Two Cases of Early Colorectal Cancer Associated with Gastric Adenoma Detected by Serum Pepsinogen Screening Method

Abstract

It is widely accepted that the serum pepsinogen levels reflect the morphological and functional status of gastric mucosa and the diagnostic value in atrophic gastritis is now established (1). Since a considerable number of gastric cancer develop in gastric mucosa affected by severe and extensive atrophic gastritis, it is considered as a precancerous condition that leads to the development of gastric cancer (2). Indeed, the prevalence rates of atrophic gastritis diagnosed by the serum pepsinogen test show a high correlation with standardized mortality ratios (3) or age-adjusted mortality rates for gastric cancer among prefectures (4). Thus, the serum pepsinogen levels could be an objective marker that selects the high risk population of gastric cancer (5). On the basis of the above mentioned facts, mass screening that utilizes the measurement of the serum pepsinogen levels has been performed in a certain workplace in Tokyo since 1991. Subjects showing low serum pepsinogen levels (pepsinogen I of less than 70 ng/ml and a I/II ratio of 3.0) were considered to have advanced stage of atrophic gastritis and further investigated by endoscopy as the second step of screening. As a result, 13 gastric adenocarcinomas and 7 gastric adenomas were found during the first two years. It is interesting that of 7 patients with gastric adenomas, two colorectal adenocarcinomas were accidentally found. Here we report the two cases of colorectal adenocarcinomas associated with gastric adenoma screened by the serum pepsinogen test.