DIAGNOSIS OF THE DEPTH OF CANCEROUS INVASION IN THE GASTRIC WALL: FROM THE STANDPOINT OF QUANTIFICATION OF ENDOSCOPIC DIAGNOSIS Kazutaka Hirokado 1 1Second Department of Internal Medicine, Faculty of Medicine, Kyushu Unicersity pp.327-337
Published Date 1969/3/25
DOI https://doi.org/10.11477/mf.1403110983
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 The present status for estimation of the depth of cancer involvement as well as dependable findings for its index is studied in this papar from the standpoint of endoscopic diagnosis, by examining 139 cases of gastric cancer,69 of which belong to early cancer X-ray and the other 70 to advanced one. All these cases have ample evidence of both and endoscopy films to sustain retrospective analysis.

 1) In cases of type Ⅰ early gastric cancer and Borrmann Ⅰ type advanced cancer, five out of six were correctly diagnosed by endoscopy. Two cases of Ⅱa type early gastric cancer were likewise well differentiated. As for Ⅱa+Ⅱc type early cancer and Borrmann Ⅱ and Ⅲ type advanced cancer, 43 in 47 cases proved to be correct in their diagnosis. The remaining four early gastric cancer cases were all mistaken for advanced one due to overestimation of extensive submucosal cancer invasion. Regarding Ⅱc+Ⅲ and Ⅲ type early gastric cancer as well as advanced one of similar types, exact differentiation was made in 60 cases out of 84, or 71%. It is noteworthy that 32 cases out of 51, or only 63% were correctly discriminated in Ⅱc+Ⅲ type early gastric cancer. Diagnostic difficulties seem to be more manifest in this type of cancer for estimation of the depth of cancer invasion.

 2) In early gastric cancer of Ⅰ and Ⅱa+Ⅱc types as well as advanced cancer of Borrmann Ⅰ, Ⅱ and Ⅲ types, close correlation is found between the size of tumor and the degree of cancer infiltration, and the former may be used as an index for measuring the depth of cancer invasion. No such correlation is seen in Ⅱc, Ⅱc+Ⅲ and Ⅲ type early gastric cancer and similar types of advanced cancer.

 3) In type Ⅱc gastric cancer, 17 out of 18 endoscopically confirmed cases proved to be early gastric cancer, while in type Ⅲ cancer, allb ut two in 15 endoscopically verified cases, or 87%, proved to be advanced one. It is thus presumed that there is a close connection between endoscopic diagnosis of each of these types and the estimation of the depth of cancer invasion.

 4) Frequency of positive endoscopic findings in each type of gastric cancer in two stages, early and advanced, is studied stochastically, in order to seek any dependable index for the differentiation between early and advanced gastric cancer. In cases of Ⅱc+Ⅲ type cancer, both early and advanced, positive endoscopic findings, that are of help for separating early from advanced cancer, is so scarce that diagnosis of the depth of cancer involvement is very difiicult.

 5) Necessity and availability are discussed in this report of objectification in handling information leading to endoscopic diagnosis; introduction of stochastic method is a must and is a great help for due estimation and coordination of obtained endoscopic findings.

Copyright © 1969, Igaku-Shoin Ltd. All rights reserved.


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