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Detection and Management of Early Gastric Cancer

  • Stomach (C Howden, Section Editor)
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Opinion statement

Early gastric cancer (EGC), defined as being confined to the submucosa, is a curable condition. In recent years, endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) have been widely applied to subgroups of mucosal cancers, thereby avoiding the burden of operation while preserving gastric function. However, it can be difficult to identify mucosal cancers, which often evade detection due to their flat shapes without ulceration. Proper preparation to clean the mucosal surface, detailed systematic observation of the entire stomach, and the use of high-resolution systems for both endoscopies equipped with image-enhanced modality and monitors would facilitate the detection of such lesions. It is also critical to evaluate the resected specimen to confirm completeness of resection (tumor-free lateral and vertical margins as well as the absence of lymphatic and vascular invasion). If the resection is incomplete, further treatment is usually recommended—further endoscopic resection for patients with positive lateral margins or surgery for patients with positive vertical margins or with lymphatic or vascular involvement. The five-year survival for endoscopically resected EGC is excellent—and comparable to that of surgical therapy. Since most gastric cancers are caused by Helicobacter pylori, this infection should be tested for routinely. If a patient is H. pylori-positive, eradication is recommended, as heterotopic, metachronous recurrence of EGC is subsequently reduced. Importantly, basic principles for early diagnosis and endoscopic treatment of EGC can be applied to neoplasms arising in other parts of the gut, such as the esophagus and colon, and would be beneficial for patients through preserving organ function and minimizing operative intervention.

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References and Recommended Reading

Papers of particular interest, published in recent years, have been highlighted as: • Of importance •• Of major importance

  1. Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 2011;14:101–12.

    Article  Google Scholar 

  2. Sano T, Kobori O, Muto T. Lymph node metastasis from early gastric cancer: endoscopic resection of tumour. Br J Surg. 1992;79:245–7.

    Article  Google Scholar 

  3. Yamao T, Shirao K, Ono H, Kondo H, Saito D, Yamaguchi H, et al. Risk factors for lymph node metastasis from intramucosal gastric carcinoma. Cancer. 1996;77:602–6.

    Article  CAS  PubMed  Google Scholar 

  4. Gotoda T, Yanagisawa A, Sasako M, Ono H, Nakanishi Y, Shimoda T, et al. Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer. 2000;3:219–25.

    Article  PubMed  Google Scholar 

  5. Tada M, Shimada M, Murakami F, Mizumachi M, Arima K, Yanai H, et al. Development of strip-off biopsy. Gastroenterol Endosc. 1984;26:833–9. in Japanese with English abstract.

    Google Scholar 

  6. Hirao H, Takeshita K, Hori H, Muraoka Y, Yoneshima H. Endoscopic resection of early gastric cancer and other tumors with local injection of hypertonic saline-epinephrine. Gastrointest Endosc. 1988;34:264–9.

    Article  CAS  PubMed  Google Scholar 

  7. Inoue H, Takeshita K, Hori H, Muraoka Y, Yoneshima H, Endo M. Endoscopic mucosal resection with a cap-fitted panendoscope for esophagus, stomach, and colon mucosal lesions. Gastrointest Endosc. 1993;39:58–62.

    Article  CAS  PubMed  Google Scholar 

  8. Ono H, Kondo H, Gotoda T, Shirao K, Yamaguchi H, Saito D, et al. Endoscopic mucosal resection for treatment of early gastric cancer. Gut. 2001;48:225–9.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  9. Yamamoto H, Sekine Y, Higashizawa T, Kihira K, Kaneko Y, Hosoya Y, et al. Successful en bloc resection of a large superficial gastric cancer by using sodium hyaluronate and electrocautery incision forceps. Gastrointest Endosc. 2001;54:629–32.

    Article  CAS  PubMed  Google Scholar 

  10. Ohkuwa M, Hosokawa K, Boku N, Ohtu A, Tajiri H, Yoshida S. New endoscopic treatment for intramucosal gastric tumors using an insulated-tip diathermic knife. Endoscopy. 2001;33:221–6.

    Article  CAS  PubMed  Google Scholar 

  11. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010 (ver.3). Gastric Cancer. 2011;14:113–23. This guideline described the principles of therapy for gastric cancer including endoscopic treatment. In Japan, version 4 was published which will be translated into English. Guidelines for endoscopic resection are similar in version 4.

    Article  Google Scholar 

  12. Schlemper RJ, Itabashi M, Kato Y, Lewin KJ, Riddell RH, Shimoda T, et al. Differences in diagnostic criteria for gastric carcinoma between Japanese and Western pathologists. Lancet. 1997;349:1725–29.

    Article  CAS  PubMed  Google Scholar 

  13. Schlemper RJ, Kato Y, Stolte M. Review of histological classifications of gastrointestinal epithelial neoplasia: differences in diagnosis of early carcinomas between Japanese and Western pathologists. J Gastroenterol. 2001;36:445–56.

    Article  CAS  PubMed  Google Scholar 

  14. Rugge M, Cassaro M, Pennelli G, Russo VM, Di Mario F, Farinati F. Pathology and cost effectiveness of endoscopy surveillance for premalignant gastric lesions. Gut. 2003;52:453–4.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  15. Rugge M, Cassaro M, Di Mario F, Leo G, Leandro G, Russo VM, et al. The long term outcome of gastric non-invasive neoplasia. Gut. 2003;52:1111–16.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  16. Schlemper RJ, Riddell RH, Kato Y, Borchard F, Cooper HS, Dawser SM et al. The Vienna classification of gastrointestinal epithelial neoplasia. Gut. 2000; 47: 251–5.

  17. Schlemper RJ, Kato Y, Stolte M. Diagnostic criteria for gastrointestinal carcinomas in Japan and Western countries: proposal for a new classification system of gastrointestinal epithelial neoplasia. J Gastroenterol Hepatol. 2000;15:G49–57.

    Article  PubMed  Google Scholar 

  18. Tanaka K, Toyoda H, Kadowaki S, Hamada Y, Kosaka R, Matusaki S, et al. Surface pattern classification by enhanced-magnification endoscopy for identifying early gastric cancer. Gastrointest Endosc. 2008;67:430–7.

    Article  PubMed  Google Scholar 

  19. Kaise M, Kato M, Urashima M, Kaneyama H, Kanazawa Y, Yonezawa J, et al. Magnifying endoscopy combined with narrow-band imaging for differential diagnosis of superficial depressed gastric lesions. Endoscopy. 2009;41:310–5.

    Article  CAS  PubMed  Google Scholar 

  20. Pimentel-Nunes P, Dinis-Ribeiro M, Soares JB, Marcos-Pinto R, Santos C, Rolanda C, et al. A multicenter validation of an endoscopic classification with narrow band imaging for gastric precancerous and cancerous lesions. Endoscopy. 2012;44:236–46.

    Article  CAS  PubMed  Google Scholar 

  21. Yao K. How is the VS (vessel plus surface) classification system applicable to magnifying narrow-band imaging examinations of gastric neoplasia initially diagnosed as low-grade adenomas? Gastric Cancer. 2012;15:118–20. This article described the classification of the microsurface pattern and microvessel patterns which has been accepted as a useful in the differential diagnosis of cancerous vs. noncancerous mucosa.

    Article  PubMed  Google Scholar 

  22. Osawa H, Yoshizawa M, Yamamoto H, Kita H, Satoh K, Ohnishi H, et al. Optimal band imaging system can facilitate detection of changes in depressed-type early gastric cancer. Gastrointest Endosc. 2008;67:226–34.

    Article  PubMed  Google Scholar 

  23. Yoshizawa M, Osawa H, Yamamoto H, Kita H, Nakano H, Satoh K, et al. Diagnosis of elevated-type early gastric cancers by the optimal band imaging system. Gastrointest Endosc. 2009;69:19–28.

    Article  PubMed  Google Scholar 

  24. Kaneko K, Oono Y, Yano T, Ikematsu H, Odagaki T, Odagaki T, et al. Effect of novel bright image enhanced endoscopy using blue laser imaging (BLI). Endoscopy Int Open. 2014;02:E212–9.

    Article  Google Scholar 

  25. Osawa H, Yamamoto H, Miura Y, Sasao W, Ino Y, et al. Blue laser imaging provides excellent endoscopic images of upper gastrointestinal lesions. Video J Encycl GI Endoscopy. 2014. doi:10.1016/j.vjgien.2014.01.001.

    Google Scholar 

  26. Yagi K, Nakamura A, Sekine A. Comparison between magnified endoscopy and histological, culture and urease test findings from the gastric mucosa of the corpus. Endoscopy. 2002;24:376–81.

    Article  Google Scholar 

  27. Anagnostopoulos GK, Yao K, Kayer P, et al. High-resolution magnification endoscopy can reliably identify normal gastric mucosa, Helicobacter pylori-associated gastritis, and gastric atrophy. Endoscopy. 2007;39:202–7.

    Article  CAS  PubMed  Google Scholar 

  28. Uedo N, Ishihara R, Ishii H, et al. A new method of diagnosing gastric intestinal metaplasia: narrow-band imaging with magnifying endoscopy. Endoscopy. 2006;38:819–24.

    Article  CAS  PubMed  Google Scholar 

  29. Sugano K, Sato K, Yao K. New diagnostic approaches for early detection of gastric cancer. Dig Dis. 2004;22:327–33.

    Article  PubMed  Google Scholar 

  30. Veitch AM, Uedo N, Yao K, East JE. Optimizing early upper gastrointestinal cancer detection at endoscopy. Nat Rev Gastroenterol Hepatol. 2015. doi:10.1038/nrgastro.2015.128. This paper published very recently was written from the viewpoint of Western gastroenterologists. However, there are a number of useful points that can be applied to daily clinical practice. Many points raised in this article are consistent with the view of this review article.

    PubMed  Google Scholar 

  31. Ezoe Y, Muto M, Horimatsu T, Minashi K, Yano T, Sano Y, et al. Magnifying narrow-band imaging versus magnifying white-light imaging for the differential diagnosis of gastric small depressive lesions: a prospective study. Gastrointest Endosc. 2010;71:477–84.

    Article  PubMed  Google Scholar 

  32. Kato M, Kaise M, Yonezawa J, Toyoizumi H, Yoshimura N, Yoshida Y, et al. Magnifying endoscopy with narrow-band imaging achieves superior accuracy in the differential diagnosis of superficial gastric lesions identified with white-light endoscopy: a prospective study. Gastrointest Endosc. 2010;72:523–9.

    Article  PubMed  Google Scholar 

  33. Ezoe Y, Muto M, Uedo N, Doyama H, Yao K, Oda I, et al. Magnifying narrowband imaging is more accurate than conventional white-light imaging in diagnosis of gastric mucosal cancer. Gastroenterology. 2011;141:2017–25.

    Article  PubMed  Google Scholar 

  34. Yagi K, Aruga Y, Nakamura A, Sekine A, Umezu H. The study of dynamic chemical magnifying endoscopy in gastric neoplasia. Gastrointest Endosc. 2005;62:963–9.

    Article  PubMed  Google Scholar 

  35. Sakai Y, Eto R, Kasanuki J, Kondo F, Kato K, Arai M, et al. Gastrointest Endosc. 2008;68:635–41.

    Article  PubMed  Google Scholar 

  36. Yanai H, Noguchi T, Mizumachi S, Tokiyama H, Nakamura H, Tada M, et al. A blind comparison of the effectiveness of endoscopic ultrasonography and endoscopy in staging early gastric cancer. Gut. 1999;44:361–5.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  37. Yoshida T, Kawachi H, Sasajima K, Shiokawa A, Kudo S. The clinical meaning of a nonstructural pattern in early gastric cancer on magnifying endoscopy. Gastrointest Endosc. 2005;62:48–54.

    Article  PubMed  Google Scholar 

  38. Kobara H, Mori H, Fujihara H, Kobayashi M, Nishiyama N, Nomura T, et al. Prediction of invasion depth for submucosal differentiated gastric cancer by magnifying endoscopy with narrow-band imaging. Oncol Rep. 2012;28:841–7.

    PubMed  Google Scholar 

  39. Kaneko T, Sekikawa A, Tsumura T, Maruo T, Osaki Y, Wakasa T, et al. Absent microsurface pattern is characteristic of early gastric cancer of undifferentiated type: magnifying endoscopy with narrow-band imaging. Gastrointest Endosc. 2014;88:1194–8.

    Google Scholar 

  40. Hirasawa T, Gotoda T, Miyata S, Kato Y, Shimoda T, Taniguchi H, et al. Incidence of lymph node metastasis and the feasibility of endoscopic resection for undifferentiated-type early gastric cancer. Gastric Cancer. 2009;12:148–52.

    Article  PubMed  Google Scholar 

  41. Sawada S, Fujisaki J, Yamamoto N, Kato Y, Ishiyama A, Ueki N, et al. Expansion of indications for endoscopic treatment of undifferentiated mucosal gastric cancer: analysis of intramucosal spread in resected specimen. Dig Dis Sci. 2010;55:1376–80.

    Article  PubMed  Google Scholar 

  42. Gotoda T, Yamamoto H, Soetikno R. Endoscopic submucosal dissection of early gastric cancer. J Gastroenterol. 2006;41:929–42.

    Article  PubMed  Google Scholar 

  43. Haruta H, Hosoya Y, Sakuma K, Shibusawa H, Satoh K, Yamamoto H, et al. Clinicopathological study of lymph-node metastasis in 1,389 patients with early gastric cancer: assessment of indications for endoscopic resection. J Dig Dis. 2008;9:213–8.

    Article  PubMed  Google Scholar 

  44. Jee YS, Hwang SH, Rao J, Park DJ, Kim HH, Lee HJ, et al. Safety of extended endoscopic mucosal resection and endoscopic submucosal dissection following the Japanese Gastric Cancer Association treatment guidelines. Br J Surg. 2009;96:1157–61.

    Article  CAS  PubMed  Google Scholar 

  45. Lee HL, Eun CS, Lee OY, Han DS, Yoon BC, Choi HS, et al. When do we miss synchronous gastric neoplasms with endoscopy? Gastrointest Endosc. 2010;71:1159–65.

    Article  PubMed  Google Scholar 

  46. Kopelman Y, Siersema PD, Bapaye A, Kopelman D. Endoscopic full-thickness GI wall resection: current status. 2012; 75: 165-73

  47. Cao Y, Liao C, Tan A, Gao Y, Mo Z, Gao F. Meta-analysis of endoscopic submucosal dissection versus endoscopic mucosal resection for tumors of the gastrointestinal tract. Endoscopy. 2009;41:751–7.

    Article  CAS  PubMed  Google Scholar 

  48. Lian J, Chen S, Zhang Y, Qiu F. A meta-analysis of endoscopic submucosal dissection and EMR for early gastric cancer. Gastrointest Endosc. 2012;76:763–70.

    Article  PubMed  Google Scholar 

  49. Yamamoto H, Yahagi N, Oyama T, Gotoda T, Doi T, Hirasaki S, et al. Usefulness and safety of 0.4 % sodium hyaluronate solution as a submucosal fluid “cushion” in endoscopic resection for gastric neoplasms: a prospective multicenter trial. Gastrointest Endosc. 2008;67:830–9.

    Article  PubMed  Google Scholar 

  50. Yang Z, Wu Q, Liu Z, Wu K, Fan D. Proton pump inhibitors versus histamine-2-receptor antagonists for the management of iatrogenic gastric ulcer after endoscopic mucosal resection of endoscopic submucosal dissection: a meta-analysis of randomized trials. Digestion. 2011; 315-20

  51. Yoon SB, Park JM, Lim CH, Cho YK, Choi MG. Effect of Helicobacter pylori eradication on metachronous gastric cancer after endoscopic resection of gastric tumors: a meta-analysis. Helicobacter. 2014;19:243–8. This meta-analysis provides evidence that H. pylori should be eradicated after endoscopic resection, if the patients are positive for the infection. Previous reviews on endoscopic therapy for early gastric cancer often ignored this important practice to reduce the metachronous development of gastric cancer.

    Article  PubMed  Google Scholar 

  52. Oda I, Gotoda T, Sasako M, Sano T, Katai H, fukagawa T, et al. Treatment strategy after non-curative endoscopic resection of early gastric cancer. Br J Surg. 2008; 1495-1500.

  53. Sekiguchi M, Suzuki H, Oda I, Abe S, Nonaka S, Yoshinaga S, et al. Favorable long-term outcomes of endoscopic submucosal dissection for locally recurrent early gastric cancer after endoscopic resection. Endoscopy. 2013;45:708–13.

    Article  PubMed  Google Scholar 

  54. Goto O, Fujishiro M, Kodashima S, Ono S, Omata M. Outcomes of endoscopic submucosal dissection for early gastric cancer with special reference to validation for curability criteria. Endoscopy. 2009;41:118–22.

    Article  CAS  PubMed  Google Scholar 

  55. Isomoto H, Shikuwa S, Yamaguchi N, Fukuda E, Ikeda K, Nishiyama H, et al. Endoscopic submucosal dissection for early gastric cancer: a large-scale feasibility study. Gut. 2009;58:331–6.

    Article  CAS  PubMed  Google Scholar 

  56. Ahn JY, Jung HW, Choi KE, Choi JY, Kim MY, Lee JH, et al. Endoscopic and oncologic outcomes after endoscopic resection for early gastric cancer: 1370 cases of absolute and extended indications. Gastrointest Endosc. 2011;74:485–93.

    Article  PubMed  Google Scholar 

  57. Kurokawa Y, Hasuike N, Ono H, Boku N, Fukuda H, for the Gastrointestinal Oncology Study Group of Japan Clinical Oncology Group (JCOG). A phase II trial of endoscopic submucosal dissection for mucosal gastric cancer: Japan Clinical Oncology Group Study JCOG0607. Jpn J Clin Oncol. 2009;39:464–6.

    Article  PubMed  Google Scholar 

  58. Kim JJ, Lee JH, Jung HY, Lee GH, Cho JY, Ryu CB, et al. EMR for early gastric cancer in Korea: a multicenter retrospective study. Gastrointest Endosc. 2007;66:693–700.

    Article  PubMed  Google Scholar 

  59. Chung IK, Lee JH, Lee SH, Kim SJ, Cho JY, Cho WY, et al. Therapeutic outcomes in 1000 cases of endoscopic submucosal dissection for early gastric neoplasms: Korean ESD Study Group multicenter study. Gastrointest Endosc. 2009;69:1228–35.

    Article  PubMed  Google Scholar 

  60. Deprez PH, Bergman JJ, Meisner S, Ponchon T, Repici A, Dinis-Ribeiro M, et al. Current practice with endoscopic submucosal dissection in Europe: position statement from a panel of experts. Endoscopy. 2010;42:853–8.

    Article  CAS  PubMed  Google Scholar 

  61. Lau M, Le A, El-Serag HB. Noncardia gastric adenocarcinoma remains an important and deadly cancer in the United States: secular trends in incidence and survival. Am J Gastroenterol. 2006;101:2485–92.

    Article  PubMed  Google Scholar 

  62. Sugano K. Screening of gastric cancer in Asia. Best Pract Res Clin Gastroenterol. 2015.

  63. International Agency for Research on Cancer. Helicobacter pylori eradication as a strategy for preventing gastric cancer. IARC working group report 8. 2014. Lyon. In this report, the IARC has announced that H. pylori eradication can prevent gastric cancer and hence the infection should be eradicated as a primary preventive measure when feasible.

  64. Ford ACF, Forman D, Hunt RH, Yuan Y, Moayyedi P. Helicobacter pylori eradication therapy to prevent gastric cancer in healthy asymptomatic infected individuals: systematic review and meta-analysis of randomized controlled trial. BMJ 348;g3174 doi: 10.1136/bmj.g3174.

  65. Sugano K, Tack J, Kuipers EJ, Graham DY, El-Omar EM, Miura S, et al. Kyoto global consensus report on Helicobacter pylori gastritis. Gut. 2015;64:1353–67. The first comprehensive consensus report on H. pylori gastritis covering classification of gastritis, differentiation of functional dyspepsia and H. pylori gastritis, diagnosis and grading of gastritis, and therapeutic strategy of H. pylori gastritis.

    Article  PubMed Central  PubMed  Google Scholar 

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  1. Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan

    Kentaro Sugano MD

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Kentaro Sugano has received lecture fees from Fujifilm Medical Inc.

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Sugano, K. Detection and Management of Early Gastric Cancer. Curr Treat Options Gastro 13, 398–408 (2015). https://doi.org/10.1007/s11938-015-0070-y

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