At the Hematology Hospital of Seoul St. Mary's Hospital, there are quite a few patients who have come through other university hospitals (tertiary hospitals). For this reason, it is also called the 'fourth hospital for hematologic cancer.' This is due to several strengths, particularly the prominent multidisciplinary consultation.

Multidisciplinary consultation is a system where doctors from various departments gather to discuss patient treatment methods. The Lymphoma Center at the Hematology Hospital of Seoul St. Mary's Hospital is at the forefront of the multidisciplinary consultation field. The Lymphoma Center introduced multidisciplinary consultation in 2009. In November 2023, 14 years later, it surpassed 4,000 consultations. As of last month, it increased to 4,160 cases, the highest record in the country. Professor Cho Seok-gu of the Hematology Department, who played a leading role in introducing this system and still leads the lymphoma multidisciplinary consultation team, was asked about its advantages. Professor Cho stated, "Due to the nature of lymphoma, multidisciplinary consultation is essential. It is the optimal system that enhances both diagnostic precision and patient satisfaction."

● The Necessity of Multidisciplinary Consultation for Lymphoma

Lymphoma is a type of hematologic cancer that occurs in the lymphatic system responsible for immune function. It is broadly divided into Hodgkin's lymphoma and non-Hodgkin's lymphoma. Hodgkin's is named after the British doctor who first discovered lymphoma. Non-Hodgkin's lymphoma has more malignant cases than Hodgkin's. In Korea, 95% of lymphoma patients suffer from non-Hodgkin's lymphoma.

Early detection is crucial to increase survival rates. First, check if there are lumps in the neck, armpits, or groin areas. If it is a tumor, it is generally larger than 2 cm and does not feel painful when pressed. It is harder than a rubber ball but not as hard as a walnut. No heat is detected from the lump.

Weight changes should also be observed. If lymphoma has progressed significantly, usually more than 10% of body weight is lost within six months. There is also a tendency to sweat profusely during sleep. If cold sweats soak the bedding, the worsening of the disease should be suspected.

However, the problem is that lymph tissue is spread throughout the body, so tumors can occur anywhere. Professor Cho stated, "If lymphoma occurs in lymph tissue deep within the body, there is no way to notice it. There is no other solution than to have regular health check-ups." In fact, there are many cases where specific diseases are discovered during health check-ups, leading to the discovery of lymphoma. For example, severe indigestion symptoms lead to a visit to the gastroenterology department, where lymphoma is found in the stomach, or suspicion of testicular abnormalities leads to a visit to the urology department, where lymphoma is found in that area. Many patients discover lymphoma has invaded the bone marrow while being treated for anemia.

Lymphoma is treated with various methods, including chemotherapy, radiation therapy, cell therapy, and hematopoietic stem cell transplantation. However, since there are over 60 subtypes, treatment methods vary depending on each pathological judgment. Professor Cho stated, "Accurately assessing the patient's condition is essential for effective treatment. This is why multidisciplinary consultation is absolutely necessary in lymphoma treatment."

● How Multidisciplinary Consultation is Conducted

At the Lymphoma Center, patients participate in multidisciplinary consultations. The scene of multidisciplinary consultation resembles a debate. There are no pre-prepared scripts or scenarios. Treatment methods are not predetermined. Each medical staff member presents their best treatment method. If opinions differ, multiple options may arise. Patients can ask questions at any time and choose a treatment method from the options presented by the doctors. Professor Cho stated, "This method has been maintained for 14 years."

Recently, a woman in her 30s, Ms. A, visited the hospital with lymphoma occurring inside her eyelid. In this case, radiation therapy is usually performed. However, side effects such as cataracts can occur. The consultation team, including an ophthalmologist, suggested monitoring the patient's condition every six months or a year. Since the disease's progression is not fast and the patient's discomfort is not significant, there is no need for urgent treatment.

Essentially, it was a 'treatment deferral,' but Ms. A willingly accepted this decision after receiving a thorough explanation. Professor Cho stated, "Deciding not to treat is also part of the treatment. Without multidisciplinary consultation, such a decision would be difficult to make."

Professor Min Ki-jun, head of the Lymphoma Center at the Hematology Hospital, also emphasized, "Multidisciplinary consultation is truly personalized care because experts from each field discuss and the patient participates in determining the treatment direction."

Multidisciplinary consultations are held every Wednesday from 10 a.m. to 12 p.m. They have been conducted without interruption, except during the COVID-19 pandemic and medical disputes. Usually, each patient takes about 20 minutes. The multidisciplinary consultation team includes △Hematology (Professors Cho Seok-gu and Min Ki-jun) △Gastroenterology (Professor Kang Dong-hoon) △Pulmonology (Professor Lee Jin-guk) △Ophthalmology (Professors Yang Seok-woo and Park Jeong-yeol) △Radiation Oncology (Professors Choi Byung-ok and Choi Kyu-hye) △Pathology (Professors Park Kyung-shin and Kim Soo-yeon) △Radiology (Professor Choi Joon-il) △Nuclear Medicine (Professor Oh Joo-hyun) △Specialized Nurse (Lee Jeong-yeon).

● Seeking Treatment Methods to Improve Quality of Life

In his late 70s, Mr. B underwent a health check-up at a local hospital a few months ago. Stomach cancer was discovered, and a procedure was performed to partially remove the area with the tumor via endoscopy. Shortly after, the doctor said the cancer had penetrated deeper areas, necessitating the removal of the entire stomach.

Mr. B moved to Seoul St. Mary's Hospital for additional tests. At this time, lymphoma was discovered in the stomach. The medical staff determined that removing the entire stomach was unavoidable to treat both stomach cancer and lymphoma. However, the results changed during multidisciplinary consultation. It was judged that partial resection between the stomach cancer and lymphoma might be sufficient, as there was no metastasis.

The partial gastrectomy was successfully completed. There was no metastasis of the cancer. However, the lymphoma remained. The multidisciplinary consultation team first implemented Helicobacter treatment, which had not been completely removed. Professor Cho explained, "Killing Helicobacter reduces lymphoma by 50-80%. Therefore, Helicobacter treatment is prioritized." Currently, Mr. B is under follow-up observation for gastric lymphoma. If there is no change in gastric lymphoma after Helicobacter treatment, radiation therapy will be administered.

Whether to completely remove the stomach or perform partial resection is a significant decision that greatly affects subsequent life. Most importantly, the quality of life changes drastically. If multidisciplinary consultation had not been conducted, Mr. B would likely have undergone surgery to completely remove the stomach based on the surgeon's judgment. At the time, Mr. B greatly welcomed the decision for partial resection, saying, "If it can be done that way, I have nothing more to wish for."

● Contributing to Preventing Misdiagnosis

Multidisciplinary consultation for lymphoma also significantly helps reduce unnecessary treatments or the risk of misdiagnosis. In the case of Mr. C, a man in his 30s, multidisciplinary consultation prevented unnecessary additional chemotherapy. Mr. C, who was diagnosed with Hodgkin's lymphoma at another hospital, visited Seoul St. Mary's Hospital. The lymphoma multidisciplinary consultation team took charge of Mr. C's treatment.

Additional tests were conducted to accurately assess the patient's condition, including lymphoma metastasis. Something resembling a tumor was found in the lung parenchyma. It was a situation suspected to be lung cancer or pulmonary lymphoma. However, the consultation team did not jump to conclusions and conducted an additional biopsy. The result revealed that the 'abnormal area' was tuberculosis. Mr. C received tuberculosis treatment followed by chemotherapy and radiation therapy for Hodgkin's lymphoma. Currently, Mr. C is in a 'remission' state where no tumors are detected.

Mr. C's multidisciplinary consultation was conducted twice. The consultation team carefully considered various possibilities. As a result, the correct disease was diagnosed, allowing Mr. C to avoid unnecessary treatment and leave the hospital early.

There is also a case where misdiagnosis was corrected through multidisciplinary consultation. This was the case for Mr. D, a man in his 50s. Mr. D was diagnosed with duodenal lymphoma at another hospital three years ago. He underwent radiation therapy, but it recurred, and he eventually came to Seoul St. Mary's Hospital.

The lymphoma multidisciplinary consultation team found something questionable in the diagnostic process. The consultation team suspected that there might be lymphoma in the small intestine between the duodenum and the stomach. This area is difficult to confirm with a general endoscopy. The consultation team conducted a capsule endoscopy and confirmed lymphoma infiltrating the small intestine. Therefore, Mr. D did not have a recurrence of duodenal lymphoma. The medical staff was unaware of the existence of small intestine lymphoma.

Once the cause was identified, the treatment process became smoother. Professor Cho stated, "It cannot be unilaterally concluded as a misdiagnosis by another hospital. There may have been a slight difference in pathological judgment." He added, "This was sufficiently explained to the patient, and although the patient was initially angry, he somewhat accepted it later on."

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