Digital illustration of a doctor examining a stomach lining with red and white patches, symbolizing predictive factors for undifferentiated gastric cancer.

Decoding Early Gastric Cancer: Can We Predict the Undifferentiated?

Kai Mendoza in Health & Wellness December 2025 • 4 min read.

"New research identifies key factors that may help doctors anticipate undifferentiated early gastric cancer before it's too late, potentially improving treatment outcomes."

Early gastric cancer (EGC) is being detected more frequently worldwide thanks to advances in diagnostic technology. Endoscopic submucosal dissection (ESD) has become a standard treatment for EGC without lymph node metastasis, particularly for differentiated mucosal cancer. However, accurately predicting whether a lesion is suitable for endoscopic resection remains a challenge.

A significant problem arises when the results of an endoscopic forceps biopsy (EFB) differ from the final diagnosis after the lesion is removed. In some cases, what appears to be differentiated cancer in a biopsy turns out to be undifferentiated cancer after ESD, which may require additional surgery. This discrepancy makes precise diagnosis before ESD crucial.

To address this issue, a recent study aimed to identify factors that could predict undifferentiated histology in lesions before endoscopic resection. By understanding these predictive factors, doctors may be better equipped to make informed treatment decisions and improve patient outcomes.

What Makes Undifferentiated Early Gastric Cancer Different?

Digital illustration of a doctor examining a stomach lining with red and white patches, symbolizing predictive factors for undifferentiated gastric cancer.

The study, published in Medicine, retrospectively analyzed 557 early gastric cancer cases in 532 patients who underwent ESD between January 2009 and December 2015. The goal was to identify factors that could predict the diagnosis of undifferentiated cancer and to assess the clinical outcomes of these lesions.

Out of the 557 cases, 535 (96.1%) were diagnosed as differentiated cancer, while 22 (3.9%) were identified as undifferentiated cancer after ESD. The researchers found several significant differences between the two groups:

Tumor Size: Tumors in the undifferentiated cancer group were larger (mean size 20.67 mm vs. 13.59 mm).
Patient Age: Patients with undifferentiated cancer were younger (mean age 60.24 years vs. 64.50 years).
Resection Rates: En bloc resection rates were similar between the two groups, but complete resection rates were lower in the undifferentiated cancer group (72.7% vs. 92.4%).

Multivariate analysis identified four factors that were significantly associated with undifferentiated cancer: tumor size ≥10 mm, age <55 years, surface redness, and whitish discoloration. These findings suggest that lesions with these characteristics need to be treated with caution.

Implications for Treatment and Future Research

This study highlights the importance of carefully evaluating lesions for potential undifferentiated histology before performing ESD. Young patients with larger tumors exhibiting surface redness and whitish discoloration should be considered at higher risk for undifferentiated cancer. In these cases, doctors may need to discuss the possibility of surgical gastrectomy with patients to ensure the best possible outcome. Further research is needed to validate these findings and explore additional factors that may contribute to the development of undifferentiated early gastric cancer.

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This article is based on research published under:

DOI-LINK: 10.1097/md.0000000000008044, Alternate LINK

Title: Predictive Factors To Diagnosis Undifferentiated Early Gastric Cancer After Endoscopic Submucosal Dissection

Subject: General Medicine

Journal: Medicine

Publisher: Ovid Technologies (Wolters Kluwer Health)

Authors: Dae G. Ryu, Cheol W. Choi, Dae H. Kang, Hyung W. Kim, Su B. Park, Su J. Kim, Hyeong S. Nam

Published: 2017-09-01

Everything You Need To Know

1

What is Early Gastric Cancer (EGC) and how is it treated?

Early gastric cancer (EGC) is detected with increasing frequency thanks to advances in diagnostic technology. Endoscopic submucosal dissection (ESD) is a standard treatment for EGC without lymph node metastasis, especially for differentiated mucosal cancer. This procedure involves removing the cancerous lesion through the endoscope. However, correctly predicting whether a lesion is suitable for endoscopic resection remains a challenge. A major problem arises when the results of an endoscopic forceps biopsy (EFB) do not match the final diagnosis after the lesion is removed. In some instances, what appears to be differentiated cancer in a biopsy turns out to be undifferentiated cancer after ESD, which may require additional surgery. This discrepancy underlines the need for precise diagnosis before ESD.

2

How does undifferentiated early gastric cancer differ from differentiated early gastric cancer?

Undifferentiated early gastric cancer differs from differentiated cancer in several ways. The study showed that tumors in the undifferentiated cancer group were larger. Patients with undifferentiated cancer were also younger. Complete resection rates were lower in the undifferentiated cancer group. Multivariate analysis identified four key factors significantly associated with undifferentiated cancer: tumor size of at least 10 mm, patient age under 55 years, surface redness, and whitish discoloration. Lesions exhibiting these characteristics warrant careful evaluation.

3

What is the role of Endoscopic Submucosal Dissection (ESD) in the treatment of EGC?

Endoscopic submucosal dissection (ESD) is a procedure used to remove early gastric cancer (EGC) lesions. It is especially utilized for differentiated mucosal cancer without lymph node metastasis. While ESD is effective, a key concern is the potential discrepancy between the pre-ESD biopsy results and the final diagnosis. This is particularly critical when an endoscopic forceps biopsy (EFB) indicates differentiated cancer, but the subsequent ESD reveals undifferentiated cancer, potentially necessitating additional surgery. The ability to accurately predict the nature of the lesion before ESD is therefore essential for appropriate patient management.

4

What factors can help doctors predict undifferentiated cancer before treatment?

The study identified four factors that predict undifferentiated cancer before endoscopic resection: tumor size of 10 mm or greater, patient age under 55 years, the presence of surface redness, and whitish discoloration. The presence of these factors suggests a higher risk of undifferentiated cancer, which could influence treatment decisions. Specifically, lesions with these characteristics should be approached with caution, as the possibility of undifferentiated cancer may influence the decision between ESD and surgical gastrectomy.

5

What are the implications of these findings for patient treatment?

The implications for treatment involve carefully evaluating lesions for the potential of undifferentiated histology before endoscopic submucosal dissection (ESD). If a patient is younger and presents with larger tumors that exhibit surface redness and whitish discoloration, they are at a higher risk for undifferentiated cancer. In such cases, doctors may need to discuss the possibility of surgical gastrectomy with patients to ensure the best possible outcome. Further research is needed to validate these findings and explore additional factors that may contribute to the development of undifferentiated early gastric cancer.