Early gastric cancer: report of twenty-five cases.

Among 267 surgical specimens of histologically proved cancer of the stomach during the last 20 years (1957 to 1976), 25 were classified as early gastric cancer. Of these early gastric cancers, 16 were found during the last 5 year period. The increasing number of early gastric cancers found in the recent years may be attributed to the more aggressive diagnostic approaches in patients who have symptoms suggestive of peptic ulcer disease. Another factor which may contribute to the increased incidence of early detection of gastric cancer is a more aggressive surgical treatment in patients with a gastric ulcer. Some patients with early gastric cancer will remain undetected if the surgical treatment was vagotomy and pyloroplasty. Lymph node metastases were present in six patients in this series. Of these 25 patients who had gastric resection for early cancer, follow-up was available in 20. Two patients were noted to have local recurrence at 3 and 8 years, respectively, after the initial operation. One of these two patients died after reoperation and the other still is living. One other patient died of cerebral hemorrhage 12 years following the initial operation of gastric resection. The remaining 17 patients all are living, with no evidence of recurrence. From these results it is concluded that (1) routine gastroscopy should be done in patients with radiological gastric abnormalities and in patients with symptoms suggestive of peptic ulcer disease, even though the upper gastrointestinal series is normal; (2) multiple biopsies should be taken from gastric lesions seen on gastroscopy; and (3) gastrectomy is the treatment of choice, since some of the early gastric cancers in this series would have remained undetected if vagotomy and pyloroplasty had been performed.