Chapter 17: Research and the Future of Surgical Oncology
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Description
In response to a question about areas of cancer research with particular promise for patients, Dr. Pollock cites tumor-based and translational research supported by SPORE grants, as well as Dr. DePinho’s Moon Shots Program addressing specific cancers, includubg melanoma, lung cancer, head and neck cancer, myeloid leukemia and myelodysplastic syndrome, chronic lymphocytic leukemia, prostate cancer, and triple-negative breast and ovarian cancers. Dr. Pollock notes the challenges of sustaining funding to make real progress in all these areas. He then talks about the future of surgical oncology, noting that “we are trying to put ourselves out of business.” Surgery, he explains, will become more localized and increasingly reliant on other specialties. For example, surgery and interventional radiology are on a “confluence course.” He explains the potential use of nano-cameras for tumor surveillance and notes that it will also be possible to radio-tag problem genes to monitor metastasis.
Identifier
PollokRE_03_20121119-C17
Publication Date
11-19-2012
Publisher
The Making Cancer History® Voices Oral History Collection, The University of Texas MD Anderson Cancer Center
City
Houston, Texas
Interview Session
Raphael Pollock, MD, Oral History Interview, November 19, 2012
Topics Covered
The University of Texas MD Anderson Cancer Center - OverviewOverview Definitions, Explanations, TranslationsDevices, Drugs, ProceduresInstitutional Mission and ValuesBuilding/Transforming the Institution Multi-disciplinary ApproachesUnderstanding Cancer, the History of Science, Cancer Research The History of Health Care, Patient CareTechnology and R&D Healing, Hope, and the Promise of ResearchDiscovery and SuccessPatientsPatients, Treatment, SurvivorsCritical Perspectives on MD Anderson
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.
Disciplines
History of Science, Technology, and Medicine | Oncology | Oral History
Transcript
Tacey Ann Rosolowski, PhD:
We’re kind of broaching another issue that I want to talk about, which is about the areas of research that are the most promising for improving patient care in the area of surgery and surgical oncology. Are there any others in addition to the ones that you just noted that are cooking here at MD Anderson?
Raphael Pollock, MD:
Our traditional strength in tumor tissue based traditional research has been extremely fruitful. Part of my concerns with the Moon Shots, frankly, is whether or not this very, very broad based level of activity embodied in the NIH SPORE grant programs—whether that will receive the type of resource recognition that is needed to be sustained over time, I don’t know the answer to that, but this is certainly a strength and it’s a particular strength within the Division of Surgery and a natural fit for surgeons in that we’re the physicians who harvest the tumor.
Tacey Ann Rosolowski, PhD:
Are there any particular areas that you feel are going to really take off in the next years as being really promising?
Raphael Pollock, MD:
Well, if you look at the SPORE activity within the division—head and neck, lung, genitourinary disease, and sarcoma are all SPOREs in which Division of Surgery faculty, myself included, has principle investigator roles. These are areas that the National Cancer Institute has felt have very strong potential to take off under the specific agents of this program in institutions such as MD Anderson. Without sounding too self-serving, I endorsed that agenda.
Tacey Ann Rosolowski, PhD:
I was going to ask the question, what has surgical oncology at MD Anderson contributed to the development of the field nationally and internationally?
Raphael Pollock, MD:
Well, those are certainly areas. Another area where there’s a lot of activity and where surgical oncology has had a huge role to play has been in the area of melanoma, where there’s also strong SPORE support at this time, and it’s one of the Moon Shot diseases. So both melanoma and lung, which are Division of Surgery areas of SPORE activity, are also Moon Shot areas, and genitourinary is as well. So three of the six SPOREs involve those areas.
Tacey Ann Rosolowski, PhD:
And how do you think the field of surgical oncology will evolve in the coming years? We’ve talked in previous sessions about how the field really coalesced over the course of your career. Where do you see it going?
Raphael Pollock, MD:
I’d like to just, for nomenclature purposes, differentiate the Department of Surgical Oncology, which is one discipline, from what I think is your broader use of the term meaning cancer surgical disciplines as a more ecumenical descriptor. I think that, without sounding cynical or smarmy, we surgical oncologists, in that broad context, are trying to put ourselves out of business. By that I mean that I anticipate that operations will be smaller, more targeted, more technologically advanced. I think that interventional radiology and surgery are on a confluence course—not a collision course but a confluence course—where increasingly in the future procedures will be done that involve both groups scrubbed in, as it were, simultaneously, both to image the areas of the tumor that are most seriously in need of resection—because tumors are heterogeneous—as well as the technical performance of the procedures, which increasingly will be done through smaller and smaller orifices, using more and more sophisticated surgical approaches.
Tacey Ann Rosolowski, PhD:
You’re talking about the robotic approaches.
Raphael Pollock, MD:
The robotic approaches, for example, but also some of the nanotechnology approaches, which when combined with robotics— For example, it’s now possible—there are radiofrequency transmitting nanocameras that can deliver images that can be expanded to macro size so that you can foresee a situation for certain types of tumors—like ovarian cancer, where tumor surveillance is very important—where we can predict where these tumors will metastasize too within the abdomen, because they are very defined loci where these tumors—just because of the flow of fluids and the way organs perfuse and peristalsis in the abdomen—so there are certain areas that we can anticipate where these tumors will ultimately lodge. So right now we’re getting CT scans every three months on patients, and that’s considered to be very intensive surveillance, with the additional radiation burden and inconvenience that that imposes. What about implanting nanocameras in the areas that are suspicious for tumor recurrence or harbor a potential for tumor recurrence? Then a patient can just take a little RF transmitter every morning and beam the image of that area to their doctor’s office, where you could have automated programs just like now is being done to follow skin abnormalities in dermatology—to be able to detect change. It can make skin maps of the entire cutaneous surface. And then you just compare the skin map for the patient periodically over time. Well, you can do the same thing with a tumor basically, and you can actually even take the human interpretation out of it, at least on first pass through. A nanocamera would provide that level of surveillance on a daily basis, and if certain changes in appearance were noted, that would set off an alarm bell that would then mandate that a human look at the scan and then decide is there something happening that we have to monitor more carefully. So that’s very, very exciting. The ability to potentially function even on the cellular level—we know the tumors are very heterogeneous, and some cells within the tumors have much higher likelihoods of being able to break away and spread to parts of the body on the basis of genetic signatures. Well, the genetic signatures can now be described very, very effectively, and it is very possible and will be very likely that aberrant genes, as they are identified, can be tagged—radio tagged—in some way that interventional radiologists can discriminate those cells from other cells, or even a pathologist is possible. I don’t know where this will end up. But with the robotic approaches, where you can micro or macro your actual dissecting and cutting activities, is it possible to do something that would be analogous to laser capture micro dissection as it’s practiced now using fixed tissue—just do that in vivo inside the patient and sculpt away the cells that have the worst potential or the more serious implications for the patients longevity. And in so doing, potentially really modify the morbidity of surgical procedures. This is the type of stuff that’s really exciting and will change the face of surgery in the future. And I want our people to be involved.
Tacey Ann Rosolowski, PhD:
I was going to ask if there are people currently involved with, for example, the nanocameras or doing this kind of microsculpting with tissue.
Raphael Pollock, MD:
No. Not yet, but we’re thinking about it. That’s the first step.
Recommended Citation
Pollock, Raphael E. MD and Rosolowski, Tacey A. PhD, "Chapter 17: Research and the Future of Surgical Oncology" (2012). Interview Chapters. 1329.
https://openworks.mdanderson.org/mchv_interviewchapters/1329
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