Chronological Changes in Early Gastric Cancer

Abstract

Background: Early gastric cancer, first described in 1908, became of clinical importance only after the introduction of fiberoptic gastroscopy with simultaneous biopsy. It was the purpose of our study to seek for the concrete changes which took place in the distribution of early cancers after the introduction of these diagnostic tools. Material and Methods: Case records and histological slides of all 132 patients with early cancers among the 1,748 gastric cancers operated in the Robert-Rössle-Klinik were investigated for size of the tumor, results of diagnostic methods, and surrounding mucosa. Results: Gastroscopy with simultaneous biopsy led to the detection of new types of early gastric cancer, smaller cancers, and cancers restricted to the mucosa. Investigation of the surrounding mucosa led to the detection of a remarkable proportion of patients with pangastritis. 6 of 8 patients with early gastric cancer and a positive test for parietal cell antibody had pangastritis, too. This is illustrating the fact that both endogenous and exogenous factors are operating together in the pathogenesis of gastric cancer. Conclusions: Gastroscopy should not only be used to explore complaints of patients, but also for the detection of early cancer and precancerous lesions in all persons examined. Persons with autoimmune gastritis and with histologically proven pangastritis should be included into an endoscopic follow-up program.