At the Forefront Live: What are Abdominal Cancers?

What are abdominal cancers and how can they be treated? Physicians Oliver Eng and Kiran Turaga join us for an in-depth conversation on the many types of abdominal cancers, the latest techniques for treatments such as HIPEC, and the extensive resources offered at UChicago Medicine. You'll also hear firsthand from a patient who was diagnosed with appendix cancer and underwent surgery at UChicago Medicine. Plus, we'll take your questions next on At the Forefront Live. 

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And welcome to At the Forefront Live. Remember, you can ask your questions of our experts by typing in the comments section. We'll try to get to as many as possible over the next half hour. We also want to remind our viewers that this program is not designed to take the place of a visit with your actual physician. Welcome to the program, gentlemen. We appreciate you being on today. 

Thanks. 

Thank you. 

Thank you. 

We're going to start with the basics and get going with our questions right off the bat. Dr. Turaga, if you could tell us a little bit about what are abdominal cancers. 

So abdominal cancers is a commonly used term for cancers that arise from the area of the abdomen, which is really the part that encases all the gastrointestinal organs, so organs that help in digestion. So that includes the stomach, the esophagus, which is the food pipe, the small intestine, the colon, the appendix, and then also some organs like the liver, the gallbladder, and the biliary tree. So cancers that arise from here are commonly called abdominal cancers. 

In females, the cancers that arise from the female parts can also sometimes be called abdominal cancers, but they're rarely abdominal of origin. But our interest today is speaking about cancers that can spread to the lining of the abdomen called the peritoneum. And the peritoneum is very interesting. It's a very thin membrane. It's almost like Saran wrap. And it basically wraps the entire lining of the abdomen and basically forms this nice, smooth coating. 

But it also is a remarkable barrier. And when cancer cells are broken off of any of these organs, specifically things like the appendix, the colon, the stomach, they can actually seed this Saran wrap, basically, and cause the cancer to spread along the entire lining. And that's called peritoneum or peritoneal surface malignancies or peritoneal cancers. And so really, that's our area of research, interest, and focus, and that's what we're here to talk about. 

Fantastic. Dr. Eng, can you tell us about the symptoms, what people might be aware of? 

Sure. Symptoms from your abdominal cancers can vary. And it can vary from a very vague abdominal pain to specific pain in areas of your abdominal cavity, depending on where the disease is. Now, of course, this is an area that is hard to really know whether or not you have an abdominal cancer. And so these symptoms can also include weight loss, fatigue, as well as nausea and vomiting, again, depending on where the disease is and where the disease is actually come from. 

And so I think a challenge that patients often have is they wonder, do I have an abdominal cancer? Do I have a cancer that is originated from somewhere in my abdomen and has now spread somewhere else? And unfortunately, sometimes we don't know until we do more imaging or lab work to help figure out what's happening with the patient. 

And we have a third guest on today, Mike Dillon. And Mike, you're a cancer survivor, and you had-- was it appendix cancer? Is that correct? 

Appendicidal cancer, yes. 

Tell us a little bit about your journey and how you ended up here at UChicago Medicine. 

Well, it was a couple years ago. It was around the end of the year 2016. And I felt a discomfort on my side. I thought I might have had appendicidal problems. I didn't know if it was appendicitis. And got a CAT scan, and eventually got referred to Dr. Turaga once we determined that there was some cancer there, some cancerous issues. And Dr. Turaga was known to be the one to go to for this kind of thing. 

So I came and met with him, had some further imaging done, and then we had a plan of action to get into surgery. And that was March of 2017. 

Great. And things are going quite well for you now? 

Yes. Fortunately, I really feel like it was a life saving operation for me after I learned about what exactly was going on. And my subsequent visits every three months, six month, on my checkups, my body scans, my cancer markers, and so far, so good. 

Great. Great. And Dr. Turaga, one of the things that you worked with Mike on was HIPEC. Is that correct? 

Mm-hmm. 

Which is a very specialized type of treatment. We've got a little video that I wanted to play that describes HIPEC. Then we talk a little bit more after the video. So let's go ahead and roll that now if we can. 

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HIPEC means hope for patients with abdominal cancer. Here's why. HIPEC, Hypothermic or Heated Intraperitoneal Chemo Perfusion, is an aggressive, targeted surgical technique for patients with a variety of abdominal cancers. HIPEC helps with fewer side effects than traditional chemotherapy, deeper penetration of the medicine, and greater effectiveness in killing cancer cells than conventional chemotherapy. 

UChicago Medicine is one of the only hospitals to offer the treatment for both children and adults. How does HIPEC work? First, surgeons remove the patient's tumors. Immediately following surgery, the patient's abdomen is treated with a heated chemotherapy bath. The chemotherapy is heated to cause blood vessels to expand and improve the medicine's penetration and effectiveness. 

The heated, concentrated dose of chemotherapy can directly target cancerous cells, destroying them before they can become future tumors. This also means that the chemo stays where it can help the most rather than circulating throughout the body. After about 90 minutes, the surgeons wash out the chemo and close the incisions. We also offer minimally invasive HIPEC to eligible patients. 

For some patients, HIPEC will achieve a long-term cure for their abdominal cancers. In other cases, HIPEC allows doctors to treat incurable cancers more like a chronic disease and less like a terminal illness. HIPEC means hope for patients with abdominal cancer. Need more information about HIPEC? Call 888-824-0200, or go to uchicagomedicine.org/hipec. UChicago Medicine is here to help. 

It's very interesting. First of all, I had no idea you could draw that fast. 

[LAUGHTER] 

That's why you go to medical school. 

But that's a very interesting process or procedure. So is it all done in one step when you remove the tumors and treat with the chemotherapy? 

It is. It is. And in fact, both of them are essential components of the treatment of this cancer. Because if you think about it, in my example of the Saran wrap or the paint on the walls, it's like having a thick layer of grime. It's like having a lot of dirty stuff on the entire wall. And you could take some Lysol and just spray it on it, but it probably won't do the job. 

And so the goal is to actually remove that layer of grime along with that Saran wrap. So we remove the peritoneum along with the cancer. And then, the heated chemotherapy kills the microscopic cells that are there. And the heat is about 108 Fahrenheit. So it actually helps potentiate the effects of chemotherapy. But the beauty of this treatment is that because it's localized, it's inside the abdominal cavity, it doesn't actually spread or cause systemic side effects as much. So patients don't have as-- the common side effects you think about chemotherapy are not as common with this treatment. 

Mike, I'm curious, from your standpoint, when you were told that you were going to get this type of treatment, were you nervous at all? Did it scary you? 

Well, I wasn't as nervous. I had seen a video of the procedure before I went into the operation. And I had a lot of confidence in Dr. Turaga and what he explained we were going to do. And it was really the only chemotherapy of any sort that I had up until now. 

And as Dr. Turaga mentioned, that chemotherapy, since it is so targeted, and you don't have quite the same side effects. 

I'm not sure I had any side effects, really. After the operation, I stayed in the hospital for five days. And I think maybe after the second or third day, Dr. Turaga warned me that I may feel a little bit ill just from the chemo. And it didn't last more than 24 hours. And after that, it was all systems go. 

That's fantastic. Dr. Eng, can you tell us about some of the current treatment options available? Obviously, we just spoke about HIPEC, but there are other options as well. 

Sure. With abdominal cancers and cancers that spread to the peritoneum, certainly the decision making behind the treatment that you receive comprises of a team of physicians, not only surgeons but medical oncologists, and potentially the radiation oncologist as well. These cancers are best treated in a multidisciplinary setting. So a lot of these patients do receive some sort of chemotherapy through the veins. 

As I tell patients all the time, every patient who has a cancer has two cancers. There's cancer that we can see, but also cancer that we cannot see. And so using multiple methods, including chemotherapy through the veins, in addition to HIPEC and cytoreductive surgery, can help give the patients the best chance in certain types of cancers of beating the cancer and, hopefully, having it never come back. 

You mentioned the multidisciplinary team that works with all of our patients. And I hear this again and again from various doctors, caregivers, surgeons, and patients. And it always impresses me because I think that people need to realize that when they do come to a place like UChicago Medicine for treatment, it's not just-- you're not just seeing one person then leaving. You've got a whole team working. And that's very critical to what you gentlemen do. And Mike, I don't know if you realized that when that was happening. I'm sure you probably did. And how did that in your mind impact your care? 

Well, I think there was a real comfort to-- as the surgery was explained to me, I was also introduced to the rest of the cancer team and got to meet with the cancer doctor. The chemo potentially wasn't another issue that I needed, but followup with the cancer team was, so I had met Dr. Polite and his team and continued to meet with them for the next few months after the surgery. So I always felt there was a comprehensive team behind my meetings with Dr. Turaga, and that brought a certain comfort to it, for sure. 

Dr. Turaga, from your standpoint, when you have all of these people that are working alongside you-- you may be leading the charge on this, but there are a lot of people that are working with you-- that's got to be helpful. 

It is. And I think the team goes beyond what we always used to conventionally think of a team, where we used to just think of the doctors being the team of people who treated our patients. But we know now that having a big cancer surgery is like any big event that happens in our life. In some ways, it's like having a big accident. And so we need to prepare for things like that. 

We tell a lot of our patients it's like running a marathon. So you just don't show up on the morning of a marathon and say, I'm going to run it. And so we have folks that help with preparing our patients for it. There's folks that now help with coordination of care. Health care has become so complex. And then we have nutritionists, and we work very closely with our gastroenterologists, our palliative care physicians that are not conventionally part of a cancer treating team. 

Like Dr. Eng mentioned, typically, the conventional cancer treatment team is the surgeon, the medical oncologist, the radiation oncologist, maybe a gynecological oncologist. But in these cases now, we have physical therapists, dieticians, nurses, Nurse Practitioners or PAs. And so there's a whole group of folks that are now trying to lead the charge in helping our patients get home soon. 

Mike just told you he left the hospital in five days. Classically, patients after their surgery would spend 21 days in the hospital. And even today, there are many institutions where people go to the ICU all the time. They spend two weeks in the hospital. So I think having this team really helps make those advances. 

That's really interesting to hear. And I think it's great for the patients. Who's a good candidate for HIPEC? 

So who is a candidate for HIPEC is dependent on several things. One is where the cancer initially came from. Certain types of cancers, such as ovarian cancer and appendix cancer and peritoneal mesothelioma are cancers that patients should have a discussion about HIPEC at some point in their treatment course. And the other aspect is how much disease is in your abdominal cavity. And so there is a difference between disease in one area of your abdominal cavity as opposed to multiple areas of your abdominal cavity. 

This in tandem with how much chemotherapy you may or may not have received, how your body has responded to it, as well as if there is disease outside your abdominal cavity all factor in into whether or not you're a candidate for HIPEC. In addition, it's how you are on a daily basis, how you're doing at home. And of course, like we had talked about, we have this team to help evaluate not just the medical part of it, but also you as a patient as a whole in terms of what are you doing on a daily basis, how can we help you improve on that, and your ability to live and to function and to, essentially, live your life. And these are important factors also when we evaluate patients in consideration of undergoing a big procedure such as this. 

So Mike, you were in the hospital for five days. How long did it take you to get back to your normal routine in life? 

It was probably six to eight weeks at home. And I think I had a pretty good feel of that from Dr. Turaga and his team that would take that long to get back on my feet. He did warn me to treat this like a marathon and prepare myself physically and mentally for what was coming. So I knew there was some recovery time and challenged myself with daily walks and built up my stamina through those walks, and eventually made it back to the YMCA and the pool and swimming. 

And another advice Doctor gave me was to exercise an hour a day as soon as I was capable of doing that. And I think that was a key for me to hear that, that I really didn't feel there was any restrictions on what I could do, and that I should push myself to do whatever I could do to get back to feeling as normal as I could. And after six or eight weeks, I truly felt that I was ready to meet the world again and get back on my feet and interact and participate in work and social events and hobbies. 

Dr. Turaga, in your position as a physician and a surgeon, how-- that's got to be tremendously gratifying-- 

It is. 

--when you see a patient that gets back to their life. That's exciting. 

It is. And I think it's important to realize that we're a team in this. And I think the patient is the one who goes through it all. It's easy for us to tell people, it's going to take time. We can only tell them from others' experiences that we've heard. But I think it's an individual patient that has to go through it. And to have the fortitude, to have the support like Mike did, I think motivation is key. 

And I think whatever we say-- medicine can only do so much. I think it's the human body and the human spirit that ultimately really decides how well patients do and everything else. So I think, obviously, Mike is a testament to one of those vigorous human spirits that just laughed at the surgery, pretty much. 

[LAUGHTER] 

So we've got a question from a viewer that I want to ask. "After pancreatic cancer surgery and treatments, it came back, unfortunately. Will a surgeon be able to operate or be willing to operate again if it's possible?" That's kind of a broad question, and I know you can't get real specific with that. 

Yeah. I think this is-- again, it's a very specific question, and I think it requires a little bit more thought than I think we could answer right now. Typically, when pancreatic cancer comes back, surgery is not usually the modality of choice that we do. There are occasions where we do operate. But typically, it's more often things like chemotherapy and radiation. But specifically, I think it'd be nice to look at the details before we can comment more. I don't know if you have thoughts. 

Yeah. I think with pancreas cancer, like we had talked a little bit about, it's more about when it's come back to a point where you can see it, a lot of times, there is a lot of cancer that you cannot see that's underlying that. And so, like Dr. Turaga was mentioning, a lot of the decision making behind that involves evaluating all the information and making a decision with, again, medical oncologists, radiation oncologists, and surgeons to think about what's the best for you in terms of going forward and controlling the disease as best as possible. 

So can we talk a little bit about clinical trials? This is another thing that I think is really unique and great about working at a place like this, because we are a place that does a lot of clinical trials and a lot of work as far as research in a lot of different areas, but specifically here. 

Yeah. And I think the-- just to lay the background, in my example that I told about the Saran wrap before, the problem with this cancer is that it is like the grime on the Saran wrap. And so it's very hard for us to detect this with any kind of conventional CT scans or conventional tests. And so a big part of our clinical trials are actually focused on how can we detect this cancer early. 

And so we are working with some of our partners at the University where we are working on blood tests to detect this cancer sooner. And so actually, a lot of our patients have volunteered their blood to help us develop this test and this trial. We also have a trial working on looking at better imaging modalities with MRIs to see if they can detect disease better. 

But that's one aspect of it. The other aspect of it is, how do we treat these cancers better? And I think with Dr. Eng joining us last year, it's been a big boost to our clinical trials in terms of how we're thinking about the concepts of applying HIPEC in different and novel ways so that we can actually control this cancer better. Maybe I'll let Oliver speak a little bit about the gastric cancer trial. 

Absolutely. I think a big problem with a lot of these cancers is that the chemotherapy through the veins in many of these cancers does not work at all or for a durable amount of time. And the question is, why? And so what I'm particularly interested in is trying to figure out why chemotherapy through the veins doesn't either get to these tumors or work for an amount of time that can control it in any meaningful way. 

And so with patients who have stomach cancer that has spread into their abdominal cavity, what we are doing here now is looking at these tumors and looking at what makes up these tumors and if there are any ways to potentially change the makeup of these tumors with using HIPEC that potentially could make patients eligible for therapies they may not have been previously. 

Or even looking at the mutations or the makeup of these tumors to see how they're different to understand why they may or may not respond better or worse to chemotherapy is very beneficial for patients to guide their treatment going forward. 

And I can't-- I think that's just very exciting for patients, patients who may not feel like they have a lot of hope. But this is an opportunity for a clinical trial and for other people to learn and hopefully, as we work towards cures in the future, could be very successful. We do have another video that I'd like to play because it's another one of your patients that is a great success story. And let's go ahead and watch that, and we'll talk a little bit about that after we get out. John, if you'll go ahead and roll that. 

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I started having a lot of pain, a lot of issues with my lower abdomen. I wasn't really sure what was going on. I saw several doctors, ended up in the emergency room twice. Because in 2013 I had a melanoma, I was under the care of an oncologist, and she got word that I wasn't feeling that well, and she set me straight in for a CT. 

They did find a small spot in my abdomen. And we went in at that time for a biopsy just to see what it was. She opened me up, and she saw at that time there was cancer. And from what she said, it was everywhere. 

The treatment we used for Jessica was a treatment called cytoreductive surgery, which means surgery where we remove all the cancer linings, and HIPEC or a heated intraperitoneal chemotherapy, where we heat chemotherapy up to about 180 degrees Fahrenheit, circulate it inside the abdomen for 90 minutes. And we talked about the fact that for a young girl like her, when we put heated chemotherapy inside her belly, it could change her life forever, especially her ability to have kids. 

That was one thing that we had been trying to do, was have a child. And of course, it wasn't going to happen because the cancer was just all over my ovaries and everything. It was just everywhere. So there was no way I could get pregnant. Thinking that in the future we could have a family at some point, I wanted to possibly try to save either eggs or my fertility if the surgery worked. At that point, we just had no idea what was going to happen. So I went back to Dr. Turaga and basically begged and said, if there is any way that you can save at least one ovary so we have a chance in the future, please. I said, obviously, if it's there and it's contaminated, we couldn't use it anyway. Get rid of it. But if there is a way-- and he found a way. He was able to save one ovary. 

I remember Dr. Turaga coming in and talking to us, and he looked at me and he gives me the thumbs up, and he's like, got it. 

So one year after the surgery, I was able to go into the fertility clinic, and we were able to start the process of IVF. And it was successful, which is wonderful, and we were just so happy. 

That little boy's smile certainly makes me want to jump up and go that extra mile when I feel like I maybe don't have a drop of energy left in me. He's my motivator, and Jessica. 

Oh, definitely. 

The fact that we were still able to come out here and be able to create a family after what we'd been through is just amazing, and we're truly blessed. 

It's a remarkable story. It is just a testament to how much the body can endure and how much together we can make an impact on cancer. 

I'm stable, and I'm good. And every single year that I'm stable is one more year that it processes with research and closer to, hopefully, a cure. 

Well, that one gets me every time. Nice work. So a very rare cancer, though. We were talking a little bit about it during the video. You don't see many of those, or nobody does. 

Well, yeah. It's a rare cancer, and there's only about 600 to 800 peritoneal mesotheliomas that are diagnosed a year in the United States. We actually do end up seeing a large percentage of that because our mesothelioma program, thanks to some early discoveries-- in fact, one of the main chemotherapies ever used for mesothelioma was developed here at the University of Chicago. 

And I think we have leaders such as Hedy Kindler who have led this amazing mesothelioma program, where now we together are able to a lot of research and make lots of advances in the care of patients with mesotheliomas. So we're fortunate that we're able to bring this to the place where you see this video. 

It's great. It's a nice outcome. So we don't have a lot of time left. Just a couple more questions. So resources that are available for patients with abdominal cancers to receive support. What's out there that people need to know about? 

Do you want to take that one? 

Sure. So a lot of these tumors and cancers, as we know, are quite rare, like we had just discussed. But what patients need to know is that there are a lot of groups and advocacy groups and organizations that are out there that provide support to patients and family members who have these rare diseases. And it is tremendously helpful for patients to talk to one another and talk about their experiences to help get through this. 

Again, it's like-- akin to a larger family of people that have been going through very similar cancer treatments. And it can be very beneficial for patients. Mike, I don't know if you have any comments on resources that you utilized. 

Well, I think in my case, I'd certainly be open to being part of a larger group and sharing my experiences. I can see the benefit in that and clearing up some of the fears that people might have going into it and just sharing my level of confidence that I have now. 

Which in part you're doing today, so we appreciate that. 

Yeah, for For sure. And just reminding people that, as Doctor said, everybody's in it together. And the human body is amazing. If you have some confidence and faith in it, you can pull it out. 

And I think if I could add a little bit to that as well, I think the-- in addition to all of these organizations, it's also important for us to be able to identify specific needs that our patients will have which are not clearly apparent, such as-- I think you had alluded to this earlier, is I think depression or financial toxicity, where patients-- many patients go broke going through those treatments and things like that. 

And I think these are all important concepts that, in medical school, we don't talk about, or when we're taking care of patients, we are not actively thinking about. Sexual function is another one that we don't talk about very often. But there are actually lots of resources for that. And I think we are fortunate that we're able to garner a lot of those resources here. And I think we're trying hard to make sure that we can help our patients live a full life despite the cancer diagnosis and hopefully just be as normal as they can be. 

It's interesting. I was talking with one of our nutritionists not too long ago, and she even mentioned that cancer patients often have some challenges with nutrition, and their tastes change and things like that. We have programs even in place to help with that. So it's important that you ask, and communication is critical to all of this, obviously. But there is help out there. That's the most important aspect of it. Gentleman, you were fantastic. Thank you very much for doing this. We appreciate it. 

Well, thank you very much. 

Thanks. 

We're a little bit over time, but that's OK. There was a lot of good information there. That's all the time we have for the program today. Thank you for watching and submitting questions. Please continue to check out our Facebook page for future At the Forefront Live programs and other helpful information. Also, you can check out our website at uchicagomedicine.org or call 888-824-0200. 

I know we have another lower third, and I think we've put it up a few times in the show, John, but if we can put that up for the HIPEC information-- there we go. That's the one I was looking for. And I apologize for not saying that earlier. So uchicagomedicine.org/hipec, or you can call 855-702-8222. Thanks again for watching. Hope you have a great week. 

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Surgeons Oliver Eng, MD, and Kiran Turaga, MD, MPH, join a patient to discuss the many types of abdominal cancers, the latest techniques for treatment, such as HIPEC, and the extensive cancer care resources offered at UChicago Medicine.

Medical oncologist Sonali Smith, MD, and lymphoma patient Clayton Harris

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