Gastric mucosal biopsy to diagnose gastric cancer

The article is professionally consulted by Master, Doctor Mai Vien Phuong - Gastroenterologist - Department of Medical Examination & Internal Medicine - Vinmec Central Park International General Hospital.

Stomach cancer is a malignancy but is quite common. Stomach cancer ranks first in the group of gastrointestinal cancers and accounts for 10.5% of all cancers. Early diagnosis is still difficult, so the disease has a high risk of death. Most patients are found to have cancer at an advanced stage of the disease, so the survival time is often short.

Early gastric cancer is the level of invasion of gastric cancer that has not penetrated the submucosa, regardless of lymph node metastasis. Cancer at this stage has a much better prognosis than advanced gastric cancer (90% of cases detected at this stage will survive for 5 years). Currently, the detection of gastric cancer at an early stage is receiving much attention.

An early gastric cancer lesion is usually very small in size, from a few millimeters to no more than 5-7cm, that lesion does not affect the stomach's function of digesting food and does not cause symptoms at all. discomfort or pain in the patient's abdomen.
Want to detect stomach cancer early stage can only rely on cancer screening programs. An inconspicuous upper GI tract symptom may appear 6 to 12 months before diagnosis. Diagnosis is early and possible in 90-95% of patients unrecognizable by screening. Ulcerative lesions may be a more valuable prognostic marker than raised lesions. With the active gastric cancer screening program in East Asian countries (mainly done in Japan), many patients are detected early gastric cancer when there are no symptoms.
With late stage patients, there may be warning signs or symptoms suggestive of anemia or weight loss, with the rate from 5 - 15% and 4 - 40%, respectively. In advanced gastric cancer, the rate of weight loss is more than 60%. At this point, the cancer is no longer at an early stage that can be completely treated.

To diagnose gastric cancer, endoscopy is the only and most valuable method combined with biopsy of the suspected gastrointestinal mucosa or, more specifically, gastric biopsy.
The common endoscopic means in our country today, the accuracy can reach 90-96%. Detecting small lesions will be very difficult, even for experienced endoscopic surgeons. Therefore, in order to diagnose gastric cancer early, it is necessary to examine the entire stomach carefully and meticulously and conduct endoscopic gastric biopsy at suspicious sites. The final results of early gastric cancer diagnosis still have to rely on biopsy as histopathology.
If there are signs of peptic ulcer disease, the location and number of biopsies are extremely important, the more biopsies there are, the higher the chance of catching a cancerous lesion. However, there is currently no consensus on the number of biopsies. For peptic ulcer lesions that have been biopsied but no cancerous cells have been detected, endoscopic monitoring is still recommended, the number of biopsies and the duration of follow-up depends on the characteristics of the ulcerative lesion and on the patient's characteristics. patient.

Patients should fast for at least 6 hours.
First, carry out the usual gastrointestinal endoscopy steps, when it is found that the lesions need to be sampled, a biopsy is performed. The doctor will put the biopsy pliers through the procedure channel and observe on the screen, when the tip of the biopsy pliers is close to the lesion, the assistant will open the biopsy pliers, the endoscope will push the pliers close to the lesion. Let the assistant help close the needle, at this time the doctor will pull back the biopsy wire to cut the specimen.

The biopsy site for ulcers is the marginal mucosa around the ulcer, for tumors it is in different locations. Do not biopsy into blood vessels or mucosal areas with vascular metaplasia. In difficult cases, the doctor can coordinate with endoscopic imaging techniques such as NBI, FICE or staining with dye to determine the exact location to be biopsied. The specimen after being removed is fixed into a container containing Formol.

Biopsy has a risk of bleeding, so it is contraindicated in patients with coagulopathy or at risk for hemostatic disorders: congenital (hemophilia) or acquired (cirrhotic) coagulation factor deficiency. liver disease, taking anticoagulants), thrombocytopenia (autoimmune, drug-induced or cirrhosis) or patients taking antiplatelet drugs.
If the patient is tested, gastric biopsy is contraindicated when platelets < 50 G/l, prothrombin rate < 50%, coagulation factor deficiency < 50%.
Vinmec International General Hospital currently has a package of screening and early detection of stomach cancer for customers > 18 years old, who should have regular check-ups to screen for esophageal cancer - stomach; Customers at high risk of cancer – especially customers with a family history of cancer such as esophageal and stomach cancer or regularly exposed to risk factors such as eating habits salty and sour foods, regular smoking, working in a polluted environment...
The package of screening and early detection of stomach cancer includes:
Specialized examination of gastroenterology with an oncologist (with appointment). Screening for esophageal and gastric cancer through endoscopy: esophagogastroduodenoscopy, stomach, duodenum (with NBI machine, with anesthesia). Coagulation test by automated thrombin time test, activated partial thromboplastin time by automatic machine. General abdominal ultrasound. With nearly 10 years of experience in the field of Gastrointestinal Endoscopy, Master, Doctor Mai Vien Phuong has successfully performed many complicated endoscopic interventions, detecting many digestive cancer lesions at an early stage. , bringing health and peace of mind to many patients. Doctor Phuong specializes in early cancer diagnosis in stomach and colon, endoscopic retrograde cholangiopancreatography in the treatment of biliary tract stones, biliary atresia, cholangiocarcinoma, biliary fistula and treatment of cardiac spasms with technique of opening muscle through the mouth to treat cardiac spasms.