This is Roswell. Rookie by Roswell Park Cancer Institute. Your team opinion or your total options. Your host him Wenger -- connector Roswell is a comprehensive look at all aspects of cancer care treatment diagnosis can research. From a comprehensive source Roswell park. Cancer institute right here in Buffalo, New York I'm -- -- that's where we are today and today we're talking with some of the relatively new folks here at Roswell park on the campus. New to Roswell so to speak and I will -- talk a little bit more about some of their background which actually brought them. To Roswell a little bit. You know along the way a few years ago doctor -- acres is here with us today doctor acres is an assistant professor of oncology in the department of gynecological oncology here at Roswell park doctor -- thank you so much thanks for having me appreciate you being here and looking forward to hearing your. You travels and how you want to appear on the Roswell campus and by your side today doctor Stephen American. An assistant professor of oncology. In the department of surgical oncology surgeon here at Roswell park doctor American thanks for being here. Pleasure thanks for having me and your that you're you're from the downstate. Portion of of New York State yes -- originally born and raised in Brooklyn New York. And came up here for our training and now my career very well let's start out with a little bit of that doctor acres you know what brought you arousal part. So I did -- -- T intersection of obstetrics and gynecology in this -- to a fellowship and do my apology and that's what how it ends up in Buffalo, New York care restaurants to post them. Currency work 'cause specifically obviously in the OBG Miami area. You know specific areas and expertise that you do -- working out right now. So we don't mailing with a Q Amylin galaxies which include old man. People are cancers that don't cancers. And need to cancers cervical cancers in your -- is well as doctor can. He trained here prior to your appointment that's correct okay. You know. It's the only -- cancers treatments in India and the outlook the outcomes of these cancers have changed dramatically through the years. You know what are you seeing. He knew in your time here so far Russell park as far as advances and you know PG gland cancer treatment and get the big. Improvement advances is due to earlier detection. -- pray tell are a lot more aware. There's a lot more information -- patient education. They're really focused on their health and actually improved. This is there are some cancers we sit here Roswell park and talk about that you know there there's not a screens for there's not a -- really detected until. There are signs of it with or PG -- cancers. For the most part part of their screens are there ways for women to two you know observe themselves and in detect these cancers before they get to advance. How unfair cervix cancer of course -- we have we do pap testing I've kept screening for protection. Endometrial cancers are hearing cancers this year easily detected and honestly I scream because they have symptoms of postmenopausal bleeding. On the big one that people care about talk about his ovarian cancer which you know is very difficult to detect and majority of cases are detected at least eight. Disease there's there's really no screening process. Right now there's a lot of investigation. For that but still nothing. To improve it outcomes. And -- later in the program and people will talk a little bit more in depth about ovarian cancer and and how it is being treated if at this stage in and in in your department here Russell park doctor American. Is the surgical oncologist here Roswell park for slow welcome welcome to the area from. From downstate new York and thanks for being here thanks again. What what areas are you specifically working and and and talk a little bit about your training here Russell prior to your appointment as well. Sure. I did my general surgery training down in New York City. And then. Actually didn't collective. Group appear Roswell park while I was a resident. And I really enjoy the area enjoyed the hospital. Did actually phenomenal work here is being done here Russell park both from a clinical and and research side. So I applied for fellowship and everything worked out and I had just finished playing the fellowship and surgical oncology here Roswell park at the this past summer and then came on staff. My focuses in Castro intense intestinal malignancy is. Mostly in colorectal cancer and some upper GI cancers like comic and esophageal work as well. You know we are just talking about ovarian cancer and in now you know it is you mentioned here colon cancer there is a great screened for colon cancer in the colonoscopy. And in so many of us -- -- we reach a certain Ager going to risk group. Are you know advised to undergo -- mean. Did that treatment of in detection of colon cancer I would imagine has changed drastically. Even in the in the past five years or so. It it has from the standpoint of additional therapies. I definitely over the years some other minimally invasive techniques like a laparoscopic surgery or robotic surgery. But the most important as you were mentioning before is screening. Colon cancer colorectal cancers. Third most common cancer in adults. And and it is -- the majority of it is often preventable with colon cancer screening specifically call Moscow peace and and there's no question that. That resource is under utilized. An and a lot of the colorectal cancers can be detected early. Be treated early and church early. By appropriate screening measures scramble get into some of your areas of expertise to as we advance here in the program one of the things I -- to talk about is that. YouTube didn't just end up here and meet you via an awful lot of background behind both of you mean ever read -- read a bit about -- your background. Before you didn't get to the point of being. Understand her arousal part you've gone through an awful lot of training -- -- I guess I'd like to just hear from each -- you. A little bit from. Maybe from the medical school point to how you've got to be here Russell park you've touched on it but let's get into some detail. Well yes from my standpoint it is it is a long road and so we finally get to. A staff position as myself and doctor acres. Four years of of undergrad usually than -- so four years of medical school. And then after that it's many years of residency training. From my standpoint it's and -- an additional five years of general surgery training which was done -- Weill -- -- presbyterian system in in Queens. And then two years additional training specifically in surgical oncology before coming on staff as a full fledged attending. Doctor acres were -- Yellow brick road lead would lead from into. -- on the relief from Birmingham Alabama so I didn't have school there and then realize -- -- -- obstetrics and our ecology. And there was during my residence for your residency that had a eyes and I just specializing in human ecology says an additional four years. So. That's how I ended up here applying for fellowship. After residency to you know -- It's these. There's so much you can do with with medicine are so many different areas that you can. You know diversify into in specialize in I don't need to tell you to that. Why did you choose what you chose factory that's what led you to comment -- well and originally as a medical school we Hindu rotations and all that. The major obstetrics and Thomas and psychiatry. -- me. From pediatric pediatrics intensive care and on. So that I realized that I do and we'll be doing and didn't end residency I realized that. I really enjoy this -- class act -- it so I decided to -- specialize in you bank policy. And though when the unique he's fragile ecology is this -- only so it's actually is actually. And see patients. Brand patients and call him up and actually administered chemotherapy to their patients so it's really nice to be able to take care the patient as a whole. They involve the patients in the future as well. Vera. After treatment. So that that's very. Unique to this especially without really why is that and -- is -- -- explainer on that. For a most certain circles especially on the patients -- receive. Have surgery and then -- treated at medical oncologists are any chemotherapy. Or radiation oncologist and appreciation is needed. Just the way in this especially has worked out -- actually. We're trained to administer chemotherapy as well. Doctor American what led you to via. The area of gastrointestinal. -- mean it's. A choice here obviously along the lady made. Yeah it's it's solemn. I don't know what it is and I think you know probably all physicians go through it at some point or another maybe it's -- medical school. Or -- to something else where you're speaking to may be mentors. Or while on the service seems you just get a certain. Feeling. That this kind of bond or connection to a specialty. That drives you that kind of wakes you up in the morning gets you out of bed. I'm not like other and you -- as doctor -- -- explaining you rotate through all the different services. But you know you just when you when you're on a certain service and just find yourself kind of jumping out of bed getting into work. Seeing those patients -- the pathologies. Wanting to talk about it is it's just this you know kind of personal connection that you make. That you know you just and you try you say well. What's my life going to be like if I chose this or if they chose that you try to listen to other people and listen to renters on advice on what should they choose but. When it comes down to it it's it's this personal bond or connection defined with. Like for my instance this GI cancer patient. And and ever since after that it once you make that connection and often is for the rest your life. You know I probably asked the wrong question first I ask you why he specialized in in the area of cancer. Surgery and treatment it that you both have. My cancer to begin -- Lyon College what we did that come from. After American babies story you and again I think it's. At some point during. Probably more residency and so you went through your medical school training you've got a broad training and all aspects of medicine. And they and -- during your residency you start getting more specific into different areas of surgery room in my case. Com but again it was that connection that was me I think. You know in Madison there's no question all areas of medicine and no matter what's going on in your life what's happening the stock market what's happening in politics. What when something in health either yourself or loved one something changes when that word cancer pops up everything stops. And I think you know as being cancer special to us that's specialists and being able to treat somebody with cancer either treat them or cure them. I truly think that there's nothing more rewarding. In a profession and to be able to do that and just see the appreciation. Patient aura or a loved one for being able to help them. So that that's that's kind of where I I I found that again bond and residency in and decided to go after it and that's what brought me here Roswell for fellowship and then as -- -- my career. Doctor could you talk about your specialty and you know -- QA and but you know before that what led you to. You know the role of an oncologist and him. Similar to what doctor American had mentioned you find you. I personally had a patient and experience as a resident. -- play it embarked on television and residency I thought I would just do such as an -- ecology and be be done that point. However you have this interaction -- this experience and and as a resident you rotate the -- ecology service and you have these interactions with patience and is so rewarding. -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- You both our our parents of of young kids straight he believed in me can't balance you know like it's it's kind of a personal note but I mean it has to be delicate balance to. Take care of you know young children and and have the weight of what you do here at Roswell park on your minds and yes it does. But definitely my wife is is. The strongest part of -- Of our family I mean without her it would not be possible to do that -- I think definitely having support around. Definitely friends family -- for me yeah I mean having my wife and take care of the children. At home when I'm here at work makes things definitely easier. I think family is is really important it's nice -- have a work you know where Sanofi rebounds. As you can get rewards at home and -- work there you know independent of each other. Behind every doctor's -- files right I think are very very good you are listening to Roswell on this and -- were talking with -- two of the relatively. New folks here on staff here at Roswell park that last voice you heard doctor Stacy acres assistant professor of oncology here at Roswell park. And also doctor Stephen Durkin is with us today and is well an assistant professor of oncology. In the department of surgical oncology. We talk so often. With with members of your staff here at at Roswell about. The entire approach here that that is taken that multi disciplinary approach. -- hope you both found that to be in treating people in approaching patients. -- not one person but as a unit a staff here Roswell park doctor American. I think it is probably. The most valuable. Part of of managing patients and and one of the most important things that I think a place like Roswell. Hasn't. And and and and -- does come a multidisciplinary care especially for cancer is crucial. I think if you know. Sometimes with -- You know you can you go to -- you're gonna get a muffler. You know if you goto a specialist and they recommend just one thing. You know it's what they know it's what they do and here. Every single one of our patients with a G I malignancy is presented at one of a multi disciplinary conferences. And we present a patient's case and everybody in the room. From each. Across -- discipline within that GI's specialty is there. From medical oncologist radiation oncologists surgeons pathologists. There everybody is there knowing. Exactly what the situation of that individual page in this and you know here we don't just treat. The cancer can we treat the individual because there are a lot of not just that disease process itself but also. You know the mental emotional. Some social often socio economic issues and other issues that are. Sometimes limiting some of the management and treatments and all of that needs to be considered. So I think presenting the case across that the these different disciplines went to document each individual patient is actually crucial. And and for the most part it's it's led to. Better care. You know it's interesting you bring up all those different things the psychosocial you know maybe the economic all different. You know aspects of of care that -- Burton represented here Russell park ultimately you know obviously we hope down to the clinical side that you as a surgeon are able to correct whatever is wrong. You know within. You know cancer regard for one of your patience but. A stronger patient is a better patient right and in a better informed patient patient that is emotionally intact. That's why all of this multi disciplinary approach is important -- -- -- and Anna yeah a well educated patient can't see as a kind of -- to. Yeah well informed well educated patient is is definitely. What who would be great for all must and up with great outcomes and and not help them as best as we can answer doctor -- take us inside one of these multi disciplinary discussions what happens there what is. Presented. With regard to a patient. So generally we. Patient information -- patient history. And pertinent information is presented. The technology is reviewed technology sites are not threatened to review the diagnosis is reviewed. Treatment options are viewed them based on encourage insisting guidelines. I think clinical trials that are available for standard of care for treatment. Creation ecology is present you know to see if there's anything that they would recommend their offer. And then late afternoon was mentioning not every patient gonna -- one. Standard so that given individualized. Approach for that patient what's it that's. It's for that patient because not all patients are sort of OK and it's so we have some nonsurgical. Options for those patients that pursued me for medical reasons or for whatever reasons can't neurosurgery. -- alternative treatments for them. That the EU is he you know as a surgeon you're in the room here talking about what your patience but it's not just positions in this this conference right there. That's correct there are. -- pharmacies and pharmacists are available. Residents. Physician assistants nurse practitioners. To anyone who might be involved and in coming up with care planning for for that that individual. Doctor and I know you work. With two different. Or go to approaches I should say. Surgery do you -- mentioned laparoscopic. And robotic. Tell me about those two men in the difference between them the benefits of those two different styles of surgery. Sure so minimally invasive surgery. For the most part -- is really in the grand scheme of things that's another word for -- -- right exactly and and why it. Minimally invasive surgery offers from the standpoint of and let's just talk about colorectal surgery on the national studies have been done looking at whether or not. Minimally invasive approaches like lap ferocity where he makes small incisions to remove. The Poland with tumor for example. Large national studies comparing laparoscopic surgery to open surgery showed that they were really no differences in long term surgical outcomes. With regards to -- cancer recurrence or even survival. But what it does offer our smaller incision so that. People are able to recover faster. With small incision is there may be less complications. Last narcotic use post operative -- getting back to work a little earlier. And things like that so. So we know that if we are able to -- incisions with laparoscopic and robotic surgery. That we can't have -- be better short term outcomes without compromising. Those on the long term cancer welcomes. -- acres is is laparoscopic surgery in robotic surgery used in your areas -- just okay. The benefits obviously you've mentioned shorter recover -- recovery time smaller incisions and that's probably why did the shorter recovery time. But I think people get nervous when they start to hear words like robotic when it comes to their body. Kind of put us at peace that robotics surgery is robotic. Assisted surgery great. Right perhaps the -- over there yeah I think there are some misconceptions that I don't wanna robot doing my surgery and it. Of course we are performing the surgery ourselves. The robot. Is brought over to the bedside. And small arms are placed within these ports the small incisions. And then we sit in the room at a console on the other side of the room were not actually technically at the bedside but we're just a few feet away. And we're able to look through a console. And where. And see action and optimize some of the visualization. And some of the high definitions. Such as my 3-D technology. And then also have some of the techniques of using. Wrist motion and and very precise movements. That the robot offers. For a situation like with robotic surgery for example. You know you're both you've be both young and your careers but you're both very experienced as we demonstrated here. But even in in the thoughts during maybe medical school have things changed. Drastically. Doctor acres since that time until now costs about. You know data about approaches to surgery about. You know outcomes and ends in between your particular area of expertise -- -- -- I think a big thing would be the namely invasive surgery robotics surgery because when I was in medical school -- that ultimately. Sunday -- and some day. Kind of it was in its pioneer as far as being routinely used. Now that we -- to me to have back surgery for her especially for endometrial cancers -- routine basis. After American you know thinking back to -- Here your early days in school and in -- medical school I mean have things changed in in need. Yeah I would have to agree I think I think after the results there there was some apprehension and some concern that. Trying to push these minimally invasive approaches would it. Maybe increased the likelihood of having cancer occurrences at certain at these may -- port sites and things like that but. After a large randomized trials. National even international trials performed showing that that. Wasn't a concern I think more and more -- people surgeons are. Pushing the envelope. Minimally invasive -- and we're finding that they can be done safely and and effectively. What are you bullets question for both of you and factory goods I'll start with you really work where you see this all going and where would you like to be. You know deeper into your career. In dealing with OB GY and cancers. What kind of hope do you have. For women dealing with those cancers and -- and what kind of progress do you see being made. The biggest power -- Text and ovarian cancer I think that's something that we still struggle would have seen a lot of improvement. So if this cancers detected earlier on those travels much better than the majority of patients have you know are detected pitted against each disease with. With a few works fight your prognosis. We mentioned earlier that it is a different ovarian cancer is a very difficult cancer to. Two to detect and how is it normally discovered. I'm dealing patients who present with some vague symptoms such as abdominal bloating early to -- IT public discomfort. And then they inducted often in the ER as their primary care doctor. Have a cat -- and that's generally expect out so it's something women need to be aware of and obviously primary -- will be QA and needs to be aware of their their their patients' conditions. Doctor -- looking into that crystal ball and you were to like to see things go. With regard to you know I guess and in particular gastrointestinal. Advances. Yeah I think more and more we're learning about. The biology of cancer. And I think ultimately that's. Where we're headed more and more we're getting information on on the -- cancer genes your individual cancer genes. I'm not all cancers the same even within. IGI malignancy is not all colorectal cancers the same. So learning more about an individual's cancer. I think goal. Ultimately be where -- where we're going in hopefully in the near future. Getting to assert certain targeted. Targeted therapies targeting -- most therapies. Those kind of things and incorporating. The foundation is. The surgical approach to managing these patients both hand in hand. Is probably where we're ending up but there's no question I think. And as we learn more about the biology cancer -- the genetic makeup of the individual cancer. It is is where we're moving to and we've even had started. Within the past few years and we just every day we're learning more and more about that. So we've got to southern. Girl from Birmingham Alabama. And a boy from Brooklyn fulfill. It too far away from buffalo and I hear you are in Buffalo, New York. Doctor makers you're the one from from Birmingham when you weigh funny in -- here in buffalo and Western New York issues. And I think that clay faces city neighbors and I think definitely it's it's a great place Hulu content and really enjoyed. This time I've been here and it's nice I can call home now. From Brooklyn to buffalo it's usually the other way around I think -- that we can normally people go from buffalo to New York. All my life I've been in New York City N and it's quite refreshing actually -- to it to be up here and starting a new family. And two year old and a seven month old and and my wife myself and and with their note to your children I'm we've just. Really just have some -- with the city. The funny thing about New York City and buffalo. Is that if if you're speaking with someone you know from across the country or someone that is not from. From New York State they think that new York and buffalo where you know lake suburbs of one another don't think yes I actually do. But it is it it's quite far away but just close enough to that they get back home see the family in and get back quickly and and -- work against you know this is something that's pointed out on this I don't need to point out as pointed out you know what within your your industry all the time is that. There are not a lot of places like Roswell park this multi disciplinary comprehensive cancer center. Here we are in little Buffalo, New York we have this gym. Raid in our front yard you know it really is blessing in our community to have. You folks in and the staff here Russell park in the facility. Both from a clinical and and research standpoint. I mean who would have thought you'd end up in Buffalo, New York but what better place to be his first cancer research and treatment right -- Couldn't agree more Perry and a welcome both of you to the city appreciate your work here it Roswell park and I'm sure we'll. The together again soon talking about your areas of expertise thank you. Thank you can't target both of you doctor Stephen Durkin. Assistant professor of oncology as well as doctor Stacy acres she's in the department of gynecological oncology and doctor American. In the department of surgical oncology. That is Roswell this if you'd like to hear this show in its entirety or any other programs. You can do so at Roswell park dot org great website and if you have any questions for Roswell you can call -- free anytime at 877 ask our PCI. That is 87727577. -- Listen to Roswell this Sunday mornings at 630 young WB yeah. -- by Roswell Park Cancer Institute your team opinion for your total options on line at Roswell this god of war. -- And hanging. Then.