Week 3.

Week 3. 

On Monday, I saw lots of patients with Dr. Milsom in clinic. He examined two colorectal cancer patients who were just diagnosed. They came to plan for the therapy. Since nowadays, multidisciplinary approach is more favored way to cure cancer, patients get chemotherapy, radiation, surgery or all of them depending on their cancer type. In case of colon cancer, it is recommended to save the rectal muscle if possible but the patients had cancer right above the muscle area. So she will be treated with radiation first, to shrink tumor size and then will get a chemotherapy, and hopefully, Dr. Milsom will get rid of the cancer without damaging the muscle. On Tuesday, I started the day with morning conference. The topic was why the hospital need to move towards patient centered care system. I thought the surgeons do care their service quality as much as their professional technique, which was pretty impressive. The presenter, who studied how much faith patients show to their surgeon depending on their race. The results show patients who have college-level education, white, female have the highest trustiness on their surgeons. Interesting result was even after they got some serious complications after surgery, the faith didn’t much go away. One thing that came into my mind was if the study included the race of the surgeons as an important factor would make more reliable result, but it was interesting talk. Afterwards, I observed several cases. One patient had severe narrowing on rectal canal so he couldn’t move the bowl or even normally eat. Doctor operated on him to dilate the obstruction using balloon and he was able to enlarge the rectum a bit. But he definitely needed more permanent way to fix the problem and Dr. Milsom will remove the inflamed area and then reconstruct his path later. Another impressive patient was female patient who was diagnosed to colon cancer a week ago. When she visited his office, he examined her bottom with flexiscopy and took some suspicious sample for biopsy. Unfortunately, those tissues turned out into adenocarcinoma so she came to OR to remove the sigmoidal colon. Before resecting the colon, doctor tried to find the lymph nodes near the cancerous tissue to inhibit further metastasis or recurrence and was able to remove them with the colon. A day after, I saw her in rounding and she looked okay and promising. The thing that I realized in here is the attitude of the patient affects a lot on their recovery time. Most patients with positive attitude showed faster recovery time like her regardless of the procedure. 

On Thursday morning, I attended research meeting with his research team and heard about the progress on developing devices and other ongoing researches. Colon cancer shows much higher preference on mesenteric side than anti-mesenteric side but the underlying mechanism hasn’t discovered yet. So his research team tested the RNA sequence of tissue on both side but surprisingly there was no significant difference. It was really constructive to be involved in that discussion since I have observed similar phenomenon in the mouse model. When we make tumor model in the mouse, I saw huge tumor mess formed along with the mesenteric walls and even on the mesenchyme but rare in the back side of the small intestine. I haven’t thought about that seriously but now I got lots of inspiration on our tumor model as well. 

Today, there was huge case that Dr. Milsom and Dr. Samstein operate. The patient has recurrent colon cancer right above the rectal muscle and also has metastasized colony on liver. Dr. Milsom removed entire colon including some portion of rectum. Since the tumor found really close to the margin, he sent the sample to pathology lab and then went up to check result right away. It was amazing that they can get a histology result in 5 mins. When we do the histology in lab, it usually takes a couple of days but in the pathology lab, it was extremely faster. We confirmed that both margin was clean from tumor so thankfully we didn’t need more resection. Dr. Samstein started his operation on liver and I was able to watch it as well. It was the first time I observed liver surgery and it used quite different tools. He had to remove the entire left robe and a portion of right robe because we found huge metastasis on left robe and two isolated spot on right robe. It was hard, difficult, and long procedure but I hope she could recover soon and live rest of her life without cancer.