Abstract
A retrospective comparison was made on preceding endoscopic lesions and evolution in depressed types of gastric cancer. Sixty cases of depressed types of gastric cancer with fair photograph on previous endoscopic examination were selected. The observation period was at least 1 year, and the macroscopic types were as follows; early cancer, 33 cases; IIc like advanced cancer, 9 cases and Borrmann 2 or 3 types, 18 cases. A total of 116 endoscopic procedures were performed in the 60 patients and preceding lesions were classified into four groups; (1) ulcerative group-46 procedures (39.7-0), (2) gastritis-like group such as irregular reddening sign, fine granulation and tiny nodular eleva-tion-35 (30.20), (3) group of no abnormality detected-31 (22.7-0) and (4) group of over-looked malignant signs-4 (3.4%). In these four groups, the percentage of advanced cancer was especially high (54.3%) in gastritis-like group compared with other 3 groups (about 25%). This may suggest different growth patterns between early and advanced cancers. In early gastric cancer, preceding lesions commonly showed appearances of peptic ul-ceration. This finding increased in frequency as the interval between endoscopic examination and final diagnosis became shorter (20% over 8 years before final diagnosis, 80% within 3 years). Reddening sign also showed a similar tendency. But in advanced cancer cases, neither ulcerative changes nor reddening sign had any relationship between the incidence and the intervals. Gastritis-like changes were found with considerable frequency (20-60%). These results may suggest that in early stage the gastritis-like changes are underestimated on their malignant features and are not diagnosed until advanced cancer has developed. On the contrary, a lesion in ulcerative group is easily found at a relatively early stage. For the early detection of advanced cancer, a qualitative diagnosis of ulcera-tive lesion as made today seems insufficient according to our studies. In the near future an emphasis must be paid on a qualitative diagnosis in gastritis-like non-ulcerative lesions.
