Week 2 started after a solid weekend of sightseeing and yummy Chinese food (still can’t believe we went to Chinatown on both Saturday and Sunday…).
Project & Lab Meetings
I attended two lab meetings this week, with Dr. Nanus’s group on Monday and a joint one with Dr. Avi’s lab. A post-doc student from Cornell (Ithaca) joined us on Monday to record/study the technologies that are involved in research collaboration between Cornell Ithaca Campus and Weill Cornell Medical College, which makes the scientific discussion rather interesting. I realized that there exist distinct differences between basic research and translational/clinical research. For example, in the King lab, we flow approximately 1 million cancer cells through the functionalized microtubes and we focus on characterizing cell rolling behavior and optimizing the capture efficiency. In the Nanus lab, we are using 200 cells instead since that is a more physiologically relevant number for circulating tumor cells. The main goal is to capture all the 200 circulating tumor cells on the surface.
We modified the surface chemistry to increase cell adhesion using three prostate cell lines and we expect to have patient samples next week to test our new syringe pump.
I also attended a genitourinary clinical conference with case presentations on Monday. Dr. Nanus, Dr. Tagawa and a few other attending physicians reviewed the most recent cases. One patient was diagnosed with bladder cancer since MRI and CT scans revealed the tumor mass and Hematoxylin–eosin staining of the bladder tumor specimen showed 95% small cell pattern carcinoma. This is a rare case since less than 1% of bladder cancers are small-cell carcinomas. Chemotherapy for these cancers is similar to that used for small-cell carcinoma of the lung. After discussion, the doctors decided to treat the patient with combined radiation and chemotherapy followed by surgery. I was surprised that I actually learned a lot of medical knowledge from this two-hour long case presentation thanks to all the extremely experienced physicians and pathologists.
I can’t recall how many times I said to my self “This is so cool…” this week in the OR (I had to try really hard to keep this thought to myself).
The patient is a 63 yr-old male with a 1.7 cm cancerous right thyroid nodule. Thyroid nodules are solid or fluid-filled lumps that form within the thyroid, a small gland located at the base of the neck. Most of the time, thyroid nodules are noncancerous and do not cause symptoms. In this case, the patient’s thyroid nodule has become large enough to press on his windpipe, making it uncomfortable to swallow.
Laparoscopic adrenalectomy (Dr. Del Pizzo)
Laparoscopic surgery refers to the technique in which a surgeon operates within the abdominal cavity with small telescopes and long instruments instead of making a large incision with conventional instruments. A 5cm large adrenal tumor mass was detected in the patient, which resides really close to the vena cava. The chief resident who was operating expected a long surgery due to the potential risk although he successfully took out the tumor within two hours using ultracision harmonic scalpels. I was fortunate to have a visiting medical student from Vanderbilt Medical School explaining the procedure in details for me. He also recommended a website (MDconsult.com) to learn medical terminologies and common disease symptoms.
Robot Assisted Prostatectomy (Dr. Douglas Scherr)
With Dr. Scherr’s permission, I observed my second robot assisted surgery with the da Vinci surgical system. Thanks to Dr. Nanus, I learned the basics of prostate cancer prognosis evaluation systems: Gleason Score and PSA Test. Prostate-specific antigen (PSA) is a protein produced by cells of the prostate gland. The PSA test measures the level of PSA in the blood. The Gleason Grading system is used to help evaluate the prognosis of men with prostate cancer. As for Gleason Score, pathologist assigns a grade to the most common tumor pattern, and a second grade to the next most common tumor pattern. The Gleason grade ranges from 1 to 5, with 5 having the worst prognosis. The Gleason score ranges from 2 to 10, with 10 having the worst prognosis. The patient, a 57 year-old male, had a Gleason score of 6 and PSA of 8.4 with no family history of prostate cancer and was perfectly healthy otherwise. Interestingly, CT/MRI scans did not detect any tumor mass. The enlarged prostate (5X4 cm2, compared to its normal walnut size) was removed followed by anastomosis on the urethra and bladders. The da Vinci surgical system is known for faster recovery and less bleeding when compared with the conventional open surgeries.