Catálogo de publicaciones - libros

Concerning the development of colorectal carcinoma, two main doctrines have been advocated: the one called “adenoma-carcinoma sequence” theory [] maintains that a cancer develops from normal mucosa through a stage of adenoma, and the other, called “” theory [], claims that a carcinoma emerges directly from normal epithelium without going through a process of adenoma. It is now believed and widely accepted that a sporadic colorectal cancer evolves through either of these two pathways. In carcinogenesis, a single cell transforms into a cancer cell, proliferates through frequent mitoses, and gradually forms a mass. It takes a certain time for a cancer to be diagnosed as such after its birth. According to the Japanese rule [], early colorectal cancer is defined as being limited to the mucosa or invading only as far as the submucosa, regardless of the presence or absence of lymph node metastases.The term “early” does not always imply that the lesion exists right after its birth, but means only that it is early enough for the tumor to be completely cured. Thus, the term “early” does not reflect the time course of the tumor, nor does it fully represent its biological nature.

The process of growth and development of carcinoma of the esophagus is an interesting theme of study. Recent progress in early detection of squamous cell carcinoma of the esophagus has allowed us to know features of esophageal carcinoma at every stage of growth and development. In this chapter, such growth and development is estimated through clinical and pathological analyses of 435 superficial esophageal cancer lesions conducted at the Tokyo Metropolitan Komagome General Hospital, Tokyo, Japan.

Subtotal gastrectomy with lymphadenectomy including Group 2 lymph nodes, D2 lymphadenectomy, has been performed in Japan as a standard surgical treatment for gastric cancer regardless of its stage, and good survival rates have been obtained. However, retrospective analysis of the results revealed that about 80% of early cancers have no lymph node involvement, suggesting curative treatment of these early cancers without the standard D2 lymphadenectomy; they may be curative with limited surgery. Limited surgery includes two limitations, the scope of the gastrectomy and lymphadenectomy. In terms of quality of life (QOL) after gastric surgery, preservation of the gastric function and less invasive surgery are desirable. In this section, we discuss indications and results of limited surgery for early gastric cancer. Furthermore, application of a newly developed surgical treatment will be proposed.