"So... It's Cancer.‪"‬ Paul Bryan Roach

[00:00] Intro and hello
[01:30] Guest - Eva Galka, M.D. FACS: personal background and path to Surgical Oncology.
[07:00] Pancreatic Cancer: typical patient
[13:35] Clinical Presentation: how does someone know they have pancreatic cancer?
[20:30] Referral: how do people show up in my office?
[33:20] What is the pancreas?
[45:00] Epidemiology of pancreatic cancer, and demographics
[48:00] Staging & Resectability
[1:04:00] Chemotherapy
[1:07:00] Breaking therapies & Studies on pancreatic cancer
[1:15:00] Thank you and closing
Key takeaways:
1. Pancreatic cancer (specifically adenocarcinoma of the pancreas) is a fairly common, and very serious diagnosis, worldwide, with three basic categories meaning early (stage 1), late (stage 4), and intermediate (stages 2-3). Different approaches to the disease are based on which of those categories it falls into, and how healthy / able to tolerate treatment the patient may be.
   2. Resection is one's only/best chance for cure; however many cases are beyond respectability at diagnosis; and some are questionably resectable (borderline or locally advanced) and require upfront treatment before any attempt at resection. Even after resection it can come back, so extra treatments such as chemotherapy is almost always recommended.
   3.  Pancreas located in center of upper abdomen, surrounded by important other organs and blood vessels, making resection of tumors from it a very complex and technically demanding procedure, with significant risks of complications, even --not often but sometimes-- death.
   4.  Chemotherapy and radiation are somewhat effective; frequently necessary, but not AS effective as they can be in some other tumors/cancers..
   5.  The condition (adenocarcinoma of the pancreas) is best treated in specialized centers by specialized teams.
  6.  New treatments (such as immunotherapy and tumor vaccines) are being explored; but need to discuss with academic centers if applies to you. If you think you might be interested in being part of a trial, ask your treating physician and also view the show notes links below.

[00:03] I. Intro and hello
[02:07] II. Guest - Farhan Shams, MD. Geriatrician & Palliative Care specialist
[02:49] III. What are Goals of Care?
[05:38] IV. What is Palliative Care?
[18:01] V. Who comprises a Palliative Care team, and what are their roles?
[31:00] Expectations, communication, and understanding where the patient is coming from.
[43:08] Change is the only constant in life
[47:04] Futility
[48:45] Closing
Key takeaways:
-- Palliative Care is a subspecialty and a team of professionals dedicated to improving the overall experience of a patient, family, and friends throughout the critically difficult moments of patient succumbing to disease.
-- Comprised of a physician, nurse practitioner, psychologist, social worker, and chaplain; all specialized and with a professional focus in the field.
-- Critical to establish "what are the goals of our treatment" and to ask "why are we doing what we are doing?"
--Understanding, communication, expectations, hope, reality, and process.
--Grief
--A Palliative Care doctor is a "Life Coach" for the end-of-life process

Timestamps:
[00:30] Intro to show and Guest Keith Bowersox, MD, PhD
[2:38] Overview on Lung Cancer
[5:55] Smoking & Lung Cancer
[7:40]  Lung Cancer Screening
[10:30] Radon, Vaping, Marijuana & Lung Cancer
[13:30] “If you’re honest with your doctor…”
[16:00] Lung Cancer workup
[20:00] Lung Cancer types:  Small Cell; Non-Small Cell.
[23:00] Lung Cancer stages and implications
[26:00] Radiation treatment
[32:45] Chemo, radiation, immunotherapy side effects and patient selection
[34:45] Cure or palliation
[35:50} Treating for cure:  patient selection & treatment options
[41:18] Post-op:  Medical Oncology assessment and treatment
[44:00] Wrap-up and thank you
Key takeaways:
-lung cancer is a heavy diagnosis; however great progress in its treatment has been made especially recently
-lung cancer is among the most common and lethal, yet among the most preventable of tumors: by quitting smoking, or never starting.
-new, powerful screening modalities in modern practices are low-dose Computed Tomography (“CT”) scans of the chest. Must meet specific guidelines and quit smoking to be able to benefit.
-“Staging” of lung cancer (“Local, regional, distant”) determines treatment options and potential outcomes; baseline health status / lung function important.
-Surgery, Chemotherapy, Immunotherapy, Radiation therapy are main treatment modalities
-Optimal / Essential to have a primary care physician, and maintain a positive relationship with them.

1  - Michael Riordan, Medical Oncologist Peter Schlagel, MD, Urologist Charlie Rinehart MD, and Surgical Oncologist Paul Roach MD embark on a full discussion of Prostate Cancer: what it is, how it happens, how it behaves, and how it's treated.
2  - Guest:  Charlie Rinehart, MD, a practicing Urologist and medical officer in the U.S. Navy, (formerly an officer in the USMC), undergraduate at Georgetown, Medical School at Columbia, and Urologic Residency at US Naval Medical Center, San Diego.  Currently practices at the Captain James A. Lovell Federal Health Care Center, in North Chicago, Illinois. This is his second time on the program; for full introduction to Dr. Rinehart please check out the episode on Bladder Cancer.
3  - Timestamps:
[00:4] - Intro & disclaimer
[01:00] Overview of Prostate Cancer: 
A. Incidence and broad description of the problem
B. What is a prostate? What is a PSA screening test? What does it mean to have an elevated PSA test? How is the PSA test done?
C. Clinical Presentation & who gets prostate cancer?
[10:50] Prostate Biopsy
[12:25] Shared decision making regarding prostate cancer screening
A. The good, the bad, the ugly
B. Risk reduction versus over treatment; the importance of age in the process
C. “Heterogeneity” and variability in prostate cancers
[20:00] Very Low risk, Low, Intermediate, High, Very High risk categories.
[26:15] The “Trifecta”
A. The goal:  Treat the cancer, preserve urinary continence, preserve sexual function.
B. Risks and benefits of treatment options, based off of estimates of baseline risk.
C. What is “active surveillance?” Impact of age, baseline health status on deciding which course of action to take.
[31:20] Active Surveillance & Radiation Therapy
A. Age, health issues, prior experiences and their influence in choosing Surveillance or Xrt.
B. External Beam, IMRT (Intensity Modulated Radiation Therapy), Brachytherapy
[34:03] Side Effects of Surgery, Radiation Treatment
A. Incidence and range of incontinence, erectile difficulties
B. Impact of baseline function, age at time of treatment, time from surgery
C. Sequencing Surgery and Radiation treatments
D. Antitestosterone therapy
[42:00] Staging tests for localized versus widespread cancer.
A. CT scan and bone scans - traditional
B.  MRI’s and PSMA tests - newer
[46:25] Michael’s questions on origin of the cancer: Genetic? Smoking? Diet? Exercise
A.  African American/Black individuals a clearly higher risk of developing prostate cancer and should consider PSA screening 10 years earlier (age
B.  Agent Orange exposure - Viet Nam Veterans.
C. Association with BRCA
i. What is it?
ii. Importance of Family Medical History (males & females)
[51:05]  Summary of points thus far, and Radioactive seeds treatment option
A. When to use which option?
B. Lower risk options and higher risk options
[54:45] Prostatectomy
[56:21] Advanced disease
A. Locally advanced (i.e. spread outside the capsule of the prostate, and/or spread into the local pelvic lymph nodes or organs) disease
B. Distant (i.e. metastatic) disease
i. Androgen deprivation
C. Microscopic disease
D. Survival and quality of life
E. Testosterone supplementation and (+/-) association with prostate cancer.
[1:03:50] How does prostate cancer cause a man to die?
A. “Go-go” phase, “slow-go” phase, “no-go” phase
B. Androgen deprivation
[1:09:22] Closing and thanks
4  - Key takeaways in bulleted format:
-- Prostate Cancer happens to Men alone, as only men have a prostate, and has about the same frequency and risks as breast cancer has for women.
—It typically...

A one hour seminar

Join Mike Riordan, Urologist Charlie Rinehart MD, and I, for a full discussion of Bladder Cancer: what it is, how it happens, how it behaves, and how it's treated.