[Medical Insight 60th] The symptoms and treatment of "gastric cancer" by a gastrointestinal surgeon.

□ Broadcast date and time: November 29, 2024 (Fri) 10:20 pm
□ Producer in charge: Lee Siwoo
□ Author in charge: Kim Bae-jung and Kim Hyun-jung
□ Cast: Park Do-joong (Seoul National University Hospital gastrointestinal surgeon)
□ Broadcast channel
IPTV - GENIE TV No. 159 / BTV No. 243 / LG Uplus No. 145
SkyLife Number 90
Cable - Delive No. 138 / Hyundai HCN No. 341 / LG HelloVision No. 137 / BTV Cable No. 152

* The text below may differ from the actual broadcast content, so please check the broadcast for more accurate information.


◆ Park Do-joong: Hello. I'm Park Do-joong, a gastrointestinal surgeon. The story I prepared today is the diagnosis and treatment of gastric cancer.

◇ Voice actor Park Sang-hoon: Gastric cancer that occurs in 55 out of 100,000 people. Although the cause or mechanism of gastric cancer is not clear, it is said that the incidence of gastric cancer increases due to Helicobacter bacteria infection, irregular and westernized eating habits, drinking and smoking, along with advanced treatments, regular tests for early detection are said to be the most important to increase the survival rate of gastric cancer. However, there are unfortunate situations in which people often miss the time to treat gastric cancer due to the treatment of folk remedies that have not been scientifically proven, so let's take a closer look at the misunderstandings and truths about gastric cancer, as well as the symptoms and treatments of gastric cancer.

<Understanding Diseases>
◆ Park Do-joong: There is a number one in Korea that has not changed in the list of causes of death for 40 years. What is it? Yes. As many of you know, it's cancer. What is cancer? Cancer is now a dangerous disease because it's constantly growing. Among the cancers, stomach cancer is the cancer that competes for the first and second place among men in Korea and is always in the top five among women's cancers. Gastric cancer is known to occur the most in the world after Mongolia and Japan. And the reason why gastric cancer is a problem is that it can occur even at a young age, so it is also a problem of interest. In particular, gastric cancer is more than twice as common in men than in women, but there is another characteristic that women are more common than men at younger ages before the age of 45. Fortunately, even if you have gastric cancer, the survival rate is about 70%, which is higher than that of other cancers, so it is very important to treat gastric cancer well.

<Structure and Function>
◆ Park Do-jung: Then what is the function above? Now, when we eat, we have functions like storing food, disinfecting it by stomach acid, sending it down while breaking it down, and absorbing it. The stomach wall consists of about five layers, and usually cancer comes from the mucous membrane layer, which is the shallowest layer, and penetrates into the lower mucous membrane, the muscle layer, and then the serosal layer.

<Why gastric cancer is scary>
◆ Park Do-joong: I told you earlier that stomach cancer is constantly growing. So when it grows, it eventually breaks through the wall and seeds are sprayed into the abdominal cavity. There's a lot of lymph nodes around that seeding or stomach cancer. Just as our throats swell when we have a cold, there are a lot of lymph nodes around our stomach, which now act as a "group." If something develops cancer or germs enter, it acts as an army that fights against it, and it goes to the lymph nodes a lot. In addition, if gastric cancer continues to grow, there are large intestine, pancreas, and liver around, so you can invade it like this. In addition, it is a cancer that can spread to the liver, lungs, or bones in the middle of blood, so it is a scary cancer.

<Risk Factors>
◆ Park Do-joong: So why do you have stomach cancer? There are studies on various risk factors, but the first known one is 'Helicobacter pylori'. Helicobacter bacteria are very prevalent in Korea. I've been drinking soup together since a long time ago, or my mom and dad scoop food with their children's spoon, or we spin the glass.Helicobacter pylori was prevalent because of some kind of habit. These days, however, interest in certain hygiene is increasing, and due to that effect, Helicobacter eradication has been performed, so it has decreased a lot. Therefore, Helicobacter pylori is known to be the biggest risk factor, and the second most common risk factor is salty eating among dietary habits. It's 'salt', also called salt. This salty food, this salty food, this stuff spoils the mucous membrane, and the barrier that keeps the mucous membrane taut like this gets spoiled, and then bacteria and bad things come in. So salt is the most important dietary habit, and salt is a risk, and the other is smoked meat, processed meat, meat, and processed foods that we made while barbecuing. These foods eventually produce nitrosamine compounds, which are risk factors for stomach cancer like pylori. Also, as in all cancers, smoking and drinking are risk factors. What is also unusual is that when the stomach and small intestine remain after gastric ulcer perforation or gastric surgery for any reason in the past, this bile continues to flow back and stays in the remaining stomach for about 30 to 40 years, and then gastric cancer occurs again. And polyps that many people are curious about. Will polyps become stomach cancer? Most of them don't. However, some of the polyps with different shapes can lead to stomach cancer, but gastritis and gastric ulcer are another story. Gastritis and gastric ulcers do not occur as stomach cancer, but some of them are "chronic atrophic gastritis", that is, the gastric mucosa, which continues to be chronically thin. If you have such chronic atrophic gastritis, you can go to stomach cancer. Another thing you've probably heard a lot about is intestinal metaplasia, where stomach cells turn into small or large intestine cells. There are two other types of stomach cancer. There are diffuse gastric cancer and intestinal gastric cancer, and there are reports that such intestinal gastric cancer can occur. And lastly, family history. A lot of people are worried about that. I have stomach cancer in my family, will I be okay? However, even if most have a family history of gastric cancer, most are now environmental factors. The dietary habits I mentioned earlier, Helicobacter pylori, and these are more risk factors, and there are very few genes that cause it. You don't have to worry too much because it's only 1% to 3%.

<Symptoms of Disease>
◆ Park Do-joong: So what kind of symptoms do you have when you have that stomach cancer? To tell you the conclusion, gastric cancer cannot be known by symptoms. There are no unusual symptoms of stomach cancer. Various symptoms can also occur when you have gastritis or peptic ulcer, such as indigestion, burning sensation, vague discomfort, pain, nausea, vomiting, stomach fullness after a meal of diarrhea or constipation, loss of appetite for some reason, too tired and too weak weakness, and bleeding like hemoptysis or bloody stool, all of which can occur when there is gastric cancer. ’ I don't have these symptoms. Therefore, health checkups are very important, and especially in the early gastric cancer, it is more asymptomatic, so it is important to check with an endoscope as a medical check-up to be released later.

<Diagnosis of the disease>
◆ Park Do-joong: So how is gastric cancer diagnosed? The most important thing is an endoscope that you can look into yourself. First, when you look up and say that you are suspicious of cancer, it leads to a biopsy and makes a diagnosis. And now, another test method is an imaging test that takes a contrast medium and then takes a stomach. Gastrointestinal examination is also one of the diagnostic methods, but it is not more accurate than endoscopy. And then there might be abdominal CT, a CT that you take a lot of, but CT is usually taken to examine whether other organs, such as the liver or pancreas, can be resected or not, rather than diagnosing gastric cancer. And there is another ultrasound endoscope that tests with ultrasound at the end of the endoscope. With this ultrasound endoscope, you can see how deep five layers of gastric cancer went before, and you can see how deep the five layers went into or if there were any enlarged lymph nodes around them. Next, there's something called PET. PET is now good for investigating cancer metastasis or recurrence if it is very advanced. However, it is difficult to think that there is no stomach cancer just because it is okay after taking PET. For example, she was a very famous actress. But at first, he didn't have an endoscope and took PET first, and it was okay. So I said it was okay, but in the end, it was later detected late as stage 4 gastric cancer. So in the end, the endoscope is very important. And now I see something wrong with my abdomen in another examination, but I'm not sure. Then, diagnostic laparoscopy, which allows you to look directly into and diagnose with a laparoscope, will be a way.

<Gastric cancer and health check-up>
◆ Park Do-joong: You said a medical check-up is important. In fact, we compared the group found by the medical examination with the group found with gastric cancer due to symptoms. Surprisingly, more than 90% of the people found through medical checkups ended in the early stages of the first phase. However, for those who were tested late because of symptoms, more than half of them had stage 2 or higher, and about 15% to 20% of them were found to have stage 4 gastric cancer. That's why health checkups are very important, so let me briefly introduce Korea's national early cancer screening. There are several cancer screenings among the national early cancer screening, but gastric cancer screening is for men and women over the age of 40. Gastric endoscopy or gastrography is performed every two years. But I recommend you to have a gastroscopy if you heard me today. Gastrography is difficult to detect early gastric cancer. I would like to tell you that it is better to have an endoscope because it comes out of this imaging test when the cancer grows.

<classification of gastric cancer>
◆ Park Do-joong: Earlier, he said, "Is it early gastric cancer?" ”, "Is it advanced gastric cancer?" ” I've told you a lot, but I'll tell you how to classify it now. Early gastric cancer or advanced gastric cancer? Earlier, I said that cancer occurs in the mucous membrane layer, but it occurs in the mucous membrane layer and keeps going down in the submucosal layer and the muscle layer. So, if you go down to the submucosal layer, which is about one lower mucosal layer, it is called early gastric cancer, and if you dig more than the muscle layer, it is called advanced gastric cancer. It's a very simple classification. However, even if you have early gastric cancer, sometimes if you have a lot of lymph nodes, you can run until stage 3. So, early gastric cancer or advanced gastric cancer is simply divided according to the depth of penetration, and considering everything is a stage that will come out later. Whether it's the 1st, 2nd, 3rd, or 4th, I'll tell you in detail later. Now, there are many categories of early gastric cancer. There are about four categories, and there are Type 1, Type 2, and Type 3. But the one that sticks out. The bump that looks like a bump is type 1, and if it's slightly dug or changed in color, it's type 2, and if it's completely dug like an ulcer, it's divided into type 3. Now, advanced gastric cancer is formed very large, even if it's a bump. And for type 2 and type 3, the ulcers are also dug very deep like craters. The visual classification of advanced gastric cancer is called Bowman type because a person named Borrmann classified it. There are types 1, 2, 3, and 3. I want to tell you a little about Type 4, but Type 1, Type 2, and Type 3 can be seen with eyes. Type 4 is really quiet, though it's formed in the mucous membrane, but it spreads silently to the side. From the outside, it looks like that, but it's already spreading inside, so it's already occupying the top and losing its elasticity. So actually, I even did a gastroscopy six months ago and it's found to be stage 4. At that time, Bowman was most likely type 4. So how can we diagnose this Bowman type 4 without missing it? That's our task, but usually, air is put in during gastroscopy, but when air is put in, the stomach swells a lot. However, in the case of Bowman type 4, it is already stiff like leather, so it does not swell. And it looks like your stomach is very swollen. In that case, we're doing a lot of research now, believing that if we suspect and take a CT scan, we'll be able to diagnose Bowman's type 4.

<∀>
◆ Park Do-joong: So what should I do if I'm diagnosed with gastric cancer? As many of you know, surgical resection is why you take it off. Getting rid of bad things is the only radical treatment. In the past, standard surgery excised 70% or 100% of these stomachs, and not only that, but also said that there were a lot of lymph nodes around the stomach. There are dozens of lymph nodes, and it is standard surgery to perform extensive resection of those lymph nodes. But these days, it's found early and endoscopic resection. That's why I'm cutting it. They say that they don't go to surgery with an endoscope, but they can end up with a cut-off. Rather, if it has progressed a little, surgical resection is needed, but these days, I'm cutting about half without cutting 70% of it as before, or I'm doing a lot of surgery called function preservation surgery. The good news is that laparoscopic surgery and robotic surgery, which used to be open like this in the past, have developed a lot these days. And now, after surgery, you are usually hospitalized around a week, and it usually takes about three to four days for gas to come out after surgery. So I don't wait for the gas to come out, but these days, I drink water after 2-3 days, and if it's okay, I drink rice wine, and if it's okay, I eat porridge, and I usually leave the hospital after about 5 days. And now, it's usually called a blood bag, and you put a drainage tube like this so that it doesn't accumulate in the operated area, but it's now removed in about three to four days. And these days, since the progress of surgery is all standardized, it is managed almost the same regardless of where you go to get surgery.

<Stage of Diseases>
◆ Park Do-joong: Now I've had that stomach cancer surgery well, now I've been treated well, and by the time you're discharged from the hospital, the most curious thing is the stage. "What's the rank, what's the rank?" The stage of this gastric cancer is to talk about the progression of the cancer. There is a stage T, such as how deeply the gastric cancer has invaded the stomach wall. In addition, there is stage N of how many lymph node metastases around it have been and how long it has been. And stage M is to see if there is any distant metastasis to the liver, lungs, peritoneum, or other organs. By combining these TNM stages, the final stage is now determined. The survival rate varies depending on the stage, but when we talk about the survival rate, we usually talk about five years. If it does not recur for five years, there is a high possibility of being completely cured, so we talk about the five-year survival rate. These days, nearly 90% and up to 95% of patients are completely cured in the first stage, and even in the second stage, about 80% are completely cured. There are three ABCs in the 3rd airway, but about 50-70%. The 4th stage was usually about 10%, but these days, various anticancer drugs are getting better, so it's a little higher than that, so I think it goes up to about 20%.

<Cancer therapy for diseases>
◆ Park Do-joong: I have another concern about chemotherapy after surgery. So when do you do chemotherapy? From what I said earlier, you don't need chemotherapy if you have one. In the second stage, you usually take a lot of anticancer drugs, and in the third stage, you take a lot of anticancer drugs, plus injection anticancer drugs, eight times. This is a supplementary treatment. This is because although the visible was removed cleanly as a surgery, it still causes some recurrence, so anticancer is performed as an auxiliary to prevent recurrence. But there are now cases where surgery is not possible. In the case of metastasis or invasion of the head of an important organ pancreas, in fact, chemotherapy is performed first, and in that case, it is called therapeutic chemotherapy. Some 'cytotoxic anticancer drugs' have been around for a while. Recently, there is 'targeted anticancer' and 'immune anticancer' that won the Nobel Prize a few years ago. So, the choice of anticancer has expanded and the effect has improved, so there are many cases where people are completely cured after the anticancer. And now radiation therapy can be done when it becomes an indication earlier.

<Postoperative management method>
◆ Park Do-joong: What many people are curious about now is how you manage it after surgery. I think that's important now, so if I tell you, you're usually discharged from the hospital while eating porridge. After that, you should practice recovering at home for about two weeks, and after two weeks, it's better to eat little by little and eat meat, vegetables, and fruits evenly. They say you shouldn't eat meat after surgery. There are many people who think like this, but now protein intake is important for immunity, so I recommend you to eat meat. But now there are four things to avoid: spicy, salty, burnt food, and overeating. These four are the worst things to manage after surgery. In addition, exercise itself starts with walking regularly like this, and after about a month after surgery, climbing, swimming, and golf are now possible, and you will travel like this. One of the most important things is to think of it as "Children's Wida," who eats one year a month. So, it's the same as a baby who is a year old after surgery. So even a little bit makes you feel full and uncomfortable. So it's very important to chew a small amount and eat it slowly, and after a few months, you'll be a three or four-year-old child, so you can eat about half a bowl of it then. So if you think that way, you can manage it very easily.

<Dumping Syndrome>
◆ Park Do-joong: I want to tell you one thing. There are a lot of people who say they feel very dizzy after surgery. The reason is that most of them are called dumping syndrome rather than anemia. Because there's a sphincter in the stomach before the duodenum goes down. There is a sphincter called pylorus, and it holds out until the food inside our stomach is broken into small pieces and becomes juice, but after surgery, the pylorus often disappears. Then you can't control it and go down right away. At the same time, there is early dumping where blood pressure decreases and makes you dizzy. That's for about 30 minutes after a meal. It's going to happen. After an hour or two after a meal, you may feel dizzy, sweat cold, and suddenly collapse. Some people fall down, and in this case, insulin secretion is instantaneously generated and blood sugar drops sharply. So if you have such symptoms, you have to eat candy, snacks, or small things no matter what. Then it gets better quickly. The way to prevent this is to eat less sweet and reduce carbohydrate and flour foods to prevent this syndrome, and if you have this, eat something right away. This will be a tip now.

<Medical AI Q&A>
◆ Park Do-joong: Viewers have sent me a lot of questions about the diagnosis and treatment of gastric cancer. Let's check it out together.

◇ Y-ON (AI Anchor): I was confirmed to have gastric cancer through a medical examination. I have to wait about two months to get surgery, but I'm afraid that the stage will progress in the meantime. Will it be okay?

◆ Park Do-joong: Yes. I think it's something that many people are worried about. If you are diagnosed with gastric cancer, it is best to perform surgery and treat it as soon as possible, but you will be very worried if there is a waiting period. So, we actually collected about 100 people who delayed or did not have surgery for any reason for a very long period of time, and it usually took 11.8 months for early gastric cancer to double in size. And it took 34 months to go from early gastric cancer to advanced gastric cancer. In addition, Japanese data showed that there was no noticeable progress within that period for about three months. So I don't think any stage will progress while waiting for about two months, but if there is a big difference between individuals, I think the best way is to get diagnosed and get surgery where you can get surgery quickly.

◇ Y-GO (AI Anchor): You'll have stomach cancer surgery in a month. I also need chemotherapy after surgery, how should I take care of my health ahead of surgery?

◆ Park Do-joong: Yes. This is what many people are curious about ahead of surgery. If chemotherapy is also necessary after surgery, it is important to take care of your health before surgery, but you can get pneumonia because you have general anesthesia during surgery. So, it would be good to practice breathing exercises to increase lung capacity before surgery, and through some muscle exercise or something, you can help recovery by smoothing out certain lines and things after surgery. Another thing is food. If you eat something too stimulating, or if you give a concentrate or some food that you don't know about, your liver level can rise and your stomach can swell a lot, so I recommend you eat food so that nutrients can be evenly consumed without irritation. And in order not to get pneumonia, people who smoke must quit smoking. Also, drinking alcohol is essential.

◇ Y-ON (AI Anchor): NK cell therapy and high-dose vitamin C injections are good for gastric cancer patients, how is it good?

◆ Park Do-joong: Yes. These days, not necessarily stomach cancer, but there are many treatments such as stem cells, NK cell treatment, and high-dose vitamin C injection. Now, to tell you the conclusion, there is no basis yet for what is good for stomach cancer. So I think it would be better not to be too tied to such treatment yet. In addition, vitamin C is now a preventive factor, but there are still divided opinions that a high-dose injection of vitamin C will increase the survival rate or cure rate of gastric cancer, so it would be better to consult a specialist.

◇ Y-GO (AI Anchor): A woman in her early 30s. I have severe reflux esophagitis, is there a possibility that it will develop into gastric cancer in the future?

◆ Park Do-joong: Yes. I'm asking a lot of questions. Reflux esophagitis. Gastritis and gastric ulcer are all three things that everyone is worried about. In conclusion, gastritis, gastric ulcer, or reflux esophagitis do not progress to gastric cancer. However, among gastritis, chronic atrophic gastritis is now at risk of progressing to gastric cancer, and when reflux esophagitis is prolonged, the esophagus and this slightly deforms the gastric junction. That's called Barrett's esophagus, and if Barrett's esophagus is old, you can get esophageal cancer, so it may not be good to leave gastroesophageal reflux disease this chronic, so it's better to treat gastroesophageal reflux disease by improving lifestyle or taking appropriate medicine.

<Let's just remember this>
◆ Park Do-joong: The cancer that the characters in the drama often get is stomach cancer. But most of them get treatment and return to their daily lives and live a happy life. Maybe it's because it was detected early. Please remember that if gastric cancer is detected early, it can be treated with endoscopy or laparoscopic resection, and the first stage cure rate exceeds 90%. For those in their 40s or older, please check your stomach health through a gastroscopy every two years. I hope my story today helped you to live a healthy and happy life. Thank you.