1.Issue in late diagnosis of gastric cancer
Tulgaa L ; Ganchimeg D ; Chinzorig M ; Erkhembayar E ; Tegshjargal B ; Nasanjargal T ; Dashmaa A ; Bayar D ; Tsegmed S ; Bolor-Erdene T ; Otgonbayar I ; Batbold B
Mongolian Medical Sciences 2019;187(1):42-47
Introduction:
Gastric cancer is still one of the most leading causes of mortality in the world. The highest mortality rate of gastric cancer is estimated in Mongolia. South Korea and Japan, where leading the incidence of gastric cancer, mortality rates are observed in 51th and 31nd rank respectively. In Mongolia, gastric cancer is the second leading site, after liver cancer.
Goal:
We aimed to determine the cause of late diagnosis of gastric cancer and to evaluate supply of upper endoscopy devices and human resource for gastric cancer in the general hospital of provinces and districts.
Materials and Methods:
In this study, 84 patients suffering from gastric cancer (42 patients in III, IV TNM stage; 42 patients in I, II TNM stage)were investigated in National Cancer Center, Mongolia. A survey questionnaire which included age, gender, education, income, risk factors and clinical questions was detected from all patients. And we conducted study of supply of upper endoscopy devices and human resource for gastric cancer in general hospitals of from 21 provinces and general hospitals of 6 districts by questionnaire.
Results:
Seventy three(86.9%) patients were over 50 years old and the highest rates of gastric cancer were in group of 61-70 years (40.5%). From the results, the reason to visiting hospital was significantly different between two groups. 55.1% of patients suffering from early-stage gastric cancer were voluntarily diagnosed by upper endoscopy. In contrary, 55.8% of patients suffering from late-stage gastric cancer have visited the hospital due to worsening symptoms or dysphagia and vomiting. Factors such as age, gender, education, employment status and income had no significant effect on late diagnosis of gastric cancer. In totally 24(89%)general hospitals out of 27 had upper endoscopy devices and 22 (81.5%) hospitals had endoscopist. Although 75% of total general hospitals conduct
annual cancer screening, 64% of them do not perform the endoscopy in annual screening.
Conclusion
In our country, late diagnosis of gastric cancer is related to the attitudes of patients for preventing and screening disease. Therefore, it is important to improve the health education of the population and to develop healthy, right attitudes and practices. And the study revealed that general hospitals have insufficient for upper endoscopy devices and human resource.
2.Measuring serum pepsinogen level for screening early stage of gastric cancer
Dashmaa A ; Chinzorig M ; Erkhembayar E ; Nasanjargal T ; Bayar D ; Ganchimeg D ; Batbold B ; Tulgaa L ; Erkhembulgan P
Mongolian Medical Sciences 2018;186(4):86-92
Gastric cancer is the second leading cause of death worldwide. About half of the incidence of stomach
cancer has been reported in East Asian countries. In Mongolia, gastric cancer is the second most common cancer in males and the third most common in females. The age-standardized mortality rate for gastric cancer was 29.3 per 100,000 in 2016, ranking second after liver cancer. Pepsinogen (PG) is a proenzyme of pepsin, by chief and mucous neck cells in the gastric mucosa. On the basis of the source of secretion, PGs are subdivided into 2 types: PG I and II. PG I is only secreted from the fundic glands in the corpus of the stomach, whereas PG II is secreted from the corpus, as well as the pyloric glands in the antrum and proximal duodenum. PG is excreted mainly into the stomach lumen, but approximately 1% diffuses into the blood stream. Atrophic gastritis and intestinal metaplasia are well-known risk factors for gastric neoplasms including dysplasia. To identify these premalignant gastric conditions, histological biopsy or image-enhanced endoscopy is performed. Gastric cancer is usually preceded by a decades-long precancerous process driven by Helicobacter pylori infection and environmental conditions with well-defined successive lesions. In the advanced stages, they are characterized by glandular atrophy and intestinal metaplasia. These changes involve loss of the original glands and result in decrease of the mass of chief cells of the gastric corpus, where PGI is produced. Loss of chief cells leads to lower PGI levels and PGI/PGII ratio in the peripheral blood. Serum PG levels are therefore a key tool to be used in screening programs. Serum PG measurements could provide a simple and noninvasive method for screening gastric neoplasms.
3.Study on the risk factors of gastric cancer
Tulgaa L ; Ganchimeg D ; Enkhmyagmar D ; Tegshjargal B ; Nasanjargal T ; Ulziisaikhan B ; Dashmaa A ; Bayar D ; Bolor-Erdene T ; Erkhembayar E ; Chinzorig M ; Serjbayar G ; Batbold B
Mongolian Medical Sciences 2020;192(2):37-44
Introduction:
In 2018, a total of 901 new cases of gastric cancer were recorded, of which 64.8% in males and
34.2% in females. The incidence rate of gastric cancer was 28.5 per 100 000 population, which 38.2
for males and 19.2 for females.
Goal:
We aimed to investigate the associations between some risk factors and gastric cancer among the
Mongolian population.
Materials and Methods:
A case-control study was conducted between November 2017 and September 2019. We selected
120 cases from National cancer center of Mongolia who newly diagnosed gastric cancer. And 120
controls were selected by matching by sex, age and the place of residence. Informed consents
were obtained from all subjects. All subjects were personally interviewed with researchers used by a
structured questionnaire consisting of 86 questions. The SPSS 21 (version 16.0, SPSS Inc., Chicago,
IL, USA) software was used for all analyses.
Results:
The mean age was 59.2±11.4 (26-85) years. Habits of having dinner after 6.00 pm (OR 1.42, 95%CI
1.11-1.83, p=0.008), having leftover meals (OR 2.22, 95%CI 1.27-3.86, p=0.008), daily consumption
of tea with salt (OR 1.97, 95%CI 1.18-3.30, p=0.01), smoking on an empty stomach (OR 2.44,
95%CI 1.11-5.37, p=0.033), weekly consumption of ham and smoked meat (OR 1.5, 95%CI 1.17-
2.13, p=0.02), and consumption of fat grease (OR 2.09, 95%CI .03-4.24, p=0.038) were significantly
increased gastric cancer risk. In contrast, habit of eating at regular times (OR 0.43, 95%CI 0.25-0.73,
p=0.002), chewing thoroughly (OR 0.39, 95%CI 0.23-0.67, p=0.001), cooking meat thoroughly until
it’s tender (OR 0.48, 95%CI 0.25-0.97, p=0.047), daily consumption of vegetables (OR 0.45, 95%CI
0.27-0.76, p=0.003), and daily consumption of fruit juice (OR 0.36, 95%CI 0.15-0.85, p=0.026) were
significantly reduced gastric cancer risk. Furthermore, having first-degree relatives diagnosed with
gastric cancer had 2-3 fold higher increased risk of gastric cancer (parents OR 2.88, 95%CI 1.07-
7.78, p=0.038, sibling (OR 3.09, 95%CI 1.09-8.81, p=0.036). Also, previous records of the digestive
disease increased risk of gastric cancer (OR 3.65, 95%CI 2.10-6.35, p<0.0001).
Conclusion
Dietary habits, family history of gastric cancer and previous records of digestive disease were
associated with risk of gastric cancer. Thus, prevention effort could be focused on the population with
a family history of gastric cancer, changing bad dietary habit and screening precancerous disease of
gastric cancer.
4.Surgical treatment and survival rate from colorectal cancer in Mongolia
Ganbaatar R ; Chinzorig M ; Tuvshin B ; Erdene-Ochir Ya ; Jargalsaikhan D ; Erkhembayar E ; Bat-Оrgil Ch ; Khaliunaa B ; Batzorig B ; Ulziisaikhan B
Mongolian Medical Sciences 2021;197(3):59-63
Introduction:
In 2018, the overall colorectal cancer (CRC) incidence rate was 3.6%, according to the
National Cancer Center of Mongolia (NCCM), and the incidence of colorectal cancer has increased
slightly in recent years. According to cancer stages, late stage cancer has a 5-year survival rate of
51%, while early stage cancer has a 5-year survival rate of 79%. The overall survival rate of colorectal
cancer in Mongolia has not been studied in precisely. In Asia, the 5-year survival rate for colorectal
cancer was 60%. Therefore, this study investigated the colorectal cancer survival rate and prognostic
factors at NCCM.
Methods:
A total of 108 patients diagnosed with CRC at NCCM’s General Surgery Department from
2013 to 2015 were used in this retrospective cohort study. The Kaplan-Meier method was used to
develop the survival graphs, which were then compared using the Log-rank test.
Results:
The median survival time was 42 months, with a 95% CI (38.55-45.66). A 5-year period,
the overall survival rate for CRC was 61.2%. Survival rates at the I, II, III, and IV stages were 100%,
75%, 65.4%, and 13.5%, respectively. There was a significant difference in CRC survival rates across
all stages (p=0.0001). There was a statistically significant difference in determining the relationship
between adjuvant chemotherapy and survival rate (p=0.0003).
Conclusion
The outcome of the surgery is determined by the CRC stage. The postoperative survival
rate (61.2%) is directly related to tumor stage, peripheral glandular metastasis, distant metastasis,
and chemotherapy effects.
5.A new diagnostic biomarker in early detection of Hepatocellular Carcinoma
Batchimeg B ; Baljinnyam T ; Khulan U ; Khaliun M ; Bilguun E ; Munkhtsetseg B ; Terguunbileg B ; Chinzorig M ; Gan-Erdene B ; Bilegtsaikhan Ts ; Erkhembulgan P ; Batbold B ; Munkhbat B ; Munkhtuvshin N ; Munkhbayar S
Mongolian Medical Sciences 2021;197(3):10-16
Background and Aims:
Hepatocellular carcinoma (HCC) is a common cause of cancer related death
in Mongolia. Early diagnosis is the very important management to increase successful treatment
and survival rate. Glypican-3 (GPC3) protein is highly expressed in hepatocellular carcinoma (HCC)
tissue and in serum of HCC patients. Recent studies have been conducted and suggested as a
diagnostic biomarker for detecting HCC in the early stage. Therefore, we investigated the diagnostic
value of the serum GPC3 level and compared it to the alpha-fetoprotein (AFP) level as a diagnostic
biomarker of HCC.
Methods:
We enrolled a total of 90 participants and divided into 3 groups with HCC (30), with liver
cirrhosis (LC/30) and healthy (30) as the control group (30). GPC3 and AFP serum (sGPC-3, sAFP)
levels were measured using commercially available enzyme-linked immunosorbent assay kits. The
diagnostic accuracy was analyzed using the receiver operating characteristics (ROC) curve and
estimated sensitivity and specificity of each biomarker.
Results:
sGPC3 was significantly elevated in the HCC group as compared to liver cirrhosis and
healthy subjects (658±138.2 pg/ml, 378±25.5 pg/ml, 356.3±29 pg/ml) respectively. sGPC-3 sensitivity
was 96.6% and specificity was 100%. The area under the ROC curve (AUC) for GPC3 was 0.999
(0.996- 1.0).
In comparison, the mean of AFP was significantly higher in HCC (16.9±11.7 ng/ml) than in LC (6.7±7.6
ng/ml) and in healthy subject (3.3±2.1 ng/ml) and AFP sensitivity was 43,3 %, specificity was 95 %
with an AUC of 0.808 (0.696- 0.921).
The combination of GPC-3 with AFP achieved the highest sensitivity (97.1%) and specificity (97%).
Conclusion
Serum GPC3 has a higher sensitivity than AFP for the early diagnosis of HCC.
Combination of two markers showed greatest diagnostic accuracy.
6.The effect of nutrition risk factors for esophageal and gastric cancer
Enkhmyagmar D ; Tulgaa L ; Nasanjargal T ; Batbold B ; Ganchimeg D ; Tegshjargal B ; Bolor-Erdene T ; Bayar D ; Erkhembayar E ; Chinzorig M ; Dashmaa A ; Tsegmed S
Mongolian Medical Sciences 2019;187(1):80-86
Gastric and esophageal cancer is a significant global health issue. The epidemiology of these tumors has significantly increased over the past several years especially in developing and developed countries. Many dietary exposures have been proposed to protect against or increase risk for esophageal and gastrointestinal (GI) cancers, including poor diets, foods, individual nutrients, methods of food preparation, and habits of consumption. Overweight/obese status is associated with an increased risk for many cancer types such as esophageal, gallbladder, kidney, pancreatic and
gastric cancer. The association between obesity and cancer is strong. Nowadays there is a recognized decrease in incidence and mortality of distal gastric cancer and an increase in incidence and mortality of proximal esophageal cancer. In Mongolia, gastric cancer is the second most common cancer in males and the third most common in females. It is very important to understand how diet and nutrition affect to gastric and esophageal cancers. In this review we will discuss the effect of diet in locally advanced gastro-esophageal cancer. Although we tried to conclude all published articles about gastric and esophageal cancers in Mongolia.
In this survey, is considered dietary risks into 5 groups as following;
• Insufficient nutrition education(don’t know food and nutrients significance and food hygiene, don’t know right consumption of food)
• Bad habits (hot tea and meals, salty tea and food, low consumption of fruits and vegetables, sometimes eating breakfast, most of daily energy of food in the night, high amount of sugar, a drink of caffeine, overweight and etc.)
• Food processing technology (such as overcooking, pickling, preserving, frying, excessive salt in tea fried and etc).
• Chemical contaminants in food products (various inorganic fertilizers, heavy metals and etc.)
• Household economic capacity is influencing
Diet can be used as a tool to evoke the positive/desirable biological responses of an organism aiming to maximize health and protection against diseases (chronic/non-communicable diseasesparticularly cancer) by mostly means of prevention.