scholarly journals Post Operative Diagnosis of Early Gastric Cancer in a Low Risk Population and the Possibility of Risk Stratified Screening

2015 ◽  
Vol 12 (1) ◽  
pp. 32-37
Author(s):  
B Ghimire ◽  
YP Singh ◽  
S Timalsina
Keyword(s):  
Gastric Cancer ◽  
High Risk ◽  
Early Gastric Cancer ◽  
Screening Program ◽  
Tertiary Care ◽  
Survival Rates ◽  
University Teaching ◽  
University Hospital ◽  
Female Ratio ◽  
Gastric Cancers

Background Gastric cancer is the second commonest cause of cancer related mortality worldwide. Though its incidence is more in Eastern Asia, it is increasing in the South Asian subcontinent. The diagnosis of early gastric cancer (EGC) confined to the mucosa or submucosa, is an important concern due to a better outcome at this stage where five year survival rates could increase by 90 percent. Though mass screening is done in few countries, it has not been applied in developing countries like Nepal. Preoperative diagnosis of EGC is rare in Nepal. The aim of this study is to analyze the clinico-pathological features of postoperative cases of gastric cancer managed in a tertiary care university hospital of Nepal.Methods All patients with histological diagnosis of gastric cancer admitted in the Department of Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal during the three year period (September 2010 to August 2013) were analyzed retrospectively.Results Ninety two patients with endoscopic diagnosis of gastric cancers were admitted during the past three years. The mean age was 60 years ranging from 28 years to 85 years with the male to female ratio of 2.8:1. Five patients were younger than 40 years and all were in advanced stage. Thirty five percent of the patients belonged to Janajatis (Hill) community though they comprise only 23% of the population and about 65% of them belonged to an area involving 25% of the country.Seventy six cases were operated. Out of 92 patients, 4 patients were diagnosed as early gastric cancer postoperatively. All patients with early gastric cancer were above 50 years with CT Scan abdomen revealing focal thickening without lymphadenopathy.Conclusion Over the years, the incidence of gastric cancer is increasing in Nepal. Though 92% are advance gastric cancers, few have been diagnosed and treated early. A screening program in a country like Nepal with diverse ethnicity and difficult terrain might be helpful if it targets high risk people in high risk areas.Kathmandu University Medical Journal Vol.12(1) 2014: 32-37

Outcomes and efficiency of national gastric cancer screening program in Korea: Single-center, large-scale study.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 29-29
Author(s):  
Beom Jin Kim ◽  
Chae Heo ◽  
Bong Ki Cha ◽  
Jae G. Kim ◽  
Sang-Jung Kim
Keyword(s):  
Gastric Cancer ◽  
Cancer Screening ◽  
Early Gastric Cancer ◽  
Large Scale ◽  
Screening Tool ◽  
Screening Program ◽  
University Hospital ◽  
Female Ratio ◽  
Cancer Screening Program ◽  
Gastric Cancer Screening

29 Background: Gastric cancer is a major cause of death and a substantial socioeconomic burden in Korea. The National Cancer Screening Program for Medicaid recipients was initiated in 1999 and has contributed to reduction of cancer-related mortality in Korea. Endoscopy may be cost-effective screening tool in Korea, where the cost of endoscopy and UGIS are similar and the incidence of gastric cancer is high. Most of Japanese studies on the efficiency of mass screening for gastric cancer have dealt with photoflurography as a screening tool. Although biennial gastric cancer screening by endoscopy has been increasing in Korea as part of the National Cancer Screening Program, few studies have evaluated its efficiency. Therefore, we analyzed the outcomes and efficiency of the National Gastric Cancer Screening Program using endoscopy in Korea. Methods: We reviewed medical records from the National Gastric Cancer Screening Program at Chung-Ang University hospital in Korea from January 2007 to December 2010. The study population was comprised of Medicaid recipients ≥ 40 years of age who were taken from the National Health Insurance Corporation. Results: A total of 41,150 asymptomatic subjects underwent endoscopy for gastric cancer screening. The mean age of the screened subjects was 56.3 years for men and 48.9 years for women. The male to female ratio of the screened subjects was 1.57:1. Gastric cancer was diagnosed in 102 (0.24%) of 41,150 subjects (60 men and 42 women). Their mean age was 54.4 years. Of these, 76 subjects (0.18%) were diagnosed as early gastric cancer and 26 subjects (0.06%) as advanced gastric cancer. The proportion of early gastric cancer among total gastric cancers was 74.5%. During the period, only 6,586 (16.0%) subjects participated in the biennial gastric cancer screening (59% for men and 49% for women). Conclusions: Despite accomplishments of the National Gastric Cancer Screening Program in Korea, low compliance to the screening program remains an issue. Furthermore, its cost-effectiveness analysis will be needed for successful progression.

scholarly journals Recent advances in the detection and management of early gastric cancer and its precursors

2020 ◽  
pp. flgastro-2018-101089 ◽  
Author(s):  
William Waddingham ◽  
Stella A V Nieuwenburg ◽  
Sean Carlson ◽  
Manuel Rodriguez-Justo ◽  
Manon Spaander ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
High Risk ◽  
Early Gastric Cancer ◽  
Endoscopic Resection ◽  
Treatment Options ◽  
Survival Rates ◽  
Premalignant Lesions ◽  
High Definition ◽  
Gastric Intestinal Metaplasia ◽  
White Light Endoscopy

Despite declines in incidence, gastric cancer remains a disease with a poor prognosis and limited treatment options due to its often late stage of diagnosis. In contrast, early gastric cancer has a good to excellent prognosis, with 5-year survival rates as high as 92.6% after endoscopic resection. There remains an East-West divide for this disease, with high incidence countries such as Japan seeing earlier diagnoses and reduced mortality, in part thanks to the success of a national screening programme. With missed cancers still prevalent at upper endoscopy in the West, and variable approaches to assessment of the high-risk stomach, the quality of endoscopy we provide must be a focus for improvement, with particular attention paid to the minority of patients at increased cancer risk. High-definition endoscopy with virtual chromoendoscopy is superior to white light endoscopy alone. These enhanced imaging modalities allow the experienced endoscopist to accurately and robustly detect high-risk lesions in the stomach. An endoscopy-led staging strategy would mean biopsies could be targeted to histologically confirm the endoscopic impression of premalignant lesions including atrophic gastritis, gastric intestinal metaplasia, dysplasia and early cancer. This approach to quality improvement will reduce missed diagnoses and, combined with the latest endoscopic resection techniques performed at expert centres, will improve early detection and ultimately patient outcomes. In this review, we outline the latest evidence relating to diagnosis, staging and treatment of early gastric cancer and its precursor lesions.

scholarly journals Comparison of clinicopathological features and long-term prognosis between mixed predominantly differentiated-type and pure differentiated-type early gastric cancer

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yutaka Okagawa ◽  
Tetsuya Sumiyoshi ◽  
Hitoshi Kondo ◽  
Yusuke Tomita ◽  
Takeshi Uozumi ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Early Gastric Cancer ◽  
Vascular Invasion ◽  
Survival Rates ◽  
Malignant Potential ◽  
Clinicopathological Features ◽  
Node Metastasis ◽  
Group 5 ◽  
Long Term Prognosis

Abstract Background Recent studies have shown that mixed predominantly differentiated-type (MD) early gastric cancer (EGC) might have more malignant potential than pure differentiated-type (PD) EGC. However, no study has analyzed all differentiated-type EGC cases treated endoscopically and surgically. This study aimed to compare the differences in clinicopathological features and long-term prognosis between MD- and PD-EGC. Methods We evaluated all patients with differentiated-type EGCs who were treated endoscopically and surgically in our hospital between January 2010 and October 2014. The clinicopathological features and long-term prognosis of MD-EGC were compared with those of PD-EGC. Results A total of 459 patients with 459 lesions were evaluated in this study; of them, 409 (89.1%) and 50 (10.9%) were classified into the PD and MD groups, respectively. Submucosal invasion was found in 96 (23.5%) patients of the PD group and in 33 (66.0%) patients of the MD group (p < 0.01). The rates of positive lymphatic and vascular invasion and ulceration were significantly higher in the MD group than in the PD group (p < 0.01). The proportion of patients with lymph node metastasis was also significantly higher in the MD group than in the PD group (5 (10%) vs 6 (1.5%), p < 0.01). The 5-year overall and EGC-specific survival rates in the PD group were 88.3 and 99.5%, respectively, while they were 94.0 and 98.0% in the MD group, respectively. Conclusions MD-EGC has more malignant potential than PD-EGC. However, the long-term prognosis of MD-EGC is good and is not significantly different from that of PD-EGC when treated appropriately.

scholarly journals Implementation of a Targeted Screening Program to Detect Airflow Obstruction Suggestive of Chronic Obstructive Pulmonary Disease within a Presurgical Screening Clinic

2015 ◽  
Vol 22 (4) ◽  
pp. 209-214 ◽  
Author(s):  
Chantal Robitaille ◽  
Esther Dajczman ◽  
Andrew M Hirsch ◽  
David Small ◽  
Pierre Ernst ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Screening Program ◽  
Tertiary Care ◽  
Airflow Obstruction ◽  
University Hospital ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Targeted Screening ◽  
History Of

BACKGROUND: Targeted spirometry screening for chronic obstructive pulmonary disease (COPD) has been studied in primary care and community settings. Limitations regarding availability and quality of testing remain. A targeted spirometry screening program was implemented within a presurgical screening (PSS) clinic to detect undiagnosed airways disease and identify patients with COPD/asthma in need of treatment optimization.OBJECTIVE: The present quality assurance study evaluated airflow obstruction detection rates and examined characteristics of patients identified through the targeted screening program.METHODS: The targeted spirometry screening program was implemented within the PSS clinic of a tertiary care university hospital. Current or ex-smokers with respiratory symptoms and patients with a history of COPD or asthma underwent prebronchodilator spirometry. History of airways disease and smoking status were obtained during the PSS assessment and confirmed through chart reviews.RESULTS: After exclusions, the study sample included 449 current or ex-smokers. Abnormal spirometry results were found in 184 (41%) patients: 73 (16%) had mild, 93 (21%) had moderate and 18 (4%) had severe or very severe airflow obstruction. One hundred eighteen (26%) new cases of airflow obstruction suggestive of COPD were detected. One-half of these new cases had moderate or severe airflow obstruction. Only 34% of patients with abnormal spirometry results had reported a previous diagnosis of COPD. More than one-half of patients with abnormal spirometry results were current smokers.CONCLUSIONS: Undiagnosed airflow obstruction was detected in a significant number of smokers and ex-smokers through a targeted screening program within a PSS clinic. These patients can be referred for early intervention and secondary preventive strategies.

GASTRIC CANCER: A 5 YEAR RETROSPECTIVE ANALYSIS OF CLINICAL, PATHOLOGICAL AND TREATMENT ASPECTS FROM A TERTIARY CARE CENTER IN SOUTH INDIA.

2021 ◽  
pp. 129-132
Author(s):  
B. Ramkumar ◽  
J. Kannan ◽  
Ingersal. N ◽  
Srigopal mohanty ◽  
Amit saklani ◽  
...  
Keyword(s):  
Risk Factors ◽  
Gastric Cancer ◽  
South India ◽  
Care Center ◽  
Tertiary Care ◽  
Tumor Location ◽  
Advanced Stage ◽  
Tertiary Care Center ◽  
Nodal Disease ◽  
Female Ratio

Context: Gastric cancer(GC) is fth most common cancer worldwide. Mostly presents with advanced stage and poor overall survival. Methods: Retrospective study on clinical, pathological, pattern of distant metastasis(DM) , treatment aspect of GC treated between January 2014 to December 2018 in a tertiary care center in south India. Statistical analysis : Chi square test and multivariate analysis (MVA) were used for analysis. P <0.05 was considered signicant. Results: Median age at diagnosis is 57 years. Higher male : female ratio. Most common presentation was abdominal pain followed vomiting. Malignant Gastric outlet obstruction(MGOO) was present in 22.7%. Histologically , all patients had adenocarcinoma with predominantly moderate differentiation (51.1%). Liver (19.1%)was most common site of metastasis . Curative surgery was done in 35.5% of patients. D2 lymph node dissection was performed in 12.4% of patient. Patients were given perioperative /preoperative/ adjuvant / palliative chemotherapy. MVA revealed history of tobacco use, body of stomach tumor location, nodal disease were risk factors for DM. Conclusion : The present analysis revealed use of tobacco, alcohol intake were main risk factors for GC. Most of the patients present in advanced stage , so prevention by avoiding risk factors and early detection by signs , symptoms and endoscopy are necessary. Use of tobacco,site of tumor location, nodal disease were factors associated with DM. Aggressive management with both surgery and chemotherapy is warranted for locally advanced disease.

Early gastric cancer in the province of Forlì: follow-up of 337 patients in a high risk region for gastric cancer.

1998 ◽  
Author(s):  
L Saragoni ◽  
M Gaudio ◽  
A Vio ◽  
S Folli ◽  
O Nanni ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
High Risk ◽  
Early Gastric Cancer

scholarly journals Prediction model of bleeding after endoscopic submucosal dissection for early gastric cancer: BEST-J score

Gut ◽  
2020 ◽  
pp. gutjnl-2019-319926 ◽  
Author(s):  
Waku Hatta ◽  
Yosuke Tsuji ◽  
Toshiyuki Yoshio ◽  
Naomi Kakushima ◽  
Shu Hoteya ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
High Risk ◽  
Early Gastric Cancer ◽  
Prediction Model ◽  
Endoscopic Submucosal Dissection ◽  
Clinical Decision Making ◽  
Validation Cohort ◽  
External Validation ◽  
Derivation Cohort ◽  
Submucosal Dissection

ObjectiveBleeding after endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) is a frequent adverse event after ESD. We aimed to develop and externally validate a clinically useful prediction model (BEST-J score: Bleeding after ESD Trend from Japan) for bleeding after ESD for EGC.DesignThis retrospective study enrolled patients who underwent ESD for EGC. Patients in the derivation cohort (n=8291) were recruited from 25 institutions, and patients in the external validation cohort (n=2029) were recruited from eight institutions in other areas. In the derivation cohort, weighted points were assigned to predictors of bleeding determined in the multivariate logistic regression analysis and a prediction model was established. External validation of the model was conducted to analyse discrimination and calibration.ResultsA prediction model comprised 10 variables (warfarin, direct oral anticoagulant, chronic kidney disease with haemodialysis, P2Y12 receptor antagonist, aspirin, cilostazol, tumour size >30 mm, lower-third in tumour location, presence of multiple tumours and interruption of each kind of antithrombotic agents). The rates of bleeding after ESD at low-risk (0 to 1 points), intermediate-risk (2 points), high-risk (3 to 4 points) and very high-risk (≥5 points) were 2.8%, 6.1%, 11.4% and 29.7%, respectively. In the external validation cohort, the model showed moderately good discrimination, with a c-statistic of 0.70 (95% CI, 0.64 to 0.76), and good calibration (calibration-in-the-large, 0.05; calibration slope, 1.01).ConclusionsIn this nationwide multicentre study, we derived and externally validated a prediction model for bleeding after ESD. This model may be a good clinical decision-making support tool for ESD in patients with EGC.

scholarly journals Profile and Outcome of Triple Negative Breast Cancer at a Tertiary Care University Hospital in Nepal

2020 ◽  
Vol 5 (2) ◽  
pp. 101-105
Author(s):  
Suman Khanal ◽  
Yogendra P. Singh ◽  
Gita Sayami ◽  
Akihiko Ozaki
Keyword(s):  
Breast Cancer ◽  
Triple Negative Breast Cancer ◽  
Triple Negative ◽  
Ductal Carcinoma ◽  
Tertiary Care ◽  
Tumor Biology ◽  
Clinical Profile ◽  
University Teaching ◽  
University Hospital ◽  
P Value

Background: TNBC (Triple negative breast cancer) subtype (ER-/PR-/HER2-) of breast cancers are known for aggressive tumor biology and poor survival prospects, with high early relapse rate. However, little is known about the prevalence and characteristics of TNBC breast cancer in Nepal. Objectives: To clarify the geographical distribution, clinical profile and outcome of TNBC patients when compared with non-TNBC patients managed in tertiary care university hospital in Nepal. Materials and Methods: This is a study on prospective observational analyses of TNBC and non-TNBC patients managed at Tribhuvan University Teaching Hospital, Kathmandu from October 2015-March 2018. We collected and analyzed data on clinical profile, pathological tumor features and outcome of the two patient groups. Results: A total of 108 breast cancer patients were included in our study, 38 (35.2%) of which were TNBCs. Mean age at diagnosis was 49±12 years. Majority of TNBCs (29%) were concentrated in Terai districts compared to non-TNBCs (18.6%). Among TNBCs, 15.2% had tumor size 5 cm or more while only 11.9% had such finding in non-TNBCs. Majority of TNBCs and non-TNBCs were of invasive ductal carcinoma of NST histology (76.3 vs 90%). TNBC tumors were significantly of grade 3 (P value=0.003). Perineural invasion was seen more (15.8%) in TNBCs compared to 8.96% in non-TNBCs. On average, 23.6% of total nodes retrieved from axilla were positive for tumor in TNBCs compared to 21% in non-TNBCs. Three patients developed metastases in TNBCs of which two were to brain while 5 had metastases in non-TNBC with none to brain. Higher percentage of patients died in TNBC group (13.2 vs 7.1%). Conclusions: TNBCs are quite common, higher grade tumors with brain metastasis without particular geographic distribution.

scholarly journals Clinical and Histopathological Features of Early Gastric Cancer With Unclear Lateral Demarcation

2021 ◽  
Author(s):  
Kengo Nagai ◽  
Yoshito Hayashi ◽  
Ryotaro Uema ◽  
Takanori Inoue ◽  
Keiichi Kimura ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Early Gastric Cancer ◽  
Narrow Band Imaging ◽  
Ki 67 ◽  
Histopathological Features ◽  
Gastric Cancers ◽  
Antibody Staining ◽  
Gastric Phenotype ◽  
History Of ◽  
Superficial Epithelium

Abstract Background Magnifying-endoscopy with narrow band imaging (M-NBI) is useful to determine lateral demarcation of early gastric cancers, but determining the lateral demarcation is sometimes difficult. Features related to the unclear lateral demarcation remain unknown. We evaluated the clinical and histopathological features of early gastric cancers with unclear lateral demarcation by M-NBI. Methods This single-center retrospective cohort study analyzed early gastric cancer treated by endoscopic submucosal dissection (ESD) from January 2013 to August 2015. We evaluated clinicopathological and immunohistochemical features using anti-p53, -Ki-67, -MUC5AC, -MUC6, -MUC2, and -CD10 antibody staining. We compared the lateral demarcation between the demarcation clear (DC) and demarcation unclear (DU) lesions by using M-NBI. Results A total of 224 differentiated adenocarcinomas (DU group: 18 lesions; DC group: 206 lesions) were analyzed. The history of successful Helicobacter pylori eradication was significantly more frequent in the DU group (p = 0.001). We examined tissues of 72 lesions immunohistochemically, including 18 lesions in the DU group and 54 randomly selected lesions in the DC group. Non-neoplastic superficial epithelium is more frequently observed in the DU group (p = 0.0058). Additionally, the DU group showed a significantly higher expression of gastric phenotype marker (p = 0.023), lower p53 score (p = 0.0002), and lower Ki-67 labeling index (p = 0.0293). The non-neoplastic superficial epithelium and low p53 score were significant independent variables associated with unclear lateral demarcation by M-NBI in the multivariate analysis. Conclusions Non-neoplastic superficial epithelium and low p53 score were associated with the difficultly in determining lateral demarcation in early gastric cancers by M-NBI.

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