Problems in the definition and treatment of early gastric cancer

Stomach (gastric) cancer is now being detected at an earlier stage as a result of improved diagnostic techniques and mass screening programs. Five-year survival for early gastric cancer has improved from 60 percent to 90 percent, but recurrence remains a problem. Early gastric cancer is currently defined as cancer that has invaded only the mucosa or submucosa; this definition does not consider whether or not the cancer has spread to the lymph nodes. A study was undertaken of 247 patients with early gastric cancer to determine the effectiveness of surgery and the influence of metastasis (spread) to the lymph nodes. Radical surgery with extensive removal of the lymph nodes was performed on 245 of these patients. The overall five-year survival rate for the group was 94.4 percent. Patients with submucosal invasion had a significantly lower survival rate than did those with only mucosal invasion (90 percent compared with 100 percent). The five-year survival rate for the 34 patients with lymph node metastasis was only 73.2 percent. Lymph node metastasis was more common among patients with submucosal cancer invasion. These findings indicate that both lymph node metastasis and submucosal cancer invasion influence the recurrence and affected the prognosis of patients with early gastric cancer. Because the exact amount of cancer invasion is not known prior to surgery, it is suggested that patients with early gastric cancer undergo radical surgery with complete removal of the first and second group of lymph nodes. (Consumer Summary produced by Reliance Medical Information, Inc.)