Early gastric cancer in Europe

Abstract

Despite mass population screening and an incidence of EGC in Japan that is at least double that of the West, there seem to be no genuine differences in the clinicopathological features of the disease between the two regions. The macroscopic appearance, size, depth of invasion, frequency of lymph node invasion, and histology of EGC are all remarkably similar in Japan, Europe and America, as are sex and age distributions.Patients with EGC are a number of years younger than those with advanced cancer. This is not surprising: Tsukuma et alfollowed 56 cases of EGC that were not surgically treated and estimated that the median “duration of EGC” before becoming advanced was 37 months.87 This suggests that EGC undergoes a period of slow growth before becoming advanced. Further differences between early and advanced cancers include a higher frequency of synchronous cancers and a longer symptom duration in EGC.Unfavourable prognostic factors in EGC include lymph node invasion, and invasion through the muscularis mucosae, though it is not clear whether these are independent. Repeated attempts have been made to identify other prognostic factors, but no clear pattern has emerged, with the possible exceptions of patient age, tumour size, and the presence of ulceration.The postsurgical outcome of EGC in the West is marginally less favourable than in Japan. In view of the similar clinical and pathological features in the two regions it seems likely, therefore, that this is because of the more aggressive surgical techniques traditionally used in Japan. Conversely, however, EMR has recently emerged as an important technique in Japan. Despite the advantages of low operative mortality and normal function of the postoperative stomach, there are also a number of potential disadvantages. It would seem sensible, therefore, to await the results of long term follow up studies before widespread adoption of EMR in Europe. Nevertheless, this technique should be considered for frail patients unfit for more radical surgery.

Treatment strategy for gastric non-invasive intraepithelial neoplasia diagnosed by endoscopic biopsy

“…Early gastric cancer (EGC) is typically small, asymptomatic and has a good prognosis [3,4] , but advanced gastric cancer has higher mortality rate [5] . Therefore, early detection and treatment is important for reducing the gastric cancer mortality rate.…”

Analysis of the color patterns of early gastric cancer using an autofluorescence imaging video endoscopy system

“…Therefore, we speculate that the elevated-type tumor reduces autofl uorescence from the submucosa and thus appears purple in AFI images, and that most of the depressed-type tumors do not affect autofl uorescence intensity because they are thin and therefore appear green. In contrast to colon or esophageal tumors, most EGCs have been found to be of a depressed macroscopic type [9]. Therefore, their color would be green, which is uncommon in other regions of the digestive tract.…”

X-ray screening seems to reduce gastric cancer mortality by half in a community-controlled trial in Costa Rica

“…Prognosis of early gastric cancer is very good worldwide. The Japanese treatment model with radical surgery seems to be successful in extending life expectancy (Everett and Axon, 1997). In this regard, the substantial increase of 5-year survival among the Cartago controls may be a positive side effect (a sort of contamination) from the intervention.…”