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10 slides generated from the cancer page, with a quiz from the open benchmark and speaker notes that cite the sources. Arrow keys move between slides; Print gives one slide per page.
Early gastric cancer has not grown beyond the submucosa, whatever the lymph nodes show. In Japan and Korea, where screening endoscopy finds most stomach cancers at this stage, many are removed through the endoscope without an operation, and the rest are cured by gastrectomy.
Early gastric cancer is defined by depth: a tumour limited to the mucosa (T1a) or submucosa (T1b), regardless of nodal spread. Its detection depends on endoscopy in people without symptoms. Korea has offered biennial endoscopic screening to everyone from age 40 in its national programme since 1999, and Japan recommended endoscopy over barium radiography in 2016; as a result more than half of gastric cancers in both countries are early, against about one in five in Europe and North America. Helicobacter pylori causes most of these cancers, and eradication after endoscopic resection roughly halves the risk of a second primary tumour in the remaining stomach.
Endoscopic submucosal dissection removes the lesion in one piece with its margins. The Japanese Gastric Cancer Association criteria cover differentiated intramucosal tumours without ulceration of any size, differentiated ulcerated tumours up to 3 cm, and, after the JCOG1009/1010 trial, undifferentiated intramucosal tumours up to 2 cm without ulceration; when pathology shows deeper invasion, lymphovascular invasion or an involved margin (a high eCura risk), gastrectomy with lymph node dissection follows because the risk of nodal disease rises. Curative dissection preserves the stomach and its function with recurrence rates comparable to surgery in matched series.
| Setting | Approach | Guideline |
|---|---|---|
| Within endoscopic criteria | Endoscopic submucosal dissection with en bloc resection and pathological assessment of depth, margins and lymphovascular invasion. | not mapped |
| Non-curative resection or outside criteria | Gastrectomy with D1+ lymph node dissection, laparoscopic or robotic (KLASS-01, JCOG0912). | not mapped |
| After resection | Helicobacter pylori eradication and annual endoscopic surveillance for metachronous cancer; no adjuvant chemotherapy for stage I. | not mapped |
| Screening | Biennial endoscopy from age 40 in Korea and from 50 in Japan; risk-based screening for people of East Asian origin and with atrophic gastritis elsewhere. | not mapped |