Early gastric cancer.

Thirty patients with early gastric cancer were studied as part of a consecutive series of 308 gastric cancers, giving a proportion of 9.7%. Twenty-eight of the early gastric cancer patients were symptomatic, pain being the most common symptom. Endoscopy proved more effective than barium studies as a first investigation but the diagnosis rate at first examination was still only 69%. Seven patients with early gastric cancer had lymph node spread at the time of presentation. Five patients eventually died of cancer metastases. There was a high incidence of benign peptic ulceration (50%) and this with lymph node metastasis was an unfavourable prognostic feature. Only four of the 26 patients submitted to standard surgical resections died of cancer. This study supports the concept that early gastric cancer does indeed occur in Western man and the five year survival rate (65%) is much higher than for late gastric cancer (13%). The high incidence of metastasis at the time of presentation may account for the difference between our survival rate for early gastric cancer, and that reported from Japan.