Episodes

  • Gallbladder Cancer Basics for Patients with Drs. Galka and McGreevy

    Gallbladder Cancer Basics for Patients with Drs. Galka and McGreevy
    Apr 29 2026

    content type Interview

    primary goal Educational

    summary

    This podcast explores gallbladder function, the development of gallbladder cancer, and the latest treatments including surgery, chemotherapy, immunotherapy, and advanced genetic testing like next-generation sequencing (NGS). Experts discuss risk factors, early detection, and personalized treatment strategies to improve patient outcomes.

    key topics

    Gallbladder function and anatomy

    Risk factors and causes of gallbladder cancer

    Latest surgical and medical treatments for gallbladder cancer

    Role of next-generation sequencing in personalized cancer therapy

    guest name

    Dr. Eva Galka, Maria McGreevy, Michael Reardon

    Titles

    Understanding the Gallbladder and Its Role in Digestion

    How Gallbladder Cancer Develops and Is Treated

    sound bites

    "Pain from gallbladder issues is often severe and localized."

    "Next-generation sequencing looks at the DNA of the tumor."

    "HER2 is a protein on some cancer cells that we can target."

    Chapters

    00:00 Introduction to Gallbladder Cancer

    01:45 Understanding the Gallbladder's Function

    05:50 Gallbladder Cancer Development

    08:09 Environmental and Genetic Factors

    10:05 Early Detection Challenges

    11:32 Symptoms and Diagnosis

    19:02 Treatment Strategies for Gallbladder Cancer

    23:44 Advancements in Gallbladder Cancer Treatments

    25:06 Surgical Approaches and Post-Operative Care

    31:30 Chemotherapy and Immunotherapy Strategies

    35:39 Survival Rates and Prognosis

    44:11 Next Generation Sequencing and Targeted Therapies

    resources

    Next Generation Sequencing (NGS) - https://en.wikipedia.org/wiki/Next-generation_sequencing

    HER2 Targeted Therapy - https://www.cancer.gov/about-cancer/treatment/drugs/her2-targeted-therapy

    Gallbladder Cancer Overview - American Cancer Society - https://www.cancer.org/cancer/gallbladder-cancer.html

    guest links

    LinkedIn - https://www.linkedin.com/in/eva-galka

    LinkedIn - https://www.linkedin.com/in/maria-mcgreevy

    Twitter - https://twitter.com/PaulRoach
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    48 mins
  • "It's Cancer: Colorectal Cancer with Sitaram Chilakamarry MD

    "It's Cancer: Colorectal Cancer with Sitaram Chilakamarry MD
    Aug 4 2024

    Summary

    In this episode, the hosts introduce Sitaram Chilakamarry, MD, a colorectal cancer specialist, and discuss his background and interest in medicine. They then delve into the topic of colorectal cancer, providing statistics on its prevalence and mortality rates. They explain the anatomy of the colon and rectum and how colorectal cancer develops from the innermost lining of these organs. The discussion also touches on the role of genetics, diet, and inflammation in the development of colorectal cancer. The hosts emphasize the importance of early screening and detection to prevent advanced stages of the disease. The conversation explores different screening methods for colorectal cancer, including stool-based tests and direct visualization tests like colonoscopy. The FIT test, which checks for blood in the stool, is the most popular stool-based test. Colonoscopy is considered the gold standard for screening, but it is expensive and carries risks. The conversation also highlights the importance of healthy lifestyle choices in reducing the risk of colorectal cancer. Tobacco use and obesity are significant risk factors. The incidence of colorectal cancer is higher in smokers, and smoking causes inflammation throughout the body. The conversation concludes with a discussion of different cases of colorectal cancer and the next steps in diagnosis and treatment. In this conversation, Sitaram Chilakamarry discusses the process of diagnosing and staging colon and rectal cancer. He explains the importance of MMR testing, staging with CT scans and blood tests, and the role of surgery and chemotherapy in treatment. He also highlights the significance of regular colonoscopies for early detection and the potential for non-operative management of rectal cancer. Additionally, he mentions the promising use of immunotherapy in treating rectal cancer in patients with Lynch syndrome.

    Chapters

    00:00 Introduction and Background

    08:11 Understanding the Anatomy of the Colon and Rectum

    13:08 The Development of Colorectal Cancer

    24:49 The Importance of Early Screening and Detection

    27:32 Exploring Different Screening Methods

    36:29 The Pros and Cons of Colonoscopy

    43:37 The Impact of Tobacco Use and Obesity

    50:43 The Importance of Healthy Lifestyle Choices

    53:49 Diagnosing Colorectal Cancer

    59:28 The Significance of Screening Compliance

    55:17 Staging and Blood Tests

    56:45 Treatment Plan and Chemotherapy

    01:04:00 Urgent Cases and Ostomy

    01:08:49 Elective Cases and Surgery

    01:14:07 Anemia and Colonoscopy

    01:19:46 Polyps and Watchful Waiting

    01:23:35 Immunotherapy and Lynch Syndrome

    Takeaways

    • Colorectal cancer is a common and serious disease, with approximately 150,000 new cases and 53,000 deaths in the United States each year.
    • The colon and rectum are part of the gastrointestinal tract, with the colon absorbing water and the rectum acting as a reservoir for stool.
    • Colorectal cancer arises from the innermost lining of the colon or rectum and is typically classified as adenocarcinoma.
    • Genetics, diet, and inflammation are factors that contribute to the development of colorectal cancer.
    • Screening for colorectal cancer is crucial, as early detection can prevent advanced stages of the disease. Stool-based tests like the FIT test are popular for colorectal cancer screening.
    • Colonoscopy is considered the gold standard for screening but is expensive and carries risks.
    • Tobacco use and obesity are significant risk factors for colorectal cancer.
    • Smoking causes inflammation throughout the body, increasing the risk of colorectal cancer.
    • Healthy lifestyle choices can help reduce the risk of colorectal cancer.
    • Diagnosis of colorectal cancer involves checking for mutations and inherited syndromes.
    • Screening compliance is important, especially for individuals with a family history of colorectal cancer. MMR testing (or mismatch repair testing) is important for diagnosing colon and rectal cancer.
    • Staging involves CT scans, blood tests, and determining the depth of tumor invasion.
    • Regular colonoscopies are crucial for early detection and treatment.
    • Non-operative management may be an option for rectal cancer patients with a complete clinical response.
    • Immunotherapy shows promise in treating rectal cancer in patients with Lynch syndrome.
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    1 hr and 24 mins
  • What is Pancreatic Cancer, and how is it treated? With Eva Galka, M.D.

    What is Pancreatic Cancer, and how is it treated? With Eva Galka, M.D.
    Feb 15 2024

    [00:00] Intro and hello

    [01:30] Guest - Eva Galka, M.D. FACS: personal background and path to Surgical Oncology.

    [07:00] Pancreatic Cancer: typical patient

    [13:35] Clinical Presentation: how does someone know they have pancreatic cancer?

    [20:30] Referral: how do people show up in my office?

    [33:20] What is the pancreas?

    [45:00] Epidemiology of pancreatic cancer, and demographics

    [48:00] Staging & Resectability

    [1:04:00] Chemotherapy

    [1:07:00] Breaking therapies & Studies on pancreatic cancer

    [1:15:00] Thank you and closing

    Key takeaways:

    1. Pancreatic cancer (specifically adenocarcinoma of the pancreas) is a fairly common, and very serious diagnosis, worldwide, with three basic categories meaning early (stage 1), late (stage 4), and intermediate (stages 2-3). Different approaches to the disease are based on which of those categories it falls into, and how healthy / able to tolerate treatment the patient may be.

    2. Resection is one's only/best chance for cure; however many cases are beyond respectability at diagnosis; and some are questionably resectable (borderline or locally advanced) and require upfront treatment before any attempt at resection. Even after resection it can come back, so extra treatments such as chemotherapy is almost always recommended.

    3. Pancreas located in center of upper abdomen, surrounded by important other organs and blood vessels, making resection of tumors from it a very complex and technically demanding procedure, with significant risks of complications, even --not often but sometimes-- death.

    4. Chemotherapy and radiation are somewhat effective; frequently necessary, but not AS effective as they can be in some other tumors/cancers..

    5. The condition (adenocarcinoma of the pancreas) is best treated in specialized centers by specialized teams.

    6. New treatments (such as immunotherapy and tumor vaccines) are being explored; but need to discuss with academic centers if applies to you. If you think you might be interested in being part of a trial, ask your treating physician and also view the show notes links below.
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    1 hr and 17 mins
  • What is "Palliative Care" and when is it time to choose it?

    What is "Palliative Care" and when is it time to choose it?
    Dec 3 2023

    [00:03] I. Intro and hello

    [02:07] II. Guest - Farhan Shams, MD. Geriatrician & Palliative Care specialist

    [02:49] III. What are Goals of Care?

    [05:38] IV. What is Palliative Care?

    [18:01] V. Who comprises a Palliative Care team, and what are their roles?

    [31:00] Expectations, communication, and understanding where the patient is coming from.

    [43:08] Change is the only constant in life

    [47:04] Futility

    [48:45] Closing

    Key takeaways:

    -- Palliative Care is a subspecialty and a team of professionals dedicated to improving the overall experience of a patient, family, and friends throughout the critically difficult moments of patient succumbing to disease.

    -- Comprised of a physician, nurse practitioner, psychologist, social worker, and chaplain; all specialized and with a professional focus in the field.

    -- Critical to establish "what are the goals of our treatment" and to ask "why are we doing what we are doing?"

    --Understanding, communication, expectations, hope, reality, and process.

    --Grief

    --A Palliative Care doctor is a "Life Coach" for the end-of-life process
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    45 mins
  • Lung Cancer - Overview and what to do after a new diagnosis

    Lung Cancer - Overview and what to do after a new diagnosis
    May 18 2023

    Timestamps:

    [00:30] Intro to show and Guest Keith Bowersox, MD, PhD

    [2:38] Overview on Lung Cancer

    [5:55] Smoking & Lung Cancer

    [7:40] Lung Cancer Screening

    [10:30] Radon, Vaping, Marijuana & Lung Cancer

    [13:30] “If you’re honest with your doctor…”

    [16:00] Lung Cancer workup

    [20:00] Lung Cancer types: Small Cell; Non-Small Cell.

    [23:00] Lung Cancer stages and implications

    [26:00] Radiation treatment

    [32:45] Chemo, radiation, immunotherapy side effects and patient selection

    [34:45] Cure or palliation

    [35:50} Treating for cure: patient selection & treatment options

    [41:18] Post-op: Medical Oncology assessment and treatment

    [44:00] Wrap-up and thank you

    Key takeaways:

    -lung cancer is a heavy diagnosis; however great progress in its treatment has been made especially recently

    -lung cancer is among the most common and lethal, yet among the most preventable of tumors: by quitting smoking, or never starting.

    -new, powerful screening modalities in modern practices are low-dose Computed Tomography (“CT”) scans of the chest. Must meet specific guidelines and quit smoking to be able to benefit.

    -“Staging” of lung cancer (“Local, regional, distant”) determines treatment options and potential outcomes; baseline health status / lung function important.

    -Surgery, Chemotherapy, Immunotherapy, Radiation therapy are main treatment modalities

    -Optimal / Essential to have a primary care physician, and maintain a positive relationship with them.
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    46 mins
  • Prostate Cancer - What is it? How did I get it? What do I do? What is the consequence?

    Prostate Cancer - What is it? How did I get it? What do I do? What is the consequence?
    Feb 12 2023
    1 - Michael Riordan, Medical Oncologist Peter Schlagel, MD, Urologist Charlie Rinehart MD, and Surgical Oncologist Paul Roach MD embark on a full discussion of Prostate Cancer: what it is, how it happens, how it behaves, and how it's treated.2 - Guest: Charlie Rinehart, MD, a practicing Urologist and medical officer in the U.S. Navy, (formerly an officer in the USMC), undergraduate at Georgetown, Medical School at Columbia, and Urologic Residency at US Naval Medical Center, San Diego. Currently practices at the Captain James A. Lovell Federal Health Care Center, in North Chicago, Illinois. This is his second time on the program; for full introduction to Dr. Rinehart please check out the episode on Bladder Cancer.3 - Timestamps:[00:4] - Intro & disclaimer[01:00] Overview of Prostate Cancer: A. Incidence and broad description of the problem B. What is a prostate? What is a PSA screening test? What does it mean to have an elevated PSA test? How is the PSA test done? C. Clinical Presentation & who gets prostate cancer?[10:50] Prostate Biopsy[12:25] Shared decision making regarding prostate cancer screening A. The good, the bad, the ugly B. Risk reduction versus over treatment; the importance of age in the process C. “Heterogeneity” and variability in prostate cancers[20:00] Very Low risk, Low, Intermediate, High, Very High risk categories.[26:15] The “Trifecta” A. The goal: Treat the cancer, preserve urinary continence, preserve sexual function. B. Risks and benefits of treatment options, based off of estimates of baseline risk. C. What is “active surveillance?” Impact of age, baseline health status on deciding which course of action to take.[31:20] Active Surveillance & Radiation Therapy A. Age, health issues, prior experiences and their influence in choosing Surveillance or Xrt. B. External Beam, IMRT (Intensity Modulated Radiation Therapy), Brachytherapy[34:03] Side Effects of Surgery, Radiation Treatment A. Incidence and range of incontinence, erectile difficulties B. Impact of baseline function, age at time of treatment, time from surgery C. Sequencing Surgery and Radiation treatments D. Antitestosterone therapy[42:00] Staging tests for localized versus widespread cancer. A. CT scan and bone scans - traditional B. MRI’s and PSMA tests - newer[46:25] Michael’s questions on origin of the cancer: Genetic? Smoking? Diet? Exercise A. African American/Black individuals a clearly higher risk of developing prostate cancer and should consider PSA screening 10 years earlier (age B. Agent Orange exposure - Viet Nam Veterans. C. Association with BRCA i. What is it? ii. Importance of Family Medical History (males & females)[51:05] Summary of points thus far, and Radioactive seeds treatment option A. When to use which option? B. Lower risk options and higher risk options[54:45] Prostatectomy[56:21] Advanced disease A. Locally advanced (i.e. spread outside the capsule of the prostate, and/or spread into the local pelvic lymph nodes or organs) disease B. Distant (i.e. metastatic) disease i. Androgen deprivation C. Microscopic disease D. Survival and quality of life E. Testosterone supplementation and (+/-) association with prostate cancer.[1:03:50] How does prostate cancer cause a man to die? A. “Go-go” phase, “slow-go” phase, “no-go” phase B. Androgen deprivation[1:09:22] Closing and thanks4 - Key takeaways in bulleted format: -- Prostate Cancer happens to Men alone, as only men have a prostate, and has about the same frequency and risks as breast cancer has for women. —It typically happens in the more advanced ages, but can happen in younger men (40’s for Black men, 50’s for other demographics) -- Frequently, Prostate Cancer does not present with symptoms; one needs to have a screening test performed (called PSA) but should discuss risks/benefits with physician prior to embarking on that. -- There are a variety of different risk categories for diagnosed prostate cancer (very low, low, intermediate, high, very high) with different risk of progression into advanced disease and death. The risk categories can change (from less risky —> more risky) over time, so a physician-patient relationship must be maintained over time. —Multiple treatment options; these are based on stage of disease, risk category of the disease, patient age and health, and patient preferences. Patient and physician must work with one another to decide which therapy to employ, and when, and why.5 - Relevant links for the episode:https://www.cancer.gov/about-cancer/treatment/clinical-trials/disease/prostate-cancer/treatmenthttps://www.cancerresearchuk.org/about-cancer/prostate-cancerhttps://www.cdc.gov/cancer/prostate/https://www.cancer.gov/types/prostatehttps://www.radiologyinfo.org/en/info/imrt6 - Follow us on your favorite Podcast program, and learn more through the homepage at https://paulbryanroach.com/so-its-cancer/7 - Coming up next month: “Lung Cancer"8 - Follow...
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    1 hr and 10 mins
  • What is Cancer? All you ever wanted to know but were afraid to ask.

    What is Cancer? All you ever wanted to know but were afraid to ask.
    Jan 19 2023
    Timestamps:[00:01] Intro: Paul Roach, MD; Peter Schlagel, MD; Michael Riordan, Man of the People[01:30] Short definitions of What is Cancer?[04:30] Framing: What is life?[04:37] Shout out to Lex Fridman's awesome Podcast- Thanks, Lex[06:40] What is a Cell?[07:15] Long definition of or exploration of “What is Cancer?”[19:00] Mutations of cell signaling, growth, and, differentiation[30:00] Detecting Cancer[43:00] Tumor markers[46:00] Hereditary mutations[53:30] Genetic Testing & Counseling[1:02:00] Genetic Signatures[1:04:00] Smoking, Age, Obesity, Heredity[1:10:00] The Basics[1:12:00] Targeted Therapy[1:16:50] Where cancer cells go wrong[1:23:02] Benign versus Cancerous[1:29:27] Summary and ClosingLinks:https://www.nasa.gov/vision/universe/starsgalaxies/life's_working_definition.htmlhttps://www.quantamagazine.org/what-is-life-its-vast-diversity-defies-easy-definition-20210309/https://youtu.be/yyBosLx7bbMhttps://youtu.be/NXU_M4030nEhttps://www.cancer.gov/publications/dictionaries/cancer-terms/def/cellhttps://www.cancer.gov/about-cancer/understanding/what-is-cancerReferences:https://www.goodreads.com/book/show/18442853-the-molecular-basis-of-cancer?from_search=true&from_srp=true&qid=Sw4zWg3ZSp&rank=1https://www.goodreads.com/en/book/show/61048190-devita-hellman-rosenberg-s-cancerKey Takeaways:“Life” as we know and accept it is the product of an intricately organized set of self-sustaining bio-chemical processes working harmoniously, with memory and the ability to carry-on over time and over new generations (Paul’s best crack at the question of “what is life?”).Biological life is comprised of individual cells, which are extremely tiny and have three main parts: cell membrane wall around it; cytoplasm filling it up; and a nucleus as the main office or command center of the cell containing the DNA / genetic code, which determines the structure and the behavior of the cells and the tissues. In life, that DNA/genetic code acquires (or sometimes is born with) “defects” or “mutations” which alter the shape, function, and behavior of the cell; some types of mutations [particularly those responsible for the processes/jobs of cell signaling, cell growth, and cellular differentiation] result in derangements and loss of proper cellular function —which brings its own set of problems— and also, aggressive behaviors of local invasion and distal metastasis —which, untreated, can produce organ system failure and death.Normal cellular machinery is so complicated that there are 10,000 ways (my made up number) in which it can break down, which in short accounts for the great variability of ways in which cancer can evolve and manifest.These multiple pathways make it impossible to treat with a “one size fits all” approach, but these days we’re learning how to identify and target with a variety of clever treatments many of those various pathways, and thereby individualize treatment to that specific, unique tumor.Advice: Cancer happens, but to minimize your risk of cancer / advanced cancer, take the best care of your own health with diet, exercise, moderation of things like tobacco / food / alcohol that you can, and keep a regular relationship with your physician for periodic check ups, screening exams, and the sharing of your family medical history. Don’t live in fear of cancer, but do take these reasonable steps against it.Parting:Follow the show! www.paulbryanroach.com parent website.Send us mail: letters@paulbryanroach.com
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    1 hr and 32 mins
  • Bladder Cancer- What just happened? What do I do now?

    Bladder Cancer- What just happened? What do I do now?
    Dec 24 2022

    1 - Mike Riordan, Charlie Rinehart MD, and Paul Roach MD embark on a full discussion of Bladder Cancer: what it is, how it happens, how it behaves, and how it's treated.

    2 - Guest: Charlie Rinehart, MD, a practicing Urologist and medical officer in the U.S. Navy, (formerly an officer in the USMC), undergraduate at Georgetown, Medical School at Columbia, and Urologic Residency at US Naval Medical Center, San Diego. Currently practices at the Captain James A. Lovell Federal Health Care Center, in North Chicago, Illinois

    3 - Timestamps:

    [00:24] - Intro & Charlie Rinehart, MD

    A. Disclosure

    B. Dr. Rinehart background & training.

    [06:22] Overview of Bladder Cancer:

    A. Incidence and Epidemiology

    B. Clinical Presentation

    C. Urinary system

    [14:10] Hematuria and how is bladder cancer causing me problems?

    A. Hematuria & its workup

    B. Male / Female incidence & etiology.

    i. Smoking Factors

    ii. Occupational factors

    iii. Low, Medium, High Risk

    [21:06] Initial Workup of Bladder Cancer

    A. Cystoscopy & Biopsy

    B. CT Scan

    [26:45] Tumor Grades and Depth of Invasion

    A. Tumor Grades

    B. Tumor Depth: Muscle Invasive and Non-Muscle Invasive

    [36:00] Treatment & Surveillance of Non-Muscle Invasive Disease

    A. Treatment

    B. Surveillance

    C. Why not bladder screening for everyone?

    [40:50] Local Invasion & Metastasis

    A. Pelvic organs

    B. Lymph Nodes

    C. Metastatic Behavior

    D. Bladder removal (Cystectomy) and reconstruction

    [50:00] Preventing progression from Non- to Muscle-invasive disease

    A. BCG

    B. Chemotherapies and Radiotherapy

    [54:00] Bladder Cancer Endemic to East Africa & Middle East

    A. Squamous Cell Cancer: Chronic Inflammation

    i. Chronic Indwelling Urinary Catheter

    ii. Parasite: Shistosoma

    [57:45] Transitional Cell, Squamous Cell, AdenoCarcinoma Cell types

    [59:30] Prevention

    [1:01:30] Advanced Disease and Clinical Trials

    [1:05:00] Closing

    4 - Key takeaways in bulleted format:

    -- Bladder Cancer happens to Men and Women, typically beginning in the more advanced ages.

    -- Blood in the urine (either visible to naked eye, or only under the microscope) is a common feature.

    -- Smoking (and some industrial exposures) important factors in its development

    -- "Transitional Cell" the most common type in USA and Europe; Squamous Cell (caused by a parasite called Shistosoma) also common in East Africa and Middle East

    -- Non-Muscle Invasive and Muscle Invasive frequently treated quite differently

    -- Chemotherapy, Radiotherapy, Immunotherapies available for Advanced Disease

    -- Important to not smoke, or quit smoking, to lower risk of disease.

    -- In East Africa and Middle East, a type of bladder cancer can occur because of a parasitic infection.

    5 - Relevant links mentioned in the episode:

    https://www.cancer.gov/about-cancer/treatment/clinical-trials/disease/bladder-cancer/treatment

    https://www.cancerresearchuk.org/about-cancer/bladder-cancer

    https://www.cdc.gov/cancer/bladder/index.htm

    https://www.cancer.gov/types/bladder/patient/bladder-treatment-pdq

    6 - Follow us on your favorite Podcast program, and learn more through the homepage at https://paulbryanroach.com/so-its-cancer/

    https://www.cancer.gov/types/bladder

    7 - Coming up next month: "What Is Cancer?"

    8 - Follow us on your favorite podcast platform, and link to show website is here: https://paulbryanroach.com/so-its-cancer/
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    1 hr and 7 mins