The tumours in the stomach.
In recent years, the incidence of neuroendocrine tumours has increased year by year, and has become increasingly the subject of attention. There is a great need for doctors in gastrointestinal surgery to learn about the treatment of tumours in the stomach.
1 Definitions
The tumour of the stomach neuroendocrine (G-NENS) is derived from neuroendocrine cells such as chromosomal cells (ECL) or G cells, chromosomal cells (EC), which account for only a fraction of the original tumours in the stomach.
2 Speculation and Classification
(1) Classification: stomach neuroendocrine cancer (G-NET), stomach neurogenocrine cancer (G-NEC), mixed gland neuroendocrine cancer (MANEC), hyperbiotic and pre-cancer pathologies, category 4;
(2) Pathological classification: WHO graded according to two indicators: Nuclear Separative Images and Ki-67 Positive Index
◎ G1 tumours with a filamental number of cells less than 2 per 10 HPF and a Ki-67 index less than 3%
G2 tumours have filamental fractions of 2-20/10 HPF and the Ki-67 index is 3-20%
◎ G3 cells with more than 20/10 HPF or Ki-67 index above 20%
(3) Clinical breakdown
Type I: Most common, 70% – 80% of G-NETs.
1 Relates to autoimmune atrophy of gastroenteritis, which can cause high gastrogenemia;
High incidences among women, usually small and multi-centre tumours, which can be found under mucous membranes or mucous membranes;
Clinical performance is mostly characterized by benign tumours.
Type II: Incidence rate is extremely low (5-8 per cent) and is similar for men and women.
1 Also linked to high gastrogen hemorrhage;
2 Very similar to the I type, but clinical performance is more intrusive and potentially shifting.
Type III: Incidence of 15-20 per cent, high male hair
1 Not dependent on a number of specific factors and not related to high gastrogen hemorrhagic disease, and therefore this type is diffuse;
3 There are no specific clinical manifestations, which can present atypical types of cancer syndrome;
Type IV: Low differentiation, distribution, short lifespan and lack of relevant research.
Treatment 3
(1) Endoscopy treatment
A. Method: Monumentation (EMR) under endoscopy and ESD (ESD) under endoscopy.
B. Adaptation certificates: for I, II G-NENS, no more than 1 – 2 cm in diameter, limited to sub-cluenum, non-ventilated cholesterol and no further movement.
C. Risk: There is a risk of indigestion perforation, haemorrhage and a high risk of recurrence after surgery, which requires periodic review of the stomach lens at a later stage.
(2) Surgery
A. Adaptive certificates: tumours with more than six cookers, tumours with a diameter greater than 2 cm, pulsary bulges, invasive muscle layers or above, local lymphorate transfer, high tissue grade (G3).
B. Surgical programmes:
a. Stomach oscillation (type I G-NENS with tumours of more than 6 and type II G-NENS with gastrogen genre sources);
b. root therapeutic stomach osteoporosis (more than 2 cm in diameter, inflammation of the muscle layer, pulsation, local lymphomy transfer, high tissue grade (G3);
c. Precautionary tumour decomposition (for good dichotomy, G1 and G2, or complications such as haemorrhaging, obstruction, perforation, etc.)
(3) Partial treatment
Adaptation certificates: mainly for cases associated with liver transfer stoves.
B. Methodology: RFA preferred.
(4) Drug treatment
A. Growth inhibitors: G-NENs for I, II G-NENs, functional G-NENs, SSR scan positives and remote transfers.
B. Interferant-α (IFN-α): Symptomic control for growth inhibitor analogues for insensitive patients, high toxicity, only as a second-line solution.
C. PPI: Surgical complications such as ulcer and haemorrhage due to high gastrogen hemorrhage can be mitigated and long-term use can accelerate tumour progress.
D. Targeting drugs:
a. Angiogenesis: G-NENs are more vascular, with VEGF and internal cortex growth factor receptors (VEGFR) expressed at a high level, and Zunitini can effectively combine with targets such as VEGFR, KIT, RET, thereby inhibiting the growth and transfer of pathological vascular growth and tumours;
b. Mammal respirogen receptor (m TOR) inhibitors: mainly for end-stage treatment of growth inhibitor analogues, not suitable for liver intervention
(5) Other:
The radionuclide therapy (PRRT), which is directed by the growth inhibitor receptor, is applied primarily to those who have no conventional treatment and is not used as a first-line treatment.
The whole-body chemotherapy is applied to G-NENS, which cannot be fully removed from the operation, or which is accompanied by a long-range transfer, especially for patients clearly classified as G3; Chinese medicine, etc.
Stomach tumor
