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 relevant to points within the episode, in this format:

[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

6 – 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: “What Is Cancer?”

I. Intro and hello

II. Rohit Sharma, MD, FACS

III. Sunscreens – thorough explanation of the ins/outs of sprays, lotions, creams for cancer prevention; rash guard clothing; wide brimmed hats; collective measures.

IV. Moles and blemishes: bad and good.

V. Interpreting the biopsy report

VI. Tumor thickness and surgical margins

VII. Lymph nodes and “Sentinel lymph node biopsy.”

VIII. Horizontal and vertical growth phases; four types of melanoma.

IX. How to talk skin with your General Practice Physician or Clinician.

X. Staging the disease: Local, Regional, Metastatic.

XI. Impact and utilization of Immunotherapy & Targeted Therapies.

XII. Predicted survival of different Melanoma stages

XIII. How do I self-advocate?

XIV. Clinical Trials explained

XV. Closing and Thank you

Key takeaways:

1. Ounce of prevention… learn your sunscreen options, how they complement one another, and use them from childhood on!

2. Moles that are uniform and unchanging are safer; moles that are irregular and changing are more dangerous

3. Thicker and ulcerated melanomas are more problematic

4. In certain patients, harvesting a sentinel lymph node gives important prognostic and treatment-related information.

5. Be clear and upfront with your doctor about your moles and blemishes

6. New types of treatments exist that are powerful and important.

7. Stick with established, well-known websites (such as American Cancer Society) when starting your self-education on Melanoma

8. Clinical Trials are fundamental to the advancement of Medicine, but they may or may not be what you’relooking for

1. Introduction:Paul,Peter,Mike(Courtneyoutthismonth)
2. Guests:Nogueststoday
3. Caseoftheday:Lymphoma patient. Workup, Treatment, & Result.
4. LessonoftheDay:Lymphoma: Hodgkins & Non-Hodgkins.
5. CancerQuestions:FromPaul:what is Car-T therapy?
6. CancerNews:None today
7. Signout

 

1 – Intro Three cancer specialists and a graphic design artist discuss cancer.

2 – Bio’s: Pete Schlegel, MD (Medical Oncology)

Courtney Coke, MD (Radiation Oncology)

Mike Riordan (Graphic Design Artist)

Paul Roach, MD (Surgical Oncology)

3 – Timestamps:

[00:05] Courtney, Pete, Mike, and Paul introduce themselves

[06:00] Case of the Day – Esophageal Carcinoma

[28:00] Lesson of the Day- Esophageal Carcinoma

[35:10] Cancer Questions: How do you tell a patient they’ve got cancer?

[41:32] Question: What do I do if my doc doesn’t present me with a plan?

[51:45] Cancer News: Keynote 811 Trial; dual PD-1 & HER2 blockade in HER2(+) Gastric Cancer.

4 – Key Takeaways:

Causes of esophageal cancer (e.g. smoking, alcohol, gastroesophageal disease)

Signs and symptoms of esophageal cancer (e.g. difficulty swallowing, painful swallowing).

Immediate actions (e.g. contact Primary Care Physician; seek family, friends, trusted help)

Workup is pretty involved, so don’t be surprised.

Treatment frequently involves endoscopic or surgical procedures, chemotherapy, radiation therapy, and now sometimes new kinds of medicines (anti-Her2, anti PD-1 medications, etc).

Don’t be shy! Reach out. Get help. Treatment is available!

5 – Sign out: write letters@paulbryanroach.com with ideas, thoughts, questions for next episodes

1. So doc, it’s Cancer? is a podcast dedicated to being a “how-to” manual for cancer patients and their friends and families.Each month we will work through different elements of the overall problem, “from soup to nuts” as they say, beginning at the beginning such as the the basics of what cancer is, who may be at risk, who is involved in the treatments, why treatments differ so much from one cancer to another, or even within the same type of cancer?The podcast will work through to the various possible outcomes, and quality of life.
2. Why? Need for physician-led podcast series that is patient centric.It helps to have a chat with your physician, only, that chat is usually short, emotional, hard to remember, and often only a beginning.
3. Hosts: Paul Roach – Surgical Oncology; Courtney Coke – Radiation Oncology; Pete Schlegel – Medical Oncology; Mike Riordan – Graphic Designer