Surgical Oncology Specialists of Ohio

Being a Surgical Oncologist is not just preforming surgeries to remove cancer.. it requires much more… caring for cancer patients mean communicating with their Medical Oncologist or Radiation Oncologist to discuss the best treatment course… it’s calling the Gastroenterologist asking them if they can see a patient ASAP due to a concern.. or reviewing radiology scans with the Radiologist in order to catch any recurrence at surveillance visit… the job is not just removing cancer. It is coordinating care through every aspect of the patient’s cancer journey.

Dr Ramy Fouad is discussing patient care with the care team.

Microwave ablation

Ablation is treatment that destroys liver tumors without removing them. These techniques can be used in patients with a few small tumors and when surgery is not a good option (often because of poor health or reduced liver function).

Ablation therapy is a treatment option for people who have liver metastases and can help reduce the risk of cancer recurrence. Although ablation therapies do not remove tumors, they can cause complete remission, especially if tumors are 3 centimeters in diameter or smaller.

Ablation therapy usually consists of heat therapy in which either high-energy radio waves, called radiofrequency ablation (RFA), or electromagnetic waves, called microwave ablation (MWA), are used.

During ablation therapy, heat is transmitted from a special machine through a needle-shaped probe placed into a liver tumor.

Bile Duct Cancer
Cholangiocarcinoma

Cancer that starts in the bile ducts
Bile ducts are tiny tubes that connect the liver and gallbladder to the small intestine
There are 2 different forms:
Intrahepatic
Cancer that forms inside the bile duct inside the liver
Extrahepatic
Cancer that forms in the bile ducts outside the liver

Risks factors:
Age (>65)
Obesity
Family history
Smoking
Hepatitis B or C
Chronic inflammation of the bile duct
Cysts in the bile ducts

Symptoms:
Yellow skin/eyes (jaundice)
Lack of appetite
Abdominal pain
Dark urine/light clay colored stools

Workup:
Liver function lab work
Tumor markers (CEA and Ca19-9)
Ct Scans
MRI/MRCP
Endoscopic ultrasound and/or ERCP for a biopsy completed by a specialist

Treatment:
Surgical removal
Stent placement to help with the blockage
Chemotherapy
Immunotherapy
Transplant
Radiation

Surveillance:
CT scans
Blood work

October is Liver cancer awareness month. As part of advanced liver surgery care, it is essential for surgeons to collaborate with each other in order to provide patients with advanced specialized care. Dr. Arrese a board certified Surgical Oncologist and Dr. Salibi a fellowship trained Hepatobiliary surgeon, here reviewing a CT scan and discussing options for one of their patients in order to devise a surgical plan for a liver cancer patient.

Surgical Oncology Specialists of Ohio updated their address.

Parathyroidectomy

Parathyroidectomy is preformed in order to remove the Parathyroid glands.

There are 4 parathyroid glands that are located behind the thyroid gland in the neck.

The parathyroid gland helps regulate the hormones level that affects your calcium.
There could be a growth, cancerous or noncancerous, that can make it under or over produce the parathyroid hormone (PTH).

The surgery in preformed through a small incision in the front of the neck.

Prior to surgery:
Sestamibi scan is completed prior to surgery to help localize the glands
Lab work
Bone density scan

Risks:
Low calcium level
Voice changes/hoarseness
Sore throat

During surgery, the PTH level is checked to monitor for surgical success.

This surgery is considered outpatient surgery, but a patient could have 1 night in the hospital

Having surgery there may be a lower level of calcium in the body which could cause:
Numbness/Tingling in the hands or around the mouth
Muscle cramping

Therefore after surgery, the surgeon may prescribe calcium to help with these side effects.

Follow up is roughly 2 weeks around surgery

Continued monitoring after surgery is completed by a Primary Care doctor or an Endocrinologist

Hyperparathyroidism

H𝒚𝒑𝒆𝒓𝒑𝒂𝒓𝒂𝒕𝒉𝒚𝒓𝒐𝒊𝒅𝒊𝒔𝒎 is when your parathyroid glands create too much parathyroid hormone.

Parathyroid is located in the neck behind thyroid.

Parathyroid gland produces hormones that help maintain 𝘤𝘢𝘭𝘤𝘪𝘶𝘮 levels in the blood and tissue.

𝕊𝕪𝕞𝕡𝕥𝕠𝕞𝕤:
Osteoporosis
Kidney stones
Increased urination
Bone or/and joint pain

ℂ𝕒𝕦𝕤𝕖𝕤:
Adenomas (no cancerous growth)
Enlargement of gland
Cancerous tumors
Calcium or Vitamin D deficiency
Chronic kidney failure

𝕋𝕖𝕤𝕥𝕚𝕟𝕘:
Parathyroid hormone (PTH level)
Vitamin D level
Calcium level
Sestamibi parathyroid scan
Ultrasound

𝕋𝕣𝕖𝕒𝕥𝕞𝕖𝕟𝕥:
Surgery to remove parathyroid
Hormone replacements
Medications

Dr. James Sivard

𝘽𝙤𝙖𝙧𝙙 𝘾𝙚𝙧𝙩𝙞𝙛𝙞𝙚𝙙 𝙂𝙚𝙣𝙚𝙧𝙖𝙡 𝙎𝙪𝙧𝙜𝙚𝙤𝙣

𝕋𝕣𝕒𝕚𝕟𝕚𝕟𝕘
Riverside Methodist Hospital

𝕐𝕖𝕒𝕣𝕤 𝕠𝕗 𝕖𝕩𝕡𝕖𝕣𝕚𝕖𝕟𝕔𝕖
39

𝕊𝕡𝕖𝕔𝕚𝕒𝕝𝕚𝕥𝕪 𝕒𝕣𝕖𝕒𝕤

Malignant and benign Thyroid diseases
Malignant and benign Parathyroid diseases
Melanoma/skin cancer
Breast cancer

Hepatectomy

Hepatectomy is a surgical resection (removal) of portions of the liver.
A liver surgeon is able to remove sections of the liver, up to two-thirds. A transplant surgeon would remove all the liver and replace it with a new liver.

This surgery is performed for different reasons, which include:
-Primary liver cancer (Hepatocellular carcinoma or cholangiocarcinoma)
-Cancers that spread to the liver (such as gallbladder cancer, colon or re**al cancers)
-Symptomatic liver cysts, hemangiomas, or adenomas
-Benign liver tumors or lesions

This surgery can be completed:
-robotically
-laparoscopically
-through an incision

This surgery can either be performed as outpatient or inpatient (require a hospital stay). The reason a person would have to stay overnight in the hospital is due to the amount of liver being removed.

If a patient is in the hospital, the stay can range from 1 to 5 days.
At the time of surgery, a surgical drain can be placed. This is either removed prior to leaving the hospital or remain in place when discharged. If a patient has to go home with a drain, teaching will occur between the family and patient and the nursing staff.

Recovery time takes roughly 3 to 5 weeks. After that time, patients are able to slowly return to normal activity.

All patients are in by the surgeon roughly 2 weeks after surgery.

Depending the reason for the surgery, there will either be:
-No other follow up
-Frequent CT scans or MRIs
-Lab work

The decision for follow up will be determined by the surgeon and discussed with the patient.

Hepatocellular carcinoma

Hepatocellular carcinoma or HCC is a type of cancer that starts in the liver.

Patient that are at a higher risk of developing HCC include:
Patients with Hepatitis B or Hepatitis C
Cirrhosis
Heavy alcohol intake
Obesity and diabetes

Symptoms include:
Right upper abdomen pain
Bloating or abdominal swelling
Loss of appetite
Jaundice (yellow skin/eyes)

Testing:
Blood work
MRI
Biopsy of site

Treatment options:
Surgical removal
Chemotherapy directed therapy (y90)
Liver transplant

Treating HCC you will need to speak with a Surgeon, Interventional Radiologist, Oncologist, and Hepatologists (liver doctor). As a team they will help determine the best course of treatment along with surveillance.

Introducing, 𝗗𝗿. 𝗣𝗮𝘁𝗿𝗶𝗰𝗸 𝗦𝗮𝗹𝗶𝗯𝗶
Board Certified Surgeon
Hepatopancreaticobiliary surgery

𝑻𝒓𝒂𝒊𝒏𝒊𝒏𝒈
Riverside Methodist Hospital

𝑭𝒆𝒍𝒍𝒐𝒘𝒔𝒉𝒊𝒑
Atrium Health

𝒀𝒆𝒂𝒓𝒔 𝒆𝒙𝒑𝒆𝒓𝒊𝒆𝒏𝒄𝒆
3

𝑺𝒑𝒆𝒄𝒊𝒂𝒍𝒊𝒓𝒚 𝒂𝒓𝒆𝒂𝒔
Hepatobilary cancers (liver and pancreatic)
Hepatocellular carcinoma
Bile duct cancers
Stomach cancers
Esophageal cancers
Pancreatitis
Liver metastases

Thyroidectomy

Thyroidectomy is the surgical removal of all or part of your thyroid gland. Your thyroid is a butterfly-shaped gland located at the base of your neck.

It produces hormones that control every aspect of your metabolism, from your heart rate to how quickly you burn calories.

Thyroidectomy is used to treat thyroid disorders, such as:
Cancer
Noncancerous enlargement of the thyroid (goiter)
Overactive thyroid (hyperthyroidism)

How much of your thyroid gland is removed during thyroidectomy depends on the reason for surgery. If you need only part of your thyroid removed (partial thyroidectomy), your thyroid may work normally after surgery. If your entire thyroid is removed (total thyroidectomy), you need daily treatment with thyroid hormone to replace your thyroid's natural function.

After Surgey:

Typically this surgery is an outpatient procedure but sometimes there is an overnight stay in the hospital needed

When you go home, you can usually return to your regular activities. Wait at least 10 days to two weeks before doing anything vigorous, such as heavy lifting or strenuous sports.

Follow up in the surgeons office happens about 2 weeks after surgery

It takes up to a year for the scar from surgery to fade. Your doctor may recommend using sunscreen to help minimize the scar from being noticeable.

Patients need to follow with their P*P or endocrinologist to monitoring and blood work.

𝙋𝙖𝙥𝙞𝙡𝙡𝙖𝙧𝙮 𝙩𝙝𝙮𝙧𝙤𝙞𝙙 𝙘𝙖𝙣𝙘𝙚𝙧

The thyroid produces hormones that regulate your heart rate, blood pressure, body temperature and weight.

A cancer of the thyroid, the butterfly-shaped gland at the base of the neck.

The most common form of thyroid cancer, 𝕡𝕒𝕡𝕚𝕝𝕝𝕒𝕣𝕪 𝕥𝕙𝕪𝕣𝕠𝕚𝕕 𝕔𝕒𝕟𝕔𝕖𝕣, arises from follicular cells, which produce and store thyroid hormones.

𝑹𝒊𝒔𝒌 𝒇𝒂𝒄𝒕𝒐𝒓𝒔

Factors that may increase the risk of thyroid cancer include:
- 𝗙𝗲𝗺𝗮𝗹𝗲 s*x
- 𝗖𝗮𝗻 𝗼𝗰𝗰𝘂𝗿 𝗮𝘁 𝗮𝗻𝘆 𝗮𝗴𝗲, 𝗺𝗼𝘀𝘁 𝗰𝗼𝗺𝗺𝗼𝗻 𝗶𝘀 30-50 𝘆𝗲𝗮𝗿 𝗼𝗹𝗱𝘀
- Exposure to 𝗵𝗶𝗴𝗵 levels of radiation
- Certain inherited 𝗴𝗲𝗻𝗲𝘁𝗶𝗰 syndromes. Genetic syndromes that increase the risk of thyroid cancer include familial medullary thyroid cancer, multiple endocrine neoplasia, Cowden's syndrome and familial adenomatous polyposis

𝑺𝒚𝒎𝒑𝒕𝒐𝒎𝒔

Thyroid gland

Thyroid cancer typically doesn't cause any signs or symptoms early in the disease. As thyroid cancer grows, it may cause:
- A lump (nodule) that can be felt through the skin on your neck
- Changes to your voice, including increasing hoarseness
- Difficulty swallowing
- Pain in your neck and throat
- Swollen lymph nodes in your neck

𝑫𝒊𝒂𝒈𝒏𝒐𝒔𝒊𝒔
- Physical exam
- Blood work
- Ultrasounds and biopsies
- Genetic testing

𝑻𝒓𝒆𝒂𝒕𝒎𝒆𝒏𝒕
- Surgical removal of thyroid or thyroid lobe
- Medication
- Radioactive iodine
- Chemotherapy
- Radiation therapy

A diagnosis of thyroid cancer can be frightening. You might feel as if you aren't sure what to do next. Reach out, we are here to answer your questions.

Stephanie Goare, MD

𝘽𝙤𝙖𝙧𝙙 𝘾𝙚𝙧𝙩𝙞𝙛𝙞𝙚𝙙 𝙂𝙚𝙣𝙚𝙧𝙖𝙡 𝙎𝙪𝙧𝙜𝙚𝙤𝙣

𝕋𝕣𝕒𝕚𝕟𝕚𝕟𝕘
Riverside Methodist Hospital

𝔽𝕖𝕝𝕝𝕠𝕨𝕤𝕙𝕚𝕡
The Alfred Hospital for Endocrine and Breast Surgery in Australia

𝕐𝕖𝕒𝕣𝕤 𝕠𝕗 𝕖𝕩𝕡𝕖𝕣𝕚𝕖𝕟𝕔𝕖
6

𝕊𝕡𝕖𝕔𝕚𝕒𝕝𝕚𝕥𝕪 𝕒𝕣𝕖𝕒𝕤
Adrenal
Malignant and benign Thyroid diseases
Malignant and benign Parathyroid diseases
Melanoma/skin cancer
Breast cancer
Benign skin lesions/lipomas

Colectomy

The 𝒔𝒖𝒓𝒈𝒆𝒓𝒚 can remove portions or all of a part of the large intestine or 𝕔𝕠𝕝𝕠𝕟.

The 𝕔𝕠𝕝𝕠𝕟 is the organ in the digestive tract.

Colectomies are used to prevent or treat different diseases such as 𝗰𝗮𝗻𝗰𝗲𝗿, 𝗯𝗹𝗲𝗲𝗱𝗶𝗻𝗴 𝗽𝗼𝗹𝘆𝗽𝘀, or 𝗰𝗿𝗼𝗵𝗻𝘀 𝗱𝗶𝘀𝗲𝗮𝘀𝗲.

Routine preventative colonoscopies are extremely effective in catching polyps that may become cancer early in the disease process.

Prior to surgery, the patient will need to drink a bowel preparation solution to reduce the risk of infection.

This surgery is typically performed laparoscopically, and new techniques in treatment have proven to enhance recovery after surgery, including epidurals or regional nerve blocks in the abdomen. The surgery can also be performed robotically or open. Usually, only a portion of the colon needs removed, and patients resume normal bowel function within a day or two.

Hospital stay is roughly 3-5 days waiting for bowel function and getting pain control.

After surgery there may be changes to bowel movements but there are many ways to help maintain and control them.

After surgery you will have frequent visits with the surgeon and scans (if surgery was to remove cancer).

𝘾𝙤𝙡𝙤𝙣 𝙘𝙖𝙣𝙘𝙚𝙧 may have a strong genetic component to it, so if someone in your family has had it, it is important to tell your doctor.

𝘾𝙤𝙡𝙤𝙧𝙚𝙘𝙩𝗮𝗹 𝗰𝗮𝗻𝗰𝗲𝗿

A cancer of the 𝕔𝕠𝕝𝕠𝕟 or 𝕣𝕖𝕔𝕥𝕦𝕞, located at the digestive tract's lower end.

Different cancers that can develop in the 𝕔𝕠𝕝𝕠𝕟 or 𝕣𝕖𝕔𝕥𝕒𝕝 include: adenocarcinoma or carcinoid

𝗙𝗮𝘀𝘁 𝗳𝗮𝗰𝘁𝘀:

Early cases can begin as noncancerous polyps. These often have no symptoms but can be detected by 𝒔𝒄𝒓𝒆𝒆𝒏𝒊𝒏𝒈.

𝑺𝒄𝒓𝒆𝒆𝒏𝒊𝒏𝒈 includes colonoscopies starting at 50 or earlier with high risk factors (family history)

ℂ𝕠𝕝𝕠𝕣𝕖𝕔𝕥𝕒𝕝 𝕔𝕒𝕟𝕔𝕖𝕣 symptoms depend on the size and location of the cancer. Some commonly experienced symptoms include:
- Changes in bowel habits
- Changes in stool consistency
- Blood in the stool
- Abdominal discomfort

Risk factors include:
- Genetics (Lynch syndrome)
- Age
- History of colore**al polyps

Modifiable risk factors that help decrease risk of developing colore**al cancer:
- Smoking
- Inactive Life style
- Obesity
- Alcohol and/or to***co use
- Diet high in processed foods

Colore**al cancer treatment depends on the size, location, and how far the cancer has spread.

Common treatments include 𝘀𝘂𝗿𝗴𝗲𝗿𝘆 to remove the cancer, 𝗰𝗵𝗲𝗺𝗼𝘁𝗵𝗲𝗿𝗮𝗽𝘆, and 𝗿𝗮𝗱𝗶𝗮𝘁𝗶𝗼𝗻 𝘁𝗵𝗲𝗿𝗮𝗽𝘆.

Surveillance after treatment includes blood work and CT scans

𝑰𝒏𝒕𝒓𝒐𝒅𝒖𝒄𝒊𝒏𝒈...

𝗗𝗿. 𝗥𝗮𝗺𝘆 𝗙𝗼𝘂𝗮𝗱

Board certified Surgical Oncologist
Board certified Surgical Critical Care

𝕋𝕣𝕒𝕚𝕟𝕚𝕟𝕘
Cleveland Clinic
Riverside Methodist Hospital

𝔽𝕖𝕝𝕝𝕠𝕨𝕤𝕙𝕚𝕡
Ichan Schools of Medicine at Mount Sinai in New York
Ohio State University

Years experience
9

𝔸𝕣𝕖𝕒𝕤 𝕠𝕗 𝕗𝕠𝕔𝕦𝕤:
Liver cancer
Pancreatic cancer
Bile duct cancer
Pancreatic lesions
Gastric cancer
Esophageal Cancer
Colon and re**al cancer
Sarcoma
Peritoneal carcinomatosis
Gallbladder cancer
Adrenal cancer
Neuroendocrine tumor
Appendiceal cancer
Pseudomyxoma peritonei

𝗪𝗵𝗶𝗽𝗽𝗹𝗲 𝗣𝗿𝗼𝗰𝗲𝗱𝘂𝗿𝗲
𝘗𝘢𝘯𝘤𝘳𝘦𝘢𝘵𝘪𝘤𝘰𝘥𝘶𝘰𝘥𝘦𝘯𝘦𝘤𝘵𝘰𝘮𝘺

Preformed for 𝒄𝒂𝒏𝒄𝒆𝒓 𝒕𝒓𝒆𝒂𝒕𝒎𝒆𝒂𝒏𝒕𝒔, 𝒑𝒓𝒆𝒄𝒂𝒏𝒄𝒆𝒓𝒐𝒖𝒔 𝒎𝒂𝒔𝒔, or 𝒄𝒉𝒓𝒐𝒏𝒊𝒄 𝒑𝒂𝒏𝒄𝒓𝒆𝒂𝒕𝒊𝒕𝒊𝒔

During the surgery, the surgeon removes the head of the 𝕡𝕒𝕟𝕔𝕣𝕖𝕒𝕤, 𝕘𝕒𝕝𝕝𝕓𝕝𝕒𝕕𝕕𝕖𝕣, part of the 𝕕𝕦𝕠𝕕𝕖𝕟𝕦𝕞 (small intestine), and the lower portion of the 𝕤𝕥𝕠𝕞𝕒𝕔𝕙

The pancreatic duct, bile duct, and stomach are reconnected to the jejunum (small intestine) allowing food and digestive fluids to more through the bowels

The 𝕡𝕒𝕟𝕔𝕣𝕖𝕒𝕤 and 𝕤𝕥𝕠𝕞𝕒𝕔𝕙 are reconnected to the jejunum (small intestine) allowing the pancreatic fluids to more through the intestine

The 𝒔𝒖𝒓𝒈𝒆𝒓𝒚 takes roughly 4-6 hours to complete

𝑹𝒆𝒄𝒐𝒄𝒆𝒓𝒚 𝒕𝒊𝒎𝒆 includes 𝒂𝒃𝒐𝒖𝒕 7-10 days in the hospital and than a few months to get back to baseline, but varies from patient to patient

During recovery the surgeons see patients multiple times for continued check ups. The surgeons will also continue to monitor patients for months to years based on the surgical pathology

HPV and it’s link to a**l cancer.

https://www.instagram.com/p/CalKdnMulyl/?utm_medium=copy_link

Being infected with human papillomavirus (HPV) is the main risk factor for a**l cancer. Being infected with HPV can lead to squamous cell carcinoma of the a**s, the most common type of a**l cancer. About nine out of every ten cases of a**l cancer are found in patients with a**l HPV infection.⁠ ⁠ People with healthy immune systems are usually able to fight HPV infections; people with weakened immune systems who are infected with HPV have a higher risk of a**l cancer.⁠ ⁠ Visit the link in our bio for a fact sheet that summarizes how to reduce the risk of a**l cancer.⁠ ⁠ Credit: Terese Winslow⁠ ⁠ #AnalCancer #HPV #CancerTypes #HPVInfection #CancerPrevention

𝗣𝗮𝗻𝗰𝗿𝗲𝗮𝘁𝗶𝗰 𝗧𝘂𝗺𝗼𝗿𝘀

There are different types of pancreatic tumors, and not all of them are a malignant cancer. The most common type of pancreatic cancer is in called 𝗮𝗱𝗲𝗻𝗼𝗰𝗮𝗿𝗰𝗶𝗻𝗼𝗺𝗮. Another type is called 𝗶𝗻𝘁𝗿𝗮𝗱𝘂𝗰𝘁𝗮𝗹 𝗽𝗮𝗽𝗶𝗹𝗹𝗮𝗿𝘆-𝗺𝘂𝗰𝗶𝗻𝗼𝘂𝘀 𝗻𝗲𝗼𝗽𝗹𝗮𝘀𝗺 or 𝗜𝗣𝗠𝗡. This tumor is benign but can turn into a malignant cancer if left untreated.

𝔽𝔸𝕊𝕋 𝔽𝔸ℂ𝕋𝕊:

*The pancreas is divided into 4 sections - head, neck, body, and tail

*Bile from the liver enters the intestines through the pancreas

*The pancreas makes insulin, which helps to control your blood sugar, as well as digestive enzymes that aide in breaking down food for your body to use as energy

*If a tumor grows large enough to block the pathway that the bile and pancreatic enzymes take into the digestive tract, patients may experience diarrhea or have a yellow tint to their skin called “𝗷𝗮𝘂𝗻𝗱𝗶𝗰𝗲”

*Tumors in the head of the pancreas require treatment that includes chemotherapy and a surgery called a 𝗪𝗵𝗶𝗽𝗽𝗹𝗲

Introducing Dr. David Arrese

Board Certified 
Surgical Oncologist
Surgical Critical Care

13 years of surgical experience

General Surgery Residency at St. Vincent’s Catholic Medical Center in New York

Surgical Critical Care Fellowship at
North Shore University Hospital in New York

Surgical Oncology Fellowship at The Ohio State University

Areas of expertise:
* Pancreatic Cancer
* Bile duct Cancer
* Liver Cancer
* Colon Cancer 
* Stomach Cancer
* Peritoneal carcinomatosis and HIPEC (heated intra-operative chemotherapy)
* Adrenal masses
* Neuroendocrine tumors (NET, also known as carcinoid tumors)
* Esophageal Cancer

Office specialist with some clinical needs.
Some travel required

March 4th… wear blue for Colore**al Cancer Awareness.

https://twitter.com/ccalliance/status/1495120810482319366?s=21

Colore**al Cancer Alliance on Twitter “Mark your calendars for Friday, March 4 when we go BLUE! We’re asking everyone -- even you! -- to post Dress in Blue Day photos on social media with the hashtag to raise awareness for colore**al cancer. https://t.co/fXTxBpiKMe https://t.co/0ILqlmaQpx”

https://instagram.com/stories/mdandersoncancercenter/2776553144853907268?utm_source=ig_story_item_share&utm_medium=copy_link

instagram.com

https://twitter.com/thenci/status/1494419885237096452?s=21

National Cancer Institute on Twitter “How does work against cancer? This type of treatment enhances the ability of the immune system to detect and kill cancer cells. https://t.co/yx9mCYKeot https://t.co/LRzSyNcGeK”

Tools of the trade

Welcome to Cancer and Surgical Specialist. We are a group of Board Certified Surgical Oncologist that specialize in diagnosing and treating patients with new or preexisting cancer.