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Seremban, Malaysia

Tata M.D.,Tuanku Jaafar Hospital Seremban | Gurunathan R.,Sunway Medical Center | Palayan K.,International Medical University
Annals of Gastroenterology | Year: 2014

Background Gastric cancer is notably one of the leading causes of cancer-related death in the world. In Malaysia, these patients present in the advanced stage, thus narrowing the treatment options and making the surgery nearly impossible for successful curative resection. Failure to identify high-risk patients and delay in diagnostic endoscope procedure contributed to the delay in diagnosis. The aim of the study was to develop and validate a scoring system (MARK's Quadrant) which can identify symptomatic patients who are at risk for gastric cancer. Methods A 3-phase approach was undertaken: Phase 1: development of the weighted scoring system; Phase 2: estimating positive predicting value of MARK's Quadrant; and Phase 3: a) testing the validity of MARK's Quadrant in an open-access endoscope system; and b) comparing its usefulness compared to conventional referral system. Results In phases 1 and 2, MARK's Quadrant with weighted symptoms was developed. The sensitivity of MARK's Quadrant is 88% and the specificity is 45.5% to detect cancerous and precancerous lesions of gastric. This was confirmed by the prospective data from phase 3 of this study where the diagnostic yield of MARK's Quadrant to detect any pathological lesion was 95.2%. This score has a high accuracy efficiency of 75%, hence comparing to routine referral system it has an odds ratio (95%CI) of 10.98 (4.63-26.00), 6.71 (4.46-10.09) and 0.95 (0.06-0.15) (P<0.001 respectively) for cancer, precancerous lesion and benign lesion diagnosis respectively. Conclusion MARK's Quadrant is a useful tool to detect early gastric cancer among symptomatic patients in a low incidence region. © 2014 Hellenic Society of Gastroenterology. Source


Tata M.D.,Tuanku Jaafar Hospital Seremban | Ratnasingam D.,Tuanku Jaafar Hospital Seremban | Gurunathan R.,Tuanku Jaafar Hospital Seremban | Palayan K.,Tuanku Jaafar Hospital Seremban
Medical Journal of Malaysia | Year: 2013

Background: Stomach and esophageal cancers are both deadly and difficult to diagnose early. Stomach cancer is the second most common cancer in Asia. Both these are one of the most common causes of cancer related death in the world. Aim: To determine the mean time delay from appearance of the symptoms to the endoscope procedure [OGDS] and rationalized the reason for this delay in diagnosis. Method: This is a cross sectional study of stomach and esophageal cancer data from Jan 2004-July 2008. All patients' records of histologically confirmed stomach or esophageal cancers during the study period were reviewed. Result: Total of 112 consecutive patients with stomach and esophageal cancer were analysed. 86 cases of stomach and 26 cases of esophageal cancer were reviewed. The average age for stomach and esophageal cancers are 60.8 years and 58.4 years respectively. The mean duration from the first appearance of cancer symptoms to endoscope procedure was 32.4 weeks for stomach cancer patient and 16.7 weeks for esophageal cancer patients. The reasons for the delays are due to 1) self-medication, 2) Empirical treatment for dyspepsia using antacid and H2 antagonist, 3) Delay in endoscope procedure for high risk patients. Conclusion: Reducing the delay in endoscope procedure may lead to early detection of cancer and thereby may improve the prognosis of these patients. Source

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