5% of gastrointestinal tumors, and small intestinal malignant tumors are rare. About 1% of gastrointestinal malignancies. The exact cause of small bowel tumors is currently unclear. The clinical manifestations of small intestine tumors are very atypical, generally related to the type, location, size, nature of the tumor and whether there is obstruction, hemorrhage and metastasis.
The clinical manifestations of small intestine tumors are very atypical, often showing one or more of the following symptoms.
1. Abdominal pain is the most common symptom, mostly due to the stretching of the tumor. Caused by intestinal motility dysfunction, etc., can be pain, pain, and even severe cramps. When accompanied by intestinal obstruction, the pain is particularly severe. Can be accompanied by diarrhea, loss of appetite and so on.
2. Intestinal hemorrhage is often a tar-like stool or bloody stool that occurs intermittently, and even a large amount of bleeding. Some are not detected by long-term repeated small amount of bleeding, but manifested as chronic anemia.
3. The most common cause of acute intestinal obstruction caused by intestinal obstruction is intussusception, but most of them are chronic recurrent. Tumor stenosis caused by tumors and compression of adjacent intestinal tract is also the cause of intestinal obstruction, and can also induce intestinal torsion.
4. Intra-abdominal masses generally have a large degree of lumps, and the position is not fixed.
5. Intestinal perforation is more common in small intestine malignant tumors, acute perforation leads to peritonitis, and chronic perforation forms intestinal fistula.
6. Carcinoid syndrome is caused by slow-acting peptides of serotonin and kallikrein, which are produced by carcinoid cells, mainly in paroxysmal facial, neck and upper body skin flushing (telangiectasia), diarrhea , asthma and heart valve disease due to fibrous tissue hyperplasia. Often stimulated by eating, drinking, agitation, and pressing a tumor. Mostly seen in patients with carcinoid and liver metastases.
Examine
Abdominal tumor examination
X-ray examination: the main examination method for gastric cancer, including the projection of different filling degrees to display mucous membrane lines, such as double contrast of pressurized projection power, especially the sputum, air double contrast method, for detecting small lesions of the stomach wall Very valuable.
Endoscopy: Direct observation of various parts of the stomach is of great value in the diagnosis of gastric cancer, especially in early gastric cancer.
Abdominal MRI: Early in malignant tumors, it is superior to CT in terms of blood vessel invasion and tumor staging. Take the advanced supine position, the median sagittal plane is consistent with the XO plane, such as the use of a respiratory compensation sensor, can be installed in the middle of the upper abdomen. Hepatobiliary spleen and pancreas examination, the center line is aligned with the midpoint of the rib arch. Kidney examination, the center line is aligned with the midpoint of the xiphoid and umbilical line.
Biological and biochemical examinations: including immunological reactions of tumors, determination of specific chemical components and enzymatic reactions. Blood such as serum pepsinogen I and pepsinogen I / II ratio of CEA, CA19-9, CA125 and other carcinoembryonic antigens and monoclonal antibodies, but these tests have higher false positives and false negatives, specificity is not Strong.
Diagnosis
Diagnosis and diagnosis of abdominal tumor
First, tumor screening
Tumor screening is the search for suspicious people from asymptomatic people. Tumor marker detection is an effective method for primary screening of tumors. Often used for high-risk population screening.
Tumor markers were abnormally elevated, no obvious symptoms and signs, and need to be reviewed and followed up. If it continues to increase, it should be confirmed in time.
Second, diagnosis
Auxiliary diagnosis: The specificity of tumor markers is not strong enough to diagnose tumors based solely on tumor markers, but can provide further diagnostic clues.
Differential diagnosis: Ben-Chou protein, AFP, HCG, PSA, etc. have characteristic cancer profiles.
Unable to locate diagnosis: tumor markers lack tissue organ specificity.
Dynamic observation: progressive elevation of tumor markers has a clear diagnostic significance; markers of benign disease are elevated; transient markers of malignant tumors are persistent.
Third, monitoring the condition and efficacy
Monitoring efficacy, recurrence and metastasis are the most important clinical applications of tumor markers. After surgery, chemotherapy or radiotherapy, the specific tumor marker content rise and fall has a good correlation with the curative effect. Dynamic observation can reflect the tumor recurrence and metastasis.
