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Early gastric cancer: Treatment, natural history, and prognosis

Author
Douglas Morgan, MD, MPH
Section Editors
Mark Feldman, MD, MACP, AGAF, FACG
Kenneth K Tanabe, MD
David I Soybel, MD
Deputy Editors
Anne C Travis, MD, MSc, FACG, AGAF
Diane MF Savarese, MD

INTRODUCTION

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. Early gastric cancer has driven the development of novel imaging technologies (eg, magnification chromoendoscopy and narrow-band imaging) as well as advanced endoscopic resection techniques (eg, endoscopic mucosal resection and endoscopic submucosal dissection). (See "Chromoendoscopy" and "Magnification endoscopy", section on 'Stomach' and "Overview of endoscopic resection of gastrointestinal tumors".)

This topic will review the treatment as well as the natural history and prognosis of early gastric cancer. The clinical manifestations, diagnosis, and staging of early gastric cancer and the management of patients with advanced gastric cancer are discussed elsewhere. (See "Early gastric cancer: Epidemiology, clinical manifestations, diagnosis, and staging" and "Systemic therapy for locally advanced unresectable and metastatic esophageal and gastric cancer" and "Surgical management of invasive gastric cancer" and "Local palliation for advanced gastric cancer".)

TREATMENT

Treatment modalities for early gastric cancer (EGC) include endoscopic resection, surgery (gastrectomy), antibiotic treatment for eradication of Helicobacter pylori, and adjuvant therapies. Endoscopic resection, by either endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD), is an option for carefully selected patients with EGC without known lymph node involvement who meet specific criteria (ie, have a sufficiently low risk for nodal metastases that endoscopic resection alone is likely to be curative). Patients who do not meet the criteria are referred for gastrectomy (which includes resection of the regional nodes), which is discussed elsewhere. (See "Surgical management of invasive gastric cancer", section on 'Extent of lymph node dissection'.)

Proper staging is crucial for determining which patients are potential candidates for endoscopic resection. The staging of early gastric cancer, including the evaluation of regional lymph nodes for metastatic disease, is discussed in detail elsewhere. (See "Early gastric cancer: Epidemiology, clinical manifestations, diagnosis, and staging", section on 'Staging'.)

All patients, regardless of approach, should be evaluated for H. pylori infection and treated if there is evidence of infection. (See 'Anti-Helicobacter therapy' below.)

                    

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Literature review current through: Nov 2016. | This topic last updated: Wed Feb 17 00:00:00 GMT+00:00 2016.
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