Clinical Diagnosis and Problems of Type Ⅲ Early Gastric Cancer S. Fukuchi 1 1Toranomon Hospital pp.171-176
Published Date 1972/2/25
DOI https://doi.org/10.11477/mf.1403109000
  • Abstract
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 Type Ⅲ early gastric cancer, having its cancer nests localized only on the margins of the excavation, can also be interpreted as Ⅲ+Ⅱb type since it is not associated with distinct Ⅱc. In the discussion of “ulcer-cancer”, type Ⅲ is apt to be regarded in a broader sense of its definition including also type Ⅲ+Ⅱc. However, seen from the standpoint of clinical diagnosis, strict distinction should be made between type Ⅲ and type Ⅲ+Ⅱc. Only then would our measures for its detection and for its still unsolved problems be justified.

 Of 124 cases of early gastric cancer found by us, type Ⅲ was seen only in three (2.4%). In all of them no malignant changes were noticed either by x-ray, endoscopy or gross findings of the removed stomach. Two were found at a time when biopsy was as yet introduced. The third was confirmed only by biopsy.

 On the other hand, a total of 611 biopsies were attempted on 398 cases (435 lesions) of gastric ulcer and on 111 cases of ulcer scar, but after all no malignancy was to seen. Type Ⅲ early cancer is thus assumed to be quite infrequent.

 Endoscopically, this variety is very difficult to discriminate from benign ulcer. Because no definite macroscopical criteria are as yet established, all cases of chronic gastric ulcer become the object of differential diagnosis. For the detection of type Ⅲ we must perform biopsy on all cases of gastric ulcer periodically at a certain time even when no malignancy is grossly apparent.

 Most of type Ⅲ early gastric cancer belong to the category of “ulcer-cancer” as defined by Hauser, but our cases seem to suggest that it could arise by acute exacerbation of gastric ulcer in the course of its malignant cycle.

 Regarding the question whether gastric ulcer can become cancerous, our results in the clinical follow-up of many ulcer cases have shown no definite evidence yet to prove that benign ulcer can become cancerous.

 Nevertheless, because not only clinical follow-up studies hitherto employed are limited in their methods, but also histopathological investigations are at fault in the chronological follow-up of ulcer courses, the most important measures left for us in the timely diagnosis of type Ⅲ early gastric cancer are detailed long-term follow up of ulcer cases not only by x-ray but also by endoscopy as well as biopsy.

Copyright © 1972, Igaku-Shoin Ltd. All rights reserved.


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