Early gastric cancer.

Early gastric cancer is a unique form of gastric carcinoma with an excellent prognosis. Now recognized worldwide, this tumor is most commonly diagnosed in Japan secondary to aggressive screening practices. Early detection is dependent on a low threshold for esophagogastroduodenoscopy with biopsies, because specific symptoms and physical findings or diagnostic laboratory tests are rarely present with early gastric cancer. Once the disease is diagnosed, subtotal gastrectomy achieves survival rates equivalent to those of age-matched controls. Consideration of total gastrectomy is warranted with proximal tumor location or multicentric carcinoma. Radical lymphadenectomy should be undertaken in patients with regional nodal metastasis. After operative resection, patient outcome is usually excellent. Large submucosal tumors with an aneuploid DNA pattern and nodal involvement denote a more ominous outlook. Close patient follow-up is necessary to detect both the uncommon recurrence and the more common nongastric malignancy.