The Current State of Diagnosis and Treatment for Early Gastric Cancer

Abstract

The prognosis for gastric cancer depends on its stage; so, detection in the early stage of disease is important, when complete and curative removal is possible. Accurate diagnosis can be facilitated by a sound understanding of the basic findings of white light endoscopy of early gastric cancer, and diagnosis can be refined further by the combined use of other imaging modalities such as image-enhanced endoscopy including chromoendoscopy and endoscopic ultrasonography. Minimally invasive endoscopic treatment has come to be the preferred therapeutic approach for early gastric cancer. In addition to conventional endoscopic mucosal resection, a new technique known as endoscopic submucosal dissection (ESD) has spread rapidly worldwide. Indeed, strategies for ESD have been established, devices developed, its indications expanded, and its safety and long-term results extensively reported. Some unique combination therapies involving endoscopy and surgical treatment have also been reported. It is anticipated that the number of patients undergoing endoscopic therapy will continue to increase, and the ongoing developments in endoscopic treatment are expected not only to improve gastric cancer prognosis but also to maintain good quality of life after treatment.

Evaluation of Fibroblast Growth Factor Receptor 2 Expression, Heterogeneity and Clinical Significance in Gastric Cancer

“…Its early detection and complete excision results in a 5-year survival rate of over 90% for patients with early-stage disease in both Western countries and Japan [2]. However, the outcome of advanced GC is still bleak [3], and targeted agents have, therefore, been investigated for these patients, including trastuzumab, which has been used to successfully treat metastatic GC [4].…”

The Historical Perspective of Gastric Cancer

“…With the introduction of innovative surgery methods towards the end of the previous century, as, e.g., the laparoscopic/minimal invasive abdomen surgery on the one hand [97], and the endoscopic mucosal resection (EMR) in early cancer on the other, surgeons and gastroenterologists hoped to make a further contribution to the treatment of gastric cancer [98]. The advantage to be gained by minimal invasive surgery techniques should decrease stress for the immune system so that subsequently both immune-suppressive therapies as well as immune stimulating therapies can be implemented to greater effectiveness in the treatment of gastric cancer.…”

Endoscopy and Endoscopic Ultrasound Examination of the Stomach

“…On WLE, early gastric cancer can be subtle, and therefore gastric contents should be suctioned away, the mucosal surface thoroughly washed of bubbles or debris, and the stomach well insufflated. The endoscopist should be attentive to interruptions of the mucosal folds, differences in mucosal color, mucosal friability, spontaneous bleeding, and changes in submucosal vessel patterns [42]. When a suspected early gastric cancer is identified, its morphology, location, size, and margins should be characterized.…”