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The carcinomas we have described here may constitute a different category from those reported previously as parietal cell carcinoma, but it would be of interest to stain the latter carcinomas using antiparietal cell antibodies, now that such antibodies have become available. Similar to parietal cell carcinoma, oncocytic adenocarcinoma of the stomach is an uncommon variant of gastric cancer that occurs particularly in older patients, and most cases were detected in the early stages. More needs to be learned about the clinicopathologic features of this subtype, and especially the prognosis.

In this section, we overviewed the present condition of the studies on adenocarcinomas of the stomach with gastric mucin phenotype. Accumulating clinical as well as pathological findings suggest that both tubular and papillary differentiated-type adenocarcinomas with gastric mucin phenotype show distinct clinicopathological behavior in contrast to those with intestinal phenotype and should be considered as a distinct pathological entity. Although differentiated-type adenocarcinomas in hyperplastic polyp also frequently show the gastric mucin phenotype, they should be separated from those that arose de novo from the point of view of biological behavior. Several investigators have tried to elucidate the genetic and epigenetic background of these carcinomas. However, the precise molecular pathway(s) of the carcinogenesis of adenocarcinomas with gastric mucin phenotype remains to be further clarified. To make this type of gastric adenocarcinoma an internationally recognized clinicopathological entity, efforts should be spared to build a consensus criteria for the evaluation of each epithelial marker and phenotypical subclassification of adenocarcinomas of the stomach.

The Japanese have pioneered research in the field of EGC and have established a universally acceptable macroscopic classification of EGC, which has contributed to the early diagnosis of gastric cancer. This chapter has discussed the endoscopic diagnosis of EGC and the typical cancerous findings of each type of EGC.

In conclusion, endoscopic ultrasonography yielded valuable information on the deeper mucosal layers and blood flow in gastric cancer and wall. Endoscopic ultrasonography also allowed puncture under ultrasonic guidance. This technique may thus become indispensable for the diagnosis and treatment of gastric cancer.

As a result of future advancements in image engineering and computer technology, digital radiographic systems and MDCT systems will continue to evolve, and it can be predicted that new diagnostic methods that utilize the advantages of digitalization in the radiological diagnosis of gastric carcinoma will also be developed. MDCT gastrography has little potential at present as a diagnostic method for the primary lesions of gastric carcinoma. However, with further advances in MDCT, higher-speed examinations, improved image quality, and optimization of exposure dose, it appears certain that MDCT gastrography will gradually replace radiography, endoscopy, and ultrasound endoscopy.

These extensive or superextensive surgical procedures for advanced cancer represent an attempt to increase the cure rate. The survival benefit, however, is limited, and the surgical procedure should be carefully selected for each patient. Adjuvant chemotherapy represents another attempt to treat advanced gastric cancer, and further investigation is required.