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All right, welcome to the

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next installment of

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Live Well with UCI Health.

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I am Ryan Manno from KOST 103.5

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iHeart Radio.

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Pleased to be joined today

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by Doctor Hari Keshava

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fellowship-trained board

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certified thoracic surgeon

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who specializes

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in the treatment of lung cancer.

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Thank you very much for having me.

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Thank you.

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I'm not done.

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No no no no no.

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You didn't do all this work

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for nothing.

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He’s an assistant professor

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in the Division of Thoracic surgery

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at the UCI Irvine School of Medicine

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and a member of the American College

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of Surgeons

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and the Society of Thoracic Surgery.

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Thank you very much. Thank you. God.

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That was a great introduction.

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Thank you, sir.

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It's a pleasure to have you here.

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And really quick one,

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before we get into lung cancer

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and all this stuff.

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We've been doing this for a while now.

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No doctor has ever

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come and sat with us and said,

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I just got out of the operating room,

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but you did.

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That is true.

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I just got out of the operating room.

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Unbelievable! This morning and changed,

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did my hair.

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Yeah, and came here,

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but I coat and came here for for this.

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I'm excited to be here.

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And it's.

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We're excited to be doing this. Yeah.

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So let's talk about lung cancer.

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It is the leading cause of cancer

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related deaths in both men and women

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in the US. Why?

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So yeah, you're exactly right.

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It is a leading cause of cancer

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related death.

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And the main reason is unfortunately,

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with lung cancer,

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we don't really do a good job

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of finding it early.

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When I say that, I mean, as a society,

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there's no real good

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symptoms for lung cancer.

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So if patients have symptoms,

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whether that's a cough

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or they're coughing blood, let's say,

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these are usually later stage.

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They're found later in cancer

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and cancer screening

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and lung cancer screening.

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Unfortunately with the screening

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We don't, we're not screening

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as many patients

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as we'd like to early enough

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so we can find it early

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and potentially deal with it early.

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So that's

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unfortunately the real reason

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why lung cancer is the leading

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cause of cancer-related death.

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And of course,

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we've had a lot of people

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in our country who have smoke

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and who still currently smoke,

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and that's the leading reason

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for developing lung cancer.

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But there is hope, right.

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There is hope here.

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I know a lot of the advancements

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you've made, but let's, let's do

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talk about the screening,

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who should be screened and when.

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So for lung cancer screening

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we do it with a low-dose CT

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scan, which is a scan of the chest

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where we look for lung

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abnormalities, lung

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nodules, lung masses for patients

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that are 50 to 80 years old

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who have smoked in the past,

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we call it a 20-pack year

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smoking history.

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And when I say smoke in the past,

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meaning within the last 15 years

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or are current smokers,

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for those people, we offer a lung

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cancer screening

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and that right now

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those are the patients that we screen.

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Okay. Got it.

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And what is a pack year?

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A pack year

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is, essentially, it's a pack of cigarettes.

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Okay. Per day. For a year. Okay.

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So if a person smokes,

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I say I smoke a pack a day.

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And I've been doing it for 30 years.

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We say that's a 30-pack year

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smoking history.

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And let's say someone says, oh,

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I smoke a half a pack a day.

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And I've done that for 20 years.

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They say there's a 10-pack-year,

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you're smoking history

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because now it's half a pack times

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the number of years. Got it?

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But as you may imagine,

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or as you can think about it,

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there's so much of a recall

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bias there

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because some people will be like,

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oh yeah, I smoked a pack a day

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and then I stopped smoking

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for a couple of months

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and started smoking a half a pack.

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So it can be really difficult

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for patients

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to tell us,

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like how much they're actually smoking.

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And to really quantify

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that, especially cigarets.

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And then, of course, people

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might not really remember

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how when they first started

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smoking or hey,

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I started in college

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and I stopped a little bit

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and I started back again

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when I had some

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stressful times at work.

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And so there's

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all these start and stop,

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so they might not remember

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when they actually started smoking.

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So these are some issues

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that come about with this.

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And I would think too,

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I mean,

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some people may even try to downplay it

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because they don't want to admit

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that this is how much they've smoked,

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or so you bring up.

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Actually, a very interesting point.

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And this is actually a big issue

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also with lung cancer screening

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is that we have a stigma behind it.

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Right?

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We have a stigma

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because of like exactly what you said,

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where people will feel

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a little bit of shame.

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They're like, oh,

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I kind of did this to myself

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or when I smoked and I feel bad.

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They might downplay it.

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So, we see this actually in

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a lot of populations.

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We have a lot of different people

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we treat here.

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People from other countries,

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Vietnamese, Chinese.

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But we

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also see this

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in the veteran population.

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And that's a population, of course,

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where you remember,

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we used to actually

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give people cigarettes to smoke, right?

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when they went to Vietnam War.

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And we used to give them cigarettes

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because we didn't

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kind of know any better as a society.

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So I think that shame part of it is,

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is now we should not think that way.

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It's not a shameful thing.

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We actually want to be able

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to help patients and screen

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them, find cancer early.

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We know it's a cancer-causing agent,

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especially with cigarette smoking.

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So, patients shouldn't

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feel shame from this.

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They're not.

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You're not there to, like, judge them.

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You're there to to find it and fix it.

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Exactly. You're exactly right.

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We're not here to judge.

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I'm not here for any of that.

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We're. Yeah.

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Find it early.

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Because if we find it early,

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we can deal with it. Right?

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I'm a surgeon.

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And if we can find it at stage one,

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I can remove it

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and potentially be cancer free. Yeah.

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So that's the goal here. Yeah.

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And it is wild.

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You bring up

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you know how

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we used to give people cigarettes

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I mean I can picture old

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magazine ads

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like the

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eight out of ten doctors recommend,

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you know, camel or whatever.

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It's like what how far we've come.

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We've come a long way.

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And I remember in

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if you could even talk

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to some of the older physicians,

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people used to smoke in the hospital.

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Oh my gosh.

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I trained out in Cleveland

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and they had areas

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with ashtrays

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like outside of patient room,

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so we just didn't know much about it.

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Right.

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You thought,

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oh, it could help with

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various different issues.

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So we've learned a lot about it.

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We learned how it is a carcinogenic.

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Sure, substance,

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especially cigarette smoking.

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So now we know we should be screening

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those patients get screened.

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How often should people get screened?

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So patients should get screened

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every year.

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Every year

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between that 50 to 80 years old.

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You smoked for 20 years.

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20-pack years.

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You should be getting screened

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every year.

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Okay.

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In terms of the screening itself,

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what is that process.

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You come in you're getting screened.

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How long does it take? What happens?

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What's the process?

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It's a good question.

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So with screening as we talked about

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is for patients

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that are 50 to 80

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that have smoked

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for 20 years, 20-pack years

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and our current smoker are quit

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within the last 15 years.

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So that's the criteria.

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So when you get screened

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for lung cancer, we do a CT scan, a CT

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scan of the chest.

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So what does that entail.

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It's in the hospital

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or it's in an imaging center.

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Where you go and you, you sit in a

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what's called a

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a CT scanner

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which is not a claustrophobic like MRI.

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It's, it's actually pretty open.

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And they do a quick scan using really,

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really low-dose

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radiation to see the chest, the lungs.

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And they even look at the chest

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wall, everything

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from essentially

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the bottom of the neck

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to the top of the abdomen

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to make sure we get the whole lungs.

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And that CT

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scanner is a really quick

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scan about 30s.

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Oh, my.

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And maybe if they have to redo

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one of them, it'll be a minute.

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It's kind of in and out,

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and at that point they can look at lung

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nodules, lung masses, the lungs,

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even the heart.

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We can look at other structures,

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potentially other issues,

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chest wall issues

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specifically for lung cancer.

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We look for those lung

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nodules, lung masses,

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and we can see both lungs.

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So it's noninvasive.

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It's not scary.

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It's there's no you don't even feel it.

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It's in and out.

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You're exactly right.

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It's not invasive.

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It's not even like a blood test. Yeah.

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It's in and out.

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It's a low-dose

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CT scan, meaning low dose of radiation.

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So when we talk about radiation

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exposure, it's

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the equivalent of a plane

00:08:04:22 - 00:08:07:13
flight from LA to New York.

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It's about that much radiation

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exposure is pretty minimal,

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but we get a really good understanding

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of what's going on in your

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in your chest and in the lungs,

00:08:16:02 - 00:08:19:03
moving away from cigarettes and smoking.

00:08:19:16 - 00:08:22:00
What about some other factors? Right.

00:08:22:00 - 00:08:22:16
Like, well,

00:08:22:16 - 00:08:24:06
even secondhand smoke or,

00:08:24:06 - 00:08:25:21
or or environmental, you know,

00:08:25:21 - 00:08:27:04
whether it's pollution or exposure

00:08:27:04 - 00:08:28:09
to radon or things like that.

00:08:28:09 - 00:08:29:07
You're exactly right.

00:08:29:07 - 00:08:31:12
So you bring up other things that,

00:08:31:12 - 00:08:32:18
can cause lung cancer.

00:08:32:18 - 00:08:34:12
So secondhand smoke, we do know about,

00:08:34:12 - 00:08:36:15
especially if you've had a large amount

00:08:36:15 - 00:08:39:08
of secondhand smoke exposure.

00:08:39:08 - 00:08:40:18
Radon is the second most

00:08:40:18 - 00:08:43:06
leading cause of lung cancer.

00:08:43:06 - 00:08:45:02
And we see this a lot in patients

00:08:45:02 - 00:08:46:09
that grew up in the Midwest

00:08:46:09 - 00:08:47:22
because they have a lot of radon

00:08:47:22 - 00:08:49:01
that's coming from the soil there

00:08:49:01 - 00:08:50:20
where houses were built.

00:08:50:20 - 00:08:52:19
So that's something we do see.

00:08:52:19 - 00:08:53:23
We're actually learning a lot

00:08:53:23 - 00:08:55:14
more about familial,

00:08:56:21 - 00:08:57:21
inheritance of lung

00:08:57:21 - 00:09:00:21
cancer and familial lung cancer.

00:09:01:20 - 00:09:03:21
If you look at some other countries

00:09:03:21 - 00:09:04:14
out, like,

00:09:04:14 - 00:09:05:16
especially, in Taiwan,

00:09:05:16 - 00:09:06:21
they've done a study out there

00:09:06:21 - 00:09:08:08
where they actually found

00:09:08:08 - 00:09:10:01
that outside of smoking,

00:09:10:01 - 00:09:12:21
that family history of lung cancer was,

00:09:12:21 - 00:09:15:00
leading reasons someone may develop

00:09:15:00 - 00:09:16:01
lung cancer.

00:09:16:01 - 00:09:17:17
Really? Correct. Yeah.

00:09:17:17 - 00:09:18:17
So let's talk

00:09:18:17 - 00:09:19:08
about that for a second.

00:09:19:08 - 00:09:20:01
My

00:09:20:01 - 00:09:21:12
you know, the host of the show

00:09:21:12 - 00:09:22:10
that I host, Ellen K,

00:09:22:10 - 00:09:23:11
she lost her mom

00:09:23:11 - 00:09:25:13
to nonsmoking lung cancer.

00:09:25:13 - 00:09:26:10
So are you

00:09:26:10 - 00:09:28:03
are you saying that that's

00:09:28:03 - 00:09:29:11
potentially a genetic thing.

00:09:29:11 - 00:09:31:22
It potentially is in the Taiwanese

00:09:31:22 - 00:09:33:23
community, they actually found a gene

00:09:33:23 - 00:09:36:06
this EGFR mutation. Okay.

00:09:36:06 - 00:09:37:08
And we see this amongst

00:09:37:08 - 00:09:38:22
a lot of Asian populations,

00:09:38:22 - 00:09:40:06
or not even just Asians,

00:09:40:06 - 00:09:42:08
but amongst other populations

00:09:42:08 - 00:09:43:14
where they found that

00:09:43:14 - 00:09:45:09
there is a familial component to that.

00:09:45:09 - 00:09:46:12
Oh, and we're actually

00:09:46:12 - 00:09:48:12
studying that now at UC Irvine.

00:09:48:12 - 00:09:50:12
I actually have a study

00:09:50:12 - 00:09:51:18
where we are doing

00:09:51:18 - 00:09:52:14
a clinical trial

00:09:52:14 - 00:09:54:21
of screening with the CT scan

00:09:54:21 - 00:09:57:06
of nonsmokers,

00:09:57:06 - 00:09:58:10
but if they had a family

00:09:58:10 - 00:09:59:10
history of lung cancer,

00:09:59:10 - 00:10:01:01
we'll be screening them now

00:10:01:01 - 00:10:02:05
to see if there is

00:10:02:05 - 00:10:03:16
this familial component,

00:10:03:16 - 00:10:04:18
even here on the West,

00:10:04:18 - 00:10:07:04
in the United States. Fascinating.

00:10:07:04 - 00:10:08:21
Since you guys have

00:10:08:21 - 00:10:10:12
and I say, you guys, as a collective,

00:10:10:12 - 00:10:12:07
you know, doing what it is that you do,

00:10:12:07 - 00:10:13:22
since these screening tools

00:10:13:22 - 00:10:15:07
have gotten better and progressed

00:10:15:07 - 00:10:17:09
and people are doing it earlier

00:10:17:09 - 00:10:17:19
and doing it

00:10:17:19 - 00:10:18:05
more often,

00:10:18:05 - 00:10:19:18
have you noticed an increase or

00:10:19:18 - 00:10:21:14
seen a decrease in deaths?

00:10:22:13 - 00:10:24:13
We have actually,

00:10:24:13 - 00:10:24:22
and this

00:10:24:22 - 00:10:26:07
is not just from screening

00:10:26:07 - 00:10:26:22
actually alone,

00:10:26:22 - 00:10:28:18
but with lung cancer in general.

00:10:28:18 - 00:10:29:19
We've actually seen

00:10:29:19 - 00:10:31:07
a market improvement,

00:10:31:07 - 00:10:34:07
improvement of survival even over time.

00:10:34:14 - 00:10:35:20
So we're finding it early.

00:10:35:20 - 00:10:36:20
We're doing a better job

00:10:36:20 - 00:10:38:08
of screening people.

00:10:38:08 - 00:10:40:04
We actually have better treatments

00:10:40:04 - 00:10:41:03
now also as well.

00:10:41:03 - 00:10:42:13
So as a surgeon,

00:10:42:13 - 00:10:44:03
I do a lot of minimally invasive

00:10:44:03 - 00:10:45:05
robotic surgery

00:10:45:05 - 00:10:46:03
so we can get people

00:10:46:03 - 00:10:47:23
out of the hospital very quickly,

00:10:47:23 - 00:10:49:09
do some advanced surgeries,

00:10:49:09 - 00:10:51:12
even minimally invasive.

00:10:51:12 - 00:10:53:03
And on the other side of it,

00:10:53:03 - 00:10:54:04
we've gotten

00:10:54:04 - 00:10:56:07
very good on radiation techniques

00:10:56:07 - 00:10:57:13
when patients might need

00:10:57:13 - 00:11:00:13
radiotherapy or radiation therapy

00:11:00:15 - 00:11:02:03
and of course, chemotherapy

00:11:02:03 - 00:11:02:23
and immunotherapy.

00:11:02:23 - 00:11:04:15
You've probably heard about

00:11:04:15 - 00:11:06:13
chemotherapy agents, newer ones.

00:11:06:13 - 00:11:08:17
There's newer immunotherapies.

00:11:08:17 - 00:11:09:19
And these targeted agents

00:11:09:19 - 00:11:11:03
where we can target

00:11:11:03 - 00:11:12:08
the genetic mutation

00:11:12:08 - 00:11:13:11
that a patient may have

00:11:13:11 - 00:11:14:15
for their cancer.

00:11:14:15 - 00:11:16:02
So we've gotten so much better on

00:11:16:02 - 00:11:17:08
from the treatment standpoint

00:11:17:08 - 00:11:19:00
as well as the detection.

00:11:19:00 - 00:11:20:08
So now people are living longer

00:11:20:08 - 00:11:21:07
with lung cancer.

00:11:21:07 - 00:11:22:13
What was,

00:11:22:13 - 00:11:23:14
you know, before

00:11:23:14 - 00:11:24:14
some of the stuff was there.

00:11:24:14 - 00:11:26:17
What was the most common way to

00:11:26:17 - 00:11:28:10
treat lung cancer prior

00:11:28:10 - 00:11:29:15
to all of these wonderful things

00:11:29:15 - 00:11:30:11
you just described?

00:11:30:11 - 00:11:32:14
So it would just be kind

00:11:32:14 - 00:11:33:22
of the generic chemotherapy,

00:11:33:22 - 00:11:35:01
so it wouldn't be anything

00:11:35:01 - 00:11:37:09
that was very specific to a patient.

00:11:37:09 - 00:11:39:01
Now we talk about patient-centered

00:11:39:01 - 00:11:41:05
medicine, patient-centered care.

00:11:41:05 - 00:11:42:20
Before it was just you kind of

00:11:42:20 - 00:11:44:02
you take whatever you can get

00:11:44:02 - 00:11:45:11
and you just give it to the patient.

00:11:45:11 - 00:11:46:14
Hopefully, it works.

00:11:46:14 - 00:11:47:13
But now if we can find it

00:11:47:13 - 00:11:50:04
early, get it out with radiation or,

00:11:51:14 - 00:11:52:21
surgery.

00:11:52:21 - 00:11:53:18
If we can test it,

00:11:53:18 - 00:11:55:10
we do genetic testing of the tumor,

00:11:55:10 - 00:11:56:17
then we can actually

00:11:56:17 - 00:11:58:07
find a targeted treatment

00:11:58:07 - 00:11:59:12
for the tumor.

00:11:59:12 - 00:12:00:22
And we have more specific agents.

00:12:00:22 - 00:12:02:03
So I think we're getting to this

00:12:02:03 - 00:12:04:04
more patient-centered care. Yeah.

00:12:04:04 - 00:12:06:06
Which is great for patients.

00:12:06:06 - 00:12:06:14
Yeah.

00:12:06:14 - 00:12:08:02
And it's got to be exciting for you

00:12:08:02 - 00:12:10:04
as somebody who's given your life

00:12:10:04 - 00:12:11:08
to to treating this

00:12:11:08 - 00:12:12:12
like to find these things

00:12:12:12 - 00:12:13:22
on the horizon that are still coming.

00:12:13:22 - 00:12:15:06
Oh, it's amazing to see

00:12:15:06 - 00:12:16:07
even since when

00:12:16:07 - 00:12:17:20
I finished my training

00:12:17:20 - 00:12:19:13
and started here at UCI,

00:12:19:13 - 00:12:21:10
during this time, I've,

00:12:21:10 - 00:12:22:15
I've seen care change

00:12:22:15 - 00:12:24:12
tremendously where I'm seeing patients

00:12:24:12 - 00:12:26:14
with stage four lung cancer

00:12:26:14 - 00:12:27:16
that are living long enough

00:12:27:16 - 00:12:29:09
to now come and see a surgeon

00:12:29:09 - 00:12:31:02
or where I'm taking them out. Sorry.

00:12:31:02 - 00:12:31:22
When I say them,

00:12:31:22 - 00:12:33:05
I mean taking the cancer out.

00:12:33:05 - 00:12:34:14
I'm taking the cancer out

00:12:34:14 - 00:12:36:05
and seeing them live a long time

00:12:36:05 - 00:12:37:13
because I took it out.

00:12:37:13 - 00:12:39:10
They got on a targeted therapy.

00:12:39:10 - 00:12:42:07
And so it's fascinating to see lung

00:12:42:07 - 00:12:43:22
cancer care change. This much.

00:12:43:22 - 00:12:45:03
Yeah, that's so cool.

00:12:45:03 - 00:12:46:12
And that's kind of feel so good

00:12:46:12 - 00:12:48:17
I mean I I'm so in all of of surgeons

00:12:48:17 - 00:12:49:08
and what you guys do

00:12:49:08 - 00:12:50:02
because the,

00:12:50:02 - 00:12:51:00
the satisfaction

00:12:51:00 - 00:12:52:18
that you must have when,

00:12:52:18 - 00:12:53:20
when you look at someone

00:12:53:20 - 00:12:55:18
and you saved their life

00:12:55:18 - 00:12:56:20
that that is exciting.

00:12:56:20 - 00:12:57:14
That's one of the skills

00:12:57:14 - 00:12:58:03
I literally yeah.

00:12:58:03 - 00:12:59:02
No, it's, it's

00:12:59:02 - 00:13:00:11
we do a lot of teaching

00:13:00:11 - 00:13:01:07
and training here. Right.

00:13:01:07 - 00:13:02:22
We we teach medical students,

00:13:02:22 - 00:13:04:10
we train residents and fellows.

00:13:04:10 - 00:13:06:01
That's actually one of the, the,

00:13:06:01 - 00:13:07:06
the joys of what we do

00:13:07:06 - 00:13:08:17
is actually showing

00:13:08:17 - 00:13:09:13
the medical students,

00:13:09:13 - 00:13:10:10
showing the residents

00:13:10:10 - 00:13:12:05
and the trainees that, hey,

00:13:12:05 - 00:13:13:21
after we remove the cancer,

00:13:13:21 - 00:13:15:11
I see them back in clinic, man,

00:13:15:11 - 00:13:17:23
next week, two years later,

00:13:17:23 - 00:13:19:07
they're doing great with hugs

00:13:19:07 - 00:13:20:04
and these types of things,

00:13:20:04 - 00:13:22:00
and I think it resonates.

00:13:22:00 - 00:13:22:23
Of course, our patients

00:13:22:23 - 00:13:24:17
with our trainees, with me, of course.

00:13:24:17 - 00:13:25:13
And like you said,

00:13:25:13 - 00:13:26:12
it gives me goosebumps

00:13:26:12 - 00:13:28:07
every time I see a patient

00:13:28:07 - 00:13:29:01
like, let's say two,

00:13:29:01 - 00:13:30:07
three years out,

00:13:30:07 - 00:13:31:05
cancer free

00:13:31:05 - 00:13:32:18
and just doing the run of the mill

00:13:32:18 - 00:13:33:23
checkup type thing. Yeah.

00:13:33:23 - 00:13:35:21
What a oh gosh, that's awesome.

00:13:35:21 - 00:13:37:04
So let's talk about,

00:13:37:04 - 00:13:40:00
let's talk about you get screened you

00:13:40:00 - 00:13:42:06
there's a nodule detected or, you know,

00:13:42:06 - 00:13:42:22
you see something.

00:13:42:22 - 00:13:43:09
What are the

00:13:43:09 - 00:13:44:22
what are the next steps there?

00:13:44:22 - 00:13:46:04
So before we get to that, I'm

00:13:46:04 - 00:13:47:00
actually gonna talk about.

00:13:47:00 - 00:13:48:19
So getting screened

00:13:48:19 - 00:13:52:05
any physician or primary care provider

00:13:52:05 - 00:13:53:02
can screen okay.

00:13:53:02 - 00:13:55:03
So if you're a patient, you know,

00:13:55:03 - 00:13:57:03
hey, you've smoked in the past

00:13:57:03 - 00:13:58:03
yourself or you know,

00:13:58:03 - 00:13:59:03
your family member has

00:13:59:03 - 00:14:01:01
you want to get them screened.

00:14:01:01 - 00:14:03:22
They're 50 to 80, smoked over 20 years,

00:14:05:07 - 00:14:07:09
pack per day, get screened.

00:14:07:09 - 00:14:08:13
So any your primary care

00:14:08:13 - 00:14:09:07
doctor could do it.

00:14:09:07 - 00:14:11:20
Or we have, like a lung nodule program.

00:14:11:20 - 00:14:13:11
If you don't know where to go,

00:14:13:11 - 00:14:14:15
we have a phone number

00:14:14:15 - 00:14:15:17
or a lot of places do,

00:14:15:17 - 00:14:17:11
but we have one where you can call

00:14:17:11 - 00:14:18:19
and you get to

00:14:18:19 - 00:14:20:01
get to one of our providers,

00:14:20:01 - 00:14:21:20
and they'll get screened.

00:14:21:20 - 00:14:23:08
Now, after you've gotten screened,

00:14:23:08 - 00:14:25:14
if you have a CT scan

00:14:25:14 - 00:14:26:09
with an abnormality,

00:14:26:09 - 00:14:27:04
like you said, a

00:14:27:04 - 00:14:30:04
lung nodule, a lung mass,

00:14:30:04 - 00:14:31:18
or any other abnormality,

00:14:31:18 - 00:14:32:13
then you can kind of

00:14:32:13 - 00:14:34:15
now see your primary care

00:14:34:15 - 00:14:36:10
or you go see, like a pulmonologist

00:14:36:10 - 00:14:37:19
or even a thoracic surgeon.

00:14:37:19 - 00:14:38:17
I get a lot of people

00:14:38:17 - 00:14:39:11
that come and see me

00:14:39:11 - 00:14:41:04
that have a lung nodule.

00:14:41:04 - 00:14:42:07
At that point,

00:14:42:07 - 00:14:43:07
we kind of look at it,

00:14:43:07 - 00:14:45:21
see if it's something that looks

00:14:45:21 - 00:14:47:18
a little bit more suspicious.

00:14:47:18 - 00:14:49:09
We might go for a biopsy.

00:14:50:14 - 00:14:52:00
After having a

00:14:52:00 - 00:14:53:13
a visit, a biopsy,

00:14:53:13 - 00:14:55:23
we can either do that bronchoscopy

00:14:55:23 - 00:14:57:07
where we go through the airway

00:14:57:07 - 00:14:58:10
or we do a needle

00:14:58:10 - 00:15:00:00
kind of from outside in,

00:15:00:00 - 00:15:01:04
try to get some tissue

00:15:01:04 - 00:15:03:18
to get a diagnosis.

00:15:03:18 - 00:15:06:03
And if we get a diagnosis of cancer

00:15:06:03 - 00:15:07:07
then we go forward.

00:15:07:07 - 00:15:07:19
We'll try it.

00:15:07:19 - 00:15:09:01
We'll get some more scans,

00:15:09:01 - 00:15:10:20
potentially a PET scan, potentially.

00:15:10:20 - 00:15:13:20
You'll see me for surgical resection,

00:15:13:20 - 00:15:14:11
or potentially

00:15:14:11 - 00:15:16:08
even my oncology colleagues

00:15:16:08 - 00:15:16:17
if you need

00:15:16:17 - 00:15:17:03
some sort

00:15:17:03 - 00:15:19:22
of chemotherapy immunotherapy.

00:15:19:22 - 00:15:21:08
And we'll kind of go from there.

00:15:21:08 - 00:15:22:13
Yeah.

00:15:22:13 - 00:15:24:01
Patients can have lung nodules

00:15:24:01 - 00:15:25:08
for a multitude of reasons.

00:15:25:08 - 00:15:27:00
Doesn't have to be for cancer alone.

00:15:27:00 - 00:15:28:22
You can have it for fungal infections.

00:15:28:22 - 00:15:29:09
You can have it

00:15:29:09 - 00:15:31:14
for what we call granulomas,

00:15:31:14 - 00:15:33:19
which are benign entities.

00:15:33:19 - 00:15:35:07
So we got to make sure

00:15:35:07 - 00:15:36:06
we're dealing with cancer.

00:15:36:06 - 00:15:37:13
Of course. First and foremost,

00:15:38:16 - 00:15:39:13
I, you know,

00:15:39:13 - 00:15:39:23
just thinking

00:15:39:23 - 00:15:40:09
back again,

00:15:40:09 - 00:15:41:16
I shared that story about Ellen K's

00:15:41:16 - 00:15:42:15
mom and

00:15:42:15 - 00:15:43:22
for, for years,

00:15:43:22 - 00:15:45:00
she was part of various

00:15:45:00 - 00:15:45:22
clinical trials,

00:15:45:22 - 00:15:47:00
you know, experimental things.

00:15:47:00 - 00:15:48:00
Can we talk about the importance

00:15:48:00 - 00:15:50:23
of clinical trials? Yes. Of course.

00:15:50:23 - 00:15:53:06
Clinical trials are crucial

00:15:53:06 - 00:15:55:04
for the treatment,

00:15:55:04 - 00:15:56:05
of, for patients

00:15:56:05 - 00:15:56:19
and also

00:15:56:19 - 00:15:58:01
for the advancement of the field

00:15:58:01 - 00:15:58:15
so that you kind of

00:15:58:15 - 00:16:00:17
get a two for one there.

00:16:00:17 - 00:16:01:12
What does that mean?

00:16:01:12 - 00:16:04:07
So we're a comprehensive cancer center.

00:16:04:07 - 00:16:06:18
So we have different providers

00:16:06:18 - 00:16:08:08
like for let's say for lung cancer,

00:16:08:08 - 00:16:10:01
you have a surgeon,

00:16:10:01 - 00:16:13:01
a radiation oncologist, an oncologist,

00:16:13:04 - 00:16:15:04
but you also get palliative care,

00:16:15:04 - 00:16:16:01
physical therapy,

00:16:16:01 - 00:16:16:23
all these types of things.

00:16:16:23 - 00:16:18:17
So we can provide all of that.

00:16:18:17 - 00:16:20:10
On top of that we also provide

00:16:20:10 - 00:16:21:09
we have clinical trials

00:16:21:09 - 00:16:22:11
that would kind of really set

00:16:22:11 - 00:16:24:16
some of these cancer centers apart.

00:16:24:16 - 00:16:25:05
Yeah.

00:16:25:05 - 00:16:26:10
As these clinical trials

00:16:26:10 - 00:16:28:22
can be really focused on the patient,

00:16:28:22 - 00:16:30:13
specifically to their own cancer.

00:16:30:13 - 00:16:31:05
If they have a certain

00:16:31:05 - 00:16:32:04
genetic mutation,

00:16:32:04 - 00:16:33:23
we can have trials for that.

00:16:33:23 - 00:16:35:12
And these trials

00:16:35:12 - 00:16:36:13
give patients

00:16:36:13 - 00:16:38:08
and options for treatments.

00:16:38:08 - 00:16:39:10
They also, like I said, help

00:16:39:10 - 00:16:40:04
further the field

00:16:40:04 - 00:16:41:07
because we learn more about it

00:16:41:07 - 00:16:43:05
and make sure it works well.

00:16:43:05 - 00:16:45:22
But it really is part of the care

00:16:45:22 - 00:16:47:07
for for patients with cancer.

00:16:47:07 - 00:16:48:07
Now, more and more and more,

00:16:48:07 - 00:16:49:06
we have clinical trials

00:16:49:06 - 00:16:50:10
from all different stages.

00:16:50:10 - 00:16:51:21
We have surgical clinical trials

00:16:51:21 - 00:16:53:10
to targeted therapies,

00:16:53:10 - 00:16:55:07
immunotherapies, radiation.

00:16:55:07 - 00:16:56:19
We even have Reiki.

00:16:56:19 - 00:16:58:10
We do all these things.

00:16:58:10 - 00:16:58:23
Yeah, we're doing

00:16:58:23 - 00:17:00:01
Reiki for patients

00:17:00:01 - 00:17:02:14
with maybe pain or chronic pain.

00:17:02:14 - 00:17:03:19
We try Reiki therapy.

00:17:03:19 - 00:17:04:17
So we have clinical trials

00:17:04:17 - 00:17:06:02
and all these things. Yeah.

00:17:06:02 - 00:17:08:16
And so these

00:17:08:16 - 00:17:11:14
this is something that I really,

00:17:11:14 - 00:17:13:14
talk it talk to them about my talk

00:17:13:14 - 00:17:14:19
to clinical trials about,

00:17:14:19 - 00:17:16:03
talk to patients

00:17:16:03 - 00:17:17:08
about these clinical trials

00:17:17:08 - 00:17:19:01
because I think it's something

00:17:19:01 - 00:17:20:19
that can really help patients.

00:17:20:19 - 00:17:22:11
Do you find that

00:17:22:11 - 00:17:23:10
when you bring that up,

00:17:23:10 - 00:17:25:00
when you start going down, that road,

00:17:25:00 - 00:17:27:10
do you find willingness or hesitation?

00:17:28:13 - 00:17:29:12
Because I think both.

00:17:29:12 - 00:17:29:20
You do.

00:17:29:20 - 00:17:30:17
Yeah, I think both.

00:17:30:17 - 00:17:33:20
I think some people are really inclined

00:17:33:20 - 00:17:35:03
to go through clinical trials,

00:17:35:03 - 00:17:37:10
like you bring up Ellen K.

00:17:37:10 - 00:17:38:21
I've also listened to growing up in

00:17:38:21 - 00:17:41:18
LA shout out, yeah, a long time.

00:17:41:18 - 00:17:42:07
That's great.

00:17:42:07 - 00:17:43:14
And I'm, I'm happy

00:17:43:14 - 00:17:44:10
that she was able

00:17:44:10 - 00:17:45:16
to kind of be part of this.

00:17:45:16 - 00:17:46:03
And yeah,

00:17:46:03 - 00:17:47:02
from the clinical trial

00:17:47:02 - 00:17:49:03
standpoint with her family.

00:17:49:03 - 00:17:51:14
But some patients are all about it.

00:17:51:14 - 00:17:52:15
Okay. We get patient.

00:17:52:15 - 00:17:54:13
We get people that read about it.

00:17:54:13 - 00:17:54:21
They know

00:17:54:21 - 00:17:56:02
friends and family

00:17:56:02 - 00:17:58:00
or friends and friends or family

00:17:58:00 - 00:17:59:09
that have gone through clinical trials.

00:17:59:09 - 00:18:00:13
They understand it.

00:18:00:13 - 00:18:02:21
They read about it on the internet,

00:18:02:21 - 00:18:05:16
which is fine, which is great.

00:18:05:16 - 00:18:06:13
And there's some people

00:18:06:13 - 00:18:07:18
that are really hesitant, right.

00:18:07:18 - 00:18:09:09
There are some,

00:18:09:09 - 00:18:10:18
populations of people

00:18:10:18 - 00:18:12:05
that might just be skeptical

00:18:12:05 - 00:18:13:03
about clinical trials.

00:18:13:03 - 00:18:13:17
They feel like

00:18:13:17 - 00:18:15:04
they're being experimented on.

00:18:15:04 - 00:18:16:11
There’s that entity. Sure.

00:18:16:11 - 00:18:17:15
I think this is something

00:18:17:15 - 00:18:19:07
that I really explain to the patient.

00:18:19:07 - 00:18:19:23
Right, right.

00:18:19:23 - 00:18:22:23
I talk to them about the pros and cons.

00:18:23:05 - 00:18:24:05
Why we're doing it,

00:18:24:05 - 00:18:25:19
why we do certain clinical trials

00:18:25:19 - 00:18:27:14
and some people are really for it.

00:18:27:14 - 00:18:28:22
Or if they weren't before,

00:18:28:22 - 00:18:29:22
now they are. Yeah.

00:18:29:22 - 00:18:31:01
And some people, you know,

00:18:31:01 - 00:18:32:09
I just don't want it and that's fine.

00:18:32:09 - 00:18:33:18
I think that's the beauty.

00:18:33:18 - 00:18:34:15
Patients

00:18:34:15 - 00:18:35:16
can choose to be part

00:18:35:16 - 00:18:37:09
of a clinical trial or not.

00:18:37:09 - 00:18:39:05
And if they're not we still treat them.

00:18:39:05 - 00:18:41:11
We still treat patients all the time.

00:18:41:11 - 00:18:42:20
Yeah. Not part of clinical trials.

00:18:42:20 - 00:18:44:21
And if they are they get

00:18:44:21 - 00:18:46:15
new potentially newer treatments

00:18:46:15 - 00:18:47:15
that we're going to be

00:18:47:15 - 00:18:48:12
out in the future.

00:18:48:12 - 00:18:49:02
Yeah.

00:18:49:02 - 00:18:49:15
It's exciting

00:18:49:15 - 00:18:51:14
what you guys are doing at UCI Health.

00:18:51:14 - 00:18:53:19
What would you say doctor, to

00:18:54:19 - 00:18:55:18
I don't know anyone.

00:18:55:18 - 00:18:56:09
Maybe that's

00:18:56:09 - 00:18:57:01
that's watching

00:18:57:01 - 00:18:58:04
or has a family member

00:18:58:04 - 00:18:59:01
who did smoke

00:18:59:01 - 00:19:01:00
and is hesitant to to get screened

00:19:01:00 - 00:19:03:10
or to even even go down the road of

00:19:03:10 - 00:19:04:22
maybe I should.

00:19:04:22 - 00:19:05:08
Yeah.

00:19:05:08 - 00:19:07:18
It's it's I know it's difficult.

00:19:07:18 - 00:19:08:20
And I think we brought up

00:19:08:20 - 00:19:09:15
that shame issue.

00:19:09:15 - 00:19:11:05
I know people think that way

00:19:11:05 - 00:19:12:01
or they think, oh, there's

00:19:12:01 - 00:19:15:01
nothing wrong with me or I don't care.

00:19:15:01 - 00:19:15:09
There's nothing

00:19:15:09 - 00:19:17:05
I can really do about it.

00:19:17:05 - 00:19:19:18
I think people got to understand

00:19:19:18 - 00:19:21:11
there is something that can be done.

00:19:21:11 - 00:19:22:19
Shouldn't feel shameful about it.

00:19:22:19 - 00:19:24:02
If we find it early.

00:19:24:02 - 00:19:25:09
Even if you don't want surgery,

00:19:25:09 - 00:19:26:13
then you can go to radiation.

00:19:26:13 - 00:19:27:11
If you don't radiation,

00:19:27:11 - 00:19:28:09
you can go to surgery.

00:19:28:09 - 00:19:30:16
But there's so many options that we can

00:19:30:16 - 00:19:31:17
that we have.

00:19:31:17 - 00:19:32:23
There's really no downside.

00:19:32:23 - 00:19:34:00
I feel just

00:19:34:00 - 00:19:35:14
the screen is just a CT scan.

00:19:35:14 - 00:19:37:01
It's literally

00:19:37:01 - 00:19:38:23
you just go, you sit in a

00:19:38:23 - 00:19:39:20
not even a tube.

00:19:39:20 - 00:19:42:02
It's a it's just like a quick scan.

00:19:42:02 - 00:19:43:01
And we know a lot

00:19:43:01 - 00:19:44:17
about what's going on in your body.

00:19:44:17 - 00:19:45:06
We know

00:19:45:06 - 00:19:45:18
a lot about

00:19:45:18 - 00:19:47:00
if you have a lung nodule or not,

00:19:47:00 - 00:19:49:06
if you have a pneumonia, potentially,

00:19:49:06 - 00:19:51:01
we can take care of that. Yeah.

00:19:51:01 - 00:19:53:06
So I think there's really,

00:19:53:06 - 00:19:54:13
really minimal downside.

00:19:54:13 - 00:19:55:13
And a lot of upside

00:19:55:13 - 00:19:57:02
to getting screened.

00:19:57:02 - 00:19:58:09
And it's so fascinating

00:19:58:09 - 00:19:59:08
I think when you

00:19:59:08 - 00:20:00:11
really think about breathing

00:20:00:11 - 00:20:02:05
we take it so for granted.

00:20:02:05 - 00:20:02:20
You know what I'm saying.

00:20:02:20 - 00:20:03:21
Like it's one of those

00:20:03:21 - 00:20:04:15
you have to do it.

00:20:04:15 - 00:20:05:19
No one's ever like I'm so happy

00:20:05:19 - 00:20:06:12
I'm breathing.

00:20:06:12 - 00:20:06:20
Yeah.

00:20:06:20 - 00:20:07:07
You know

00:20:07:07 - 00:20:08:09
it's one of those things

00:20:08:09 - 00:20:09:10
you don't think about it

00:20:09:10 - 00:20:11:14
until you have problems. Right. It.

00:20:11:14 - 00:20:12:12
And unfortunately,

00:20:12:12 - 00:20:14:08
like we talked about with lung cancer,

00:20:14:08 - 00:20:16:12
when you start having problems,

00:20:16:12 - 00:20:17:16
the likelihood you're at a later

00:20:17:16 - 00:20:19:04
stage is high is higher. Right?

00:20:19:04 - 00:20:21:11
Then you might not be seeing a surgeon

00:20:21:11 - 00:20:22:18
because it's not a it's

00:20:22:18 - 00:20:24:09
not in a earlier stage.

00:20:24:09 - 00:20:25:18
Yeah. So these are the problems.

00:20:25:18 - 00:20:27:06
That's why you might not have symptoms.

00:20:27:06 - 00:20:28:05
A lot of people say, oh, you know,

00:20:28:05 - 00:20:29:22
I feel fine, I'm going to work

00:20:29:22 - 00:20:31:08
or I'm still working out.

00:20:31:08 - 00:20:32:06
I'm not on oxygen.

00:20:32:06 - 00:20:32:22
None of these things.

00:20:32:22 - 00:20:35:14
So yeah, I don't need to be screened.

00:20:35:14 - 00:20:36:08
That's the problem.

00:20:36:08 - 00:20:37:14
There's no symptoms here.

00:20:37:14 - 00:20:40:01
So we have to be able to find it early.

00:20:40:01 - 00:20:41:21
Even when you have no symptoms.

00:20:41:21 - 00:20:42:21
You're asymptomatic

00:20:42:21 - 00:20:44:12
because at that time it's there.

00:20:44:12 - 00:20:45:15
But the symptoms don't present

00:20:45:15 - 00:20:46:16
until later. Correct.

00:20:46:16 - 00:20:47:21
And if it's still there, we can

00:20:47:21 - 00:20:49:18
we can do something about it earlier.

00:20:49:18 - 00:20:50:19
Wow.

00:20:50:19 - 00:20:51:13
That's the main thing

00:20:51:13 - 00:20:52:16
I tell patients

00:20:52:16 - 00:20:53:03
that we can do

00:20:53:03 - 00:20:54:17
something about it earlier. Yeah.

00:20:54:17 - 00:20:55:07
Really good.

00:20:55:07 - 00:20:56:07
You know, one other one

00:20:56:07 - 00:20:57:00
we didn't bring up.

00:20:57:00 - 00:20:58:13
And maybe you have thoughts on this is,

00:20:58:13 - 00:20:59:10
I know, you know,

00:20:59:10 - 00:21:01:10
vaping has become like a really,

00:21:01:10 - 00:21:02:23
you know, popular thing.

00:21:02:23 - 00:21:04:10
Now, what are you seeing with that?

00:21:04:10 - 00:21:05:04
That's.

00:21:05:04 - 00:21:06:03
So you bring up

00:21:06:03 - 00:21:08:04
a very interesting point,

00:21:08:04 - 00:21:10:03
especially in the younger population.

00:21:10:03 - 00:21:11:13
We are seeing a lot more people

00:21:11:13 - 00:21:13:10
that vape e-cigarettes.

00:21:14:17 - 00:21:17:23
Currently, we don't have enough data.

00:21:18:00 - 00:21:18:13
Okay.

00:21:18:13 - 00:21:19:06
And, unfortunately,

00:21:19:06 - 00:21:20:13
that's the problem with data, right?

00:21:20:13 - 00:21:22:05
It takes a long time

00:21:22:05 - 00:21:22:22
to, to

00:21:22:22 - 00:21:23:18
to have enough data

00:21:23:18 - 00:21:25:05
to really extrapolate

00:21:25:05 - 00:21:26:08
what's happening for,

00:21:26:08 - 00:21:28:07
especially, from a cancer standpoint.

00:21:28:07 - 00:21:29:12
That being said, we know

00:21:29:12 - 00:21:31:07
tobacco is a carcinogen.

00:21:31:07 - 00:21:33:08
It can cause cancer

00:21:33:08 - 00:21:35:05
or other non-cancerous issues

00:21:35:05 - 00:21:36:13
that do happen with vaping.

00:21:36:13 - 00:21:38:01
There's a lot of what we call a vaping

00:21:38:01 - 00:21:39:20
related lung injury,

00:21:39:20 - 00:21:41:16
where it's a diffuse lung injury

00:21:41:16 - 00:21:42:17
where we see

00:21:42:17 - 00:21:45:14
even really young patients,

00:21:45:14 - 00:21:46:23
have lung injury

00:21:46:23 - 00:21:47:23
where they're in the hospital

00:21:47:23 - 00:21:49:05
needing oxygen,

00:21:49:05 - 00:21:50:09
otherwise healthy people.

00:21:50:09 - 00:21:52:19
So we do know that there are problems

00:21:52:19 - 00:21:55:02
with vaping, that there can be issues

00:21:55:02 - 00:21:56:12
specifically with lung cancer.

00:21:56:12 - 00:21:57:07
I think we're learning

00:21:57:07 - 00:21:59:01
more and more about it.

00:21:59:01 - 00:21:59:19
We're learning

00:21:59:19 - 00:22:01:17
how much is like,

00:22:01:17 - 00:22:03:03
how much do people vape even

00:22:03:03 - 00:22:04:16
I think just even quantifying that.

00:22:04:16 - 00:22:05:13
Right, right, right.

00:22:05:13 - 00:22:06:09
You see these kids,

00:22:06:09 - 00:22:08:02
they're just going, going, going.

00:22:08:02 - 00:22:09:06
And what does that even mean?

00:22:09:06 - 00:22:11:19
Is a cartridge the same as a pack?

00:22:11:19 - 00:22:12:15
I think these are things

00:22:12:15 - 00:22:13:15
we're learning more and more,

00:22:13:15 - 00:22:14:21
especially from the

00:22:14:21 - 00:22:16:17
exposure standpoint.

00:22:16:17 - 00:22:17:09
I could tell you

00:22:17:09 - 00:22:19:11
it's probably not good for you. Yes.

00:22:19:11 - 00:22:21:06
I think it's probably safe to say it's

00:22:21:06 - 00:22:22:10
safe to say right there.

00:22:23:10 - 00:22:24:21
But from a true lung cancer

00:22:24:21 - 00:22:26:20
risk we're learning more and more.

00:22:26:20 - 00:22:28:20
And, especially, if you have had lung,

00:22:28:20 - 00:22:30:17
lung cancer, you smoked in the past

00:22:30:17 - 00:22:32:06
and you're trying to quit using vaping.

00:22:32:06 - 00:22:33:08
I think it's great,

00:22:33:08 - 00:22:34:04
but hopefully you can get to

00:22:34:04 - 00:22:36:05
that quit standpoint.

00:22:36:05 - 00:22:37:16
But if you're just starting up vaping,

00:22:37:16 - 00:22:39:00
especially for the young,

00:22:39:00 - 00:22:40:16
young people out there,

00:22:40:16 - 00:22:41:07
I hope

00:22:41:07 - 00:22:43:06
I don't see you in the future

00:22:43:06 - 00:22:45:03
as a patient.

00:22:45:03 - 00:22:46:21
But I think we will be seeing more

00:22:46:21 - 00:22:47:20
and more of that in the future.

00:22:47:20 - 00:22:48:16
And, unfortunately,

00:22:48:16 - 00:22:51:06
we might be seeing more later stage.

00:22:51:06 - 00:22:53:08
Just because of the way I think it is.

00:22:53:08 - 00:22:54:22
Yeah. With vaping. Interesting.

00:22:54:22 - 00:22:56:09
We guys are doing great work at UCI Health

00:22:56:09 - 00:22:57:03
Thank you so much.

00:22:57:03 - 00:22:58:09
I really this has been fascinating.

00:22:58:09 - 00:22:59:09
You're you're you're great.

00:22:59:09 - 00:23:00:09
And, I know

00:23:00:09 - 00:23:01:20
you'll continue to do great things

00:23:01:20 - 00:23:02:14
and help people breathe

00:23:02:14 - 00:23:03:08
easier and better.

00:23:03:08 - 00:23:04:09
Thank you. Live longer.

00:23:04:09 - 00:23:04:20
Thank you. Yeah.

00:23:04:20 - 00:23:05:14
That's the goal here.

00:23:05:14 - 00:23:06:15
Thank you very much.