Abstract
A series of 536 patients who underwent gastric resections for advanced gastric cancer has been reviewed with regard to the diagnostic procedures for detecting gastric cancer. There were no characteristic symptoms of gastric cancer, but weight loss was a frequent complaint. Variation in the type and frequency of symptoms did not appear to depend on the presence or absence of metastases. Patients whose operations were delayed more than one year after the onset of symptoms accounted for 33% of the series, and 38% of these had visited their physicians within 6 months after the onset of symptoms but were misdiagnosed as having chronic gastritis or benign ulcer. The results of various laboratory examinations were not specific. Gastric acidity was found to be distinctly lower than in patients with benign gastric disease. Techniques of radiology, endoscopy, and endoscopic biopsy of the stomach have greatly improved, and the overall rates of correct diagnosis of gastric cancer were 96% by x-ray, 98% by endoscopy, and 90% by biopsy. These rates were slightly lowered when only Borrmann type IV lesions were considered. Celiac angiography was useful to determine the extent or depth of cancerous invasion and to detect liver metastases. The frequency of positive PPD or DNCB skin tests appeared to decrease as the stage of cancer advanced, indicating immunologic impairment in advanced gastric cancer.
Résumé
La valeur des méthodes de diagnostic du cancer gastrique a été revue dans une analyse de 536 cas de gastrectomie pour cancer avancé. Il n'y a pas de symptome caractéristique du cancer gastrique; la perte de poids est fréquente. Les variations de type et de fréquence des symptomes semblent être indépendantes de la présence ou de l'absence de métastases. Dans la série, 33% des malades ont été opérés plus d'un an après le début des symptomes: 38% d'entre eux avaient consulté leur médecin moins de 6 mois après les premiers symptomes, mais un diagnostic erroné de gastrite chronique ou d'ulcère bénin avait été posé. Les résultats des examens de laboratoire n'ont rien de spécifique. L'acidité gastrique est nettement plus basse dans le cancer que dans les lésions bénignes de l'estomac. Les techniques de la radiographie, de l'endoscopie et de la biopsie endoscopique se sont fort améliorées et donnent actuellement 96% de diagnostics exacts pour la radiographie, 98% pour l'endoscopie et 90% pour la biopsie. Ces pourcentages sont un peu moins favorables pour les lésions de type Borrmann IV. L'artériographie coeliaque est utile pour préciser l'étendue et la profondeur de l'extension du cancer et pour déceler les métastases hépatiques. La fréquence de tests positifs au PPD ou DNCB semble se réduire pour les cancers aux stades avancés, suggérant l'existence d'altérations immunologiques.
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Nagao, F., Takahashi, N. Diagnosis of advanced gastric cancer. World J. Surg. 3, 693–698 (1979). https://doi.org/10.1007/BF01654790
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DOI: https://doi.org/10.1007/BF01654790