Early gastric cancer: from recognition to solution

Introduction: Early diagnosis and treatment of gastric cancer can decrease mortality effectively. Early removal can assure full recovery, since the five-year-survival rate may be above 95%.

Diagnosis and methods: A 54-year-old man was admitted for consultation after having chronic epigastrial pain even with PPI treatment. Gastroscopy with intravital staining (methyl blue) proved an approximately 10×14mm sized, slightly emerging and centrally sank area in the antrum. Early gastric cancer, combined type ll/a+ll/c, was suspected. To evaluate the depth of the extension and involvement of the lymph nodes Endoscopical Ultrasonography (EUS) was performed. Due to the size and type of the lesion, removal was doubtful with endoscopical mucosectomy, thus laparoscopical surgery was initiated. However, during the operation convertion and Billroth-ll resection had to be done. Histopathology proved adenocarcinoma supporting the EUS findings.

Conclusion: The endoscopical sings and extension of early cancers are meticulous. Intravital staining can be a big help in their recognition and judgement. With the help of EUS the depth extension and lymph node status can also be well evaluated. In our case histopathology proved the EUS findings. Removal of early gastric cancer may be performed with either endoscopical mucosectomy or with laparoscopical gastric resection or with open surgery. The decision should be based on multidisciplinary approach.