Gastric cancer is common in China. At present, early detection with prompt resection of early gastric
carcinoma (EGC) is crucial for improving patient's survival. Because of high heterogeneity of EGC in Chinese patients we reviewed recent clinicopathological and molecular evidence and proposed a grouping EGC in three subgroups according to their location for appropriate management. In group 1 (cardia), most patients with EGC in this small location were elderly men. The
tumors originated in the cardiac mucosa with a high proportion of cases with slightly elevated gross patterns and intestinal
adenocarcinoma histology with moderate to well differentiation. Poorly cohesive
carcinoma was infrequent. As the risk for
lymph node metastasis in this kind of
tumor was significantly lower than that in the distal stomach, endoscopic
therapy is preferred. Group 2 (fundus-corpus), many patients with EGC in this large location were young women. The EGCs originated in the oxyntic mucosa with pure and mixed poorly cohesive
carcinomas that are more commonly present in this area than in any other. Most
tumors were poorly differentiated with a high risk for
lymph node metastasis. Thus, endoscopic
therapy may be appropriate for intramucosal, but not for submucosal,
carcinoma. Group 3 (antrum-pylorus). EGC
tumors arose from the
antral mucosa, primarily because of Helicobacter pylori
infection, following the Correa
gastric cancer tumorigenetic pathway. Erosive and ulcerated gross patterns were most frequently observed. While most EGCs in this location were mainly intestinal
adenocarcinomas, poorly differentiated EGCs were substantial in number. Because the risk of
lymph node metastasis remains to be illustrated, clinical management requires an individualized approach. This preliminary observation requires verification in large nationwide multicenter studies.