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Endoscopic findings of early gastric cancer with submucosal involvement



Endoscopic findings of early gastric cancer with submucosal involvement



Stomach & Intestine (Tokyo) 17(5): 521-526



In the estimation of the invasion depth of human gastric cancer, 3 categories are widely used: mucosal cancer, submucosal cancer and advanced cancer. Many problems exist in the endoscopic estimation of the invasion depth. In type III or type III + IIc early gastric cancer, active ulceration will sometimes prevent the diagnosis of the invasion depth. Differentiation between mucosal cancer and submucosal cancer is often a problem. On the other hand, advanced cancer especially invading the muscularis propriae (pm cancer) must be strictly differentiated from mucosal cancer and submucosal cancer. In type I early gastric cancer, it is almost impossible to estimate the invasion depth by endoscopic findings. Only the size of polyps suggest the invasion depth. Large polyps > 4 cm in diameter frequently have submucosal invasion. In type IIa early gastric cancer, central depression, erosion and/or bleeding on the surface of the elevated lesion can be signs of submucosal invasion. On the other hand, most of the elevated lesions with normal surfaces are mucosal cancer. In type IIc early gastric mucosa, small nodule formation and drumstick formation and/or fusion of the interrupted folds at the depressed margins are signs of submucosal cancer. In addition, submucosal invasion is frequently observed in cases with irregular mucosa, multiple erosions with or without bleeding and stiff surfaces on the depressed mucosa. pm cancer (the so-called IIc advanced type) usually shows the above-mentioned 3 signs together, e.g., irregular mucosa, multiple erosions and stiffness on the depressed area. In cases of simple depressions in which the mucosal surface is almost the same as other normal parts, the cancer is mostly limited within the mucosa.

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