Minds of Medicine: Beating Cancer with Surgery

Frank Hill was taken
to the Henry Ford Hospital Emergency Room
for a head injury and a cut above his eye.
He and his family believed this would be a short visit
and a quick recovery.
But after stitches above his eye
and a precautionary scan,
doctors found there was much more to this story,
a diagnosis that no parent should ever hear.
All of the results had come back
and the radiologist had read it and they reported.
When she came into tell us,
oh my God,
it was all over her face that something else was wrong.
She came in and said that they had found
something else in the CAT scan.
The lady said that it was massive.
Now a surgery risking his sight
and his life will need to be performed,
removing a brain tumor the size of a tennis ball,
and only after its removal will doctors know
if the tumor he has is cancer.
My first thought was that I'm going to lose my baby.
But all cancers are not the same.
They can appear at random
or they can be shared along family lines.
I had a bit of a weight loss
and I wanted to get that checked out.
Took a CAT scan of me
and they found an area that concerned them,
and John's four years, five years older than me,
and he went into Ford to get checked
and they found an area with him.
After getting the ultrasound done,
the doctor said
they found something suspicious on my kidney.
Almost at the same time,
we both came up with the same problem.
The traditional approach, which was an open...
a big open incision
and removal of the entire kidney,
now we can do an approach through very small incisions,
about the diameter of your pinky or a pen,
and we can do that whole operation
where the patient's out of the hospital within a few days,
avoiding the big scar,
they're back to work more quickly,
and try to save the kidney if it's technically feasible.
I'm thinking the worst when I heard the word cancer,
so he gave me great confidence that this could be handled.
I'm lucky, they caught it.
Years ago people died from something like this.
Right now discover some of the greatest surgical innovations
transforming patient lives,
shared around the world and developed right here.
[Music]
These are the Minds of Medicine.
This is their story.
Hello and welcome to Minds of Medicine!
I'm Paul W. Smith.
Since the very beginning of modern medicine,
surgery has been used to treat cancer.
For years it's been used to remove tumors
in hopes of stopping cancer.
Today, thanks to surgical innovations
like some of the ones you're about to see,
cancerous tumors that formerly were impossible to reach,
now are being removed,
preserving lives and improving outcomes.
Many of these advancements begin
at the Center for Cancer Surgery at Henry Ford Hospital.
This new collaboration focused dozens of the very best surgeons
from virtually every subspecialty
on finding new innovative surgical solutions
for beating cancer.
The Center for Cancer Surgery team treats
more adult cancer cases than anywhere else in the state.
The Center for Cancer Surgery is an innovative collaboration
really of all of our cancer surgeons,
as well as all of the innovative technology research
and clinical trial support
that goes into making
a patient's prognosis the best that it possibly can.
We've endeavored to streamline this process for our patients
and bring everyone together in one setting
so that multidisciplinary tumor boards
sharing the best practices
and really promoting the best possible outcomes imaginable.
With a history of surgery that dates back nearly 100 years,
Henry Ford Hospital has always attracted
some of the country's most talented physicians,
and now with technology that can only be found
in a handful of locations in the United States,
they're breaking new ground
against an illness that still strikes fear.
Anybody hears cancer,
oh, you know, everybody flips out,
you know, and from talking to various people,
this is the way to go as far as I was concerned,
you know, just go and get it handled.
You know, it's a little thing right now.
People used to die from it, you know,
they didn't get it handled,
and I want to get it handled and get it taken care of.
-You ready? -Oh yeah doc, I am.
Me too!
So just to review the plan for today.
So the goal is to remove the tumor in the kidney,
save the rest of the kidney,
and do it all through the small incisions.
Now, he arrives for a robotic surgery
to remove a tumor on his kidney.
His physician, Dr. Craig Rogers,
has performed more robotic kidney cancer surgeries
than anyone else in the world,
and in Bill's case,
he will attempt to remove the tumor
and spare Bill's kidney.
It's a procedure he has done hundreds of times before
and just months ago for Bill's brother, John.
I went in for my annual physical in January
and during routine examination
one of the things I told my doctor
about is, I felt a slight pain in my right side,
towards the back.
My doctor, Dr. Burch, called me the next morning,
and I said, oh, oh, what's wrong?
He says, they have discovered what they think is
probably a malignant tumor on my kidney,
and it scared the bejesus out of me.
Bill's brother John recently had successful treatment
for his kidney cancer, to remove his tumor.
Fortunately, because it was caught early enough,
doctors were able to remove it
before the cancer advanced further.
Because of this serious cancer risk,
Bill has elected to remove the tumor.
A partial nephrectomy
as opposed to a total removal of the kidney
involves identifying the blood vessels
and temporarily clamping those blood vessels.
Now, that all has to be done within a time window,
because the kidney only tolerates
about 30 minutes of no blood flow
without irreversible damage.
We've done studies that have shown
that the robotic approach lowers the time that we're on clamp
by about 25%.
So I'm going to go on a...
will go on in and get started here.
Using robotic surgical technology,
that is also used at Henry Ford
to treat prostate, gynecological,
bladder, throat, lung, and abdominal cancers,
Dr. Rogers will travel visually through tiny incisions
using three-dimensional imagery
and tools designed to cut, grab, and suture.
With only a fraction of the blood loss
of traditional surgery,
he'll be able to spare Bill's kidney
and give him a recovery that last days,
instead of months.
All right, let's lock the liver retractor one more time,
we're going to go a little higher up.
All right, so we've got the kidney in front of us,
the bowels out of the way, perfect!
Okay, to find the tumor now.
All right, come in with your sucker
and just gently push the kidney tissue about 2 o'clock.
We've got the kidney mobilized
to the point where we can get to the tumor.
We're closing in on it.
We want to do everything we can
to keep this kidney at full capacity,
so we minimize the amount of kidney that we're taking out
by doing a kidney sparing surgery.
We minimize the amount of time that the kidney...
the blood vessels are clamped.
Now, the clamp time is not going to start
until I put the second bulldog on,
because we're still going to have inflow to this kidney,
so we've got clamp number one coming in,
hold on,
it's going to start here in just a second.
Clamp number two,
all right, we are on clamp.
All right!
So call out every five minutes please!
With the blood supply cut off,
Dr. Rogers has less than a half hour
before the kidney is irreversibly harmed.
He must be sure to remove the entire tumor
to ensure a surgical cure
and be careful not to leave leaks
that would keep the kidney from retaining fluid.
This is the bottom of the tumor,
so we've got the...
we got it.
And we're seeing just the...
beginning of the sinus fat collecting system,
so we're definitely deep enough.
All right, we'll lay the tumor aside,
needle driver.
Hardest suture first,
which is going to be our left-sided suture.
All right, now this may have to be an inner layer,
so we're going to come off clamp now.
Hey, we're off clamp.
Nine minutes two seconds.
Okay.
Nine minutes.
All right, let's bag the tumor.
This is the tumor here.
This is the normal surface of the kidney right there.
Tumor, and if we look on the inside,
this shows normal kidney tissue,
sort of that tan color,
so there's no kidney visible there or tumor visible,
because there's is a margin
of normal tissue all the way around.
So this looks good, looks like we got it all out
and just a thin rim of normal tissue,
but the majority, I'd say 95%
of the kidney is preserved and intact,
and we've got a good specimen here.
All right, so we can send this off.
With the tumor removed,
pathology will determine the type of tumor Bill has,
and if further cancer treatment will be needed.
Dr. Rogers goes to talk with the family.
So everything went like clockwork.
I was able to remove the tumor completely,
save the rest of the kidney
and do it all through the small incisions robotically.
Clamp time on the kidney was very short,
-it was only nine minutes. -Wow!
The kidney looked very healthy when it was done.
I'd say 95% of the kidney or so is still intact
and functioning well.
Oh, 45 minutes or so we'll probably get him fully awake,
moved to the recovery room,
the nurses will get him settled in there
and then you can go back and see him.
-Thank you! -Thank you so much!
-No problem! -Thank you!
Good seeing you again!
When we return, a family waits as doctors use unique technology
to remove an enormous tumor from a 22-year-old's brain.
To learn more about the Henry Ford Hospital Center
for Cancer Surgery,
go to henryford.com.
We'll be right back!
[Music]
These are the Minds of Medicine.
This is their story.
Hey Mr. Hill, good morning!
Hey! How are you doing?
Good! Good! How are you doing?
-I'm all right! -Good!
After coming into the Henry Ford Hospital ER
for stitches above his eye on a CAT scan,
doctors found a tumor
the size of a tennis ball in Frank Hill's brain.
Now, five days later, he will have surgery to remove it.
He has put his health into the hands
of Henry Ford Hospital Neurosurgeon, Dr. Ian Lee.
Any diagnosis of a tumor is pretty shocking,
but the diagnosis of a brain tumor,
it can be devastating.
A lot of the patients that we see
will eventually die of their tumor.
What we can do... what I can do is
not only provide them excellent medical care,
but also provide them hope.
It's really actually pretty amazing
that he had no symptoms at all.
You know, normally you might expect to see a patient
like that to have something,
either some kind of weakness, perhaps vision trouble,
or seizures, and he had none of those.
It's probably almost about the size of a tennis ball,
given a tumor that size, you have to know what it is.
You know, your options at that point are either
try to do a small surgery,
take a small piece of it and see what it is,
or try to take the whole thing out.
And given that he was so young
and that the tumor was so unusual appearing,
we felt strongly this is definitely a tumor
that we should try our best to try to take
as much of it out as possible;
in fact, try to get the whole thing out if we could.
Prior to surgery,
Frank underwent extensive test to help map his brain
and give doctors an exact location of the tumor.
What they found was this large tumor
pressing on an area of the brain controlling Frank's vision,
making this surgery even more critical.
To ensure the tumor's precise removal,
the team will use an intraoperative MRI.
This is the only high field adult iMRI in Michigan,
and one of only a handful in the United States.
In addition to brain tumor surgeries,
it's also used at Henry Ford Hospital
during deep brain stimulation.
With all of these tools,
Dr. Lee will be able to travel to the tumor,
remove it, and spare Frank's normal brain tissue,
with precision never before available.
The intraoperative MRI allows us to know in a real-time way
how much of the tumor we've taken out
and how much is left,
if anything else has gone on during the operation;
if there's a stroke,
if there's bleeding that we need to know about.
And to determine, based on how much tumor is left,
whether or not we can take anymore out safely.
The goal of any brain tumor surgery
is to take out as much as possible safely.
Dr. Lee was very confident
and this tool would bring about a greater success
for Frank and he wanted...
he could have done the surgery without the tool,
however utilizing this tool would give us the best results.
He said the machine gives him a better chance
of taking it all out.
Getting all of it, instead of just parts of it,
and he doesn't want to leave any of it.
That's what he was saying with being aggressive,
so that made me feel even better that the machine,
along with his skills, would be able to remove it.
You know, I'm a mom,
he's my oldest son,
and I wouldn't say that I'm afraid,
but I'm just very hopeful, very hopeful.
Once positioned, Dr. Lee can begin the delicate work
of removing Frank's tumor.
Be advised, what you are about to see is extremely graphic.
Look at this,
feel it, feel the bone.
Even as he pulls away a small piece of Frank's skull,
Dr. Lee can see that this tumor has been here for a while.
What I wanted to point out was on this side,
the bone has been remodeled by the tumor,
so it's been there for a very long time,
but you can feel that the bone has been thinned out over here,
compared to here where it's very thick,
it's very thin over here.
Each step to remove the tumor must be done with care.
Because the tumor was pressed against an area of Frank's brain
that affects vision,
the very removal of the tumor
could mean Frank's eyesight will be affected;
remove too much tissue and Frank could become blind.
Now with the tumor removed,
Frank will have an MRI to determine how much,
if any, of the tumor is left behind.
While Frank sleeps,
using specialized stretchers and personnel,
he is moved through steel doors to the room next door.
No metal can be left inside Frank or near the MRI
and every member of the team
has been specially trained
to make sure the scan is safe for him
and for the other surgical personnel.
As Frank undergoes his scan,
Dr. Lee speaks with a pathologist about what he found.
I can tell you it's not a high grade glioma,
it's not a choroid plexus tumor.
It doesn't look like a PXA.
We're doing intraoperative MRI right now,
so this is definitely one where
we're going to want to try to get the whole thing out,
if possibly, if it's one of these grade 1 tumors
-and potentially -Right,
that's what this thing looks like.
It does look like it's probably what we call a glioma,
so it's a tumor that's come from
the supporting cells of the brain
called the glial cells.
There is a wide range of these glial tumors from grade 1,
which are potentially surgically curable, to the worst kind,
which are the grade 4s, the glioblastomas.
This looks like it's probably one of those grade 1 tumors,
based on what they can see so far on the frozen section.
Now with the intraoperative MRI,
if we can get the whole thing out,
potentially this is something that can be cured.
Dr. Lee returns to surgery to review the scans
and to determine if more tumor must be removed.
So that little tissue right there is enhancing.
There might be a little tissue there.
It's in the cavity itself,
you know, surgical, the section side,
more to the upper side.
You know, that should be safe,
we can clean that up a little bit,
get that last little bit out.
To ensure the best chance of a surgical cure,
Dr. Lee returns to surgery.
Because the scan showed potential tumor tissue
that is invisible to the naked eye,
he will remove a very small section of tissue
based on the findings of the iMRI.
When we come back, Dr. Lee discusses
what's next for Frank and if his sight will be lost.
We'll also visit with our kidney tumor patient
for his diagnosis.
To learn more about the Henry Ford Hospital
Center for Cancer Surgery,
go to henryford.com.
We'll be right back.
[Music]
These are the Minds of Medicine.
This is their story.
Okay, next patient is Frank Hill.
He's a 22-year-old gentleman.
Intraoperatively is a very, very unusual looking tumor.
It did look like it was
in direct contact with the ventricle,
we did get into the ventricle,
but surprisingly he actually woke up
with no visual deficits.
So where we got in was actually in the occipital horn
of the lateral ventricle,
so that's why he was able to avoid any visual deficits.
So very unusual looking cystic, very tough on the outside
and pathology is...
So all three of the neuropathologists
examined the slides
and came up with a diagnosis of consensus,
and it's a low-grade glioma,
with a gangling cell component,
which would make it a ganglioglioma.
Probably the best outcome we could think of and hope for,
so I would recommend that we just reimage him.
And in three months
to see that everything has settled well, another MRI,
and then follow him clinically.
Frank Hill's brain tumor was determined
to be a grade 1 glioma,
although dangerous,
his tumor was determined to be cured surgically
and he will be watched closely by his team.
No other immediate cancer treatment will be necessary,
and Frank can return to a normal life.
He returns to visit the surgeon that saved his life.
Hi! How are you doing?
Hello.
-How you been? -I'm doing good.
Good to see you!
It's good to see you!
Generally speaking,
most gangliogliomas are benign tumors,
okay, meaning that if it's completely resected,
potentially you can be cured of this tumor.
Okay, there are gangliogliomas that are more aggressive,
all right, they're called anaplastic,
but this is not one of those.
-Okay. -Okay?
Now, this doesn't mean that you're...
doesn't absolutely mean that you're cured,
but at least right now,
you know, things are looking good.
-Got you! -Okay? So you know...
They say I'm cured,
but just in case anything starts to go back or anything,
they keep track of it,
and they got me under their radar.
I've got set goals.
I want to go on the same track pursuing,
trying to get down with school as fast as I can,
but I'm very grateful for Dr. Lee
and everybody at Henry Ford.
All right, do you have any questions, ma'am?
You have been amazing.
We have told this story so many times to so many people
that if it had not been for Dr. Lee
and the intraoperative MRI and the surgery,
we wouldn't know basically
where we would be today.
So Frank is very grateful and I'm very grateful.
Like Frank, Bill returns to meet with Dr. Rogers
hoping to hear similar good news.
-Good to see you! -Good morning!
Welcome!
Well, how are things going, it's been a couple of weeks?
-Good! -Yeah?
You feel like your recovery is coming okay?
No pain where the incisions are?
Any dizziness, lightheadedness, anything like that?
-No. -Okay.
Well, I have some good news for you.
I've got your pathology report.
So I think you'll be happy with this.
So you were in one of the lucky ten percentile
in which your tumor ended up not being cancerous.
That's great!
And now you won't even need to follow this.
So there won't be... unlike your brother,
who still gets to see me a few more times,
where we'll get CAT scans,
in your case you don't even need follow-up with the imaging.
Well, Mr. Maclnnis, I want to thank you
for putting your care in our hands
and your confidence you put in us.
Thank you very much!
It's been a pleasure working with you!
-Thanks Doc! -Thank you!
-Best of luck to you! -Thank you!
You know, in my case, I don't know why,
but I always knew I wanted to be a surgeon.
I didn't know exactly what kind of surgeon I wanted to be.
And then there were some events in my family
that really hit home to me,
or that became very personal into doing what I do now.
My mother was diagnosed with
a very aggressive form of kidney cancer
and I had both of my grandparents
diagnosed with prostate cancer.
As I look back on just how everything happens in life,
I didn't go into this planning to end up where I am today,
but it really is satisfying to go to work everyday
and to use cutting-edge technologies
to treat those very cancers that,
you know, affected people in my family.
I had all kinds of confidence in Rogers and I still do, you know.
He's a great... he's a real, real good man and good doctor.
All my activities, I am back at now.
It's been three, four months, I feel great.
I've resumed everything.
In fact, almost two weeks
after I was operated I resumed everything.
You get a lot of chance to think
and, you know, about changing habits;
my diet's changed a lot and I feel a lot better.
There used to be steak and potatoes,
you know, and it's not anymore,
you know, it's very seldom in fact to have a steak now;
a lot more fish, a lot more vegetables.
You know, we're getting real big on salads.
We're living longer.
I think we're living better.
I think we all got to probably adjust our ways
of going at things.
I notice myself,
I couldn't do the same things now I could do ten years ago,
but that doesn't mean I can't be smarter about it.
Where I go from here,
there's nothing to stop me that's for sure.
What's gratifying for me, there are a lot of things
that we can do now to help prolong survival
and prolong meaningful survival,
and what's gratifying for me is to
be able to help them live as long a life as possible,
in a way they want to live it.
Cancer surgeons are in the front lines of cancer therapy
and we often find ourselves in a position
where we're the ones who are telling the patient
and their family that in fact, yes,
cancer is there.
Because of everything that we have to offer,
we are going at this disease full throttle.
Not only is there a hope, but there is a plan,
there's an action plan
to actually make the path easier,
and to take the steps
that are necessary to combat the cancer
and to improve quality of life.
Unlike any other illness,
beating cancer takes a team effort,
and with the Center for Cancer Surgery,
Henry Ford Hospital
has assembled a group of specialists like nowhere else.
If you've recently been diagnosed with cancer
and want to see one of the country's best cancer teams,
go to henryford.com.
If you'd like to watch episodes of Minds of Medicine
at any time, go to
henryford.com/mindsofmedicine.
These are the Minds of Medicine.
This is their story.
[Music]