For the past five years we have experienced six cases of remnant stomach cancer. All of the cases were successfully operated in our hospital, but in almost of them the preoperative conditions were not well and cancer had progressed considerably, so that their prognoses were not promising.
The key for the cure of this malady lies in early detection and early treatment. Even those who have undergone partial gastrectomy should receive examinations for gastric cancer on a regular basis. But in our series only one patient (case 4) had received fluoroscopy since the first operation. The remaining five patients had no examination of the remnant stomach, nor gastric mass screening at all.
Now case 4 was detected by mass screening, so we emphasize in this paper the necessity of gastric mass screening for those who had partial gastrectomy.

During Nov. 1978 and Jul. 1985, we had operated 27 cases of malignant tumors of biliary tracts, namely 16 cases of gallbladder cancers, 9 bile duct cancers, one gallbladder sarcoma and one metastatic tumor of gallbladder from gastric cancer.
The average age of the patients is 70 years old and the ratio of man and woman is 1 to 2.2 in gallbladder cancers and 5 to 4 in bile duct cancers.
Regarding to the diagnostic approach to these diseases, excretery or indirect cholangiographies (OC, DIC) were not useful, but ultrasonic scanning (US) was so effective that we were able to diagnose 2 cases of early gallbladder cancers and get important views in all others.
In 5 cases which we could diagnose as gallbladder cancer preoperatively, only one was resectable to be healthy now. 5 cases diagnosed samely while the operation were all unresectable for the tumors had extremely advanced. In the rest 6 cases diagnosed postoperatively, 5 were now healthy during 19 and 84 months after operation.
All of the bile duct cancer patients were recognized jaundice clinically. 8 patients were diagnosed as cancer by method of direct cholangiography (PTC, ERCP) and seven were resected resulting that five are now surviving for 7 and 67 months after operation. 3 of them presented infiltration to gallbladder and or pancreas, but are alive over three years.
According to these facts and in order to find early or resectable cancers of biliary tract, we began mass screening using US for the inhabitants and have found, for only two years, 1 case of liver metastatic tumor from gastric cancer, 19 cases of asymptomatic gall stones and 4 cases of polypoid lesions of the gallbladder.
Now a 53 year old man who was found an early cancer of the gallbladder ultrasonographically, was examined for electron microscopic observation. Summarily, almost of the cancer cells are resembling each others without goblet and Paneth cells, and surrounded with basement membrane.
Intracellulary, there are abundant organelles and secretery granules. Golgi apparatuses are extremely developed and GERLs are also seen frequently.

Nagato-machi and Wada-mura Nagano prefecture, are mountainous farm villages, with a population of about 8, 000. Over the past years, depopulation has progressed at a steady pace. The trend is still continuing and the average age of the populace is following an upward curve.
Since 1971, mass screening for early detection of stomach cancer has been conducted on a regular basis in Nagato-machi and Wada-mura.
While looking back upon the past 10 years, we made an attempt to analyze the cases of gastrectomy performed since 1978. Some of the cancer cases had been detected by the mass screening and the rest had been detected among the outpatients.
(1) The ratio of those who receive the mass screening tests to the total number of eligible inhabitants stood somewhere around 6% during the initial years, rose to the 10% level in 1976, and went up further to the 20% level in 1978, when stomach exams were started as part of the adult disease prevention scheme by the local health center of both town and village. However, the ratio of the elderly persons (65 and above) who come in for the checkup has been, and still is, notably low. This is one of the serious problems yet to be solved. It is serious in light of the fact that the average age of those outpatients who have been found contracting gastric cancer is 66.
(2) Since 1978, fiberscopy has been incorporated into the intensive examination course following the primary screening. During the past three years, seven cases of stomach cancer have been detected. The detection ratio was 0.23%. Six out of the seven cases were diagnosed as early stomach cancer.
(3) Between September 1978 and March 1981, 53 stomach cancer patients were treated in our hospital. Of the number, 10 had been screened by the mass survey and 43 had been diagnosed at the outpatient clinics. Except for three outpatients, 50 cases were operated.
We have reviewed the outcome of operations and prognoses of the operated cases and the following observations have been obtained
The average age of the patients who had been screened by the mass medical checkup is 62.0, and that of the outpatients is 64.9.
Eighty percent of the screened patients had no complaints.
Out of the outpatients, 75% had not undergone screening at any time previously.
Six patients out of the 50 had received screening five times or more. Five out of the six cases had early stomach cancer.
Curative operation could be performed on all of the patients who had been found in mass screening, but was possible in only 65% of the cases detected in the outpatient clinics.
Histologically, it was found, cancer had invaded no further than the submucosal layer in 80% of the screened patients as against 20% of the outpatients.
Metastasis to the lymph node had not taken place in 60% of the screened patients as against 40% of the outpatients.
As for the progress of cancer, 90% of the cases screened by mass survey had been at stage II or below as against 40% of the outpatients.
As of October 1981, 11 cases of the outpatients had died from cancer.

Since Sep. 1978, 123 patients of gastric cancer were operated in our hospital, 32 patients of them were detected by gastric mass rurvey (MS group) and 91 were outpatients (OP group).
Clinically and histologically, we have reviewed and compared the two groups about the process of detection, the treatment and the prognosis.
Results are as follows.
(1) There were much more patients in MS group than OP group who had no symptom and no complaining period and who had experienced mass survey more frequently. It resulted that the ratio of early gastric cancer of MS and OP group were 68.8% and 33.0% and those who received curative resection were 96.9% and 61.5% respectively.
(2) The cancer occupying the upper third of the stomach was rarely seen and tumorsize less than 0.5 cm was never seen in MS group, but the both were not rarely in OP group which had been examined mainly by endoscopy.
Of course we know that we must make efforts to find these lesions from mass survey. But endoscopical method is more profitable than indirect fluoroscopy to find fine lesions, so it is suggested that endoscopy mass survey will be more useful.
(3) According to The General Rules For The Gastric Cancer Study In Surgery And Pathology (Japanese Research Society For Gastric Cancer), we compared the prognosis of the two groups concerning 4 matters of the patients who were received absolute curative resection, whose cancer invaded to serosa, who had no evidence of regional lymph node involvement and whose histological stage was I or II.
The result was that MS group was superior to OP group on all matters.
The causes, we supposed, were the facts of OP group that many patients were in bad preoperative condition, so the dissections were not made successfully, and that many died of other malady.
Five year survival rates of MS and OP group were 89.8% and 39.0% respectively.

For about 8, 000inhabitants of Nagato-machi and Wada-mura, Nagano prefecture, various mass screenings have been carried out for this 14years. These are gastric mass survey carried out from 1971, primary health screening from 1972, multiphasic health testing and service from 1978, mass screening for breast and thyroid cancer from 1980 and ultrasonographic mass screening for liver, gallbladder and pancreas cancer from 1983.
Among the total of 38, 593examinees, 90patients 92diseases were detected to be operated. Maligant diseases are 9kinds 40patients 42diseases and benign ones are llkinds 50patients.
The largest number of the diseases is 29gastric cancers. Almost of malignant diseases, 36/ 40patients, were detected sincel978 and their prognosis are very good, namely 2patients of gastric cancer, one hepatoma and one breast cancer have died of the malady and one bile duct cancer died of other disease until now.
The route of detection and prognosis of all operated patients, the present condition and the policy of all mass screenings and the necessity of increase of the examinees, especially the old men and women, are discussed.