Early gastric cancer: Epidemiology, clinical manifestations, diagnosis, and staging
- Douglas Morgan, MD, MPH
Douglas Morgan, MD, MPH
- Division of Gastroenterology, Hepatology, & Nutrition
- VIGH Director for Latin America sites
- Vanderbilt Institute for Global Health (VIGH)
- Vanderbilt Ingram Cancer Center (VICC)
- Vanderbilt University
- Section Editors
- Mark Feldman, MD, MACP, AGAF, FACG
Mark Feldman, MD, MACP, AGAF, FACG
- Section Editor — Acid Peptic Disease
- Texas Health Presbyterian Hospital Dallas
- Clinical Professor of Internal Medicine
- University of Texas Southwestern Medical School at Dallas
- Kenneth K Tanabe, MD
Kenneth K Tanabe, MD
- Section Editor — Gastrointestinal Malignancies
- Professor of Surgery
- Harvard Medical School
- Deputy Editors
- Anne C Travis, MD, MSc, FACG, AGAF
Anne C Travis, MD, MSc, FACG, AGAF
- Deputy Editor — Gastroenterology/Hepatology
- Assistant Professor of Medicine, Part-time
- Harvard Medical School
- Diane MF Savarese, MD
Diane MF Savarese, MD
- Senior Deputy Editor — UpToDate
- Deputy Editor — Oncology and Palliative Care
- Clinical Instructor of Medicine
- Harvard Medical School
Early gastric cancer (EGC) is defined as invasive gastric cancer that invades no more deeply than the submucosa, irrespective of lymph node metastasis (T1, any N). While EGC is of particular importance for patient care in Eastern Asia, its significance extends to other disciplines and patient populations:
●Globally, gastric adenocarcinoma, with nearly one million incident cases annually, is the second leading cause of global cancer mortality and the leading cause of infection-associated cancer death [1,2]. EGC accounts for 15 to 57 percent of incident gastric cancer, depending upon the geographic region. (See 'Epidemiology' below.)
●EGC has driven the development of novel imaging technologies for early neoplasia detection such as narrow band imaging and autofluorescence imaging. These technologies are now being used throughout the gastrointestinal tract.
●The need for better approaches to the treatment of EGC has led to the development of advanced endoscopic resection techniques such as endoscopic mucosal resection and endoscopic submucosal dissection. (See "Early gastric cancer: Treatment, natural history, and prognosis", section on 'Endoscopic mucosal resection' and "Early gastric cancer: Treatment, natural history, and prognosis", section on 'Endoscopic submucosal dissection'.)
●New surveillance guidelines are in evolution for gastric intestinal metaplasia, which may increase the frequency of detection of EGC in the western populations [3,4]. (See "Gastric intestinal metaplasia" and "Gastric cancer screening".)
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- SCREENING FOR GASTRIC CANCER
- Histologic classification
- - Lauren classification
- Macroscopic classification
- - Early gastric cancer
- Molecular classification
- CLINICAL MANIFESTATIONS
- Upper endoscopy
- TESTING FOR H. PYLORI
- Lymph node metastases in EGC
- Staging work-up
- - Endoscopic resection
- - Endoscopic ultrasonography
- - Other tests
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS