After these two items were added to the physical examination, two cases of gastric cancer and one case of intestinal cancer/kloc-0 were found in a unit of nearly 1000 people in Hangzhou.

In the past two years, more and more units are willing to spend money on employees' health, such as adding gastrointestinal endoscopy to the medical examination package, so that some diseases that are difficult to find in routine medical examination can be found and treated early.

Not long ago, the physical examination center of a hospital in Hangzhou paid a return visit to the physical examination results of employees of a certain unit. This company has nearly 1000 employees. Since last year, employees over 45 years old have increased gastroscopy and employees over 50 years old have increased colonoscopy.

During the return visit, it was found that there were *** 178 people who underwent colonoscopy, among which the positive lesion rate (such as polyps, ulcers, etc. ) is 50%, the incidence of positive lesions in men is slightly higher than that in women, and colon cancer has been diagnosed 1 case.

Gastroscope examination was 24 1 person, and the positive rate of lesions (such as polyps and ulcers) was 16%. The incidence of positive lesions in women was slightly higher than that in men, and 2 cases of gastric cancer were diagnosed.

Two people who have been diagnosed with gastric cancer, one of whom is a woman in her fifties, have been in good health and have never felt anything uncomfortable in her stomach before. This is her first gastroscope, and it turns out that it is early gastric cancer. The other is a man in his sixties. It is a 60-year-old man who was diagnosed with intestinal cancer and had no symptoms before.

"Fortunately, the gastrointestinal cancer of these three people is still in the early stage, and all of them have completed radical surgery under endoscope, and no chemotherapy is needed in the later stage."

Yang Fenfang said that it takes 5- 10 years for polyps to develop into cancer. In the meantime, if it can be found and removed in time, it can prevent its canceration. Gastrointestinal endoscopy can find these lesions in time, deal with them in time, and stifle the possibility of canceration of polyps.

Lu Lei, director of the Physical Examination Center of Cancer Hospital affiliated to Chinese Academy of Sciences, mentioned that gastrointestinal endoscopy is the first choice for early screening of digestive tract tumors. When the doctor gave the patient a colonoscopy, he found that there were intestinal polyps with poor morphology. In the case of ensuring safety, they will directly remove these polyps and send them for pathological examination.

"Pathological examination of partially resected polyps suggests precancerous lesions, so it may develop into malignant tumors in several years or even 10 or 20 years. Early screening, early diagnosis and early treatment are the best preventive methods. "

Polyp surface is very fragile and easy to bleed. If you have gastrointestinal symptoms, such as abdominal pain, nausea and vomiting, abdominal distension, belching, black stool, bloody stool, changes in stool shape and habits, the condition is often not serious.

Some time ago, Dr. Zhao Jing from the Department of Gastroenterology, Zhejiang Provincial Hospital of Traditional Chinese Medicine admitted a 42-year-old male patient who had to undergo colonoscopy because of intermittent bloody stool. I didn't expect it was the late stage of intestinal cancer, and I lost the opportunity of surgery.

The male patient surnamed Wu (pseudonym), a native of Hangzhou, happened to find blood in his stool when he went to the toilet in the first half of last year. But at first he thought it was just hemorrhoids and didn't care too much. Later, he would pay attention to it every time he went to the toilet. Sometimes the stool is bloody, sometimes it is not. The most important thing is that he doesn't feel uncomfortable. Plus, he is busy at work and doesn't want to go to the hospital for examination.

In the first half of this year, he found that the number of bloody stools increased significantly, and sometimes he felt abdominal distension and discomfort. He began to feel a little anxious and decided to go to the hospital for a check-up.

Three months ago, Mr. Wu made an appointment for colonoscopy in the Department of Gastroenterology, Zhejiang Provincial Hospital of Traditional Chinese Medicine. This is his first colonoscopy, and the doctor found a lump on the rectum, about 3 cm in diameter. Initially, the tumor is more likely to be malignant.

The size of the tumor is beyond the scope of endoscopic treatment, but as long as there is no spread and metastasis, there is still a chance for surgery. Unexpectedly, a series of follow-up examinations found that Mr. Wu's tumor had reached the advanced stage and spread and metastasized in a large area. There are multiple metastases in the liver, leaving only about 20% of the normal liver, and there are multiple metastases in the whole abdominal cavity. There is no way to do surgery, and the disease can only be controlled through comprehensive treatment such as chemotherapy and targeted therapy.

The precancerous lesions of colorectal cancer are clear, which can be said to be one of the few preventable and treatable malignant tumors, and colonoscopy is a reliable means to find early colorectal cancer at present.

Because most colorectal cancers are derived from colorectal adenomas. However, this process is very long and may take several years. As long as the adenoma can be removed at the first time, cancer can be killed in the cradle, providing opportunities for early prevention.

Epidemiological investigation and special screening show that the incidence of colorectal cancer is increasing year by year, and the number of new cases of colorectal cancer in China is as high as130,000-160,000 every year. The onset age is mostly 40-60 years old, and the peak is around 50 years old.

Colonoscopy should be performed in people over 50 years old, especially those with the following high risk factors: male, long-term smoking habit, family history of colorectal cancer, intestinal polyps, tumor history, chronic diarrhea, chronic constipation, bloody mucus, chronic appendicitis, after cholecystectomy, etc.

It should be noted that if there are two or more high-risk factors at the same time, it is a high-risk group of intestinal cancer.

Director Yang Fenfang suggested that both men and women over 50 should have colonoscopy. If the colonoscopy is normal, you can review the colonoscopy every 3-5 years; If colon adenoma is found and resected under endoscope, colonoscopy should be carried out regularly. If there are more than two high-risk factors, it is recommended to start colonoscopy as early as 40 years old.

Dr Zhao Jing suggested that in addition to early screening, we should also be alert to the signals sent by the body. The typical symptom of colorectal cancer is the change of stool habits or traits. For example, the stool suddenly becomes thinner and bloody in the stool; It turns out that the stool has been normal and suddenly constipation; I used to be constipated and suddenly began to have diarrhea; Sudden mucus or color change in stool is abnormal and must not be ignored.

Director Yang Fenfang reminded that the tumor markers of digestive tract such as CEA (carcinoembryonic antigen) and CA 199 (carbohydrate antigen) were found to be elevated during routine physical examination, and the reasons should also be investigated, and gastrointestinal endoscopy should be done as soon as possible if necessary.

"Early gastric cancer is difficult to find because early gastric cancer has almost no symptoms. I met many patients with early gastric cancer in clinic. I happened to accompany others to do gastroscopy, and I also did the examination together. As a result, I accidentally discovered early gastric cancer. " Bao Haibiao, director of the Department of Gastroenterology, Zhejiang Provincial Hospital of Traditional Chinese Medicine, said that from an epidemiological point of view, the incidence of gastric cancer in people under 40 is relatively low. In most countries, 40-45 years old is the initial critical age for gastric cancer screening, and the following six groups of people are the key screening targets-

1.40 years old, male or female;

2. Living in an area with high incidence of gastric cancer;

3. Family history of digestive system tumors, especially family history of gastric cancer;

4. Heavy taste, like to eat pickled food;

5. There are different degrees of intestinal metaplasia, gastric ulcer, gastric polyp, chronic atrophic gastritis and other stomach diseases;

6. Helicobacter pylori infection.

"It should be noted that the above six groups of people are the key screening targets for gastric cancer, but it does not mean that all people over 40 will take gastroscopy as a routine examination item."

Professor Jack lu, from the Department of Gastroenterology, Zhejiang Traditional Chinese Medicine Hospital, said that although gastrointestinal endoscopy is the most important method to find early cancer, it is unrealistic to ask everyone to do it as far as the national conditions of China are concerned. At present, there is a method to screen the risk of gastric cancer by taking a few milliliters of venous blood, that is, by detecting the situation of Helicobacter pylori and pepsinogen, to further judge whether gastroscopy is needed.

If you are over 40 years old and have one of the above points, you can check it out. The test results are divided into four situations: A, B, C and D, representing different risk groups.

A. Helicobacter pylori and pepsin are negative: the risk of gastric cancer is very low, which can be said to be not much different from that of normal people. This group of people can't follow up yet. If you are concerned, you can follow up once every 3-5 years, just check your serum first.

B. Helicobacter pylori positive, gastric collagenase negative: This group of people need to eradicate Helicobacter pylori. Before eradication, a gastroscope should be done to understand the situation in the stomach and follow up once every three years.

C. Both Helicobacter pylori and pepsin are positive: they belong to the high-risk group of gastric cancer. It is recommended to consult a specialist in time and have a gastroscope every two years.

D. Helicobacter pylori negative and pepsin positive: people who are also at high risk of gastric cancer also need to do gastroscopy in time and be treated accordingly. Follow-up suggested that gastroscopy should be done once a year.

Professor Lu Bin reminded that healthy people who usually have no obvious stomach discomfort should see a doctor in time if they have warning symptoms, regardless of their age or family history of gastric cancer. The so-called warning symptoms mean that the symptoms of stomach diseases are different from before, such as prolonged pain and aggravated symptoms; Symptoms such as emaciation, melena, bleeding and anemia appear.

Correspondent Bao Hanghang Wang Wenting Yif Wang

Editor Wu Jingjing