August 16, 2023
Gastric cancer is the most common malignant tumor of digestive tract, which can be divided into early gastric cancer and progressive gastric cancer according to the degree of invasion.
1. Early gastric cancer.
At present, the diagnosis is based on the definition and classification put forward by the Japanese Endoscopic Society. Early gastric cancer means that the cancer is limited to the mucosa or submucosa, with or without lymph node metastasis and the size of the lesion. This definition focuses on the depth of invasion, regardless of the size and range of cancer foci, and puts forward three basic types and three subtypes, namely, I-type protuberant type, type Ⅱ shallow phenotype, which can be divided into three subtypes according to the degree of protuberance and concave of cancer foci. Subtypes Ⅱ a, b, c; type Ⅲ depressed type.
X-ray: double contrast radiography of stomach can show the fine structure of mucous membrane, which is an important examination method of early gastric cancer and has important application value. Type Ⅰ protuberant type: the tumor was round and protruding into the gastric cavity, the height was higher than 5mm, the boundary was clear, the base was wide and the surface was rough. The double phase showed irregular filling defect. The size of the tumor was 10 ~ 40mm. In type Ⅱ superficial phenotype, a belongs to uplift type, Ⅱ b belongs to shallow phenotype, and Ic belongs to sunken type. On the double contrast phase, the gastric area and gastric sulcus were disordered, showing irregular granule-like shadow, and the boundaries of most lesions were clear. In type I early gastric cancer, the protuberance or depression of I an and Ⅱ c cancer foci was smaller than that of 5mm. Type Ⅲ sunken type: the tumor was obviously sunken, but the cancer tissue should not exceed the submucosa. Double contrast showed that the mucosal wrinkle wall was interrupted, obvious niches could be seen, the edge was irregular, the mucous membrane was clubbing, and the gastric area was irregular and granular. The local softness decreased. The depressed early gastric cancer includes type Ⅱ c, type Ⅲ and type Ⅱ c + Ⅲ gastric cancer. Early gastric cancer is more common in the antrum and lesser curvature of the body. It is worth noting that the diagnosis of early gastric cancer needs to be closely combined with endoscopic and biopsy results.
two。. Advanced gastric cancer.
Advanced gastric cancer refers to the infiltration of cancer tissue below the muscular layer, often with lymph node metastasis, also known as advanced gastric cancer.
In 1926, RobertBorrmann divided the advanced gastric cancer into four types, which were consistent with the current pathological, X-ray and gastroscopic findings, and were widely used: type Ⅰ (massive type, umbrella type), type Ⅱ (ulcerative type), type Ⅲ (infiltrative ulcerative type), and type IV (diffuse infiltrative type, sclerotic type).
The results of X-ray air-barium double contrast radiography are as follows.
Type Ⅰ (massive type, Qin umbrella type): local irregular filling defect, rough wall, small niches, clear tumor boundary, peristalsis disappeared.
