Early Cancer of the Gastrointestinal Tract: Endoscopy, Pathology, and Treatment

262 Pages·2006·19.094 MB·English

by  Ronald J. Schlemper (auth.), Rikiya Fujita M.D., Jeremy R. Jass M.D., Michio Kaminishi M.D., Ph.D., Ronald J. Schlemper M.D., Ph.D. (eds.)

R.Fujita,J.R.Jass,M.Kaminishi,R.J.Schlemper (Eds.)
Early Cancer of the Gastrointestinal Tract
Endoscopy,Pathology,and Treatment
R. Fujita, J.R. Jass
M. Kaminishi, R.J. Schlemper (Eds.)
Early Cancer of the
Gastrointestinal Tract
Endoscopy, Pathology,
and Treatment
With 353 Figures,Including 289 in Color
Rikiya Fujita,M.D.
Chief of Endoscopy Division,Gastroenterology Center,Cancer Institute Hospital
3-10-6 Ariake,Koto-ku,Tokyo 135-8550,Japan
Jeremy R.Jass,M.D.
Department of Pathology,McGill University
Duff Medical Building,3775 University Street,Montreal,Quebec,Canada H3A 2B4
Michio Kaminishi,M.D.,Ph.D.
Department of Gastrointestinal Surgery,The University of Tokyo
7-3-1 Hongo,Bunkyo-ku,Tokyo 113-8655,Japan
Ronald J.Schlemper,M.D.,Ph.D.
Specialist in Internal Medicine and
Medical Director,International Clinic Tojinmachi
1-4-6 Jigyo,Chuo-ku,Fukuoka 810-0064,Japan
Library of Congress Control Number:2005935946
ISBN10 4-431-22872-1 Springer-Verlag Tokyo Berlin Heidelberg New York
ISBN13 978-4-431-22872-1 Springer-Verlag Tokyo Berlin Heidelberg New York
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Foreword
First of all,I would like to discuss two undeniable facts. meeting of the Japanese Society of Gastrointestinal
One is that cancers that are malignant neoplasias of the Endoscopy.This book is a compilation of major aspects
gastrointestinal tract are epithelial in origin, so it is of that meeting.
natural that they grow from the mucosa of the gas- Actually, these attempts had already been made in
trointestinal tract.Another is that an early stage of the the TNM classification and the Vienna consensus crite-
cancer invariably exists in the mucosa.Because an early ria for pathological diagnosis, which are mentioned
diagnosis is extremely important in the initial stages of in this book, but they are still incomplete in spite of
cancer in the gastrointestinal tract,the following studies remarkable progress. We hope that the information
in this book are indispensable to reveal the growth and from this book may lead to a more general under-
extension of the disease. standing,and may help to settle existing differences.
For a long time there has been a decisive difference Dr.Ronald J.Schlemper collected biopsy and resec-
between Japanese and Western pathologists in the tion specimens, including specimens from 12 gastric
understanding of early cancer.That is,Japanese pathol- cases,7 colorectal cases and 5 esophageal cases,which
ogists diagnose intramucosal neoplastic lesions that are described at the beginning of this book.His work is
have remarkable cellular atypia and structural atypia as admirable. By comparing these corresponding speci-
cancers,but most Western pathologists don’t accept that mens readers may ascertain that resection specimens
and diagnose them as dysplasias. They diagnose as (most of them are endoscopic mucosectomy specimens
cancers only those lesions that show invasion.In a sense, of the stomach) appear to be more malignant than
these diagnoses are based on philosophical and con- biopsy specimens. This may be an important key to
ceptual differences in thinking.One Western gastroen- finding intramucosal cancers.Furthermore,readers may
terologist described Japanese diagnostic methodology well recognize that certain differences exist between
as “Japanese fairy tales.”Prof.Manfred Stolte analyzes Japanese and Western pathologists’ diagnoses.The clas-
this point of view in this book and notes that it might sification used to detect the existence of intramucosal
better be described as a “Western deficiency.” signet ring cell carcinoma or poorly differentiated ade-
If we leave this problem untouched,however,studies nocarcinoma may be a major breakthrough. When
of gastrointestinal cancers may be deadlocked.How to many cases like these are collected, if Japanese and
fill the gap between Japanese and Western interpreta- Western pathologists examine the same specimens and
tions? Is it possible to obtain a unified view or a con- discuss them without prejudice,an advanced consensus
sensus on pathological findings of cancers? I believe may be produced and the study of gastrointestinal
that if Japanese and Western pathologists were to cancers may be improved. I am sincerely looking
examine full sets of biopsy and resection specimens forward to that.
simultaneously, including endoscopic findings, and
through discussion make a mutual diagnosis, the gap Takeshi Oohara,M.D.,Ph.D.
might be filled.I believed that resolution of this problem President Emeritus,Tsuru-City Hospital
was absolutely necessary, so I adopted it as the main President Emeritus,Japanese Society of
theme when I took up my presidency of the general Gastroenterological Carcinogenesis
V
Foreword
This is a thoroughly unusual book—not so much sified as T1(M) or T1(SM). This differentiation is
because of its title,but because 31 leading pathologists important because these carcinomas require different
from 12 countries have compared their experiences in therapies. In The Gastric Cancer Treatment Guideline
treating patients.They subjected the results from biop- from 2004, for instance, the Japanese Gastric Cancer
sies and resections of 24 patients with early neoplastic Association recommended performing an endoscopic
changes of the gastrointestinal hollow organ to a blind mucosal resection (EMR) for T1(M) tumors and dif-
study and comparison. The results of this study had ferentiated gastrectomy variations for T1(SM) tumors.
provided the basis of the Vienna Classification of Some endoscopists, meanwhile, are performing an
Gastrointestinal Epithelial Neoplasia,published on the endoscopic submucosal dissection (ESD) for the latter.
occasion of the 1998 World Congress of Gastroenterol- Nevertheless, these guidelines of the Japanese Gastric
ogy in Vienna.It was demonstrated then that Western Cancer Association remain interesting and obligatory
and Japanese pathologists had,as expected,formed dif- reading for every gastroenterologist and abdominal
ferent opinions based on their assessments of identical surgeon with an interest in digestive oncology.
changes in the mucous membrane.Where,for example, Please allow me to conclude my remarks by remind-
the histological assessments of Western pathologists of ing readers of the unique achievements of Rudolf
case 1 (early cancer of the stomach) covered a wide Konjetzny,surgeon at the Eppendorf University Clinic
range, from an adenoma with a low-level dysplasia in Hamburg in the early years of the previous century.
(n=1) to an intramucosal carcinoma (n=7),all of their By 1913 he had pointed out a connection between gas-
Japanese colleagues had diagnosed a carcinoma.These tritis and stomach cancer.Later he discovered changes
differences are due to the fact that many Western in the gastric mucous membrane,which he interpreted
pathologists classify changes of the mucous tissue as the first stage of cancer and which he initially
without any definite indication of invasion as a dyspla- described as a “pre-carcinomatous state.” In the face
sia, whereas the same findings will be diagnosed by of the typical contemporary pathological definition
Japanese doctors as well-differentiated adenocarcino- of stomach carcinoma as “deep-reaching, destructive
mas,as long as they share their cellular and structural growth,” Konjetzny emphasized the striking similarity
atypias. This problem is particularly acute for biopsy of the mucosal syndrome with an “indubitable carci-
preparations from the surface of mucous tissue changes noma which is spreading into the deeper-lying layers
without obvious indications of infiltration into deeper- of the abdominal wall.” In 1940, he finally described
lying areas of the mucous tissue. a stomach cancer “whose growth is restricted to
We cannot thank the editors enough for having com- the mucous membrane.” It was also Konjetzny who
piled this complex work.The book is particularly impor- provided evidence for the hypothesis that stomach
tant because it goes beyond the mere description of the carcinomas are preceded by a chronic gastritis with
problems created by differing histological diagnoses of metaplasia and “unusual glandular growth in different
“early” neoplasias of the digestive tract; it also inter- shapes which originates from the upper epithelium,by
prets and explains them. multilayered dark epitheloid coronae without basal
This section of the book is accompanied and further membrane and by many cell divisions.”Today we know
enriched by excellent descriptions of clinical images and that the Helicobacter pyloribacterium is the culprit for
such endoscopic diagnostic techniques as chromoen- acute and chronic gastritis, which may in turn cause
doscopy and endosonography (including their pitfalls), peptic ulcers or metaplasia, dysplasia, and finally the
as well as magnificent images of the superior quality development of carcinoma.
that we have come to expect from our Japanese col- I hope that this book will find the wide readership it
leagues over the years. doubtlessly deserves.It will prove to be an indispensa-
The term “early” tumors is, of course, not quite up- ble guide and companion not only for pathologists,but
to-date, because its qualitative assessment of the time also for gastroenterologists and surgeons.
factor seems to defy any integration into the more
common tumor classifications. Early stomach carcino- Dr.med.Meinhard Classen,Dr.hc mult.
mas, which by definition include carcinomas of the Emeritus Professor of Medicine,Second Department
mucous tissue and the submucosa, are nowadays clas- of Medicine,Technische Universität München,Germany
VI
Foreword
Worldwide,in the year 2005 there were approximately Their interpretation was compared to the pathology of
10 million new cases of cancer and 6.2 million deaths resected specimens.Commentary is then made on both
from cancer,according to the most recent data available the endoscopic and pathologic interpretation, with a
from the World Health Organization.Digestive cancers view toward arriving at an understanding of the differ-
account for the highest incidence and mortality of ences.This is unique.The approach provides insight into
cancer worldwide, with 3 million new cases and 2.2 the two contrasting viewpoints.The second part of the
million deaths annually (colorectal, esophageal and book enhances this format with more didactic presen-
stomach,liver and pancreas).Because of the increasing tations of various aspects of diagnosis and management
size and aging of populations in both developed and of gastrointestinal cancers in general and also specific
developing countries,the absolute number of many of cancers, such as gastric and colorectal cancers. These
these cancers will dramatically increase over the next topics include a discussion of the Vienna classification
few years. National health policy in every country for pathological diagnosis, early cancer in Barrett’s
should be concerned with the prevention of digestive esophagus, endoscopic ultrasound, endoscopic treat-
cancers.The gastroenterologist,primary care physician, ment,and survival rates of early cancer.All of the cases
endoscopist,surgeon,oncologist,and other health-care and topics deal with the luminal gastrointestinal
providers have a major role in the prevention of diges- cancers,i.e.,of the esophagus,stomach,and colorectum.
tive cancers.A critical role is in endoscopic detection of The book is an ambitious undertaking in terms of its
early cases and premalignant disease (e.g.,Barrett’s and unusual clinical–endoscopic–pathological integrative
adenomas) in asymptomatic persons. Primary preven- format and its presentation and discussion of Japanese
tion is also of critical importance, especially in certain and Western viewpoints. It has succeeded in bringing
cancers,such as gastric cancer where Helicobacter pylori together contrasting perspectives by some of the world’s
infection has been shown to be responsible for approx- most experienced, skilled, and knowledgeable endo-
imately 50% of these cancers,in addition to such dietary scopists,pathologists,and clinicians.The book is truly a
factors as diets poor in fruits and vegetables and rich in remarkable learning experience and achievement. It
salt. Genetic susceptibility also plays a role, and the should be read and studied by everyone involved in
effect of chemoprevention in some digestive cancers is the detection and management of patients at risk of
under rigorous study. digestive cancers.
There are worldwide differences in the detection and
management of early gastrointestinal cancers,especially Sidney J.Winawer,M.D.,MACG,Dr.of Sci (Hon)
when one compares the Japanese and Western experi- Professor of Medicine,Weill Medical College
ences.This book addresses those differences superbly. of Cornell University
Its format is novel,exciting,and very informative.Cases Paul Sherlock Chair,Memorial
are presented,endoscopy described,and then Western Sloan-Kettering Cancer Center
and Japanese pathologists interpret biopsy specimens. Co-Chairman,International Digestive Cancer Alliance
VII
Foreword
It is a great pleasure to see the publication of Early order to reveal the difference of the views among them.
Cancer of the Gastrointestinal Tract, compiled by Pro- By examining the Tables that show those differing
fessor Fujita, Professor Jass, Professor Kaminishi, and views,readers can see how different pathological inter-
Dr.Schlemper. pretation can be from person to person, culture to
Because early cancer in the gastrointestinal tract— culture. It seems we have a long way to go before
above all, early gastric cancer—is very common in achieving a consensus of opinions among specialists in
Japan, its diagnosis is not generally considered to be Japan,Europe,and the United States.
very complicated,except in special cases.However,the In Chapter Two,the details of the Vienna consensus
concept of what we call early gastric cancer in Japan was criteria for pathological diagnosis are presented.
not easily understood in Europe and the United States Although the definitions of dysplasia, neoplasia, and
at first.The reason was that the number of early gastric carcinoma in situ are agreed upon, it is stated that
cancer cases itself was very small in Europe and the Japanese pathologists are more likely to make diag-
United States,and if diagnosed at all,they were classi- noses of cancer, while European and American coun-
fied as dysplasia,not cancer. terparts do not diagnose the same cases as cancer but
Recently, it has gradually become known that there as dysplasia. Again, we find there is still a wide gap
are early gastric cancer cases in Europe and United between different cultures.
States as well, and the classification of early gastric Featured in the following chapters are early cancer in
cancer established by the Japan Gastroenterological Barrett’s esophagus,how to detect an early cancer,the
Endoscopy Society has been widely acknowledged.Still, effectiveness of EUS, endoscopic treatment for early
there exists a wide gap in awareness. cancer in the gastrointestinal tract,the natural course of
That gap between Japan on the one hand and Europe an early cancer,surgical treatment,and survival rate of
and the United States on the other regarding gastroin- early cancer. The sections on early cancer in the gas-
testinal tract cancer was revealed in two papers written trointestinal tract are summarized concisely.
by Dr.Ronald J.Schlemper (who also wrote a chapter in This is the first book to compile in a straightforward
this book) and his colleagues.One was “Diagnostic crite- manner the views of leading endoscopists and patholo-
ria for gastrointestinal carcinoma in Japan and Western gists in Japan, Europe, and the United States on the
countries: proposal for a new classification system of same early cancer cases in the gastrointestinal tract.It
gastrointestinal epithelial neoplasia,” published in the graphically depicts the differences of opinions between
Journal of Gastroenterology and Hepatologyin 2000,and different cultures.
the other was “Vienna classification of gastrointestinal Efforts to exchange views will be increasingly impor-
epithelial neoplasia,”published in Gutthe same year. tant in the future to bridge the gap in pathological diag-
The Vienna classification of gastrointestinal epithelial nosis of early cancers in the gastrointestinal tract. To
neoplasia was completed by asking 31 well-known know the differing views of different specialists about
pathologists in 12 countries to examine 76 pathological the same cases has significant value.This book will play
specimens of mostly early neoplastic lesions, and then a critical role in promoting global consensus on early
compiling the members’ opinions in a meeting held in cancer cases in the gastrointestinal tract.It is a book that
Vienna in September 1998. every endoscopist and pathologist should read to
In Chapter One of this book,many cases offered for exchange opinions on a global basis.
this pathological study are presented with the views of
endoscopy commentators and pathology commentators, Hirohumi Niwa,M.D.
which include many famous endoscopists and patholo- President,World Organization for Digestive
gists from Japan and other countries.The composition Endoscopy
of the cases comprised 12 gastric cases, 7 colorectal President,Japan Gastroenterological
cases,and 5 esophageal cases. Endoscopy Society
The correlation between the biopsied specimens and Professor of Medicine,St.Marianna
endoscopically or surgically resected specimens was University School of Medicine
intentionally concealed from the 31 pathologists in
VIII
Preface
Advanced cancers of the gastrointestinal tract develop early cancer has been intensively studied,we believe we
from either superficial neoplasm or early cancer,and if have collected important articles exploring the natural
they could be identified in these stages by endoscopy history of early cancer,which has been demonstrated to
and diagnosed pathologically as cancer by biopsy, the develop into advanced cancer.We have also included an
benefit for patients would be immeasurable.We hope article describing many cases of Barrett’s cancer,though
that the global dissemination of this knowledge and the rare in Japan, from Professor Stolte. The diagnostic
techniques for the diagnosis and therapy of either methods for early cancer,including chromoscopy,mag-
superficial neoplasm or early cancer will be of world- nifying endoscopy, and narrow band imaging (NBI)
wide benefit. are still developing.Even endoscopic therapies,such as
Differences in the diagnostic criteria for cancer of endoscopic mucosal resection (EMR) and endoscopic
the gastrointestinal tract, especially for early cancer, submucosal dissection (ESD), as well as laparoscopic
between Japanese and Western pathologists have been surgery and combination therapies, are in their devel-
a long-standing issue. Surgically resected specimens opmental stages.Since more than five years have passed
of either superficial esophageal cancer, early gastric from the planning of this book to its publication, we
cancer,or early colon cancer have often been diagnosed asked the authors for additions and revisions immedi-
as dysplasia by Western pathologists. Gastroenterolo- ately before publication. We would like to sincerely
gists, endoscopists, and gastrointestinal surgeons have thank them for their cooperation.
been unable to resolve this issue.This became a topic of The 12 gastric and 5 esophageal cases presented in
personal interest during a lecture and live demonstra- Part 1 are from Showa University Fujigaoka Hospital,
tion in a Western country.In the autumn of 1996,eight 5 of the 7 colorectal cases (13–17) are from National
pathologists from Japan, North America, and Europe Cancer Center Hospital,Tokyo, and 2 colorectal cases
gathered and reviewed the same pathological specimens (18 and 19) are from Niigata University School of
during the Asian Pacific Congress in Yokohama,Japan. Medicine. We would like to thank these patients and
R.J. Schlemper, who was a visiting scientist at Showa their physicians for their contribution to the clinical,
University Fujigaoka Hospital at that time, worked as endoscopic and pathological material presented.In par-
the coordinator and raised this issue.In 1997,T.Oohara, ticular we would like to thank Professor H.Watanabe,
president of the 53rd Congress of the Japan Gastroen- who made almost all photographs of the histological
terological Endoscopy Society,chose it as a topic of the material in his office in Niigata University in 1996,and
congress, addressing it in an international symposium. Dr.T.Shimoda,who helped to collect clinical data for
Publication of Dr. Schlemper’s article in Lancet the National Cancer Center Hospital cases in Septem-
(1997;349:1725–9) eventually led to the Vienna classifi- ber 2005.
cation.More recently,it was our great honor and pleas- We would also like to especially acknowledge the
ure for the Japanese macroscopic classification to be invaluable assistance of the editorial staff at Springer-
recognized internationally as the Paris classification Verlag Tokyo,for their devoted efforts in the prepara-
(2003).In this way,M.Kaminishi,who succeeded Pro- tion and editing of this book.
fessor Oohara,J.R.Jass,who attended the international
symposium, R.J. Schlemper, and R. Fujita were September 2005
appointed as the planning editors of this book. Editors
The main feature of this book is that it is organized R.Fujita
in the form of contrasting the views of East and West, J.R.Jass
bringing in the opinions of world experts in both endo- M.Kaminishi
scopic and microscopic specialities.From Japan,where R.J.Schlemper
IX
Contents
Forewords . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V III. Early Neoplasia in Barrett’s
Esophagus
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . IX
1. Early Neoplasia in Barrett’s
List of Authors . . . . . . . . . . . . . . . . . . . . . . . . . . XIII
Esophagus . . . . . . . . . . . . . . . . . . . . . . . 143
IV. Detection of Early Cancer: Is
I. Case Presentations: Clinical Endoscopic Ultrasonography
Data, Endoscopy, and Pathology Effective?
1. Introduction . . . . . . . . . . . . . . . . . . . . . . 3 1. Gastric Cancer . . . . . . . . . . . . . . . . . . . . 159
2. Early Cancer of the Stomach 2. Colorectal Cancer . . . . . . . . . . . . . . . . . 165
(Cases 1–12) . . . . . . . . . . . . . . . . . . . . . . 4 3. Esophageal Cancer . . . . . . . . . . . . . . . . 171
Case 1,IIc . . . . . . . . . . . . . . . . . . . . . . . 4 4. Gastrointestinal Tract Cancer in
Case 2,IIc . . . . . . . . . . . . . . . . . . . . . . . 10 Europe . . . . . . . . . . . . . . . . . . . . . . . . . . 177
Case 3,IIc . . . . . . . . . . . . . . . . . . . . . . . 14 5. New Trends in Endoscopic
Case 4,IIa+IIc . . . . . . . . . . . . . . . . . . . . 18 Ultrasonography . . . . . . . . . . . . . . . . . . 181
Case 5,IIc . . . . . . . . . . . . . . . . . . . . . . . 24
Case 6,IIa . . . . . . . . . . . . . . . . . . . . . . . 30 V. Endoscopic Treatment
Case 7,IIa . . . . . . . . . . . . . . . . . . . . . . . 36
1. Gastric Cancer . . . . . . . . . . . . . . . . . . . . 191
Case 8,IIa . . . . . . . . . . . . . . . . . . . . . . . 42
2. Colorectal Cancer . . . . . . . . . . . . . . . . . 195
Case 9,IIa . . . . . . . . . . . . . . . . . . . . . . . 46
3. Management of Colorectal Cancer by
Case 10,IIa . . . . . . . . . . . . . . . . . . . . . . 50
“Hot Biopsy”and Snare Resection . . . . 201
Case 11,IIa . . . . . . . . . . . . . . . . . . . . . . 54
4. Esophageal Cancer:Photodynamic
Case 12,IIa+IIc-like . . . . . . . . . . . . . . . 60
Therapy . . . . . . . . . . . . . . . . . . . . . . . . . 207
3. Early Cancer of the Colorectum
5. Esophageal Cancer:Endoscopic Mucosal
(Cases 13–19) . . . . . . . . . . . . . . . . . . . . . 66
Resection . . . . . . . . . . . . . . . . . . . . . . . . 213
Case 13,IIa . . . . . . . . . . . . . . . . . . . . . . 66
Case 14,IIa . . . . . . . . . . . . . . . . . . . . . . 72
VI. Natural Course of Early Cancer
Case 15,IIa . . . . . . . . . . . . . . . . . . . . . . 76
Case 16,IIc+IIa . . . . . . . . . . . . . . . . . . . 80 1. Gastric Cancer . . . . . . . . . . . . . . . . . . . . 223
Case 17,IIa+IIc-like . . . . . . . . . . . . . . . 86 2. Colorectal Cancer:Retrospective,
Case 18,Is . . . . . . . . . . . . . . . . . . . . . . . 92 Prospective,and Histologic
Case 19,Ip . . . . . . . . . . . . . . . . . . . . . . . 96 Observations . . . . . . . . . . . . . . . . . . . . . 229
4. Superficial Carcinoma of the 3. Colorectal Cancer:Ulcerative Colitis-
Esophagus (Cases 20–24) . . . . . . . . . . . . 100 Associated Neoplasia . . . . . . . . . . . . . . . 237
Case 20,IIc . . . . . . . . . . . . . . . . . . . . . . 100 4. Colorectal Cancer:The Importance of
Case 21,IIc . . . . . . . . . . . . . . . . . . . . . . 106 Depressed Lesions in the Development
Case 22,IIc . . . . . . . . . . . . . . . . . . . . . . 112 of Colorectal Cancer . . . . . . . . . . . . . . . 243
Case 23,IIc . . . . . . . . . . . . . . . . . . . . . . 118 5. Natural Course of Squamous Cell
Case 24,IIb . . . . . . . . . . . . . . . . . . . . . . 124 Carcinoma of the Esophagus . . . . . . . . . 249
5. Comments on the Variability of the
Diagnoses . . . . . . . . . . . . . . . . . . . . . . . . 130 VII.Surgical Treatment and Survival
Rate of Early Cancer
II. Vienna Consensus Criteria for
Pathological Diagnosis 1. Surgical Treatment and Survival Rate
of Early Cancer . . . . . . . . . . . . . . . . . . . 259
1. Vienna Consensus Criteria for
Pathological Diagnosis . . . . . . . . . . . . . . 135 Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 273
XI
List of Authors
Aoki,Fumio (Chap.VII-1) Fujimori,Takahiro (Chap.VI-3)
Department of Gastrointestinal Surgery,Graduate Department of Surgical and Molecular Pathology,
School of Medicine,The University of Tokyo,7-3-1 Dokkyo University School of Medicine,880
Hongo,Bunkyo-ku,Tokyo 113-8655,Japan Kitakobayashi,Mibu,Shimotsuga,Tochigi 321-0293,
Japan
Axon,Anthony T.R.(Chap.I-2)
Department of Gastroenterology,Room 190A Fujisaki,Junko (Chap.IV-1)
Clarendon Wing,The General Infirmary at Leeds, Endoscopy Division,Gastroenterology Center,Cancer
Great George Street,Leeds LS1 3EX,UK Institute Hospital,3-10-6 Ariake,Koto-ku,Tokyo 135-
e-mail:[email protected] 8550,Japan
Chiba,Tsutomu (Chap.VI-3) Fujita,Rikiya (Chap.IV-1)
Division of Gastroenterology and Hepatology, Chief of Endoscopy Division,Gastroenterology
Department of Internal Medicine,Graduate Center,Cancer Institute Hospital,3-10-6 Ariake,
School of Medicine,Kyoto University,54 Koto-ku,Tokyo 135-8550,Japan
Kawara-cho,Shogoin,Sakyo-ku,Kyoto 606-8507, e-mail:[email protected]
Japan
Gossner,Liebwin (Chap.III-1)
Crespi,Massimo (Chap.I-4) Dr.Horst-Schmidt-Klinikum,65199 Wiesbaden,
National Cancer Institute,Viale Regina Elena 291, Germany
Rome 00161,Italy
e-mail:[email protected] Hayashi,Kazuhiko (Chap.IV-3)
Surgery,Institute of Gastroenterology,Tokyo Women’s
Dawsey,Sanford M.(Chap.I-4) Medical University,8-1 Kawada-cho,Shinjuku-ku,
Nutritional Epidemiology Branch,Division of Cancer Tokyo 162-8666,Japan
Epidemiology and Genetics,National Cancer Institute,
6120 Executive Boulevard,Suite 320,Rockville,MD Hiki,Naoki (Chap.VII-1)
20852,USA Surgery Division,Gastroenterology Center,Cancer
e-mail:[email protected] Institute Hospital,3-10-6 Ariake,Koto-ku,Tokyo 135-
8550,Japan
Dohmoto,Matatoshi (Chap.IV-4)
Tokushukai General Hospital Yamagata,2-89-6 Hoshino,Yoko (Chap.IV-3)
Kiyosumi-cho,Yamagata 990-0834,Japan Gastrointestinal Endoscopy Institute of
e-mail:[email protected] Gastroenterology,Tokyo Women’s Medical
University,8-1 Kawada-cho,Shinjuku-ku,Tokyo
Dostler,Irina (Chap.III-1) 162-8666,Japan
Institute of Pathology,Klinikum Bayreuth,
Preuschwitzer Str.101,95445 Bayreuth,Germany Itabashi,Masayuki (Chap.I-4)
Department of Pathology,Ibaraki Prefectural
Ell,Christian (Chap.III-1) Central Hospital and Cancer Center,6528 Koibuchi,
Dr.Horst-Schmidt-Klinikum,65199 Wiesbaden, Tomobe-machi,Nishiibaraki-gun,Ibaraki 309-1703,
Germany Japan
e-mail:[email protected]
Fujii,Shigehiko (Chap.VI-3)
Department of Surgical and Molecular Pathology, Iwashita,Akinori (Chap.I-3)
Dokkyo University School of Medicine,880 Department of Pathology,Fukuoka University
Kitakobayashi,Mibu,Shimotsuga,Tochigi 321-0293, Chikushi Hospital,377-1 Zokumyoin,Chikushino,
Japan Fukuoka 818-8502,Japan
e-mail:[email protected] e-mail:[email protected]
XIII