Korean J Gastroenterol.  2011 May;57(5):288-293. 10.4166/kjg.2011.57.5.288.

Characteristics of Advanced Gastric Cancer Undetected on Gastroscopy

• Sung IK
• Kim YC
• Yun JW
• Seo HI
• Park DI
• Cho YK
• Kim HJ
• Park JH
• Sohn CI
• Jeon WK
• Kim BI
• Oh SJ
• Son BH
• Yoo CH
• Sohn JH
• Lee HY
• Won KH

• KMID: 1792785
• DOI: http://doi.org/10.4166/kjg.2011.57.5.288

Abstract

BACKGROUND/AIMS
Stomach cancer can be easily diagnosed via endoscopy, but also possible to be missed. The aim of this study was to investigate the clinical and endoscopic characteristics of advanced gastric cancers that were not diagnosed based on endoscopic examination.
METHODS
We evaluated patients who had newly diagnosed advanced gastric cancer that was undetected via endoscopy within the last six months.
RESULTS
Sixteen patients were included in this study. The locations of the cancers were the cardia in six cases, the greater curvature side of the body in eight cases and the antrum in two cases. The histological findings were tubular type adenocarcinoma in 11 cases, with ten cases of moderately to poorly differentiated adenocarcinoma and five cases of signet ring cell type adenocarcinoma.
CONCLUSIONS
Even advanced gastric cancer lesions may not be detected during endoscopy. If a patient continues to complain of upper gastrointestinal symptoms, even though endoscopy does not find abnormal findings, repeated endoscopy and/or additional diagnostic studies should be considered.

Keyword

Gastric cancer; Gastroscopy

MeSH Terms

Adenocarcinoma/*diagnosis/pathology
Adult
Aged
Cardia/pathology
Diagnostic Errors
Female
Gastroscopy
Humans
Male
Middle Aged
Prognosis
Pyloric Antrum/pathology
Stomach Neoplasms/*diagnosis/pathology

Figure

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  Fig. 1. Hospitals and endoscopists of prior endoscopic examinations which could not detect gastric cancer. (A) Most of the hospitals were general hospitals or private clinics. (B) Most of the prior endoscopists were gastroenterologists or internists.

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  Fig. 2. Histological characteristics of misdiagnosed advanced gastric cancer.

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  Fig. 3. Endoscopic and histological classifications of misdiagnosed advanced gastric cancer according to the location in the stomach. (A) Most cancers were located around the cardia and greater curvature side of the body. Endoscopically, the cancers around the cardia are Borrmann type III, and the cancers on the greater curvature side of the body were Borrmann type IV. (B) Microscopically, the cancers around the cardia were moderately differentiated, and the cancers on the greater curvature side of body were signet ring cell and poorly differentiated.

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  Fig. 4. Endoscopic finding of misdiagnosed advanced gastric cancer around the cardia (A) and antrum (B). (A) The endoscopic findings on later examination showed a large ulceroinfiltrative lesion around the cardia. (B) A very large ulcerative lesion was observed on the second endoscopic examination. The prior endoscopist misdiagnosed the encircling antral ulcerative cancer lesion as a duodenal ulcer within the duodenal bulb.

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  Fig. 5. Endoscopic finding of misdiagnosed advanced gastric cancer on the greater curvature side of the body. (A) On the first endoscopic examination, there was no remarkable lesion on the greater curvature side of body except for an ulcer scar on the duodenal bulb. (B) However, three months later, endoscopic examination showed a very large irregularly shaped ulcer with thickened mucosal folds and poor expansibility along the greater curvature side of stomach from the antrum up to the mid-body.

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  Fig. 6. Endoscopic finding of misdiagnosed advanced gastric cancer of the upper body. (A) On the previous endoscopic photograph, there appeared to be no abnormal lesion; there were gastric secretions and air bubbles on the greater curvature side of the upper body. (B) Follow-up endoscopic examination revealed a large round ulcerative cancer lesion on the greater curvature side of the upper body. This lesion was missed because of inadequate removal of gastric secretions during the first endoscopic examination.

Reference

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