Early gastric cancer. Recent experience

Early gastric cancer (EGC) is defined as carcinoma in which malignant invasion is limited to the mucosa or submucosa. Records of pathologic examinations from the Hospital of the University of Pennsylvania show that EGC comprised 6% of all gastric carcinomas diagnosed between 1977 and 1983 (7/118 cases) compared with 8.2% of gastric carcinomas diagnosed between 1965 and 1977 (12/147 cases). Double contrast radiographic techniques and fiberoptic endoscopy became widely available at our institution in 1976. Thus, the application of these techniques to symptomatic patients has not improved our ability to diagnose EGC. In contrast, the incidence of EGC in Japan has risen from 5% to 35% with the widespread use of these diagnostic techniques. This discrepancy can be attributed to mass screening of asymptomatic patients in Japan because of the unusually high prevalence of gastric carcinoma in that country. American radiologists and endoscopists should therefore recognize that they are unlikely to experience a significant increase in the detection of EGC as long as these examinations are performed predominantly on symptomatic patients.