USEFULNESS OF ENDOSCOPIC EXAMINATION IN THE DETECTION OF MINUTE CANCER OF THE STOMACH

Abstract

The usefulness of X-ray and endoscopic examination was analysed comparatively concerning the discovery of minute cancer of the stomach less than 5mm in diameter. Out of 141 lesions in the authers' 130 cases of early gastric cancer, 13 lesions in 13 individuals were such minute ones as above mentioned, and it was in 9 of them that this diagnosis was established preoperatively. They were IIc type of early gastric cancer larger than 3mm in diameter, all of which were histologically differentiated adenocarcinoma and showed intramucosal invasion. Endoscopically, 2 cases belonged to ha + IIc, 5 to IIc, and one looked like ulcer scar with bleeding tendency, and remaining one showed irregular red spot. Then all of these losions exibited more or less some sign of malignancy. All of the 4 cases, discovered by pathohistological examination of the resected materials, were less than 3mm in diameter and consequently were hard to discern macroscopically. In 6 (66.7%) of the 9 cases, preoperatively diagnosed as having cancer, other co-existing lesions of the stomach played the important role of a trigger in the discovery of the minute cancer. The diagnostic capability of X-ray for the minute cancer was 15.4% (2/13) in the first attempt, and 30.8% (4/13) in the final. The endoscopic result was 69.2% (9/13) both initially and finally. In the cases of small gastric cancer, measuring 5 to 10mm in diameter, the capability of X-ray examination was 30.8% (5/13) initially, and 53.8% (7/13) finally, while that of endoscopy was 84.6% (11/13) initially and 92.3% (12/13) finally. From the above results, the following coclusions were drawn: (1) The size of minute gastric cancer that permits clinical diagnoses is larger than 3mm, and it has some signs of malignancy. In many cases, it belongs to IIc category with intramucosal invasion. Most of them are histologically differentiated adenocarcinoma. (2) Associated gastric lesion other than cancer plays an significant role of a trigger in the discovery of a minute cancer. (3) Endoscope is far superior to X-ray in the detection of a minute cancer. The decision of whether malignant or benign must await the result of biopsy.