At present, the COVID-19 epidemic has not stopped. What should I do if a tumor patient seeks medical treatment? Can the needs of difficult patients be solved? In order to carry out accurate treatment for tumor patients to the greatest extent, despite the severe epidemic situation and the heavy epidemic prevention task of the hospital, the MDT expert team of the Affiliated Obstetrics and Gynecology Hospital of Fudan University still adheres to the "anti-cancer battlefield", actively uses the online system to organize MDT discussions in an orderly manner, and lights up hope for gynecological tumor patients.
Due diligence, online MDT helps patients with malignant tumors
Ms. Lan (pseudonym), 40, is an ovarian clear cell carcinoma patient who just underwent surgery a month ago. Having another child and being a mother is the trajectory of her dream life. After recovering from the operation, she came to the Obstetrics and Gynecology Hospital affiliated to Fudan University, eager to get an accurate diagnosis and treatment plan.
According to the accumulated clinical experience, Ms. Lan is not suitable for childcare treatment. "Stage IC3 means that cancer cells have appeared in the patient's intraperitoneal fluid, and if the follow-up treatment plan is not determined in time and the treatment is delayed, it will affect the patient's prognosis." For the safety of patients' lives, Professor Hua Keqin, who has been directing and fighting in the frontline of epidemic prevention and control for many days, still leads the team to find and study domestic and foreign literature, hoping to help Ms. Lan through MDT multidisciplinary consultation and multidisciplinary advantages of the hospital.
MDT multidisciplinary consultation is one of the important means of standardized treatment of tumors. On March 29, under the organization of Lu Xin, director of the Gynecology Department of the hospital, experts from the gynecology department, gynecology, pathology, radiology and other departments of the hospital gathered online, and Professors Hua Keqin, Zhou Xianrong, Lu Xin, Hu Weiguo, Yi Xiaofang, Zhu Zhiling and other professors, together with radiology expert Ma Fenghua and pathology expert Tao Xiang, demonstrated in many ways according to the patient's condition, pathology and imaging data, etc., to provide Ms. Lan with the most optimized and reasonable treatment plan.
The MDT consultation lasted nearly 3 hours. In addition to Ms. Lan, there are 4 other tumor patients who benefited. They come from different cities, there are rare three-month-old trophoblastic tumors, there are vulvar cancer patients, high-grade serous endometrial cancer patients, endometriosis malignant patients, both difficult malignant tumors and rare diseases... The "strongest brains" from various disciplines revolve around "expanding the scope of surgery or chemoradiation?" "How precise is the surgical range?" "Can the patient both cut the tumor and preserve fertility?" "Discuss decisions together with such focal points or contradictions, formulate accurate and individualized diagnosis and treatment plans for patients, and solve the treatment plan of tumor patients in one stop, bringing them more benefits."
Tossing and turning, this pathological diagnosis is too critical!
Under the epidemic, the pace of life and work of many people has become slower, but the treatment of malignant tumors is a race against time, and a clear diagnosis a day early may be able to win more opportunities for patients.
Ms. Liu, 36, who had abdominal pain for more than ten days in May last year, found a lump the size of 7cm*6cm in one side of the ovary after visiting the local hospital. Soon, Ms. Liu underwent surgery in the local area, and the pathological results showed: ovarian cancer sarcoma. The malignant pathological results after the operation made her unacceptable, and Ms. Liu rushed to Beijing for a pathological consultation, and the results of the consultation showed that immature teratoma was accompanied by high-grade sarcoma.
Pathological outcomes are essential for subsequent treatment and prediction of recurrence. What's next? Will the tumor come back? The inconsistency of the pathological results of the two units made Ms. Liu anxious. In order to further clarify the diagnosis, Ms. Liu came to the Red House Hospital with slices for the first time and asked Director Zhou Xianrong to consult.
Director Zhou detailed the patient's medical history data, carefully analyzed the pathological slices, and looked for suspicious clues like Sherlock Holmes detectives. With rich experience in reading films, Director Zhou found "abnormalities" through a small number of tissue forms, and the subsequent immunohistochemistry also confirmed his conjecture. The lump on Ms. Liu's ovaries is not a single immature teratoma with a high-grade sarcoma, but a more complex malignant mixed primitive germ cell tumor, containing immature teratoma class III and interstitial ocyst cyst, with secondary somatic mutant high-grade nonspecific sarcoma. Interstitial-like yolk cysts are generally altered by chemotherapy, but Ms. Liu has not had chemotherapy, and such pathological results are even rarer.
Even at the critical moment of the epidemic, the Pathology Department also gave Ms. Liu an accurate answer in a timely manner, and this diagnosis provided authoritative guidance for her follow-up treatment. Subsequently, Ms. Liu needs to undergo complementary surgery as soon as possible, removing the uterus, the ovaries and fallopian tubes on the other side, and even dissecting the lymph nodes.
Through the microscope magnified thousands of times, in the oil painting-like pathological images to peel the cocoon, follow the vine to touch the melon, at the seminar, young doctors will often come up with difficult to determine the case and the "big coffee" discussion, learn reading skills, "practical training" let them benefit a lot.
The Department of Pathology of Red House Hospital has always been recognized by the industry as the "golden signboard" of gynecological pathological diagnosis, and Professor Zhou Xianrong, director of the department, is an authority on gynecological pathological diagnosis in China. Despite the reputation, the pathology department has never stopped the pace of exploration, and has maintained a tireless spirit of learning for many years, even during the epidemic period, it has to discuss general pathology almost every day. Senior doctors share valuable experience, young doctors learn while watching, and "passing, helping, and bringing" day after day has created the keen insight of pathologists. At present, half of the doctors in the pathology department respond to the call of the hospital, rush back to the hospital before the management of Puxi sealing, stay in the department, always maintain the enthusiasm for learning and work, and make a clear diagnosis for many patients with urgent and complex situations like Ms. Liu.
At present, the epidemic situation in Shanghai is in a critical stage of prevention and control, and most of the medical staff of The Red House Hospital have not left the hospital for 7-10 days. "Every need of patients is in their vital interest." In the midst of their busy schedule, they are willing to sacrifice their time to seek medical attention and brainstorm to point out the direction for their patients.
Author: Li Min, Li Miaoran
Editor: Li Miaoran