Often patients who have been diagnosed with liver or pancreatic cancer don't realize that viable treatments are available for even advanced and complex cancers. At City of Hope, our goal is to turn the tide against this often intractable illness and save more lives.
Listen to City of Hope Radio as internally-renowned liver and pancreatic surgeon, research and author, Dr. Yuman Fong, City of Hope's chair of the Department of Surgery, discusses how research plays a key role in developing new and improved cancer therapies and how the future of cancer surgery is "less invasive, more cures."
Pancreatic & Liver Cancers: Compassionate Care Meets Scientific Excellence
Featured Speaker:
Yuman Fong, M.D.
Esteemed liver and pancreatic surgeon, researcher and author, Yuman Fong, M.D., is one of today’s most respected and recognizable physicians in the treatment of the liver, bile duct, gallbladder and pancreas. He has pioneered and enhanced many surgical, laparoscopic, robotic and ablative, therapies now widely used around the world to treat these difficult cancers. Especially notable is his track record of launching human clinical trials of genetically modified viruses with the potential to fight cancer. Transcription:
Pancreatic & Liver Cancers: Compassionate Care Meets Scientific Excellence
Melanie Cole (Host): City of Hope takes an aggressive, multidisciplinary approach to diagnosing and treating patients with pancreatic and liver cancers. A coordinated team of specialists combine innovative therapies, state-of-the-art technologies and highly compassionate care to give pancreatic and liver cancer patients the best hope possible. Today, we have with us Dr. Yuman Fong. He’s an esteemed liver and pancreatic surgeon and chairman of the Department of Surgery and associate director for International Relations with City of Hope. Welcome to the show, Dr. Fong. Tell us, when you first started medicine, cancer care and cancer treatments were a lot different than they are now. Tell us some of those differences.
Dr. Yuman Fong (Guest): It was that vastly different. When I graduated from medical school in 1984, if someone had pancreatic or liver cancer, it was basically a death sentence. It has come such a long way. Not only can we now provide a lot of the patient a chance at a better and longer survival, but some of those patients and many of those patients, we actually now provide a chance of cure.
Melanie: That’s amazing and such hopeful information to people. Now, you have a motto and you treat some of the most difficult cancers, Dr. Fong. So tell us your motto and talk about some of the newer treatments available today.
Dr. Fong: Yeah. So, I come to work every day and think “more cure, less invasive” and it’s both those parts. So, just take for example, the most common cancer we’ve removed out of the liver every year in the United States which is metastatic colorectal cancer. These are cancers that started in the colon or the rectum, traveled by blood and reached the liver and basically, those patients classed by their stage four when the disease is found. When I finished medical school, it was thought to be incurable. In fact, many of those patients weren’t even treated. Then it was discovered that those tumors, many times, it’s only in the liver. That’s because, again, all of the blood from the colon and the intestines travel to the liver first before it reaches anywhere else, and the liver is such a good filter that many times those tumor cells don’t reach anywhere else. It also turns out that the liver is really good at killing cancer cells. It takes millions of tumor cells to reach a liver for a few spots to form. So, starting in the late 1980’s, surgeons started removing the tumors from the liver, and lo and behold, many of those patients just by surgery alone were long-term survivors and potentially cured. Then chemotherapy got better and better over the years, and so through the 1990’s, through the 2000’s, the chemotherapy got so good that even patients who have 10-20 tumors in the liver can now potentially be cured. It has really become a new age, and a lot of patients that weren’t living more than six to eight months back in the 1980’s now are long-term survivors living into old age and seeing all of those personal milestones that are important, like watching their kids grow up and seeing their grandchildren born, those things that were never imaginable back in the 1980’s. Then in the 2000’s, as we got better at these surgeries, we also discovered that we could do these operations in a much easier way on the patients, meaning that we can actually use smaller and smaller incisions. First, we started using laparoscopic incisions. Those are little incisions where we put a camera through, put small instruments through, we cut no muscles and reach in and do the work and get rid of cancers. Now, we’re even able to do it using robots, where we actually reach in with those instruments. Well, it is not that we put a robot inside; it is that we control those instruments using the computers and other electronic gadgetry that now allows us to even better see and remove tumors and allow the patients to recover so much faster, so it really is about more cures, less invasive. And now, about 50% of the people with metastatic colorectal cancer to liver can be given a chance at cure.
Melanie: Tell us a little bit about pancreatic cancer, Dr. Fong, because we seem to be hearing more about it, with celebrities, and people really think that this is something without much hope, but that’s not true, is it?
Dr. Fong: No. Yes, pancreatic cancer is a difficult disease to treat. It’s difficult for three reasons. One is that the cancer itself can oftentimes spread even when it’s small, and so many times, if diagnosed, the patients are found to have metastatic disease. Second reason it is hard is because, again, the pancreas is an organ sitting in the part of the body that is very inaccessible and there are many, many major blood vessels nearby, so all kinds of surgeries that we do to get rid of cancers of the pancreas can carry with it potential risk. But over the years, three things have happened. One is that we are now able to find pancreatic cancer much earlier. Our scanning techniques, our index to suspicion, all of those things have gotten better, and so nowadays, many times, we find the cancers at a stage when it’s treatable. Surgeries have also become safer. The operations that, years ago, were thought to be the biggest of the operations that can be done for humans have now become simpler. In high volume centers, those are the big cancer centers, these operations now fairly routine. In major cancer centers where a lot of these pancreatic operations are being done, we have operative mortality of less than 1%. They’re bringing one of the biggest operations that can be done for people down to less than a 1% operative mortality. Then lastly, our chemotherapies have gotten much better. In the last five years, there have been a number of advances in chemotherapy that now allows us to get at the bad pancreatic cancer site with very, very good chemotherapy that shrinks the tumor, sometimes even before surgery to make the surgery easier, but allows us to also give the chemotherapy after surgery to provide more people with long-term survival and potential cure.
Melanie: Dr. Fong, if someone comes to you, what is the best advice you give their family and the patient when they are faced with one of these very scary diagnoses?
Dr. Fong: These are very scary diagnoses, and it usually strikes someone in their prime of life, like somebody is feeling perfectly healthy a day before and then suddenly they are not feeling well and discovered to have a metastatic cancer in the liver or discovered to have pancreatic cancer. Most important thing is to make sure that you get the appropriate medical opinions to make the right decisions. The appropriate medical opinion for the very difficult cancers should be a high volume cancer center that deals with these diseases every day. It’s been long proven that for most cancers, if you seek help from a surgeon and a medical oncologist who are taking care a lot of those cancers, the outcome is better. But for the very difficult cancers, like liver cancer and pancreatic cancer, the difference between being treated by someone who only occasionally sees one of these versus a center where a lot of these are taken care of, that difference in outcome is particularly marked. So the key thing is number one, to make sure that you’re seen at a place where they take care of a lot of these cancers. There are also many issues that come up during the consultation and during the planning for therapies. If there are any questions, seek second opinions. That’s because for anybody who cares tremendously about the patient, we’re never offended if a patient would like to have other opinions before having a major operation or having chemotherapy and an operation; therefore, making sure that patient is actually completely at peace with the decision and/or is completely confident that the plans for that patient are the best ones possible, that’s what it’s all about. So, again, it’s seeking the best opinion and then seeking more opinions if you’re still wondering.
Melanie: What an amazing doctor you are, Dr. Fong, I can just absolutely tell. In just the last minute or so, tell patients and listeners why they should come to City of Hope for their cancer care.
Dr. Fong: Well, the City of Hope is one of the oldest comprehensive cancer centers in this county. It’s been around a long time and the entire mission here is about treating cancer. It is not just the surgeons; it is about the entire team. It includes an amazing team of not only the surgeons, the medical oncologist and the radiation oncologist, but also all the support staff that helps a patient through a difficult time and a big operation. But beyond that, the City of Hope is also one of the biggest centers for minimally invasive surgery in this country. The programs here for laparoscopic resections and robotic resections are amongst the best and biggest and using these minimally invasive techniques. What we’re trying to do is couple it with the teams to provide “more cures, less invasive.”
Melanie: Thank you so much, Dr. Yuman Fong. You’re listening to City of Hope Radio. For more information, you can go to cityofhope.org. That’s cityofhope.org. This is Melanie Cole. Thanks for listening.
Pancreatic & Liver Cancers: Compassionate Care Meets Scientific Excellence
Melanie Cole (Host): City of Hope takes an aggressive, multidisciplinary approach to diagnosing and treating patients with pancreatic and liver cancers. A coordinated team of specialists combine innovative therapies, state-of-the-art technologies and highly compassionate care to give pancreatic and liver cancer patients the best hope possible. Today, we have with us Dr. Yuman Fong. He’s an esteemed liver and pancreatic surgeon and chairman of the Department of Surgery and associate director for International Relations with City of Hope. Welcome to the show, Dr. Fong. Tell us, when you first started medicine, cancer care and cancer treatments were a lot different than they are now. Tell us some of those differences.
Dr. Yuman Fong (Guest): It was that vastly different. When I graduated from medical school in 1984, if someone had pancreatic or liver cancer, it was basically a death sentence. It has come such a long way. Not only can we now provide a lot of the patient a chance at a better and longer survival, but some of those patients and many of those patients, we actually now provide a chance of cure.
Melanie: That’s amazing and such hopeful information to people. Now, you have a motto and you treat some of the most difficult cancers, Dr. Fong. So tell us your motto and talk about some of the newer treatments available today.
Dr. Fong: Yeah. So, I come to work every day and think “more cure, less invasive” and it’s both those parts. So, just take for example, the most common cancer we’ve removed out of the liver every year in the United States which is metastatic colorectal cancer. These are cancers that started in the colon or the rectum, traveled by blood and reached the liver and basically, those patients classed by their stage four when the disease is found. When I finished medical school, it was thought to be incurable. In fact, many of those patients weren’t even treated. Then it was discovered that those tumors, many times, it’s only in the liver. That’s because, again, all of the blood from the colon and the intestines travel to the liver first before it reaches anywhere else, and the liver is such a good filter that many times those tumor cells don’t reach anywhere else. It also turns out that the liver is really good at killing cancer cells. It takes millions of tumor cells to reach a liver for a few spots to form. So, starting in the late 1980’s, surgeons started removing the tumors from the liver, and lo and behold, many of those patients just by surgery alone were long-term survivors and potentially cured. Then chemotherapy got better and better over the years, and so through the 1990’s, through the 2000’s, the chemotherapy got so good that even patients who have 10-20 tumors in the liver can now potentially be cured. It has really become a new age, and a lot of patients that weren’t living more than six to eight months back in the 1980’s now are long-term survivors living into old age and seeing all of those personal milestones that are important, like watching their kids grow up and seeing their grandchildren born, those things that were never imaginable back in the 1980’s. Then in the 2000’s, as we got better at these surgeries, we also discovered that we could do these operations in a much easier way on the patients, meaning that we can actually use smaller and smaller incisions. First, we started using laparoscopic incisions. Those are little incisions where we put a camera through, put small instruments through, we cut no muscles and reach in and do the work and get rid of cancers. Now, we’re even able to do it using robots, where we actually reach in with those instruments. Well, it is not that we put a robot inside; it is that we control those instruments using the computers and other electronic gadgetry that now allows us to even better see and remove tumors and allow the patients to recover so much faster, so it really is about more cures, less invasive. And now, about 50% of the people with metastatic colorectal cancer to liver can be given a chance at cure.
Melanie: Tell us a little bit about pancreatic cancer, Dr. Fong, because we seem to be hearing more about it, with celebrities, and people really think that this is something without much hope, but that’s not true, is it?
Dr. Fong: No. Yes, pancreatic cancer is a difficult disease to treat. It’s difficult for three reasons. One is that the cancer itself can oftentimes spread even when it’s small, and so many times, if diagnosed, the patients are found to have metastatic disease. Second reason it is hard is because, again, the pancreas is an organ sitting in the part of the body that is very inaccessible and there are many, many major blood vessels nearby, so all kinds of surgeries that we do to get rid of cancers of the pancreas can carry with it potential risk. But over the years, three things have happened. One is that we are now able to find pancreatic cancer much earlier. Our scanning techniques, our index to suspicion, all of those things have gotten better, and so nowadays, many times, we find the cancers at a stage when it’s treatable. Surgeries have also become safer. The operations that, years ago, were thought to be the biggest of the operations that can be done for humans have now become simpler. In high volume centers, those are the big cancer centers, these operations now fairly routine. In major cancer centers where a lot of these pancreatic operations are being done, we have operative mortality of less than 1%. They’re bringing one of the biggest operations that can be done for people down to less than a 1% operative mortality. Then lastly, our chemotherapies have gotten much better. In the last five years, there have been a number of advances in chemotherapy that now allows us to get at the bad pancreatic cancer site with very, very good chemotherapy that shrinks the tumor, sometimes even before surgery to make the surgery easier, but allows us to also give the chemotherapy after surgery to provide more people with long-term survival and potential cure.
Melanie: Dr. Fong, if someone comes to you, what is the best advice you give their family and the patient when they are faced with one of these very scary diagnoses?
Dr. Fong: These are very scary diagnoses, and it usually strikes someone in their prime of life, like somebody is feeling perfectly healthy a day before and then suddenly they are not feeling well and discovered to have a metastatic cancer in the liver or discovered to have pancreatic cancer. Most important thing is to make sure that you get the appropriate medical opinions to make the right decisions. The appropriate medical opinion for the very difficult cancers should be a high volume cancer center that deals with these diseases every day. It’s been long proven that for most cancers, if you seek help from a surgeon and a medical oncologist who are taking care a lot of those cancers, the outcome is better. But for the very difficult cancers, like liver cancer and pancreatic cancer, the difference between being treated by someone who only occasionally sees one of these versus a center where a lot of these are taken care of, that difference in outcome is particularly marked. So the key thing is number one, to make sure that you’re seen at a place where they take care of a lot of these cancers. There are also many issues that come up during the consultation and during the planning for therapies. If there are any questions, seek second opinions. That’s because for anybody who cares tremendously about the patient, we’re never offended if a patient would like to have other opinions before having a major operation or having chemotherapy and an operation; therefore, making sure that patient is actually completely at peace with the decision and/or is completely confident that the plans for that patient are the best ones possible, that’s what it’s all about. So, again, it’s seeking the best opinion and then seeking more opinions if you’re still wondering.
Melanie: What an amazing doctor you are, Dr. Fong, I can just absolutely tell. In just the last minute or so, tell patients and listeners why they should come to City of Hope for their cancer care.
Dr. Fong: Well, the City of Hope is one of the oldest comprehensive cancer centers in this county. It’s been around a long time and the entire mission here is about treating cancer. It is not just the surgeons; it is about the entire team. It includes an amazing team of not only the surgeons, the medical oncologist and the radiation oncologist, but also all the support staff that helps a patient through a difficult time and a big operation. But beyond that, the City of Hope is also one of the biggest centers for minimally invasive surgery in this country. The programs here for laparoscopic resections and robotic resections are amongst the best and biggest and using these minimally invasive techniques. What we’re trying to do is couple it with the teams to provide “more cures, less invasive.”
Melanie: Thank you so much, Dr. Yuman Fong. You’re listening to City of Hope Radio. For more information, you can go to cityofhope.org. That’s cityofhope.org. This is Melanie Cole. Thanks for listening.