During a period beginning in 1946 and ending in October of 1978, 1000 cases of solitary early gastric carcinoma were operated on at the Cancer Institute Hospital, Tokyo, Japan. The clinical characteristics and the macroscopic and chronological changes were studied in these cases. Early gastric carcinoma comprised one third of all resected gastric carcinoma. If early gastric carcinoma was divided into two groups, the depressed and the elevated, the former was more common. By location, the depressed type lesions were more frequently seen in the middle third of the stomach and the elevated type lesions in the lower third. By age, distribution of the elevated type lesions showed a peak with a mode at the age of 60 to 69 years and of the depressed type, a plateau with a mode at the age of 50 to 59 years. The relative incidence of the elevated type of gastric carcinoma to the depressed type was one to four. In depth of invasion, the mucosa and the submucosa were equally involved. Lymph node metastases were encountered in 12.7% of early gastric carcinoma cases. The incidence of positive nodes in mucosal carcinoma was 3.4% and that of submucosal lesions was 21.7%. Of the elevated type carcinoma, 20.9% of the cases had positive nodes. The 5-year survival rate of the patients with surgery for cure was 93.8% in contrast to 56.5% of those with palliative resection.

This is an epidemiological study of 107 patients with large bowel cancer and 307 control patients interviewed in Japan. Colon cancer is significantly less common in Japan, but rectal cancer is as common in Japan as it is in the United States. Japanese patients with cancer of the colon have a higher socioeconomic status than rectal cancer patients. Associated with the higher status is a more Western style diet. It is suggested that perhaps dietary fat influences the make‐up of the bacterial flora and thus affects the pathogenesis of cancer of the colon. No significant relationship was found to medical and surgical diseases nor to the cholesterol and weight levels.

A group of 243 patients with gastric cancer was subjected to a prospective randomized trial of adjuvant chemotherapy after curative gastrectomy. One of the three arms (regimen A) is induction therapy with a three-drug combination of mitomycin C (MMC), 5-fluorouracil (5-FU), and cytosine arabinoside (ara-C) followed by intermittent oral administration of 5-FU for two years (MFC + F). In regimen B, 5-FU in regimen A is replaced by ftorafur, administered on the same schedule as regimen A (MF'C + F'). Regimen C is the control, in which patients are treated by surgery alone. Regimen A was proven effective for the suppression of relapse in the limited groups of moderately locally advanced cancer; five-year survival rates of the subset of stages I, II, and III were 72.1% with regimen A and 53.1% with regimen C (P less than .05). Regimen B yielded a better survival than the control, although the difference did not reach statistical significance. The results seem to favor 5-FU as adjuvant chemotherapy for gastric cancer.

Over the past 3 decades, ending in 1979, resection has been performed in 7,220 patients with gastric carcinoma. Synchronous multiple gastric carcinoma, according to the diagnostic criteria of Moertel, was found in 468, of which 178 (38%) were "early." There were 135 double, 33 triple, and 10 quadruple early earcinomas. Fewer than one-third of the smaller tumors were diagnosed preoperatively, and 61.5% of the smaller lesions were less than 10 mm in diameter. In 53% of the patients, the smaller lesions were in the lower one-third of the stomach with the main lesion in the upper one-third, whereas in 13% the smaller neoplasms were iocated in the upper one-third of the stomach with the main lesion in the Iower one-third. The clinical significance of the smaller lesions was their location relative to the resection line. When planning treatment of gastric carcinoma, it is important to evaluate the whole stomach before and during the operation and after examining the resected specimen. The 5-year survival rate for patients with multiple early gastric carcinoma was 85.8%.The concept of the management of early gastric carcinoma bas evolved since the first description by Verse in 1908 [1]. Recently, we have achieved an increase in the detection of early gastric carcinoma by improved diagnosis principally due to fiberoptic instruments. In 1980 Ohta et al. [2] reported that more than one-third of the resected gastric carcinomas (108 of 277 cases) at the Cancer Institute Hospital in Tokyo were "early." The frequency of early cancer has also increased in the United States [3] and in Europe [4]. This increase has contributed significantly to the recent improvement in survival