Week 2

My week this week was actually quite similar to last week. I spent one day in the clinic with Dr. Nanus, a medical oncologist, for chemo patient follow-up visits. This week, we saw numerous patients with metastatic cancer. In particular, I learned that bone metastases are a likely location when prostate cancer is initially presented. Interestingly, I was able to see a visit between Dr. Nanus and a new patient, and all of the information and examination that goes into it. It turns out that this patient had quite the past history including: leukemia, a triple bypass heart surgery, kidney cancer, and diabetes. Unfortunately, he now also has metastatic bladder cancer invading into his muscle, and to avoid any further kidney damage caused by chemo and radiation, his only sensible treatment option is to replace his bladder in a neobladder reconstruction.

Again this week I went to the genitourinary (GU) tumor board meeting where many doctors from different departments meet to discuss a patient’s past results and decide what the next step to take is, collectively. I also attended the cardiac care unit (CCU) rounds with David. Here, we observed a transesophageal echocardiograph of an older woman with multiple holes in her septum between the ventricles in her heart. It was very interesting to be able to see blood flow through the heart, but it was a little hard to tell the different anatomy of the internal organs.

This week I also spent time observing in lab. I was able to see three different methods that they use to isolate circulating tumor cells (CTCs) from patient blood samples. The methods include (1) an FDA-approved machine with extremely high purity called CellSearch, (2) several rounds of centrifugation, that is easy, quick, inexpensive, but low purity, and (3) a microfluidic chip with antibodies attached to posts that specific to the type of cancer cell (ex. PSMA for prostate cancer). It is very interesting to see the tradeoffs between difficulty, expense, and purity of the different diagnostic methods.