Endoscopic treatment of gastric cancer
Treatment for early-stage gastric cancer can be divided into two main categories: endoscopic treatment and surgical treatment including laparoscopic surgery. Most gastric cancers can be completely cured by endoscopic treatment if they are detected at an early stage. Endoscopic treatment is a local treatment in which the cancer is removed from the submucosal layer of the digestive tract. Endoscopic treatment is indicated for early-stage cancer without lymph node metastasis, and not for advanced cancer or cancer with a high possibility of lymph node metastasis.Gastric cancer usually begins in the mucosal layer, the most superficial part of the stomach, but as it grows, it gradually spreads to take root deeper in the stomach wall. Early-stage gastric cancer is defined as cancer that has only invaded the submucosa, and can be classified as intramucosal or submucosal invasive carcinoma.Gastrointestinal endoscopic treatment is performed from the inside of the stomach using an endoscope inserted through the mouth, so it is not possible to treat cancer that has invaded the deep layers of the stomach wall or has spread to lymph nodes or other areas outside the stomach. For this reason, endoscopic treatment is only available for early-stage gastric cancer that is relatively shallow and has not metastasized to the lymph nodes or other organs. Intramucosal carcinoma does not metastasize, and if the cancer can be completely removed by endoscopic resection, no additional treatment is necessary.
On the other hand, submucosal invasive carcinoma may have metastasized to the lymph nodes and requires careful attention. Endoscopically resected cancers are examined by pathology to determine the depth of the cancer and to assess the risk of lymph node metastasis. After endoscopic treatment, if it is comprehensively determined that there is a high possibility of lymph node metastasis, additional surgical treatment, including lymph node dissection, is performed.
Endoscopic treatment methods
Gastrointestinal endoscopic treatment has changed dramatically in recent years with the advent of endoscopic submucosal dissection (ESD)(Fig. 1, Photo 1).
Previously, the most widely used treatment was endoscopic mucosal resection, in which a snare was placed over the tumor and tightened to remove it through a high-frequency electric current. This method is simple and very effective, but en bloc resection was difficult for large lesions. If the lesion cannot be resected en bloc, it may remain or recur more easily.
ESD is performed using various electrocautery knives (Photo 2) to make an incision around the lesion and dissect the submucosal layer, enabling en bloc resection of even large lesions. ESD is a difficult procedure and is performed at higher tertiary care institutions such as our hospital.
Endoscopy for health screenings and physical examinations
For early detection of cancer, it is important to have regular checkups.
Incidentally, Tokushima Prefecture has a low rate of medical checkups nationwide, and we hope that many more individuals will undergo these examinations.We recommend that people actively undergo endoscopic examinations by going for medical checkups, physical examinations, or consultations with a nearby internal medicine or gastroenterology doctor (Photos 3, 4).
