Editor's note: On the long road to fighting cancer, the medical community continues to explore and innovate in order to bring more effective treatment options to patients. Professor Wang Kai, Director of the Department of Hematology-Oncology and Radiation Oncology of Xi'an Honghui Hospital, and his team have recently made breakthroughs in the treatment of cancerous intestinal obstruction, bringing new hope to patients with advanced gastrointestinal tumors. On the occasion of the National Cancer Prevention and Treatment Awareness Week, Professor Wang Kai was invited to share the treatment, hoping to inspire more medical practitioners, and provide confidence and strength to patients and their families.
Interviewees
Prof. Kai Wang
Director of the Department of Hematology and Oncology Radiation Oncology of Xi'an Honghui Hospital
Deputy Chief Physician, Master's Supervisor
Doctor of Medicine, Postdoctoral Fellow, Fourth Military Medical University
He is the head of the Center for Capacity Building and Continuing Education of Minimally Invasive Interventional Oncology (Lung Cancer) of the National Health Commission
Member of the Standing Committee of the Special Committee on the Integration of Diagnosis and Treatment of the Chinese Anti-Cancer Association
Chairman of the Shaanxi Provincial Red Cross Foundation Tumor Multidisciplinary Diagnosis and Treatment Committee
Vice Chairman of the Special Committee of Multiple Primary and Unknown Primary Tumors of Shaanxi Anti-Cancer Association
Chairman of the Hematological Oncology Committee of Xi'an Cancer Rehabilitation Association
Vice Chairman of the Medical Science Popularization Branch of Xi'an Medical Association
Editorial Board Member of CACA Guidelines - Gastrointestinal Protection
Yiyuehui: It is reported that you have recently successfully cured two patients with cancerous intestinal obstruction, one of which is also the first successful case of combined heat and cold ablation in the treatment of cancerous intestinal obstruction in China, can you tell us more about this case?
Professor Wang Kai: This case has a certain particularity, the patient's primary tumor has widely metastasized to the abdominal cavity, forming a cancerous intestinal obstruction. Cancerous intestinal obstruction, a blockage caused by a tumor pressing on the intestine, is common in advanced gastrointestinal tumors, but it is often difficult to treat effectively, and patients are often not candidates for surgery. Because of the patient's primary disease, the risk of surgery is high, and wound healing is difficult, while traditional treatments in internal medicine, such as the use of paraffin oil, antibiotics, gastrointestinal decompression, etc., can only provide limited remission and cannot treat the root cause because the primary tumor is progressing.
In the past, when encountering such cases, we had no choice but to choose palliative care to persuade patients and their families to accept the reality, but now in the face of this situation, we can take local ablation therapy, which is a relatively new treatment method, which does not require a large incision to treat the tumor, which greatly reduces the pain of patients. During the operation, we found that the patient's digestive tract compression symptoms had been relieved, and the patient felt significant relief within an hour after the operation, and the bowel function was restored the next day, and he could be discharged from the hospital after three days.
Image source: Red Cross News
The operation of this patient is also a great challenge for us, because this situation is a contraindication in the previous concept, the patient has obvious intra-abdominal flatulence, and there is a greater risk of ablation treatment, and the failure of the operation is likely to lead to intestinal rupture, which requires emergency laparotomy, and even then the effect of the operation is relatively poor. In the end, the team performed the operation under pressure, and the patient was treated very well, and our new search confirmed that this was indeed the first case in the country.
Yiyuehui: Can this successful surgical experience be a guideline for the clinical treatment of cancerous intestinal obstruction?
Professor Wang Kai: That's what I expect. At that time, there was no example to learn from before the operation, and the operation was risky. But after these two successful experiences, we hope to be able to learn from the experience that there are not a few patients with cancerous intestinal obstruction, and many of them may give up early and miss the opportunity to be saved. I hope that through more exploration, we can provide new ideas and references for my peers and help more patients receive effective treatment.
Ablation is actually a relatively new technique, and it was initially marginalized in the medical community. It is mainly used in patients who are not locally able to undergo traditional surgical treatment, so the initial patient population for which it is suitable is relatively small. Later, with the deepening of medical practice and the accumulation of clinical research, we gradually found that in some patients with advanced tumors, if the tumor has local progression, the use of ablation therapy can also bring survival benefits to the patients. This treatment has now been officially codified in the relevant clinical guidelines and is clearly recommended.
Yiyuehui: What are your suggestions for the popularization of science on the prevention and treatment of gastrointestinal tumors?
Prof. Kai Wang: We participated in the compilation of the guidelines for the development of CACA gastrointestinal protection. I believe that it is imperative to change the public perception of cancer, which is still considered incurable by many people, which affects treatment decisions for patients and families. We need to raise awareness of cancer and move from the previous perception of cancer as an incurable disease to a preventable and treatable chronic disease, so that patients can receive the right treatment at the right time.
Yiyuehui: In response to the problem of undertreatment and overtreatment you mentioned, how can we change this phenomenon?
Prof. Kai Wang: This is exactly what our CACA guidelines have always been about – integrated treatment of tumors. The so-called interlacing is like separating mountains, and the branches of modern medicine are becoming more and more refined, and there may be a knowledge gap between different disciplines. The disease that cannot be treated by one discipline does not mean that another discipline is helpless, just like my previous case of treating intestinal obstruction, the convention is considered to be an untouchable forbidden area, but there must be new technologies to try and break the routine, our understanding of the tumor needs to be improved, and we must comprehensively understand it from an integrated perspective to ensure that patients get the most appropriate treatment.
How to improve undertreatment and overtreatment is also another manifestation of this idea, both doctors and patients should reach an overall consensus, we should encourage patients to be more involved in treatment decisions, and work with the medical team to manage the disease from the five aspects of prevention, screening, diagnosis, treatment and rehabilitation.
Yiyuehui: Integrating the advantages of experts and breaking the barriers of disciplines, what are the advantages of your department in MDT?
Prof. Kai Wang: As the name suggests, our department is the Department of Hematology-Oncology and Radiotherapy, which is composed of three specialties: hematology, oncology and radiotherapy, which provides us with a unique advantage in carrying out the MDT model, and we can quickly carry out an MDT model covering most of the cancer treatment modalities in the undergraduate room.
In the future, the treatment of tumors will definitely be multidisciplinary, and the MDT model can comprehensively assess the patient's condition, realize the effective coordination and supervision of various disciplines, and provide reasonable and appropriate medical services. At the same time, we also need to consider the opinions of patient participation, and patient-centered medical decision-making is the best choice for both doctors and patients, and the comprehensive trade-off between science and technology and humanistic care.
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