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2009.11.11

Benefits of Internet medical information

In September, I wrote a column titled "Shortage of Infectious Disease Specialists" and pointed out some problems that I noticed in Japanese clinical practice. Recently, I had another appalling experience. My aunt in Miyazaki called me and said, "my doctor told me that I have a rare cancer called GIST and must be hospitalized tomorrow to get my stomach removed. But I'm so old. I'm afraid that such major surgery might debilitate me and hasten my death. What shall I do? "

According to my aunt, she has had complete medical checkups every year at the largest hospital in her area. Ten years ago, a small tumor was found in her stomach, but it has never been sent for biopsy (test involving removal of tissue from a living subject for diagnosis) until this year, when it grew to over 1 cm. The tumor was diagnosed as GIST, but her doctor did not seem to know anything about GIST. My aunt was sent out of the office while the doctor did some research on the Internet. Then, about 15 minutes later, she was told, "gastrectomy is your only choice. Your tumor cannot be removed by endoscopic resection."

I told her that I would do some research on GIST and call her back later, and started searching through the Internet for information related to GIST. I immediately found the website of the Japanese Study Group on GIST, established by a group of GIST specialists. There, I could get useful information including the GIST practice guideline. I wondered why her doctor had judged that endoscopic resection was not feasible, because, as shown in Chart 1, a tumor smaller than 2 cm has a very low risk of recurrence and can usually be removed through endoscopic resection without imposing a physical burden on the patient.

Chart 1 Criteria for GIST recurrence risk assessment

Tumor diameter
(Tumor size)
Number of mitotic figures
(Number of cells undergoing division per 50 high-power fields under the microscope)
Very low risk Smaller than 2 cm Less than 5
Low risk 2 cm or larger, smaller than 5 cm Less than 5
Intermediate risk Smaller than 5 cm 5 or more, less than 10
5 cm or larger, smaller than 10 cm Less than 5
High risk 5 cm or larger, smaller than 10 cm 5 or more, less than 10
10 cm or larger Any value
Any size 10 or more

(Source) Prepared by the author based on the information available from the Japanese Study Group on GIST <http://www.gist.jp/>
(Note) GIST= Gastrointestinal Stromal Tumor

In the first place, why had they left the tumor untreated for 10 years after detecting it in a medical checkup? Why did they not send it for biopsy much earlier? I searched through the Internet for medical institutions having GIST specialists and immediately found out that Kumamoto University Hospital was her nearest. Two hours after getting that phone call from my aunt, I could make an appointment for her to see the GIST specialist at Kumamoto University Hospital, and three weeks later, her tumor was successfully removed by endoscopic resection. I came to a strong realization of the benefits of Internet medical information and, at the same time, became deeply concerned about the current situation where some physicians who cannot use the Internet properly are arriving at potentially life-threatening decisions too easily.

Yukihiro MATSUYAMA , Other Columns & Papers

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