Scott Webb (Host): This is One-on-One with Regional One Health, your inside look at how we're building healthier tomorrows for our patients and our community. Join us as we get to know some of the individuals who help provide life-saving, life-changing care for our community.

I'm Scott Webb. And today, we're talking with Dr. Ian Solsky, a surgical oncologist with Regional One Health Cancer Care. Dr. Solsky is a specialist in the treatment of cancers that involve the lining of the abdominal cavity, which are called peritoneal surface malignancies. He joins the podcast to educate patients about these cancers and discuss the treatment options available.

Doctors, it's nice to have you here today. We're going to talk treatments for peritoneal surface malignancies, and that's a mouthful and I want to find out from you like what those are, what that means, how you help folks. So, let's start there. Like, what are those, what are peritoneal surface malignancies? And what are the risk factors and symptoms that maybe patients should be aware of?

Dr. Ian Solsky: Well, thanks so much for having me. And I agree, it definitely is a mouthful, but it's really just a general term that actually refers to a variety of different cancers such as appendix, colon cancer, ovarian, gastric cancer, mesothelioma, cancers that have spread to the lining of the abdominal wall, and sometimes the organs within the abdominal cavity as well.

So, we use that term in doctor speak kind of refer to this variety of cancers. But for each individual patient who's coming into the clinic, they will have either appendix, colon, gastric, and so on. And so, for each individual patient, they may not sort of come in saying, "I have that particular type of disease." But surgeons and other oncologists who manage patients in this space, this is sort of doctor speak for the types of patients that we'll see.

Host: Right. Yeah. And just wondering, in terms of the risk factors or who's at risk or, you know, what we can do, like, are these genetic type malignancies or is it more behavior, lifestyle, that kind of thing? Like, is there anything we can do, in other words, Doctor, to prevent or reduce our risk of being diagnosed with one of these peritoneal surface malignancies?

Dr. Ian Solsky: Well, I think it goes down to each individual different cancer type, and there will be different risk factors for colon, appendix, and so on. But I think, you know, there's a lot of confusion in this space, both among patients and also providers when we're using terminology like peritoneal surface malignancies, that doesn't sort of strike people in the same way as just saying colon cancer.

And so, what I hope to get across to the audience is that really, you know, in my role, I see myself as just a general surgical oncologist who helps patients who have stage IV cancers, meaning cancers that have spread distantly beyond where they started. And in terms of peritoneal surface malignancies, generally, we are talking about things like surgery when the disease is confined to the abdomen itself.

But I think one of the takeaways is really just that for any cancer patient who has stage IV disease, I think it's important that they have a surgeon involved as part of their care team. And we are selective in who would be a candidate for these procedures. But I think it's always important to have somebody who has expertise in the space to be able to evaluate a patient, to help guide them and provide input and to set expectations as well.

Personally, I really welcome that opportunity to collaborate with medical oncologists and primary care doctors and GI doctors and others, just to kind of be part of that team and to help navigate patients down the right treatment pathway.

Host: Sure. Yeah. So, let's talk treatment options. As you say, you're a, you know, surgical oncologist. And you've mentioned there the value in someone like yourself, an expert like yourself, being involved in these conversations, and the treatment and care plans and all that. What are the options, I guess? And then, what type of outcomes do patients usually see, or as you were saying about what can they expect anyway?

Dr. Ian Solsky: Sure. Well, you know, when patients would be diagnosed with these stage IV cancers, historically, there was almost a nihilistic type of approach to it. And, you know, providers were not very optimistic about the options. But I think with the advances in medicine, that there's a lot more hope and a lot more opportunities for a lot of patients when there previously was not.

So, in the realm of peritoneal surface malignancies, what surgeons like myself are often talking to patients about is the possibility of having an aggressive surgery called the cytoreduction to essentially debulk all of the disease that is present on the inside and the abdomen. Now, sometimes this can involve different procedures such as things called peritonectomy, which is a fancy term for removing or stripping the lining of the abdominal wall that has these tumor implants on them. However, this may also be combined with actual procedures to remove certain organs, say, part of the intestine, the colon, the spleen, or the gallbladder in order to try to remove all the disease from the abdomen.

Scott Webb: Right.

Dr. Ian Solsky: And the reason why this is considered is because there have been studies that have found that if we can get an ideal cytoreduction, meaning removing essentially all or nearly all the disease within the abdomen, patients can have a survival benefit from that. And actually, with surgery, they can have a survival benefit that's improved from just the best chemotherapy that we have currently.

So, that's why, I think, patients who are candidates for this definitely should be evaluated for it. Of course, as was mentioned, this is an aggressive surgery. And there certainly, you know, are risks to that. But for the right patient, this can give them a potential survival benefit. And so, that's why those are the patients that we're trying to find.

Host: Right. So, Doctor, if we can look into the crystal ball a little bit, but it does seem like just in speaking with experts that just day by day, almost minute by minute, you know, advancements are being made in the treatment and the diagnosis, treatment of cancer, what are some of the new treatments that we wouldn't know about, but you would, that are on the horizon? What type of research is being done? Like, what's got you excited about the future of cancer treatment?

Dr. Ian Solsky: There's a lot of excitement in the space, especially because I think there's a great clinical and scientific community that's really dedicated to trying to improve outcomes for these patients. And there's really so much to learn in this space. I think, conceptually, one of the things that we actually didn't talk about, but what we do in addition to the debulking procedure, again for some cancer types, is something that's called HIPEC. And that's another mouthful of a term, but it stands for hyperthermic intraperitoneal chemotherapy. And what we do is after we debulk all the tumor within the abdomen, we can then perfuse the abdominal cavity with a heated chemotherapy. And the idea behind this is that we remove all the disease that we can see with our eyes with the surgery, but there is the possibility of some microscopic cancer cells floating within the abdomen. And that's why we would perfuse with this heated chemotherapy.

Now, there is some controversy in the space and, among clinicians, it's certainly debated who should get this, what is the true efficacy of the treatment. But I think this is also exciting, because there's a lot of interest in trying to figure out what is the real benefit of this, who is going to benefit from this, how can we combine surgery, the regional therapy of the HIPEC along with traditional treatments like chemotherapy and new advances, things like immunotherapy and so on and so forth. So, I think, there's a lot of activity and interest in trying to figure out what are the most effective therapies, but also what is the right sequence of treatments between chemotherapy, surgery, and the like.

And so, I think, in the coming years, we're going to be learning a lot about just how the entire cancer community should be working together and treating these patients. But certainly now, I think, it requires a team of experts on every side of the cancer team, medical oncology, surgical oncology, pathologists, radiation oncology, radiologists. It's really a team effort.

And so, that's what I would hope for all patients, that they have that opportunity to be evaluated in that multidisciplinary way to make sure that they are getting the right individualized plan for him or her.

Host: Right. Yeah, a team effort for sure. And I do appreciate your time today. I know you're busy. I just want to give you a chance here at the end, you know, explain to me and to listeners really why you think it's so important to have someone like yourself — who does what you do, who's good at what they do, right, and specializes in certain types of cancers, and is involved in research. Why do we need you there as a part of that team?

Dr. Ian Solsky: Well, I think, you know, it's key for these rare cancers to have somebody who has experience in managing these patients, because sometimes the exact right treatments or sequence of treatments, it can be nuanced. And so, you know, while a surgeon and love to be able to offer these therapies to the right patients, there really are a select group of patients who will benefit.

So, I think, it's sometimes also important to be able to know and to be able to have a nuanced discussion with patients and families when they're not a candidate for an aggressive treatment like this. And again, I hope all the patients who come through my door would be candidates for, you know, this potentially life-prolonging therapy, some are not. But even in those circumstances, I think, it's helpful for patients and families to have a discussion about what next steps may be, even if they don't involve surgery.

And I like to be involved and check in with them and reevaluate these patients to see if they ever do turn into eventually be candidates or if they don't, sometimes there still are surgical needs to help these patients, you know, be able to maintain good quality of life and to get other treatments that may be more helpful for them, such as chemotherapy.

And so, I think having somebody who knows when to offer the treatment, but also when it's not the right time. I think that's appropriate. Because, ultimately, you know, our mission is to try to save lives, but also to maintain the best quality of life possible for these patients. And certainly, for all my patients, I'm going to have frank and upfront discussions about, you know, what I think would be best for them. I try to treat all my patients like my own family members and counsel them in the way that I would a family member. And so, I hope to be able to provide that individualized and personalized care to every patient.

Host: Right. As you say, that your services, if you will, may not be needed or appropriate today, but they may be in the future, and you're nearby, of course, as a member of the team. I appreciate your time and your expertise today. It's great to learn from you. Thanks so much.

Dr. Ian Solsky: Thank you so much.

Host: And to learn more, go to regionalonehealth.org/cancercare. And for an appointment call 901-515-HOPE. That's 4673.

And thanks for making One-on-One with Regional One Health, part of your journey to better health. Join us next time as we introduce you to another member of the Regional One Health Family. I'm Scott Webb. Stay well.