Early Gastric Cancer: Update on Prevention, Diagnosis and Treatment

Abstract

Gastric cancer (GC) is a relevant public health issue as its incidence and mortality rates are growing worldwide. There are recognized carcinogen agents, such as obesity, tobacco, meat, alcohol consumption and some dietary protective factors. Strategies of early diagnosis through population-based surveillance programs have been demonstrated to be effective in lowering the morbidity and mortality related to GC in some countries. Indeed, the detection of early lesions is very important in order to offer minimally invasive treatments. Endoscopic resection is the gold standard for lesions with a low risk of lymph node metastasis, whereas surgical mini-invasive approaches can be considered in early lesions when endoscopy is not curative. This review outlines the role of lifestyle and prevention strategies for GC, in order to reduce the patients' risk factors, implement the surveillance of precancerous conditions and, therefore, improve the diagnosis of early lesions. Furthermore, we summarize the available treatments for early gastric cancer.

Keywords: Helicobacter pylori; early gastric cancer; endoscopic submucosal dissection; gastric cancer; upper endoscopy.

Figure 1

Gastric antrum with atrophic mucosa (A) and with IM, visible as whitish lesions surrounding the pylorus (B). Arrows indicate the areas with more atrophy (A) and the areas with IM (B), respectively.

Figure 2

EUS image of a gastric lesion 24.5 × 7.8 mm in size. The endoscopy result was low-confident for SM invasion. EUS was suggestive of SM1 invasion only. After ESD, SM1 invasion was confirmed.

Figure 3

Cap-assisted EMR of a T1a early gastric cancer 1 cm in size, located in the antrum. The figures show: the entire lesion (A); the endoscopic device for cap-assisted EMR and the needle filled with the lifting solution approaching the lesion (B); the lesion after lifting, before the suction in the cap and the resection (C); the antrum immediately after the resection (D); the surface of the antrum after the resection and the exposed submucosal layer (E).

Figure 4

Traditional ESD of a high-dysplasia lesion, 20 mm in size, located in the gastric antrum. In (A) the mucosal layer surrounding the lesion is already pre-cut, after the injection of a lifting agent, which can be seen in blue. In (B) most of the lesion is already dissected. A clip had been positioned to stop arterial bleeding which occurred during the dissection procedure. The lesion can be seen in the upper part of the figure, almost all dissected. In the lower part of the figure the submucosal layer can be seen. In (C) the dissection is completed. The clips were positioned during the ESD to stop an arterial bleed. The submucosal layer is intact after the dissection.