A STUDY ON THE PRESENT PROBLEMS IN THE ENDOSCOPIC DIAGNOSIS OF EARIY GASTRIC CANCERS

Abstract

138 cases of early cancers and 45 cases of “early-looking” advanced cancers of the stomach were studied with the following results. 1) Most of the cases with failed preoperative diagnosis on the depth of cancerous invasion were small lesions of 1-2 cm in the greatest diameter or lesions with a wedge-shaped infiltration. If all the characteristic clues which may suggest a malignant invasion into the submucosal layer are looked for carefully, the accuracy of macroscopic judging the depth of cancerous infiltration may be as high as 72.5%. 2) A type-classification of an early gastric cancer in the resected specimen differed occasionally from that previously made by endoscopic examination. The study in cases of IIa + IIc or IIc + IIa showed that one of the reasons was the difficulty in interpreting a low elevation at the edge of IIc as malignant or not. This difficulty may be overcome by taking biopsy from that part. 3) 76.8% of 138 early gastric cancers were seen in the pyloric gland area, 13.8% were in the transitional area and 9.4% in the fundic gland area. The endoscopic atrophic border shifted from C-I type to O-III type as the age of the patients increased. 91.3% of 46 macroscopically elevated lesions were differentiated adenocarcinoma, and mostly located in pyloric gland area. There were 13 early cancers in the fundic gland area and all of them were of undifferentiated type, while 87 out of 106 cancers in the pyloric gland area were of differentiated type. 4) There were 44 minute gastric cancers with the diameter less than 10mm, in which 35 lesions were detected preoperatively by endoscopy as abnormal and 9 lesions were overlooked until the examination of resected specimens. The smallest lesions endoscopically diagnosed was 4mm in diameter.