Gastric carcinoma is a commonly-seen malignant tumor ,which accounts for 40%-50% of the tumors of digestive tract .The incidence and mortality of this disease remain the highest in different kinds of malignant tumors.Its clinical manifestations include epigastric discomfort and pain,vomiting ,haematemesis,nausea and tarry stools and mass in the epigastric area.With no obvious symptoms at the early stage,it is often confused with gastritis,anorexia and gastric ulcer.And at the later stage,there appears epigastic mass and general cachexa,it is already the late stage of gastric carcinoma.This disease occurs in patients at any ages ,but more common in males than in females .
The etiology and pathogenesis are not clear at present ,but they are related to hypersaline diet ,some carcinogenic substances like nitrosamine ,polycyclic hydrocarbon,etc.,chronic bacteria infection,post-gas-trectomy,some astric diseases (such as gastric ulcer,chronic atrophic gastritis,gastric polyp,intestinal epithelial metaplasia ),pernicious anemia and general factors .
According to its manifestations ,the disease belongs to “fanwei”(regurgitation), “ wei wan tong” (epigastric pain ), “yi ge” (difficulty in swalling), “xin fu pi” (fullness in epigastrum) in traditional chinese medicine. The causes of the disease are emotional disturbance improper diet or long-term deficiency of the spleen and stomach .In terms of pathogenesis ,the liver g\fails to maintain free flow of qi ,the stomach qi fails to descend ,the viscera fail to function norally ,and dampness,phlegm,toxic heat and blood stasis accumulate in the stomach,which may lead to gastric carcinoma .
Essentials for Diagnosis
Over 30 years old patients suffering from gastric pain or flatulence for more than 1 year,recently with agravation of the pain,changes of rhythm and slight tender in the gastric area,should be aware of the possibility of gastric carcinoma.
The patient has no history of diagnosed gastric diseases,but suffers from emaciation with unknow cause,tarry stools and also anorexia,lassitude,reduced hematochrome,or frequent bleeding and stubborn pain .
The patient has the history of gastric pain,transferring focus to the lung and liver,swelling of the supraclavicular lymph nodes or mass felt in the front wall of the rectum .
Labortory examination shows persistent positive occult blood on stools,deficiency or absence of gastric acid in gastric juice analysis,absence of free acid on empty stomach;biochemical examination indicatesincreased AFP cotent in the gastric juice,positive gastric carcinoma antigen,significant difference of akaline phosphatase and acid protease in biopsy sample of gastric membrace comparing with normal tissues and increase of CEA,CA19-9,CA242 in the blood .
Barium meal X-ray examination indicates the ulcer larger than 2.5 cm with irregula shape of the niche,erect image inegative image,meniscus sign,irregular rough or anishing membrane folds around theulcer,nearby stomach wall rigid and disappearance of the movement.The size and location of the tumor or the surface of the tumor or ulcer,bleeding by touching can be observed under endoscope.To make clear diagnosis,biopsy or smear examination is recommended.The ultrasonic B and CT examination indicate the growth of the cancer inside and outside of the stomach cavity and the transference to the liver,pancres,kidney,ovary or celiac lymph nodes .
Syndrome Differentiation and Treatment
At the early stage,mst of the cases are characterized by excessive pathogenicfactors ,usually manifestedas incoordination between the liver and the stomach,blockage of toxic stasis and stagnation of phlegm and dampness.Chronic cases are marked by dificient healthy qi,usually manifested as stomach heat damaging yin,yang deficiency of spleen and deficiency of qi and blood .The treatment principle is to soothe the liver qi and strength the spleen,remove phlegm and blood stasis.At the late stage ,the treatment principle is to nurish stomach qi and stomach yin,treat the symptoms and the causes ,strengthen the antipathogenic factors and expel the pathogenic factors simultaneusly .
Incoordination Between the liver and stomach
Chief manifestations : Distention in the gastric area ,intermittent dull pain radiating to the hypochondriac regions ,belching with foul smell of undigested food,anorexia,or vomiting,nausea ,ple tongue with thin ad white coating,thready and wiry pulse .
Therapeutic Methods: To soothe the liver and regulate the function of the stomach,subdue the adverse flow of qi and relieve pain .Stomach Heat Damaging Yin
Chief manifestations : Burning pain in the gastric area aggravated after meals ,gastric discomfort,drtness in the mouth,feverish sensation in the soles ,palms and chest ,dry stools,anorexia,red tongue with little coating ,thready and rapid pulse .
Therapeutic Methods : To nurish yin,clear away heat,regulate the stomach and remove toxic substance .
Internal Stagnation of Blood and Toxic Substance
Chief manifestations : Localized pricking pain in the gastric area and evencutting pain,abdominal mass with tenderness,or haematemesis,hematochezia,squamous and dry skin,purple tongue or dark spots on the tongue deep,theady and unsmooth pulse .
Therapeutic Methods : To remove toxic substance and blood stasis ,activate blood circulation and relieve pain .
Accumlation of phlegm and dampness
Chief manifestations : Fullness and pain in the chest ,vomiting of phlegm,abdominal distention ,diarrhea,swelling of the lymph nodes,pale tongue with smooth and greasy coating and deep,thready and soft-superficial pulse.
Therapeunic Methods : To strengthen the spleen ,dry dampness,expel phlegm and disperse mass .
Yang Deficiency of the Spleen
Chief manifestations : Dull gastric pain which is relieved by warmth and pressure,or vomiting of retained food,vomiting of clear fluid ,pale complexion,lassitude,coldlimbs,loose stools,edema,pale and swollen tongue with teeth marks and white,moist and smooth coating,deep and slow or deep,thready and soft-superficial pulse .
Therapeutic Methods : To warm the middle energizer and expel cold ,strengthen the spleen and regulate the stomach .
Defficiency of Qi and Blood
Chief manifestations : Gastric carcinoma with severe anemia,lassitude,palpitation,shortness of breath,dizziness,lusterless complexion ,restlessness,insomnia,spontaneous sweating,night sweating ,anorexia,emaciation,pronounced mass in the epigastric area,pale and swollen tongue,thready and feeble pulse .
Therapeutic Methods : To nourish qi and blood,strengthen the spleen and kidney .