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OriginalTencent Medical DictionaryWhenever we talk about cancerBecause we cannot defeat it yetWe are always full of fear and anxietyIf we can detect it earlymaybe it will slow down its onsetPre-cancerLesions are a wake-up call to the bodyIf we can correctly understand and treat them early at this stageMaybe the cancer cells in the body can be eliminatedThis is also the significance of precancerous lesionsToday, we take gastric cancer as an example to talk about this matter.From normal gastric mucosa to gastric cancer, there will be a stage of precancerous lesions [1,2]:In 1971, the World Health Organization first proposed the concept of gastric precancerous lesions.Several pathological conditions have been identified that have a greater risk of potential canceration than normal tissues, including atrophy, intestinal metaplasia, and dysplasia [3].Precancerous lesionsWhat does the word mean?Does it mean it鈥檚 cancer?Can it be cured?How long will it take for cancer to come back?Normal gastric mucosa is composed of epithelial cells and glands. The surface epithelial cells can secrete mucus and form a protective barrier. The glands below secrete digestive enzymes, gastric acid, etc. [4] for digesting food.When the garden of gastric mucosa is invaded by "insect pests" such as Helicobacter pylori for a long time, the local inflammation cannot be healed for a long time, the mucus layer becomes thinner, and the glands are reduced or disappeared [5], this is an atrophic lesion.Just when the gastric mucosa is severely weakened and its defenses are empty, there is a group of "weeds" ready to move around. They are intestinal epithelial cells that originally grew in the intestines, but they covet the "better" environment in the stomach.Now is a great opportunity for them to conquer the city. They swarm in, occupy the magpie's nest, and replace the original glands of the stomach with intestinal glands. This is intestinal metaplasia [5].The intestinal glands multiply and grow at an uncontrolled rate.The limited space in the flowerbed is becoming more and more crowded, and weeds are growing here and there, and some even have abnormal growth. This is what people often call dysplasia, or intraepithelial neoplasia [5].If dysplasia develops further and genetic mutations occur within the cells, causing cells to have characteristics such as unrestricted growth, invasion, and metastasis, they will truly develop into cancer [5].The early stage of gastric cancer is very confusing. The vast majority of early stage gastric cancer has no obvious symptoms or only insignificant symptoms, such as abdominal discomfort, acid reflux, loss of appetite, etc.[6]Don鈥檛 underestimate the symptoms if you think they are not serious. Even if you don鈥檛 have any symptoms, it is recommended to do a gastric cancer screening for friends who meet the following conditions [7]:1. Age 鈮?40 years old2. Meet any of the following鈶?People in areas with a high incidence of gastric cancer鈶?People infected with Helicobacter pylori鈶ave previously suffered from chronic atrophic gastritis, gastric ulcer, gastric polyps, post-operative gastric remnant, hypertrophic gastritis, pernicious anemia and other diseases鈶?First-degree relatives of gastric cancer patients鈶?Presence of other risk factors for gastric cancer (such as high salt, pickled diet, smoking, heavy drinking, etc.)1.The root of all evil, get rid of the "worm"Helicobacter pylori infection plays an important role in the development of gastric mucosal atrophy and intestinal metaplasia. If you are infected by it, you must eradicate it. Don't be careless!Removing it can reduce gastric inflammation and possibly improve gastric atrophy; Block low-grade gastric intraepithelial neoplasia from progressing to high-grade gastric intraepithelial neoplasia or gastric cancer [1].2. Prevention in life is also very important [3]:Eat less salt and pickled food.Stay away from cigarettes.For friends who already have precancerous lesions, there are only four words: you must quit.Avoid bile reflux: It is not advisable to lie in bed immediately after eating; reduce factors that cause increased intra-abdominal pressure, such as constipation and belt tightening; reduce the consumption of certain foods that may cause reflux, such as chocolate, strong tea, and greasy foods.3. Reasonable "herbicides" - pharmaceutical applicationsFolic acid and antioxidant vitamins can delay the progression of atrophic gastritis, and gastric mucosal protectants can improve the gastric mucosal barrier and promote erosion healing [1,3].4. Eliminate the root cause - endoscopic surgical treatmentIf the disease has progressed to intraepithelial neoplasia or has developed into early gastric cancer, the best way is to perform endoscopic surgery to remove the lesion and eliminate the root cause.The development of gastric cancer is a relatively long process. Before it develops into dysplasia, it can be considered that the lesions are likely to be reversed.After dysplasia, it can be cured through endoscopic minimally invasive surgery in the early stage. Drug treatment can only control the disease and delay its progression.Research investigations have found that:The annual incidence rate of gastric cancer caused by gastric mucosal atrophy is 0.1%, the annual incidence rate of gastric cancer caused by atrophy combined with intestinal metaplasia is 0.25%, and the annual incidence rate of gastric cancer caused by patients with dysplasia and low-grade intraepithelial neoplasia is 0.6% [1].So while carrying out corresponding treatment, we should also pay attention to regular monitoring and review of precancerous lesions to kill the signs of cancer in time [1].Precancerous lesions are not a "death knell"but a reminder from your bodyOnly when you face it proactively can you nip cancer in the cradleReviewer: Shi JihuaDeputy Chief Physician of the Department of Gastroenterology, Beijing HospitalReferences[1] National Clinical Research Center for Digestive Diseases (Shanghai), National Alliance of Early Digestive Cancer Prevention and Treatment Centers,Helicobacter pylori scientific group of the Gastroenterology Branch of the Chinese Medical Association, the Health Management Branch of the Chinese Medical Association, the Digestive Endoscopy Professional Committee of the Endoscopist Branch of the Chinese Medical Doctor Association, and the Professional Oncoendoscopy Committee of the Chinese Anti-Cancer Association. Expert consensus on management strategies for precancerous states and precancerous lesions of gastric mucosa in China (2020) [J]. Chinese Journal of Digestion, 2020, 40(11): 731-741.[2]CorreaP. Human gastric carcinogenesis: a multistep and multifactorial process--First American Cancer Society Award Lecture on Cancer Epidemiology and Prevention. Cancer Res.1992;52(24):6735-6740.[3]Wang Ping, Li Peng, Chen Yingxuan, Li Li, Lu Yuanyuan, Zhou Weixun, Bian Liqun, Zhang Beihua, Yin Xiaolan, Li Junxiang, Chen Jie,Zhang Shutian, Shi Yongquan, Tang Xudong. China Integrated Clinical Management Guidelines for Gastric Precancerous Lesions[J]. Gastroenterology, 2021, 26(02):91-111.[4] Li Chengxi, Zeng Yuanshan.Histology and Embryology [M]. People's Medical Publishing House, 2018. 137鈥?38.[5]Yakirevich E, Resnick MB. Pathology of gastric cancer and its precursor lesions. Gastroenterol Clin North Am. 2013;42(2):261-284.doi:10.1016/j.gtc.2013.01.004[6]Smyth EC, Nilsson M, Grabsch HI, van Grieken NC, Lordick F. Gastric cancer. Lancet. 2020;396(10251):635-648.doi:10.1016/S0140-6736(20)31288-5[7] Du Yiqi, Cai Quancai, Liao Zhuan, Fang Jun, Zhu Chunping. Current status of early gastric cancer screening in ChinaExpert consensus opinion (draft) (2017, Shanghai) [J]. Gastroenterology, 2018, 23(02):92-97.*Produced by Tencent Medical Dictionary content team