February Director's Message
The new year started with a bang for those of us who care about cancer. Advances in targeted therapy and immunotherapy continue to dominate the news about precision cancer medicine. And in his farewell State of the Union address, President Obama proposed a new “moon shot” initiative against cancer and charged Vice President Biden with leading a federal task force to harmonize, integrate and accelerate public and private efforts in cancer research.
With this high-profile backdrop, it is easy to forget the extraordinary progress that has been made in cancer surgery, a key part of the treatment of many cancers. Surgical oncology has deep roots in Pittsburgh as Pittsburgh great, Bernard Fisher, M.D, and his colleagues at the National Surgical Adjuvant Breast and Bowel Project (NSABP), have worked to tailor surgical management of breast cancer in an evidence-based fashion for nearly 50 years. Their efforts have enabled the evolution from radical mastectomy to lumpectomy and sentinel node localization with radiotherapy for many women with early breast cancer.
Our University of Pittsburgh Division of Surgical Oncology follows in this grand tradition. Led by the University of Pittsburgh's Bernard Fisher Professor of Surgery and Vice Chairman for Surgical Oncology and GI Surgical Services, David Bartlett, M.D., the division is celebrating its 25th anniversary. Basic and clinical research in surgical oncology has never been more vibrant. That was clear at the annual scientific retreat for the Division that I was privileged to attend last month and learn about some of the clinical research directions being pursued by surgical oncology faculty members. Here are just a few:
- Galvanized by the knowledge that nearly 60,000 women are diagnosed with ductal carcinoma in situ (DCIS) each year, breast cancer surgeon scientists have established new models for this vexing problem. The goal is to understand what determines whether a DCIS will follow a path toward invasive cancer or remain an indolent growth that will never threaten the health of the host. Led by surgeon scientist Priscilla McAuliffe, M.D., Ph.D., a multidisciplinary team has coalesced to transform human DCIS specimens into laboratory models that can speed our understanding of what constitutes a “bad” DCIS.
- Thanks to increased awareness and the use of imaging, the incidence of thyroid cancer has skyrocketed around the world. But, as with DCIS of the breast, only a fraction of thyroid cancers are destined to pose a grave threat to the health of the patient. Led by pathologist Yuri Nikiforov M.D., Ph.D., and endocrine surgeon Linwah Yip, M.D., the thyroid team is painstakingly using molecular changes in thyroid tissues to identify the type of surgery that is required. It is their hope that molecular profiling will allow surgeons to recommend observation, partial thyroidectomy or total thyroidectomy, at diagnosis thereby enabling precision cancer surgery.
- On the other end of the malignant spectrum falls pancreatic cancer, a common and frequently fatal disease. The classic surgery for operable pancreatic cancer, the Whipple procedure, has traditionally been associated with substantial morbidity. Enter the pancreatic cancer surgery oncology team led by Herbert Zeh, M.D., that has introduced robotic approaches to pancreatic surgery as a way to decrease complications and speed post-operative recovery. Of course adoption of such a technique requires education of physicians and Melissa Hogg, M.D., is spearheading the development of a curriculum to bring surgical oncologists up to speed in simulation laboratories before they approach a patient and then monitor and improve their performance via videotaping and peer review.
- Finally as they identify new ways to profile cancers to tailor surgical therapy and bring new surgical techniques to patients rapidly and safely, our surgical oncologists are also challenging long held beliefs about how to provide optimal supportive care before, during, and after cancer surgeries. So-called ERAS (early recovery after surgery) approaches are revising policies about use of intravenous fluids, optimal pain management, early feeding, and early mobilization after surgery to speed recovery for patients who must undergo cancer surgeries.
Together with radiotherapy and systemic therapies - including chemotherapy, targeted therapy and immunotherapy approaches - surgery is central to the management for so many types of cancer. It is gratifying to know that our surgical oncology team is at the forefront of the field, paving the way for the next 25 years of progress in cancer surgery.