Early Gastric Cancer

As a result of advances in diagnostic procedures, there are increasing numbers of reports concerning the detection of early-stage gastric cancer, particularly in Japan with the application of mass gastric screening,18-20 where almost one-half of all gastric cancer diagnoses refer to early lesions.

Early gastric cancer is defined as a tumor confined to the mucosa and submucosa, regardless of the presence or absence of perigastric lymph node metastasis.

Depth of invasion is the most important prognostic factor in early gastric carcinoma. Patients with lesions confined to the mucosa have a <5% chance of having nodal metastases and a nearly 100% 5-year survival. This

Lesion Gastric Cancer

Fig. 5-1. TNM classification of gastric cancer.

Increasing T stages correlate with depth of penetration of wall of stomach.

(a) T1 cancers (early gastric cancer) may be limited to the mucosa or may also invade the sub-mucosa.

(b) T2 cancers may be limited to the muscularis propria or may also invade the subserosa.

(c) T3 cancers penetrate the serosa.

(d) T4 lesions further invade adjacent structures. (Reproduced from Spiessel et al.2)

Lesion Gastric Cancer

Fig. 5—2. T stages of colonic mural penetration.

(Reproduced from Fielding LP: Staging systems. In Cancer of the Colon, Rectum and Anus. Edited by AM Cohen, SJ Winawer. McGraw-Hill, New York, 1995, p 210.)

Fig. 5—2. T stages of colonic mural penetration.

(Reproduced from Fielding LP: Staging systems. In Cancer of the Colon, Rectum and Anus. Edited by AM Cohen, SJ Winawer. McGraw-Hill, New York, 1995, p 210.)

outstanding survival is related to the fact that the stomach has a paucity of lymphatic channels in the lamina propria, in contrast to the esophagus and small intestine. These early carcinomas may be treated by endoscopic

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mucosectomy or by endoscopic laser treatment. Invasion through the muscularis mucosae into the sub-mucosa is associated with a 10-20% likelihood of nodal metastases and a 90-95% 5-year survival.

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