Endoscopic Approach to Progression from Early to Advanced Cancer of the Stomach higeaki Yoshida 1 1Department of Medicine, National Cancer Center Hospital Keyword: 進行胃癌 , 経過観察 , 急速発育 , 緩速発育 , 多変量解析 pp.825-834
Published Date 1997/5/25
DOI https://doi.org/10.11477/mf.1403105145
  • Abstract
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 In order to clarify macroscopically how early cancers progress to advanced ones, we examined the early appearances of cancerous lesions in endoscopic films from followed up cases of advanced gastric cancer (AGC), of which malignancy had not been diagnosed at the previous endoscopy carried out within five years prior to the final examination. In those of Ⅱc-like advanced type,78% (7/9) were derived from ulcerative lesions. In contrast, in those of 2,3 and 4 types 75% (12/ 16) were from nonulcerative lesions, i.e. shallow depression, faint erythematous mucosa and so on, or nonspecific mucosa. The growth patterns of these two groups were apparently different. In the latter group the progression from superficial mucosal to massive invasive lesions was dramatically rapid (within two or three years) in most of the cases as shown in 〔Cases 1~3〕, whereas, endoscopically, the ulcerative lesions in the former group were not markedly changed, except for one case shown as 〔Case 4〕.

 In the two cases of early gastric cancer (EGC) in which the patients delayed surgery, the endoscopic appearance of their lesions changed remarkably to that of deep invasive ones during three years in one case 〔Case 7〕 and 30 days in the other one 〔Case 8〕.

 From the multivariate analysis examining the correlation of macroscopic types to sex, location and histological type which are stable during the cancer progression, close correlation was observed between the depressed type of EGC in younger patients and type 3 or 4 AGC, as well as that between the Ⅱa + Ⅱc type of EGC and type 2 AGC.

 The above may indicate that there are two ways in the progression of early gastric cancer to advanced gastric cancer, i.e. that from ulcerative types and that from nonulcerative types. The endoscopic progression from superficial to massively invasive findings is completed within a short period, except for most ulcerative cancers with fold convergence. In addition, it can be said that Ⅱc type of EGCs in the younger generation have much more potential for progression than those found in older patients.

Copyright © 1997, Igaku-Shoin Ltd. All rights reserved.


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