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Amanda Wilde (Host): One on One with Regional One Health is your inside. Look at how we're building healthier tomorrows for our patients and our community. Join us for expert insight that empowers you to achieve a lifetime of better health. Today, we're talking to Dr. Evan Glazer, a surgical oncologist at regional one health cancer care, and the University of Tennessee. Dr. Glazer is an internationally known expert in the treatment of liver cancer, which is one of the most common forms of cancer diagnosed in patients each year. Welcome Dr. Glazer. Glad to have you here.

Dr. Evan Glazer: Thank you very much. My pleasure to join you today and discuss liver cancer. As a surgical oncologist, I work with many colleagues to take care of patients with liver cancer in Memphis and across the Mid-South. It really is my privilege and pleasure to take care of patients. And thank you for inviting me to join you.

Amanda Wilde (Host): Do we know why liver cancer is so common?

Dr. Evan Glazer: Some cancers of the liver we do. And not other ones. For example, the two most common types of liver cancer are hepatocellular and biliary tract cancers. Hepatocellular cancer is the most common one. And this is usually associated with some infections such as hepatitis B or C or chronic alcohol use. There are some other causes of it as well. These problems that patients have are usually longstanding issues and eventually they develop into cancer. And that's when usually I'm involved in taking care of patients as part of a multidisciplinary approach.

Amanda Wilde (Host): What symptoms might signal liver cancer?

Dr. Evan Glazer: Unfortunately like many cancers, it's very hard to identify symptoms or signs of cancer before it's really present. And so we aggressively use screening. These are tools to look at patients who are at higher risk of developing liver cancer. And try to identify these cancers as early as possible. We use ultrasound or sometimes different MRI imaging and tools like that. As well as blood tests to identify patients who are at higher risk. Sometimes patients will complain about feeling pain or discomfort their abdomen related to where the liver is. And sometimes they'll notice changes into their bowel or bladder habits.

Unfortunately, it can be quite challenging for patients. And so that's why it's so important for those who are a little bit higher risk to undergo surveillance and screening. So we can identify liver cancer as early as possible.

Patients who have significant amounts of alcohol use or chronic hepatitis infections like hepatitis B or C. There are some other patients that have what's called fatty liver disease. As the obesity epidemic has increased in this country, more and more patients have fatty livers and we're seeing more and more patients who develop liver cancer related to their fatty liver.

Amanda Wilde (Host): So you said that liver cancer is sometimes not an early diagnosis and that's what you're working on screening. how do you go about reaching an accurate diagnosis so that you can then decide on the proper treatment plan?

Dr. Evan Glazer: Sometimes patients will have abnormal blood tests or will have abnormal discomfort or difficulty eating or otherwise have a symptom that leads to a scanning. We scan with ultrasound or CT scans or MRI scans, and frequently we identify a lesion. Which is basically a fancy way of saying a spot on their liver. Many patients have spots on their liver that are not cancer and are really not a big deal at all, but some patients do unfortunately have cancer. That's identified initially as a spot on their liver. And so what we do as, experts in cancer care is we use what's called, we work up the spot, we work up the lesion.

And so that can involve other tests to better characterize and look at this lesion. It involves blood test. And if we really can't identify or give a diagnosis. Then we move on to biopsying the lesion or biopsy the spot. And that's where a radiologist puts a small needle actually into it. We remove a little piece of it and have our pathologist look under the microscope to understand exactly what it is that spot, the lesion can be hepatocellular carcinoma. It can be what's called Klangio carcinoma.

Even sometimes people have cancers in other parts of the body that end up going to the liver. And so we use a combination of all these things, the imaging, the pathology, the patient's history to really understand what's going on and really understand how best to treat them.

Amanda Wilde (Host): If it is cancer, what is the treatment

Dr. Evan Glazer: Each cancer has a slightly different treatment plan. Over the last few years, patients with hepatocellular carcinoma really went from having very limited treatment options, to many treatment options. Patients that have disease that's just in the liver, oftentimes are eligible for surgery. And that's where I come in as a surgical oncologist. I'm a physician who treats cancer primarily with surgery. And so that means removing it, cutting it out and making sure to take good margins around it, to minimize the risk of it coming back.

Sometimes patients with certain liver cancers will transplant the whole liver. Other times, unfortunately we can't remove it. We can't resect it. And so we use other treatments where we inject particles into the tumor. And most recently we've actually developed a number of therapies, either pills or IV therapy that patients can take. This harnesses, the patient's own immune system to attack the cancer, as well as other therapies that try to have the cancer slow down its growth.

Amanda Wilde (Host): At Regional One Health, you offer some of the more advanced state-of-the-art surgeries for liver cancer treatment. Can you talk a little more about those procedures?

Dr. Evan Glazer: Absolutely. As I mentioned as a surgery oncologist, I offer patients, robotic surgery, laparoscopic surgery, or traditional open surgery. And part of my job is really to identify the right operation for the right patient at the right time. Some of the factors that are involved is where is this tumor located on liver, the patient's other medical problems, other treatment options available. And so I work with a multidisciplinary team of medical oncologists, other surgical oncologists radiologist. And other healthcare professionals in order to maximize the treatments.

And so sometimes we'll give treatments such as radiation particles or chemotherapy particles first, and then we'll do surgery. Other times we do surgery first and then do other treatments afterwards We even can use different tools besides for just resecting it. One of the tools that I have here is called navigation ablation. And this is where I use ultrasound in real time, which means while the patients asleep in the operating room, I use ultrasound and a special antenna that burns the tumor enough to kill all the cancer cells.

and the area around the tumor to ensure negative margins. This in combination with resection allows me to treat many patients that would not otherwise be good candidates for surgery.

Amanda Wilde (Host): So

there are a lot of options in terms of less invasive procedures, even with surgery. What can patients expect in terms of overall outcomes and also recovery?

Dr. Evan Glazer: Every patient's Unique and every patient's experience is unique. And one of the aspects that we pride ourselves here is really personalizing the approach, both for the patient, as well as their cancer and their tumor. And so sometimes, we're able to do minimally invasive approaches, often using robotic system. And some of those patients will actually go home in two or three days. Other patients for a number of factors are not good candidates for the minimally invasive approach. And those patients have traditional open surgery that may take five or six days to go home.

As you can imagine everyone's different. And part of the therapy and treatment is to also involve physical therapist, occupational therapist, nutritionist, to really optimize the patient before surgery and then help them recover afterwards. Sometimes patients can go home a day or two earlier and will set up physical therapy at home or physical therapy at a facility to help them continue to recover.

Amanda Wilde (Host): So there's every chance of successful outcomes in each situation.

Dr. Evan Glazer: That's right. Part of taking care of the patient is not only recognizing their cancer and the specific aspects of their cancer that help guide our recommendations for care, but also realize a patient and their family. And what does that look like? And what is their family comfortable with and what do the patients prefer? Different patients can obviously have different preferences and different priorities. And a big part of our job is to help those patients work through all the different options to come up with the best possible outcome.

Amanda Wilde (Host): Very individualized. What would you say is the future of liver cancer treatment? And as we talk about robotic surgery and using all these disciplines together, I'm wondering what is the future of liver cancer treatment, and how are you helping advance that field just to make sure your patients always have access to the latest care options?

Dr. Evan Glazer: Yeah, I think in, working together with the other healthcare professionals, primarily the medical oncologist and the interventional radiologist, we all try to do our job better. That means looking for clinical trials, understanding the modern research. And as one of us gets better, we all get better. And the entire country and the world gets better at treating patients with these cancers, we learn from each other. And so, the less invasive surgery I can do helps patients recover the faster they recover, the more easy they can receive other therapies down the road if necessary. And so we really work together to help each other improve all the outcomes.

I'm also involved in research. And I have a lab that studies a number of important factors for cancer. One of the things we're most interested in is how the cancer responds to the tumor cells around it and how the cells around the cancer respond as well. As you can imagine, cancer starts in a person. So this was something that was in that patient and it turned really bad. Understanding how and why it turned bad is important, so we can develop further therapies. And that's how we've come so far with immunotherapies, where we harness the immune system.

We've other therapies that are molecules that go and target the cancer cells. One of the most exciting things is. The idea that we can develop therapies to get the patient's own body or in this case, their own normal liver to attack the cancer as well. And so, whereas perhaps at some point in the past, cancer is just true with one drug, we use a combination approach, as well as with a combination of surgery and other therapies to maximally kill the cancer cells and maximally help the patient.

Amanda Wilde (Host): These are amazing advances. Are they kind of happening all the time?

Dr. Evan Glazer: The They are, things are changing very quickly. We are a national comprehensive cancer network institution. And I sit on the panel for hepatobiliary, which means liver and bowel, doc cancers. And every six months we get together and look over the most cutting edge research to give the best recommendations to physicians and providers in the country and really around the world to best take care of these patients. And progress is made every month, and every year. And that's one of the reasons I really do. Like my job. It's very exciting to learn new things. It's very exciting and really a privilege to take care of patients.

And it's really exciting when we have new tools and new therapies to offer them because like everyone else we want our patients to do well. We want to help them recover. We want to help them live a very long time and a combination of surgery and chemotherapy and even other therapies like immune therapy. Really has changed the paradigm for our patients and being able to offer not only those therapies, but the next therapies that are gonna come next year and in five years and 10 years really is making what tomorrow looks like quite optimistic.

Amanda Wilde (Host): Very much. Thank you, Dr. Glazer for this thoughtful conversation and for helping us gain a much better understanding of liver cancer and treatment and what the future might hold. Thanks again so much.

Dr. Evan Glazer: Thank you very much. It's been my pleasure.

Amanda Wilde (Host): Dr. Evan Glazer is a surgical oncologist at Regional One Health Cancer Care. For an appointment with Dr. Glazer call 901-515-9595 Thanks for making One on One with Regional One Health part of your journey to better health. Join us next time as we cover another topic to keep you on the path to a healthier tomorrow, until then be well.