New Diagnostic Approaches for Early Detection of Gastric Cancer

Abstract

Detection of gastric cancer in early stages is vitally important for ascertaining better prognosis and quality of life for the patients. Therefore, every endoscopist should be trained to master enough diagnostic skills to identify early gastric cancer that often shows minimal alteration from the surrounding mucosa, easily evading detection. For the first step, it is essential that endoscopists understand the normal gastric mucosa as well as the mucosal changes caused by chronic H. pylori infection, a high-risk condition for the development of gastric cancer. Once a suspicious lesion is identified, use of a dye-spraying method may be useful to clarify structural alteration caused by neoplastic changes and facilitate the biopsy sampling. Development of zoom (magnifying) endoscopy enabling 80× magnification with a one-touch switch from conventional endoscopic observation helps to identify the detailed surface structure as well as the vascular architecture of the mucosa without tissue biopsy. Combined with chromoendoscopy, this powerful endoscopic method can be used to identify small cancer foci or delineate the margin of early gastric cancer that can be treatable by mucosal dissection. Other new modalities using a variety of optical devices have been developed but the real value of their utility still remains to be proven in the actual clinical settings.

Cost-effectiveness Analysis between Primary and Secondary Preventive Strategies for Gastric Cancer

“…Dramatic differences in prognosis (5-year survival >90% versus <10%) and medical resource consumption between early and advanced gastric cancer explain why secondary prevention with an early detection rate above 70% can dominate chemoprevention. Currently, endoscopic detection of early gastric cancer can be improved by using magnification, chromoendoscopy, and optical device to identify or delineate the margin of small cancer foci (49). However, in cases with large population or limited clinical manpower, endoscopic surveillance may not be feasible.…”

The Angiotensin I–Converting Enzyme Gene Insertion/Deletion Polymorphism Is Linked to Early Gastric Cancer

“…The recent introduction of chromoendoscopy has improved the identification of early gastric cancer restricted to either mucosa or submucosa, which are accessible to endoscopic resection (14). However, most patients are still diagnosed in advanced stages with lymph node or distant metastases prohibiting curative resection.…”

Screening of gastric cancer in Asia

“…Although endoscopic examination may be superior to photofluorography in detecting cancerous lesions, it still has several problems. The [13, 20,21] which can be variable depending on many factors that influence the quality of examination: these factors include the skill and experience of endoscopists, preparation methods (use of mucolytic agents or injection of anti-spasmodic agent) before examinations, use of high-resolution endoscopic equipment with image-enhanced modalities and double check system on the recorded images [22]. As these factors are not ideal in many endoscopic screenings that are done by board-uncertified endoscopists without using high-resolution endoscopy [19], gastric cancer that evaded detection by endoscopic screening would remain to a certain extent.…”