Early gastric cancer: Diagnosis, treatment and outcome

The method of diagnosis, management and outcome in 18 patients with symptomatic early gastric cancer presenting to the Department of Surgical Oncology were studied. The age range was 56-84 years. There were 12 mucosa only cancers and 5 with N1 nodal metastases. The diagnostic accuracy of initial endoscopy was 38% rising to 61% when combined with histology. The remaining 8 patients required a median of 2.5 (2-5) endoscopies before the diagnosis was made. Concurrent symptomatic therapy in 7, produced complete resolution of symptoms in 6 and improvement in remaining case. Resection was undertaken in 17 patients and endoscopic excision in 1. The actuarial survival rate was 89% at a median follow up of 27 (1-80) months. Patients considered 'at risk' of early gastric cancer should undergo serial investigation if initial endoscopy is non diagnostic even when therapy cures their symptoms. Surgery for symptomatic early gastric cancer is associated with a survival rate similar to that reported in Japanese series.