Gastric cancer is a common malignant tumor of the digestive tract, and the 5-year survival rate of early gastric cancer can reach more than 90% after surgery, but the 5-year survival rate of advanced gastric cancer is still less than 30%.
OneThe study of the pathogenesis of gastric cancer in modern medicine
The risk factors for gastric cancer are relatively clear: environmental factors, genetic factors, age and gender, Helicobacter pylori infection, serum pepsinogen level, dietary habits, smoking, alcohol consumption, metabolic syndrome, socioeconomic status, psychological factors, etc.
There is a familial aggregation phenomenon of gastric cancer, about 10%, and the first-degree relatives of gastric cancer patients have an increased risk of **disease compared with the general population15-3.5 times. Studies have also shown that eating more fruits and vegetables can reduce the incidence of stomach cancer.
Modern research believes that the occurrence of gastric cancer is a complex process of multiple factors and steps, which is the result of the interaction between the above risk factors and host genes.
Pathogenesis
Helicobacter pylori
Helicobacter pylori infection is a risk factor for gastric cancer, and some prospective studies have shown that Helicobacter pylori has a decreasing risk of gastric cancer.
The inflammatory cascade triggered by Helicobacter pylori infection can cause chronic atrophic gastritis, intestinal metaplasia, etc., resulting in the loss of gastric mucosal main cells, affecting secretion function, and ultimately promoting the occurrence of gastric cancer.
Helicobacter pylori can also promote the development of gastric cancer by promoting cell proliferation and causing mutations in target oncogenes such as ARId1A.
Genetic factors
Multiple genes play a key role in the occurrence and development of early and advanced gastric cancer.
For example, CDH1 gene mutation leads to down-regulation of E-cadherin expression, which affects HP adhesion and signaling pathways after infection, which is closely related to the occurrence of gastric cancer.
Abnormal DNA methylation and specific RNA changes play an important role in the occurrence and development of gastric cancer, and a large number of studies have shown that DNA methylation can be detected in the process of gastric cancer.
Mutations in the CDH1 gene can lead to down-regulation of related protein expression, thereby affecting the signal transduction after HP infection, and this signaling pathway is related to the occurrence of gastric cancer.
The abnormal methylation of the tumor suppressor gene TFF2 decreases its expression, which affects the mucosal repair mechanism and leads to the occurrence of gastric cancer.
The tumor suppressor gene Runx3 plays a role in cell differentiation and apoptosis, and the abnormal methylation of its promoter also exists in the development of gastric cancer.
Gene polymorphisms are another important factor in the process of gastric cancer, and gene polymorphisms such as interleukin-1b, interleukin 6, 10, and 16 have also been found to be closely related to gastric cancer in recent years.
Molecular Immunology
In the occurrence and development of gastric cancer, the body's immune response and many immune molecules play an important role.
Weakened T cell immunity is associated with the progression of gastric cancer, and CD8+ T cells play an important role in controlling tumor growth, and studies have shown that CD8+ T cell apoptosis is increased during gastric cancer development.
Dendritic cells can suppress tumor cells and have immune surveillance functions, and their decrease or lack of function can promote tumor invasion and metastasis.
The mucosal immune system of the gastrointestinal tract can prevent the invasion of harmful substances, and in this process, pro-inflammatory factors and anti-inflammatory factors interact with each other, including tumor necrosis factor, interleukin and other cytokines, which play an important role in anti-tumor.
Gastric cancer stem cells
The presence of cancer stem cells was confirmed by implanting gastric cancer cells cultured in vitro and eventually forming gastric cancer xenografts under the skin of nude mice. Foreign scholars have isolated cells with deliberate markers from gastric cancer cells that can form tumors under the skin. Bone marrow stem cells infected with Helicobacter pylori can converge into the gastric mucosa and induce atypical hyperplasia and even carcinogenesis under certain factors.
2. Research on the pathogenesis of gastric cancer in traditional medicine in China
Traditional Chinese medicine believes that the occurrence of gastric cancer is closely related to the deficiency of righteous qi and the invasion of evil poisons.
(1) Poor diet
For example, excessive smoking and alcohol or indiscriminate consumption of spicy, dry, hot, smoked, pickled, fried products, or moldy and unclean foods, etc., will cause the spleen to lose its health, unable to transport the subtlety of the water valley, stagnate qi, and produce dampness and phlegm; or overeating raw and cold, hurting the yang qi of the spleen and stomach, and not being able to warm the water to drink, the water is damp and endogenous.
(2) Emotional disorders
If anxiety hurts the spleen and the spleen loses its health, it will accumulate dampness and produce phlegm; Or depressed anger hurts the liver, liver qi stagnation, spleen and soil, spleen injury qi knots, water dampness and unlucky.
(3) Righteousness and internal deficiency
If there is stomach pain, ruffian and other symptoms, it has not been cured for a long time, and the disease is caused by the deficiency of righteous qi and the combination of phlegm and stasis. Or due to old age and physical weakness and other diseases that cannot be cured for a long time, lack of righteousness, weakness of the spleen and stomach, and other factors such as eating disorders and emotional disorders, phlegm and stasis are intertwined, resulting in gastric cancer.
2. Pathogenesis
Gastric cancer is located in the stomach, but it is closely related to the liver, spleen, kidney and other organs, because the meridians of the three organs follow the stomach.
The stomach and spleen are on the surface, the spleen is the stomach and its fluid, if the spleen is not healthy, it will cause dampness and phlegm, which is blocked in the stomach; The harmony and decline of stomach qi depends on the passage of liver qi, and the loss of liver qi leads to the loss of stomach harmony and decline, and qi stagnation, which can then develop into qi stagnation and blood stasis, forming clumps over time; If the kidney yin is insufficient, it is lost in nourishment, the stomach yin is insufficient, and the stomach loses moisture and moisturizes it can become gastric cancer, or the kidney yang is insufficient, the spleen and stomach are lost in warmth, the deficiency and cold are endogenous, and the yang qi is insufficient to turn qi into water, then qi stagnation, phlegm obstruction, and blood stasis become a cluster.
In the early stage of gastric cancer, phlegm-qi obstruction and phlegm-dampness coagulation are the main problems. Long-term illness is mainly characterized by stomach yin deficiency, spleen and stomach deficiency, cold and qi and blood deficiency, and phlegm and stasis are more common.