Abstract
While earlyga stric cancer has been increasingly detected in the past two decades, cancer located in the proximal one third (“ C” area) of the stomach is still infrequently diagnosed in “ early” stage. To know the clinical and technical problems which might contribute to diagnostic delay and lower frequency of early gastric cancer in this area, we have reviewed our experience with 28 cases of early gastric cancer in this area, drawn from 1, 715 cases of curatively resected gastric cancer. The results were as follows; 1) Frequency of early gastric cancer in “ C” area was only 5% of total number of early gastric cancer, and no tendency of increase was observed over the period from 1965 to 1978. 2) None of the cases with early gastric cancer in “ C” area was detected by mass survey, indicating technical difficulties in screening. 3) At the initial work-up after the onset of symptoms, the cancerous lesion was over-looked in 46% and 30% of the cases examined by UGI series and endoscopy respectively. 4) Polypoid type of early gastric cancer, mostly type I, was detected by UGI series with ease. However, in 2 out of 7 cases with type I, cancer was overlooked by UGI series, whose lesion located within 2cm from GE junction. 5) Depressed type of early gastric cancer was frequently overlooked by routine UGI series, and checked by subsequent endoscopy which led to suspicion of malignancy. Because of difficulties in both visualization and identification of early gastric cancer in “ C” area, we recommend combined use of endoscopy particularly when one feels that an optimal UGI series is not achieved.
