Pathological studies of human gastric cancer.

Historical review of the pathological investigation on stomach cancer in Japan shows that the central problem had been whether or not gastric cancer developed from chronic peptic ulcer. This theory of ulcer cancer sequence was developed from chronic peptic ulcer. This theory of ulcer cancer sequence was supported by many researchers after the war in the period of 1946-64. Subsequently, systematic studies made at the Cancer Institute revealed that carcinoma arises from the gastric mucosa independently of chronic ulcer. The pathological interest then shifted toward investigation of the histogenesis and biological characteristics of gastric carcinoma. It is concluded that gastric carcinoma can be classified into two types; undifferentiated carcinoma (UCA or gastric type) and differentiated one (DCA or intestinal type). The former arises from the ordinary mucosa and cancer phenotype of this carcinoma resembles to that of the ordinary mucosa, and the latter arises from the metaplastic epithelium of intestinal type showing a cancer phenotype resembling to that of the intestinal metaplastic epithelium. These two carcinomas are also different in biological behaviors, such as growth pattern, invasiveness, metastasis, and prognosis. The frequency of UCA is almost the same in both sexes. DCA, however, occurs more often in male than in female. The time trend data indicates that in both sexes the number of DCA decreased, but that of UCA is steady, so that the ratio of DCA to UCA decreased since 1965. These results combined with the concept of the basic and variable cancer leads to a conclusion that UCA is a basic cancer and DCA is a variable cancer of the stomach.