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Radiological Diagnosis of the Depth of Invasion for Early Gastric Cancer Beyond the Indications of the Guideline Tsutomu Hamada 1 1Department of Gastroenterology, Social Heath Insurance Medical Center Keyword: 早期胃癌 , 内視鏡的切除 , 外科切除 , 適応拡大 , X線診断 pp.19-30
Published Date 2006/1/25
DOI https://doi.org/10.11477/mf.1403100016
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 Endoscopic therapy has made it possible to remove early cancers within the guidelines such as cancers less than 2 cm in size, depressed type without ulceration and differentiated type. Recently, a new technique called ESD (endoscopic submucosal dissection) which can remove a wider range of cancers, has been introduced and it has been used to treat early cancers more than 2 cm in size, depressed type with ulceration and undifferentiated type. But, in such lesions which are considered as being beyond the indication of endoscopic therapy, cancerous infiltration is not always limited to the mucosa and sometimes has already invaded the submucosa. When we endoscopically remove a cancer it is hard to diagnose the depth of invasion relying only on endoscopy, so we emphasize that radiological figures are very useful for determining the depth of invasion.

 The radiological findings which indicate cancerous invasion to the submucosa are as follows. In elevated lesions ; ( 1 ) rigidity of the gastric wall often pictured in the lateral view of the tumor, ( 2 ) complicated depressed change around the elevated lesion in the double contrast frontal view, ( 3 ) complicated margin just like submucosal tumor in the double contrast or compression view. In the depressed lesions ; ( 1 ) deep depression and complicated central nodural changes in the double contrast view, ( 2 ) elevated change covered with normal mucosa around the depressed lesion in the double contrast or compression view, ( 3 ) obvious clubbing and adhesion of converging folds in the double contrast view with an abundant amount of air.


Copyright © 2006, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院

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