Malignization is the degeneration of normal or damaged body tissues into a malignant tumor. Consequently, malignancy of gastric and duodenal ulcers is the process of the formation of cancer at the site of the ulcerative defect.
Malignancy of cells occurs due to disruption of their normal activity. According to various sources, from 2 to 15% of gastric ulcers undergo malignancy. In the duodenum (duodenum), the phenomenon is extremely rare (0.1-0.3% of cases).
A malignant formation can originate at the bottom of the ulcer, at its edges, or from a healed ulcerative defect. There is an opinion that the percentage of ulcers that have undergone malignancy is overestimated due to the similarity of the initial development of a cancerous tumor and an ulcer, and in fact does not exceed 2-3%.
What is malignancy, what are its causes, signs, symptoms and treatment methods - this is what this article is about.
What is malignancy
It is known that pathological cells, including malignant ones, constantly appear in the body. But the immune system always repels such attacks. Therefore, the effectiveness of protection largely depends on the state of immunity and the general state of human health.
Thanks to protective mechanisms, abnormal cells are recognized and destroyed. But, when the immune system is weakened due to bad habits, unhealthy diet, external factors, and age, the risk of developing the disease increases.
Malignization of cells is the initial process of the appearance of a malignant tumor in the body, its origin
Both healthy and pathological (damaged) cells of the body undergo this change. Malignancy is also called the transition of a benign tumor to a malignant one.
With this phenomenon, a genetic mutation of cells occurs and their uncontrolled growth occurs. At the initial stage, the patient himself does not feel any discomfort, unaware of the disease. Also, diagnosis is difficult during this period.
More often, tissues with various types of erosion become malignant:
- ulcerative defects;
- tissue inflammation;
- benign tumors.
The phenomenon is not excluded in healthy tissues. Pathological changes are uncontrollable and irreversible. They can capture increasingly larger spaces with the formation of new foci - metastases.
Many factors contribute to malignancy: genetic predisposition, external and internal influences. Early detection of the disease significantly increases the chance of recovery, while late detection leads to the formation of a malignant tumor with metastases with all the ensuing consequences.
Causes of malignancy of stomach ulcers
The impact of digestive juice on an ulcer, periods of exacerbation and relapses of the disease lead to the proliferation of connective tissue, vascular sclerosis and atrophy of the stomach wall at the site of the ulcer. All this leads to changes in the properties of cells and can cause the appearance of a cancerous tumor in the area of ulcerative lesions.
Ulcers of the pylorus, anterior and posterior walls, and the greater curvature of the stomach become malignant more often. The presence of the Helicobacter pylori bacterium contributes to the process. Malignancy of a stomach ulcer can begin regardless of the nature and duration of the peptic ulcer, but more often occurs in older people with chronic ulcers.
Malignancy of a duodenal ulcer, due to more gentle conditions for the mucous membrane compared to the stomach, is an extremely rare phenomenon.
The full picture of the mechanism of cell malignancy is still not clear. There is also no cure for cancer. The onset of the disease is preceded by unfavorable factors that trigger the pathological process. They are divided into internal and external.
Internal factors:
- weakened immunity;
- hormonal disorders;
- improper metabolism;
- genetic predisposition;
- the presence of a benign tumor;
- viral, fungal diseases;
- chronic tissue inflammation, scars, ulcers;
- prolonged stressful conditions.
External factors:
- poor nutrition;
- bad ecology;
- solar and other types of radiation;
- exceeding the X-ray dose;
- harmful chemical influences.
Research indicates that the risk of malignancy is closely related to diet:
- absence in the diet or insufficient consumption of natural human food - fresh fruits, vegetables, herbs;
- the predominance of fried, salted, smoked, chemical-containing and other unhealthy foods.
Thus, certain aggressive factors become the causes of cancer, as a dangerous complication of gastric ulcer, or less commonly, duodenal ulcer.
Causes of the disease
Scientists still do not have a consensus on what causes the malignant degeneration of epithelial cells in gastric ulcers. The role of factors that serve as provocateurs in the development of malignancy is obvious.
The genetic predisposition of the patient's body to the development of cancer. In this case, special attention is paid to the study of the history and pedigree of the patient who has cancer in the family.
Violation of the regime and nature of nutrition. Patients with malignancy often have an unbalanced diet with a predominance of fried, smoked, spicy or salty foods, alcohol abuse, eating disorders - lack of breakfast, frequent overeating at night.
Frequent consumption of excessively hot food.
Signs and symptoms of malignancy
Signs and symptoms that raise suspicion of malignant ulcers are as follows:
- pain in the stomach loses its frequency and locality, acquires a diffuse, constant, aching character (can radiate to the back and intensifies at night);
- loss of appetite, weight loss;
- aversion to meat dishes;
- digestive disorders (belching, heaviness, nausea, vomiting);
- poor health (emotional exhaustion, fatigue, discomfort).
These signs may indicate that stomach cancer is already developing, which means this is a reason to immediately seek help from doctors. Also, such signs, when confirming a malignant tumor, indicate that the malignancy phase was missed.
At an early stage, the patient does not suspect the malignancy of a stomach ulcer. It is possible to detect the disease at the initial stage only in one case, if the patient with a peptic ulcer undergoes periodic medical examination.
If the ulcer has undergone malignancy, then medical examination will reveal the following signs:
- decreased stomach acidity;
- presence of lactic acid in the stomach;
- progressive anemia;
- possibly hidden blood in the stool due to bleeding in the area of the ulcer;
- failure of cell differentiation;
- enlargement of the ulcer (more than 25-30 mm) with the acquisition of an irregular shape with high, uneven, undermined edges;
- the boundaries of the ulcer become blurred, the surrounding mucosa may have a granular appearance;
- rigidity of the stomach wall, lack of peristalsis around the affected area.
Also, the lack of effect from antiulcer therapy may indicate malignancy.
Signs of malignancy of a gastric ulcer are determined by diagnostic methods.
Morphological characteristics
Histologically, the disease is confirmed based on tissue biopsy examination. Visible changes:
- Destruction of the smooth muscles of the stomach at the bottom of the ulcer.
- There is no submucosal layer at the edge of the ulcer.
- A wide scar is found at the bottom of the ulcer.
- In the early stages, cancer cells infiltrate the edges of the ulcerative lesion.
Primary gastric cancer is usually accompanied by an atrophic inflammatory process, while malignant ulcers occur with symptoms of hypertrophic gastritis.
Diagnosis of malignant gastric ulcers
To identify malignancy, the same diagnostic methods are used as when examining any pathology of the stomach:
- study of anamnesis (medical history);
- blood, urine, stool analysis;
- contrast X-ray examination;
- CT scan;
- Ultrasound;
- gastroscopy with targeted biopsy;
- laparoscopy.
A blood test serves as an indirect indicator of the occurrence of cancer. This is reflected in changes in such quantities as:
- decreased hemoglobin levels;
- decrease in the number of red blood cells;
- increased leukocyte levels;
- an increase in erythrocyte sedimentation rate (ESR) and other important indicators.
Detection of blood during stool analysis is a reason to find out the exact causes of its occurrence, including possible blood loss due to malignancy of a stomach ulcer.
Fluoroscopy may reflect the following signs of malignancy:
- increase in ulcer size (more than 20 mm);
- the ulcer takes on an atypical appearance (irregular shape);
- uncharacteristic condition of the gastric mucosa around the defect, disappearance of folds;
- lack of perilstatic movement of the affected area;
- a symptom of a submerged niche and other signs are detected.
But, it is important to note here that early signs of the disease are almost impossible to detect by X-ray examination. The listed symptoms appear later.
Therefore, the most reliable way to diagnose malignancy of a gastric ulcer is an endoscopic examination (EGD) with the collection and subsequent histological analysis of tissue samples from the ulcer. Fragments are taken from 5-7 different places of the ulcer (bottom, edges, area around). The accuracy of this diagnostic method reaches 100%.
EGDS, in addition to the valuable opportunity to take tissue samples, also detects the described signs of atypicality of the ulcer and the area around it:
- uneven, undermined edges of the ulcer, a gray coating is possible at the bottom of the defect;
- wide infiltration of the ulcer, possible deformation of the stomach wall in the area of the defect;
- erosion of the mucosa around the defect;
- bleeding, etc.
Ultrasound and CT also help to identify atypical development of ulcerative defects.
If necessary, a laparoscopic diagnostic method is used to examine the stomach from the abdominal cavity.
Treatment for malignant ulcers
The mere fact of detecting a gastrointestinal ulcer requires the active adoption of all necessary treatment measures. The patient is examined and given intensive therapy.
If drug treatment is effective (the ulcer decreases, characteristic symptoms disappear), then treatment is continued with periodic monitoring, including cytological monitoring (to check the ulcer for the presence of malignancy). If the treatment does not have an effect, then surgery is used.
This statement by the prominent Soviet surgeon and scientist S.S. is often quoted. Yudin (1891-1954), who most succinctly expressed the circumstances under which surgical intervention is indicated:
“The larger the ulcer, the deeper the niche, the older the patient, the lower the acidity, the greater the risk of cancer arising from the ulcer” (S.S. Yudin, 1965).
And, therefore, the sooner the operation is indicated.
Thus, treatment when malignancy of a gastric ulcer is detected is carried out by surgery. The choice of surgical intervention depends on the location of the ulcer, its nature, size, degree and extent of tissue damage around the defect:
- Distal gastrectomy is a significant removal of the lower part of the organ. An example is the removal of the antrum. In this case, the stomach is reduced in volume by 1/3. Subtotal resection is almost complete removal of the stomach (only a small part of it remains on top).
- Proximal resection - removal of the upper part, including the cardiac part, while preserving the lower part of the organ.
- Ring segmental resection - removal of the middle part of the stomach while preserving the upper and lower parts. This operation is used extremely rarely.
- Total gastrectomy – complete removal of the stomach.
As noted above, if the occurrence of a cancerous tumor is detected at an early stage of malignancy and subsequent surgery, the likelihood of cure increases significantly. However, the only way to detect malignancy in a timely manner is periodic endoscopic examination of the ulcer with a biopsy.
At the same time, if malignancy is not detected, but there is no effect of antiulcer therapy and the diameter of the ulcer exceeds 20 mm, then in this case surgery is still indicated. You should not wait for direct signs of malignancy, since earlier surgical intervention can prevent more serious, life-threatening development of the disease in the future.
Diagnosis of early stage malignancy
A number of specialists who studied the symptoms of malignancy of ulcers at an early stage came to the unanimous conclusion that it is necessary, first of all, to observe and control the nature of the course and possible changes in the ulcer. The early stages of malignancy are characterized by the disappearance of periodicity and seasonal dependence of the pain syndrome. The nature of pain during peptic ulcer disease can change.
The pain becomes less pronounced and sharp, becomes unstable, and loses dependence on food intake. There is a decrease in appetite, which is not typical for peptic ulcer disease. The general condition of the patient's body worsens. The patient begins to rapidly lose weight and experience weakness for no apparent reason. A characteristic symptom appears - an aversion to meat dishes. The acidity of gastric juice gradually decreases. The amount of lactic acid in the gastric juice increases. A picture of hypochromic anemia develops; traces of blood are constantly present in stool tests.
