Hanyang University. Korea: Professor Hang Lak Lee of the College of Medicine is
a doctor and researcher whose research interests mainly lie in
colorectal and gastric cancer. He has recently discovered a way to
examine whether upper gastrointestinal subepithelial tumors (SETs) are
benign or malignant on preoperational level, which saves patients from
physical, emotional, and financial burdens imposed by surgical
procedures.
Upper gastrointestinal SETs are found in two or three people among a
hundred. “As taking regular medical check-ups has been a norm, more and
more people have been diagnosed with it. 90 percent of the time it is
symptomless,” said Lee. Not all upper SETs require treatment. “There are
benign tumors and malignant tumors. Benign tumors, as it is
self-explanatory by its name, do not potentially aggravate nor cause
harm.” Unfortunately, though, they cannot be identified by their size or
shape. Therefore, to evaluate SETs, cell inspections are needed. Thus,
patients with SETs bigger than 2 centimeters are frequently advised to
get the tumors operated, at least until now.
About five years
ago, Lee had a female patient of mid 20’s with upper gastrointestinal
SETs. “The tumor was found in the upper stomach right under the
esophagus. It is an area which is very difficult to treat but
unfortunately the tumor was found to be bigger than three centimeters,”
Lee explained. The shared procedure of SETs bigger than two centimeters,
in the medical field then, was to cut the part of stomach with the
tumor off. “My patient didn’t want to do so since it would affect her
digestive system after the surgery, leave a scar, and it may possibly be
benign. However, she was also deeply concerned that it may be malignant
SET and put her health at risk.” To find effective ways to define the
severity of her SET, Lee implemented endoscopic submucosal dissection
(ESD) technique, the medical procedure that is frequently used to treat
colorectal and gastric cancer, into SET biopsy.
With his aim of preoperative pathological diagnosis, Lee had 58
patient volunteers with SETs in the stomach or esophagus and divided
them into two groups. “One group underwent endoscopic ultrasound (EUS)
and endoscopic deep biops using ESD techniques (40 patients), and the
other group (28 patients) underwent urgical resection after EUS without
obtaining preoperative pathological diagnosis, in accordance with
accepted clinical management algorithms. The results were promising; 90
percent of the first group had gotten accurate and successful diagnostic
yield of deep biopsy, and it changed the treatment plan in 14 patients.
Among the other 28 patients in the second group who underwent surgical
procedures, 12 were confirmed to have benign lesions after all.
Deep
biopsy by the ESD technique is safe as a high-yield diagnostic method.
It is also provides relatively less painful times to patients as it only
takes about 15 minutes, does not require general anesthesia, and igives
no side effects. Lee’s research has changed the paradigm of clinical
managements in supper gastrointestinal SETs. “Surgical resection, even
if the area subjective to removal is small, imposes huge burden on
patients as their bodily reaction would not be the same after the
operation on a major organ. Though it may be benign, we had not had
better option than operating on patients to prevent the worst, but now
it has become possible to avoid unnecessary surgical procedures.”
“To me, research is a way to satisfy my curiosity. There are so many
things I want to discover and know about when I treat patients, and the
answers to the questions are usually unavailable in books or journals.
Research is the process of finding the answers by myself,” Lee said
enthusiastically. He plans to study deeper about the cause of
gastrointestinal stromal tumor (GIST). “GIST is one of the major SETs,
and the cause of its outbreak has not been discovered yet. It is the
area that I hope to find the answer for someday.”