Increase of Gastric Cancers in which Borders were Difficult to Recognize Osamu Hosokawa 1 , Yasuharu Kaizaki 2 , Kunishige Watanabe 1 , Masakazu Hattori 1 , Kenji Douden 1 1Department of Surgery, Fukui Prefectural Hospital 2Department of Pathology, Fukui Prefectural Hospital Keyword: 胃癌 , 浸潤範囲診断 , 肉眼的識別 , 形態学的変遷 , 時代的変化 pp.1229-1237
Published Date 2001/9/25
DOI https://doi.org/10.11477/mf.1403103313
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 As patients with early gastric cancer frequently underwent local resection such as endoscopic mucosal resection and segmental resection, it became more important to recognize the borders of the lesions. We studied the change, over a period of about 20 years, of gastric cancer in terms of the difficulty encountered in recognizing its boundry.

 A series of 100 patients with early gastric cancer resected in the late 1990s were compared with 100 patients with early gastric cancer in the early 1970s. The patients in the late 1990s were significantly older than those in the early 1970s. In the late 1990s the rate of patients without complaints increased and endoscopic examination had replaced x-ray examination as the initial diagnostic method.

 In 19 patients of the early 1970s compared with the boundaries which were histologically proved, the extent of cancerous infiltration was not correctly recognized by the macroscopic investigation. In the late 1990s such patients increased to 43, which difference is significant. The difficult-to-recognize lesions increased significantly among the protruded type of early gastric cancers in the late 1990s. In the early 1970s the histological type of difficult-to-recognize lesions was confined to moderately differentiated adenocarcinomas and signet ring cell carcinomas, but in the late 1990s this difficulty was encountered in all histological types. In most of the difficult-to-recognize lesions of the early 1970s, cancerous cells had infiltrated the atrophic region and were covered with surface mucosa. However, in the late 1990s such lesions decreased and other infiltrating types increased.

 Gastric cancers, whose borders were difficult-to-recognize, increased in the late 1990s in comparison with those in the early 1970s. We suggested that this change occurred due to the adoption of the new initial diagnostic method and the use of strong anti-ulcer drugs such as histamine H2-receptor antagonist and proton pump inhibitor. Endoscopist often detected gastric cancers with abnormalities inside the lesions but without abnornalites at the margins and these drugs tend to alter the margins of depressed lesions.

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