위암의 내시경적 분류 및 병기 - gie.or.kr

1 46 21 , The Classification and Staging of gastric CancerTae Ho KimDivision of Gastroenterology and Hepatology, Department of Internal Medicine, Bucheon St. Mary s Hospital, The Catholic University of Korea, College of Medicine, Seoul, KoreaA-I. : Room A , 1 , 3 .1 2008 988,000 , 736,000 2 .2 , 50 60% .3 , , . 95% .4 , , 2 cm , , .5.

2 1.. 70% , .6 : , , , , , , .7 , , indigocarmine .8,9 6 2 .10 95% , .11 , Linitis plastica . 22 The Korean Society of Gastrointestinal EndoscopyTable 1. Macroscopic Types of gastric cancer ( japanese Classification of gastric Carcinoma: 3rd English Edition)TypeDescriptionType 0 (superficial)Typical of T1 tumorsType 1 (mass)Polypoid tumors, sharply demarcated from the surrounding mucosaType 2 (ulcerative)Ulcerated tumors with raised margins surrounded by a thickened gastric wall with clear marginsType 3 (infiltrative ulcerative)Ulcerated tumors with raised margins, surrounded by a thickened gastric wall without clear marginsType 4 (diffuse infiltrative)Tumors without marked ulceration or raised margins, the gastric wall is thickened and indurated and the margin is unclearType 5 (unclassifiable)Tumors that cannot be classified into any of the above typesTable 2.

3 Subclassification of Type 0 ( japanese Classification of gastric Carcinoma: 3rd English Edition)SubtypeDescriptionType 0-I (protruding)Polypoid 0-II (superficial)Tumors with or without minimal elevation or depression relative to the surrounding 0-IIa (superficial elevated)Slightly elevated 0-IIb (superficial flat)Tumors without elevation or 0-IIc (superficial depressed)Slightly depressed 0-III (excavated)Tumors with deep 3. 7th Edition of the AJCC cancer StagingT category definitionTXThe primary tumor cannot be evaluatedT0 There is no evidence of a primary tumor in the stomachTisCarcinoma in situ : intraepithelial tumor without invasion of the lamina propriaT1 The tumor has invaded the lamina propria, muscularis mucosae, or the submucosaT1aThe tumor has invaded the lamina propria or muscularis mucosaeT1bThe tumor has invaded the submucosaT2 The tumor has invaded the muscularis propria (the muscle layer of the stomach)T3 The tumor has grown through all of the layers of the muscle into the connective tissue outside the stomach, but it has not penetrated the peritoneal lining or serosaT4 The tumor has grown through all of the layers of the muscle into the connective tissue outside the stomach and has penetrated the peritoneal lining or serosa or the organs surrounding the stomachT4aThe tumor has invaded the serosaT4bThe tumor has invaded organs surrounding the stomachN category definitionRegional lymph nodes cannot be evaluatedNXRegional lymph nodes cannot be evaluatedN0 The cancer has not spread into the regional lymph nodesN1 The cancer has spread to one to two regional lymph nodesN2 The cancer has spread to three to six regional lymph nodesN3 The cancer has spread to seven or more regional lymph nodes2.

4 12 Borrmann s classification . I IV . I 13(polypoid) . II (fungating) . III (ulcerated) . IV linitis plastica . JGCA ( japanese gastric cancer Association) japanese classification (Table 1).14 1 4 Borrmann s classification , 0 . 5 0 4 . 46 23 Table 4. Anatomic Staging/Prognostic Groups, gastric cancer (7th Edition of the AJCC cancer Staging)StageT stageN stageM stageStage 0 TisN0M0 Stage IAT1N0M0 Stage IBT2N0M0T1N1M0 Stage IIAT3N0M0T2N1M0T1N2M0 Stage IIBT4aN0M0T3N1M0T2N2M0T1N3M0 Stage IIIAT4aN1M0T3N2M0T2N3M0 Stage IIIBT4bN0 or N1M0T4aN2M0T3N3M0 Stage IIICT4bN2 or N3M0T4aN3M0 Stage IVAny TAny NM1 japanese classification 0 Paris endoscopic classification.

5 15 Borrmann s classification . Chen Li , Borrmann III IV Borrmann I II , , , stage IIIb IV .16 , JGCA (Table 2, 3), AJCC (the American Joint Committee on cancer ) UICC (the International Union against cancer ) (Table 4). 2009 UICC/AJCC TNM classification 7 . 2010 JGCA japanese classification 3 . 2010 . , .. , japanese classification AJCC TNM 7 , . D1/D2.

6 17 , . AJCC 7 5cm . japanese classification 2 cm .18 . , .. 1. Shin A, Kim J, Park S. gastric cancer epidemiology in Korea. J gastric cancer 2011;11:135-140. 2. Shah MA, Kelsen DP. gastric cancer : a primer on the epidemi-ology and biology of the disease and an overview of the med-ical management of advanced disease. J Natl Compr Canc Netw 2010;8:437-447. 3. Nam SY, Choi IJ, Park KW, et al. Effect of repeated endo-scopic screening on the incidence and treatment of gastric cancer in health screenees.

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8 Accuracy of the first endoscopic procedure in the differential diagnosis of gastric lesions. Ann Surg 1982;195 Murakami T. Early cancer of the stomach. World J Surg 1979; 3 Borrmann R. Geschwulste des magens and duodenums. Berlin: Springer-Verlag, 1926 japanese gastric cancer Association. japanese classification of gastric carcinoma: 3rd English edition. gastric cancer 2011;14: The Paris endoscopic classification of superficial neoplastic le-sions: esophagus, stomach, and colon: November 30 to December 1, 2002. Gastrointest Endoscopy 2003;58 Li C, Oh SJ, Kim S, et al. Macroscopic Borrmann type as a sim-ple prognostic indicator in patients with advanced gastric cancer . Oncology 2009;77 Santiago JM, Sasako M, Osorio J. TNM-7th edition 2009 (UICC/ AJCC) and japanese Classification 2010 in gastric cancer . Towards simplicity and standardisation in the man-agement of gastric cancer . Cir Esp 2011;89 Sano T, Aiko T. New japanese classifications and treatment guidelines for gastric cancer : revision concepts and major re-vised points.

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