Early gastric cancer
Wednesday 03 June 2009, Branislav Kunčak, M. D.
- Definition
Early gastric cancer is defined as gastric cancer in which invasion is limited to the mucosa or to the submucosa.
Definition of the Japanese Research Society for Gastric Cancer published in 1962.
In Japan the proportion of gastric cancer patients presenting with early gastric cancer is up to 50%. In Western countries early gastric cancer is much less common.
- Macroscopic classification of early gastric cancer
Meticulous inspection of the gastric mucosa is essential for the diagnosis of early gastric cancer.
Subtle changes in the color or texture of the gastric mucosa, and surface irregularities (elevations or depressions) are endoscopic features of early gastric cancer.
- Type I: protruded lesions
- Type II: superficial lesions, with three subtypes (II a slightly elevated, II b flat, II c slightly depressed)
- Type III: excavated lesions
The use indigo-carmine spray (chromoscopy) increases the detection of minor mucosal irregularities and allow for more accurate macroscopic classification.
Patients aged 60 years and older with gastric lesions (adenoma or ulcer) and marked atrophy of the gastric mucosa are at high risk of having gastric cancer.
The five-year survival rate depends on the depth of the cancer infiltration in the gastric wall (being highest in cancer with invasion limited to the mucosa, followed by submucosal, muscularis propria and serosa invasion).
Surgical resection of early gastric cancer is higly effective.
Endoscopic mucosal resection (EMR) is less invasive treatment option for select subgroup of patients (mainly elderly patients with comorbidities).
- Indications for EMR of early gastric cancer:
- differentiated mucosal adenocarcinoma
- elevated type mucosal cancer less than 20 mm in largest diameter
- flat or depressed type lesion (without ulceration) less than 10 mm in size
» Shimizu S et al. Early Gastric Cancer: Its Surveillance and Natural Course. Endoscopy 1995;27:27-31
» Hosokawa O et al. Detection of Gastric Cancer by Repeat Endoscopy Within a Short Time after Negative Examination. Endoscopy 2001;33:301-305
» Reshamwala PA, Darwin PE. Endoscopic Management of Early Gastric Cancer. Curr Opin Gastroenterol. 2006;22:541-546
Bigger image, Endoscopy
Fig. 1
Early gastric cancer (macroscopic type II c + II a).
Slightly depressed lesion with elevated margins 6-7 mm in a diameter located on a lesser curvature of the stomach (retroflexed view).
Poorly differentiated adenocarcinoma invading the submucosal layer with lymphatic invasion.
Cancer was resected surgically.
