[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.