EARLY GASTRIC-CANCER IN URUGUAY

This report comprises all early gastric carcinomas (EGCs) submitted to surgery in Uruguay from 1972 to 1989. The EGC definition and type classification have been carried out according to the guidelines of the Japanese Research Society for Gastric Cancer. We have included 25 personal cases and also several other cases on the basis of the information provided by other pathologists. We have had frequent access to the microscopic slides for revision as well. 15 cases were discarded due to inadequacy of sampling of the surgical specimen. 69 EGCs were detected in the surgical specimens of 64 patients. Three patients showed a second independent EGC while one showed three lesions. The most frequent endoscopic types were: type IIc (slightly depressed) 36.2%, type IIc + III (combined type, depressed + ulcerated) 29% and type I (protruding type) 18,8%. Three were classified as minute EGCs (5 mm or less in diameter). 39 lesions showed neoplastic cells only in the mucosa (m type) whereas 30 invaded the submucosal layer (sm type). EGCs with a diameter of 10 mm (or less) showed at the microscopical level only two histological types: tubular well-differentiated adenocarcinoma (intestinal type) or signet ring cell carcinoma. When the ratio of EGCs versus advanced carcinomas was studies reviewing the pathological files of the Hospital de Clinicas, we found the EGC percentage increased continuously from 1981 to 1989. The median value was 16.6%. This evidence indicates an improvement in the early detection of gastric cancer concomitant with the better training of endoscopists. However, the medial value decreased to 4.9% when specimens from the whole country were considered. These numbers should be compared to data obtained in Italy (8.2%) and Japan (32%). The frequency of different endoscopical types of EGC was similar to the larger Japanese series and different from those published in Europe. In this sense the racial and dietetic differences do not seem to have any influence over the different types of early gastric carcinomas detected. This fact stresses the relevance of the pathological method of study in assessing the EGC characteristics.