Summary

In this episode, the hosts introduce Sitaram Chilakamarry, MD, a colorectal cancer specialist, and discuss his background and interest in medicine. They then delve into the topic of colorectal cancer, providing statistics on its prevalence and mortality rates. They explain the anatomy of the colon and rectum and how colorectal cancer develops from the innermost lining of these organs. The discussion also touches on the role of genetics, diet, and inflammation in the development of colorectal cancer. The hosts emphasize the importance of early screening and detection to prevent advanced stages of the disease. The conversation explores different screening methods for colorectal cancer, including stool-based tests and direct visualization tests like colonoscopy. The FIT test, which checks for blood in the stool, is the most popular stool-based test. Colonoscopy is considered the gold standard for screening, but it is expensive and carries risks. The conversation also highlights the importance of healthy lifestyle choices in reducing the risk of colorectal cancer. Tobacco use and obesity are significant risk factors. The incidence of colorectal cancer is higher in smokers, and smoking causes inflammation throughout the body. The conversation concludes with a discussion of different cases of colorectal cancer and the next steps in diagnosis and treatment. In this conversation, Sitaram Chilakamarry discusses the process of diagnosing and staging colon and rectal cancer. He explains the importance of MMR testing, staging with CT scans and blood tests, and the role of surgery and chemotherapy in treatment. He also highlights the significance of regular colonoscopies for early detection and the potential for non-operative management of rectal cancer. Additionally, he mentions the promising use of immunotherapy in treating rectal cancer in patients with Lynch syndrome.

Chapters

00:00 Introduction and Background

08:11 Understanding the Anatomy of the Colon and Rectum

13:08 The Development of Colorectal Cancer

24:49 The Importance of Early Screening and Detection

27:32 Exploring Different Screening Methods

36:29 The Pros and Cons of Colonoscopy

43:37 The Impact of Tobacco Use and Obesity

50:43 The Importance of Healthy Lifestyle Choices

53:49 Diagnosing Colorectal Cancer

59:28 The Significance of Screening Compliance

55:17 Staging and Blood Tests

56:45 Treatment Plan and Chemotherapy

01:04:00 Urgent Cases and Ostomy

01:08:49 Elective Cases and Surgery

01:14:07 Anemia and Colonoscopy

01:19:46 Polyps and Watchful Waiting

01:23:35 Immunotherapy and Lynch Syndrome

Takeaways

• Colorectal cancer is a common and serious disease, with approximately 150,000 new cases and 53,000 deaths in the United States each year.
• The colon and rectum are part of the gastrointestinal tract, with the colon absorbing water and the rectum acting as a reservoir for stool.
• Colorectal cancer arises from the innermost lining of the colon or rectum and is typically classified as adenocarcinoma.
• Genetics, diet, and inflammation are factors that contribute to the development of colorectal cancer.
• Screening for colorectal cancer is crucial, as early detection can prevent advanced stages of the disease. Stool-based tests like the FIT test are popular for colorectal cancer screening.
• Colonoscopy is considered the gold standard for screening but is expensive and carries risks.
• Tobacco use and obesity are significant risk factors for colorectal cancer.
• Smoking causes inflammation throughout the body, increasing the risk of colorectal cancer.
• Healthy lifestyle choices can help reduce the risk of colorectal cancer.
• Diagnosis of colorectal cancer involves checking for mutations and inherited...

[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