Early gastric cancer in a United States hospital

Early gastric cancer (EGC) confined to mucosa and submucosa, described by Japanese physicians over 20 years ago, yields about 90% 5-year postoperative survival. EGC has been increasingly reported from centers outside Japan, but rarely from the United States. Between 1976-1981, EGC was found in six patients or about 8.5% of all gastric carcinomas diagnosed in our hospital. Diagnoses were established by following suspicious upper gastrointestinal series or negative x-rays in patients with dyspepsia by means of gastroscopy and gastroscopically obtained biopsies, brush, and/or wash cytology. All six patients underwent subtotal gastrectomy with histological findings of EGC not invading the muscularis and with no metastases. So far no tumor recurrences have been found in these six patients. The results suggest that EGC as defined by Japanese investigators occurs in our hospital and presumably across the United States more often than heretofore appreciated. Previous fatalistic attitudes toward diagnosing gastric cancer should be replaced by efforts at early diagnosis. Patients with symptoms suggestive of gastric carcinoma, including unexplained dyspepsia, should undergo early upper gastrointestinal x-ray and endoscopic examinations with biopsies and cytological tests of any suspicious raised, flat, or depressed area.