Learn to Teach and Teach to Learn
- Written by N. Simon Tchekmedyian, MD
- Category: General
Dictionary Anyone? The word doctor comes from the Latin word for "teacher," itself from docēre, meaning "to teach." That is what we do throughout our careers. We learn and we then teach, and this collegial spirit drives the daily transfer of knowledge and experience among doctors and students at hospitals and clinics. We also learn a lot while teaching because it is a dynamic and interactive process, often based on real patients and real life; and our experience grows every day, no matter how long we have been in practice. At Pacific Shores Medical Group (PSMG), we have 14 oncologists on staff, with a combined experience of about 300 doctor/years! At our frequent physician conferences, we combine our knowledge as one of us presents a patient’s condition to be evaluated and analyzed by the team. We all have access to the entire medical record, and the interaction is refreshing and revealing, often bringing light and consensus as a path of management is considered and forged. We learn and teach at these conferences, and our patients are all the better for it. Importantly, each of us has a sphere of activity and a network of advisors and consultants that span the entire country and the world. We will call and consult, when needed, anyone anywhere who is best suited to provide the most relevant information and advice. In this context, you can consider the PSMG doctor caring for you as the tip of an iceberg, bringing to you the combined knowledge and experience of an amazing constellation of talented experts. As one of the largest oncology programs in the country and the world, PSMG is also present at regular meetings with the largest oncology groups in the country; and at these conferences, there is intense information transfer, discussion, and timely implementation of newer procedures and technologies to help our patients. I believe it is important for our patients to know how we operate and to know they are the focus of our daily efforts. They are constantly in our minds and we are always thinking about them and discussing their care. Our allegiance to our patients is in our DNA, and we are proud of it. We also teach our patients and learn from them. Patient education is a huge component of our practice, and we go through great lengths to ensure that patients have the information they need to understand their condition, understand any tests and treatments they may need, and be aware of best ways to prevent side effects and to stay safe. We also know how important it is that we answer their questions!
Want Some Examples? So, how about starting to answer some questions that we get asked frequently?
Question: What is cancer, anyway?
Answer: It is a disease that develops when cells somewhere in the body change from their normal behavior and become a threat to the rest of your body. Normal cells are born, go on to accomplish a function, and then they die. A new cell replaces the cell that died; and, at the end of the process, you have still the same number of cells. Cancer cells are basically immortal. They are born, they do not have much of a good function, and instead of dying, they actually divide. Consequently, this leads to an accumulation of cells because they keep dividing, so as time goes on you can have thousands, millions or even billions of them. For comparison, we have about one billion cells approximately in the tip of one finger over an extent of about ½ an inch. At the beginning, when only a few of these cancer cells are present, the growth is so small that it is undetectable. It can often take years for this small number of cells to become a large growth or tumor. Usually we can detect the cancer as it grows and makes its presence known because it presses on something, bulges somewhere, causes pain, produces some substance that goes into the blood stream and causes symptoms, or because it shows in some screening or incidental imaging test. Once the growth reaches some size, say an inch or so, it has lots of blood vessels in it and that is how the cells get oxygen and nutrients to grow. The problem is also that the cells tend to misbehave, and they move around and creep through the wall of blood vessels and start circulating in the blood stream. From there they can spread to locations in other organs, away from the site of origin. That can be serious, because it often makes the treatment more difficult. Our immune system should kill these abnormal cells and get rid of them! The problem is that not uncommonly the immune system cannot distinguish between cancer cells and abnormal cells. In other words, the immune system cannot tell who the enemy is.
It all sounds pretty awful, but we also have very good news! We can get rid of cancer now better than ever because we also understand it better. So, of course, that brings up the next question!
Question: How can we get rid of this cancer?
Answer: We are getting better at it, and we cure the majority now. Surgery is great for cancers that grow slowly, tend to not spread, and can be entirely removed. Typically, we are talking about a small cancer measuring like ½ and inch or sometimes substantially more, located for example in the skin, lung, breast, or colon. Many cancers can be removed but experience shows that they can grow back in other sites of the body because the cells have spread, even though the spread is not yet visible. In those instances, we use treatments after surgery to kill those hidden cells. We call that “adjuvant” therapy. Remember that the cancer cells are dividing all the time? That is actually a weakness we exploit. Most chemotherapy treatments mess up the process of cell division of the cancer cells and when those bad cells try to divide, they die instead. That is nice to see and is a good thing.
Radiation treatments also interfere with cell division. Radiation works in the area that is irradiated while chemotherapy works all around because it circulates in the blood. Targeted treatments are directed to cancers that have some specific abnormality that the treatment is directed to. This can be very effective in some cases, and that is for example how we control the vast majority of cases of chronic myelogenous leukemia and many cases of lung cancer. Immunotherapy is now part of the core of treatments we have for many cancers, including those that have spread and were until recently not well controlled. Examples are melanoma, kidney cancer, and lung cancer. Remember that the immune system could not identify the enemy? Well, immunotherapy uncovers the enemy and enhances the ability of the immune system to knock the heck out of the cancer cells. And that is, my friends, also a very good thing. The general information here is basically to provide context so that when an individual specific situation is discussed, there is better understanding.
We plan to keep adding questions and answers, so please stay tuned.