When 58 minute gastric cancers less than 5 mm in diameter from 55 patients were classified into 22 of the single group (minute gastric cancer alone) and 36 of the multiple group (associated with other large gastric cancers), the preoperative correct diagnostic rate by x‐ray was 22.7% and 11.1% in the single group and in the multiple group, respectively, with a total rate of 15.5%. The diagnostic rate by endoscopy, aided by endoscopic biopsy, was 95.5%, 13.9%, and 44.8%, respectively. Therefore, it appears that endoscopy and endoscopic biopsy are most efficient diagnostic tools for the detection of such minute gastric cancers. Since the detection of the depressed type (IIc) of minute gastric cancers is considered most significant because of their frequent submucosal invasion, their characteristic endoscopic findings are emphasized: (1) irregular and polygonal shape, (2) distinct depression, (3) clear demarcation, (4) nodular margins, and (5) moth‐eaten appearance and abrupt thinning of the mucosal folds. Cancer 53:162‐165, 1984.

Clinical records of 406 patients over 70 years of age with gastric cancer operated on during the past 22 years were analyzed. These cases amounted to 11.8% of the 3,425 patients with gastric cancer treated surgically at our hospitals during the same period. The primary tumor was confined to the upper one‐third portion of the stomach in 15.8% of the cases, which was significantly higher than that usually reported. Macroscopic staging of the lesion revealed that more than two‐thirds of the patients were suffering from highly advanced disease. The size of the tumor was larger than 50 mm in diameter in 50.8% of the cases. The tumor was predominantly of Borrmann II and III types. Early gastric cancer was observed in only 14.8% of the cases, which was approximately one‐half of the usual rate. However, histological study revealed well‐differentiated adenocarcinoma in two‐thirds of the lesions, a remarkable characteristic of gastric cancer in the elderly. Resection was possible in 70.9%, and curative resection was performed in 46.8%. The over‐all hospital mortality rate was 16.5%. The prognosis of curative resection cases yielded a 5‐year survival rate of 51.5% and 10‐year survival rate of 25.5%. These results would justify the practice of early diagnosis and aggressive surgery in every acceptable risk patient, if no contraindication exists.

Minute gastric cancers with maximum dimensions of less than 5 mm were studied clinicopathologically. There were 49 intramucosal cancers among 46 patients and nine submucosal cancers among nine patients. No lymph node metastasis was found. Macroscopically, eight (13.8%) were elevated, 12 (20.7%) were flat, and 38 (65.5%) were depressed. Most submucosal cancers were of the depressed type (8/9, 88.9%). Classification of cancers according to association with other large cancers into single group (22 cases) and multiple group (33 cases) revealed that (1) the majority of the minute gastric cancers (20/22, 90.9%) in the single group were the depressed type and (2) submucosal cancers in the single group were 8/22, accounting for 36.4%, a much higher incidence as compared with 1/36 (2.9%) in the multiple group. These facts indicate that gastric cancers should be detected when they are about 5 mm in maximum dimension and before they invade beyond the submucosal layer, especially in single and depressed type.

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Histogenesis of microscopic adenoma in nonpolypoid colons (those not included in the special disease group of familial polyposis coli) was investigated using complete serial sections with the following results: Adenoma arises from basal cells in the deep layer of the mucosa; and two types of basal cells found were 1) those which had already undergone changes to adenoma and 2) those which are in their transitional stage to adenomas. Early-phase growth of adenoma is brought about by branching. Individual hyperplastic (metaplastic) glands constituting so-called hyperplastic (metaplastic) polyps are considered to be only an expression of one variant in the growing process of adenomas and the glands showing these changes most characteristically have a serrated pattern. Based on these findings, the histogenesis of adenoma in nonpolypoid colons is shown schematically.