早期胃癌50年の歩みと展望─「胃と腸」論文より

Progress and Prospects of Diagnosing Early Gastric Cancer in the Past 50 years: A Review of Articles from “Stomach and Intestine”

要旨●本誌における早期胃癌に対する診断の歩みを以下の事項について簡潔に述べた．すなわち，胃癌のスクリーニング法はX線検査から内視鏡検査に移行したが，内視鏡検査はがん検診では死亡率減少効果という点で現在のところ有用性は明らかにされていない．深達度診断はM・SMの鑑別から，SM1の診断が求められるようになったが，現在のところ困難である．範囲診断では従来の検査に加えて画像強調内視鏡が用いられるようになりより詳細な画像が得られるようになったが，病理学的な対比が困難なため拡大所見の解析が十分に行えないが，今後の進歩が期待される．早期胃癌はより小さい病変，微細な所見の病変が増加しており，さらに，Helicobacter pylori感染が減少しており，癌の所見の変化に注目する必要がある．

　Reports on the improvements in the diagnosis of early gastric cancer from the journal“Stomach and Intestine”were reviewed. Although, with time, the screening method for gastric cancer changed from X-ray to endoscopy, the usefulness of endoscopy remains uncertain with respect to a decrease in mortality. The diagnosis of SM1 is essential in distinguishing M from SM based on invasion depth; however, diagnosing SM1 is currently very difficult. Although range diagnosis uses image-enhanced endoscopy to generate detailed images, the comparison of pathological findings is also challenging. Therefore, a novel method that assesses endoscopic images in relation to pathological findings is warranted. The incidence of smaller lesions has recently increased in early stages of cancer, whereas the prevalence of Helicobacter pylori infections has decreased. Therefore, endoscopists need to focus to changes in endoscopic findings.