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Chronological Trend in Morphological Features of Early Stomach Cancer: Recent changes especially of macroscopic findings T. Hirota 1 , M. Unagami 1 , M. Itabashi 1 , H. Kitaoka 2 , Y. Oguro 3 , T. Yamada 4 , H. Ichikawa 4 1Pathology Division, National Cancer Center Research Institute 2National Cancer Center Hospital pp.13-26
Published Date 1981/1/25
DOI https://doi.org/10.11477/mf.1403107896
  • Abstract
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 Cases of early stomach cancer, surgically resected at National Cancer Center Hospital in Tokyo during the period from 1962 to 1979 were 995 cases, which correspond to 28% of the total number of stomach cancer during the same period. In order to search chronological changes of various features like gross types as well as histological types of early stomach cancer, clinicopathological review was carried out on 995 cases. The result obtained was as follow;

 (1) Age and Sex.

 Cases of younger people (younger than 40 years) gradually decreased recently while elder people cases increased in the frequency. Especially cases older than 70 years have increased and reached 18% of total annual number of early stomach cancer cases in 1979. Sex ratio (male/female) had been 2/1 till 1978 but changed into 3/1 in 1979.

 (2) Location.

 According to CMA classification by Japanese General Rules for the Gastric Cancer Study in Surgery and Pathology, “M” area was the most frequent area of cancer (around 60% of the total cases) during the earlier period (1962~1973) of our examination, however, decreased in the frequency of cancer to 50% in contrast with increase of cancer in “A” area up to 40% during the later half period.

 Frequency of cancer localization on the lesser curvature was the highest (70% of the total annual cases) during the early period but gradually decreased to 45% during the later half period, while cancer in either anterior or posterior increased up to 24% and 35%, respectively. Cancer on the greater curvature did not show noticeable change in its frequency throughout the whole period.

 (3) Macroscopic Types.

 Superficial, depressed type (Ⅱc) early stomach cancer occupied about 60% of the total cases in the early period and showed increase up to 74% in the later half period. In contrast to this, elevated type of early stomach cancer showed the decreasing tendency in the frequency. Flat type (Ⅱb) was slightly increased in the frequency up to 3.5% during the earlier period but decrease to 1.6% in the later period.

 We tried to classify the superficial, depressed type (especially Ⅱc-type) into two subtypes; relatively deep Ⅱc-type, and relatively shallow Ⅱc-type. The two subtypes had been almost equal in the frequency during the earlier half period, however, in the later half period the relatively shallow Ⅱc-type (which is difficult to detect) increased remarkably from 64% in the Ⅳth period to 82.4% in 1979. The relatively deep well defined Ⅱc-type (typical Ⅱc) decreased to 20% in 1979.

 (4) Size of the Lesions.

 During the early period, large cancerous lesions were common; lesions larger than 2 cm were 80%, larger than 5 cm; 40%. During the later period, smaller lesions have become more frequent; lesions larger than 5 cm become 10%, lesions smaller than 2 cm occupied 40% of the total early stomach cancer of the year. Minute lesions smaller than 5 mm in diameter, were almost unchanged to be of 1 to 3% throughout the whole period.

 (5) Histologic Types.

 Differentiated type and undifferentiated type adenocarcinoma were found almost equal in the frequency during the early period. The former become more frequent than the latter to be 72% of the total cases during the later half period.

 (6) Ulcer and Ulcer Scar whithin Cancerous Lesions.

 Cancerous lesions with peptic ulcer therein occupied more than 90% of total depressed type early stomach cancers during the early period. They have gradually decreased in the frequency to 74.4% during the later half period.

 As shown above, early stomach cancer has been changing during the examination period in their characteristic features; that is, in gross types including subtypes of depressed lesions, frequency of association of peptic ulceration, histologic types and their maximal diameter and so on. We have discussed about the factors which may have an influence on or may give a reasonable interpretation to the chronological trends of early stomach cancer written above.


Copyright © 1981, 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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