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 as we get to know some of the individuals who help provide life-saving life-changing care for our community. Today, we're talking to Dr. Saloni Mehrotra, a colorectal surgeon with Regional One Health Cancer Care. Dr. Mehrotra recently joined the team at Regional One Health, so we're getting to know her and what drives her as she provides care to patients. Dr. Mehrotra, welcome.

Dr. Saloni Mehrotra: Hi. Thank you for inviting me, Amanda. Nice to meet you.

Host: Thank you so much for being here. Since we are just meeting and you're meeting the community, tell us a little about your background and why you decided to pursue a career in medicine.

Dr. Saloni Mehrotra: So, a little bit about myself. I grew up in Mumbai, India and moved to the States right after high school. I studied biomedical engineering at Brown, and that's really what brought me here. I thought that I would like to pursue genetic engineering or med device creation. And in college, I worked on several projects that helped create medical devices to be used by physicians.

However, at some point in that training, while I was building these devices, I decided that I'd rather have a more direct impact on patient care and sort of cut out the middleman. And that's really what led me to apply to medical school. And that led me to apply to medical school. And I applied and went to St. Louis University to pursue my medical training, after which in medical school, sort of the same things that had interested me and brought me to biomedical engineering led me to surgery and I really enjoyed using my hands and kind of having a more one-on-one impact with patients. And so, that led me to apply to general surgery as a field. And I applied for my residency in general surgery and went to the University of Buffalo for that training.

While I was in general surgery residency, I had always had an interest in oncology and knew about that because I had had several family members kind of go through treatment with cancer, as well as a lot of my research up to that point had to do with oncology. And so, that had already led me to realize that I had an interest in surgical oncology. And within the field of surgical oncology, I think my interest in colorectal grew because of the high positive impact and survivability of colorectal cancer and the fact that, when caught early and treated, patients can live fairly normal lives.

And I think the privilege of being able to have patients lead fairly regular lives after having a cancer diagnosis was really attractive to me, and the fact that the field allows you to take care of patients longitudinally, which isn't always the case in various different surgical fields, it's not sort of a one and done field because it allows you to create lifelong relationships with these patients that you have to continue to assess over a period of time and get to know them and their families. And then, also, sort of the field allowed for both large and small cases. And also, it is constantly evolving from like a technology standpoint, which is also quite interesting to me from like my engineering background.

Host: That is quite a full journey. And it has had its twists and turns, but you listen to what was exciting to you in yourself, how does that translate to what brought you to Memphis and Regional One Health?

Dr. Saloni Mehrotra: When I was being recruited and applying for jobs, after colorectal fellowship, I think the thing that drew me really to Memphis and Regional One was the real need for a colorectal surgeon in the community. It seemed like in the specific setting of a quite underserved patient population, it seemed like there was really a gap to fill in the market. And that really excited me because there are many places that colorectal surgery is a highly sub-specialized field. And I think that there are many places that one can apply for a job. But usually, you're one of many. And it's sort of competing for the patient market versus, here, it really feels like you're a part of a mission. And that felt quite meaningful to me, to provide for the community in that way. I also had several mentors from my previous residency in Buffalo that are practicing surgeons here that had only great things to say about the system. So, that also kind of helped with my draw here.

Host: So, the working environment and the way it is set up is really conducive to your doing your work. And what can you offer patients at Regional One Health?

Dr. Saloni Mehrotra: So at Regional One Health, I'm a part of the surgical oncology team. So, I personally help take care of colorectal cancer patients in a multidisciplinary system. We have, you know, medical oncologists, radiation-oncologist and supportive care and genetic testing. And so, that's sort of an entire system made so that people can have individualized cancer care.

In terms of actually the surgeries that are provided, they're both minimally invasive as well as open. So, both laparoscopic and robotic when appropriate for patients for colon and rectal cancer. And then, in addition to just cancer care, I also provide care for other colorectal conditions that are benign. So, that includes diverticular disease, inflammatory bowel disease, so like Crohn's or ulcerative colitis, rectal disorders. So like hemorrhoids, fissures, fistulas, patients with rectal prolapse or fecal incontinence, as well as patients that have like early stage polyps like colon or rectal polyps, because I provide colonoscopies as well in addition to surgery.

Host: So, you bring a broad range of treatments and experience, you specialize in the treatment of colorectal cancer. Can you talk a little about the warning signs and risk factors for this disease as well as treatment options that you offer?

Dr. Saloni Mehrotra: Sure. So, I think, the thing that brought me into colorectal surgery, which I mentioned earlier, it's exciting because it's highly treatable, especially when found early. So, it's really important for us to recognize the warning signs and also stay up-to-date on the screenings. So, the warning signs when they do appear, which isn't always the case, which is why screenings are important, but the warning signs when they do appear mainly include rectal bleeding or like blood in the stool, and change in your bowel habits if you start to have a lot of diarrhea or constipation or your stool appears to be narrowed. And if patients have abdominal pain and cramping for a prolonged period of time, or any unexplained weight loss or anemia, those are sort of considered red flag signs. And any age of a patient when they experience those should probably be referred to a colorectal surgeon or get a colonoscopy. Those would be what I consider warning signs.

And I think risk factors, there are some like risk factors that are modifiable and non-modifiable. So, the ones that can't be changed is obviously your personal or family history of colorectal cancer or polyps or if you have inflammatory bowel disease or certain inherited symptoms. Those will increase your risk of colorectal cancer. But there are certain modifiable risk factors they've found that increases your risk, such as obesity, even being overweight increases your risk, physical inactivity, also smoking, heavy alcohol use, and then recently there's been a lot of interest in sort of how diet contributes to the risk of colorectal cancer. And there have been many studies that have shown that ultraprocessed foods, and red meat specifically increase the risk of colorectal cancer. So, I think that those are important to keep in mind moving forward.

And so, those are the signs and risks. And then, I think if there's anything that I would say the most important thing that I can bring across through this is that they've, in the last couple years, changed the average screening risk to 45 for colonoscopies, and that's because colorectal cancer is getting younger and younger. And so, I would advise everyone if they have a high-risk or like a family history, then they should even go younger than that. But an average person should be getting their colonoscopy at 45.

Host: Yeah. We hear a lot lately about patients being diagnosed with colorectal cancer at a younger age. And with that in mind, you have described how patients can be proactive. Is there anything you'd add to that list—lifestyle, basically diet, smoking, exercise, and also getting screening?

Dr. Saloni Mehrotra: It's just, I think, important to know. So yeah, it's definitely more commonly still in older patients, but it's getting younger and younger. And so, I think the thing to emphasize is that patients shouldn't ignore their symptoms simply because they think they're too young for it.

In the early onset colorectal cancer, which I call under 50, rectal bleeding is present in like at least 50% of those patients. And abdominal pain is about in like 40% and the change in bowel habits in about 30%. So if patients are having these "red flag symptoms," they should undergo a colonoscopy regardless of age. I think that I've seen it several times when patients come in to see me and they've had a delayed diagnosis for several months to a year from when the symptoms started because they just dismissed it as like hemorrhoidal bleeding. They were just like, "Oh, I just have some hemorrhoids. And so, I've had this for a while." And then, they never end up getting the colonoscopy. They just end up getting like local treatment for hemorrhoids. And then, eventually, when they do get it or when they do see me, we found that the cancers progressed or we could have caught it earlier.

So, I think I would just recommend for average risk patients to start their colonoscopies at 45, but just to be cognizant of your family history, to stay current with your screening and then seek medical attention if something doesn't feel right or if you have any of those symptoms.

Host: And it's really important, as you've mentioned, not to ignore those symptoms because the earlier cancer gets treated, the more treatable it is.

Dr. Saloni Mehrotra: Yeah. Colon cancer is one of those cancers that early stage, you can just get surgery for it. You may not even need chemotherapy or anything of that sort and sort of continue to live a normal life.

Host: So while it's really human to, at first, you know, when something's wrong, we all think it's something minor, but you need to recognize when something's an ongoing symptom.

Dr. Saloni Mehrotra: Yeah, especially now in this like current environment where we know that, even now that they've lowered the screening to 45 and 40, now we're seeing a lot more 20 to 39-year-olds that are showing up. And obviously, if the screening age hasn't reduced, that doesn't mean that the incidence of cancer in those patients isn't increasing. So, I just want everyone to have a bit more caution.

Host: Well, Dr. Mehrotra, how would you describe your approach to patients and families to provide the support and compassion they need?

Dr. Saloni Mehrotra: I think it's important that, in order to provide compassionate care, communication is the foundation of that. And so, usually, when I approach patients and their families, obviously, a cancer diagnosis can feel very overwhelming. And so, the best way to approach patients is with honesty and empathy.

And how I try to do that is first assess the patients understanding of what they're going through, And then try to respond to their emotions and then affirm them that we'll be with them along every step of the way and support them, and then also involve family and any other support systems that they may need from even an institutional standpoint. I think it's important that patients feel heard. They feel informed and supported through every step of the way. And I think explaining the diagnosis clearly, the treatment options, answering any questions, and then making sure that both the patient and their loved ones understand what's about to happen and sort of connect them with the resources they need as well.

Specifically, I think, in colon cancer, especially with advanced disease, I do think it's important to involve palliative care early so that they can maintain a quality of life and understand what's truly important to them. And then, in terms of providing proactive support, because this could be a tough thing to deal with, especially with cancers that require you to have like a permanent ostomy and what that does to like your sense of self and sort of mental health from that standpoint too.

Host: So, lots of support and lots of compassion. And you mentioned you follow patients all the way through, during and after their colorectal care.

Dr. Saloni Mehrotra: Yeah. Because especially rectal cancers, but definitely colon cancers, they require screenings at least for up to five years at a fairly regular three to six-month basis. So, you're sort of checking up on them and their labs and having this longitudinal care with them, that you're seeing them over a period of time.

And then, even after those five-year periods, you'll still be in communication. If they're getting treatment for chemo, you'll be in communication with their oncologists and see them not as frequently, but semi-regularly. And so, I think that there is sort of a relationship over a period of time.

Host: Dr. Mehrotra, as we're getting to know you, I'd like to ask about your life outside of work. How do you balance work with other things? And what are some of the things you enjoy doing during your free time?

Dr. Saloni Mehrotra: I have had definitely, in the last couple months, more time than I did while I was training. And I've just moved to Memphis. I'm kind of learning about the region, getting to know it as a city.

But outside of work, I really enjoy staying active. I've started running and I'm training for a half marathon at the end of the year, so that's part of it. And I like lifting and hiking. I also really like enjoying my creative hobbies. So, I started a pottery class, which is really helpful to get my hands away from my phone for several hours, help build some things with my hand in this age of computers. Getting a little bit of analog is helpful. And then, otherwise I'm getting to know the area and make friends, go out to new restaurants and live shows, music. So, I think that sort of the things that help me stay grounded and energized.

Host: Well, Dr. Mehrotra, it'll be fun to explore where you're living now. Thank you for sharing your interests and what motivates you to provide supportive, compassionate care. And thank you also for the vital work you do in surgical oncology.

Dr. Saloni Mehrotra: Thank you for having me.

Host: Dr. Saloni Mehrotra is a colorectal surgeon with Regional One Health Cancer Care. 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. For more information, visit regionalonehealth.org/cancer-care. For appointments, you can call 901-515-4673. That's 901-515-4673.