51: What Do You Do For a Living?⎥Why It Matters, with Dr. Ashok R. Shaha from MSKCC

When assessing thyroid cancer surgery, this is the first question a surgeon should ask

Dr. Shaha

specializes in head and neck surgery, with a particular interest in thyroid and parathyroid surgery. He uses an algorithm of selective thyroid tumor criteria (the size, location, stage and type of cancer, along with the patient’s age), to tailor therapy to each individual’s circumstances. This can help thyroid cancer patients avoid unnecessary and potentially damaging over-treatment, while still providing the best option for control of their cancer and better quality of life after treatment. Dr. Shaha works very closely with Memorial Sloan Ketterings’ endocrinologists to monitor the careful post-treatment hormone balancing necessary for thyroid cancer patients. Many academic hospitals and medical societies worldwide have invited Dr. Shaha to speak on the principles of targeted thyroid surgery and to share his expertise in the treatment of head and neck cancers.

In this interview, topics include:

  • The first question a surgeon should ask and why.
  • When talking active surveillance or observation, changing the language to deferred intervention,  ‘we are going to defer’.
  • Understanding the biology of the cancer
  • The biology of thyroid cancer is a friendly cancer.
  • Anxiety when diagnosed with cancer.
  • Medical legalities ? spend a lot of time with patient ? and empower patient.
  • Let the treatment not be worse than the disease.
  • Large tumors, more than 4 cm,  bulky nodes,  voice hoarseness,  vocal cord is paralyzed.  All circumstances where surgery maybe advocated.
  • If a tumor is benign but there is presence of compressive goiters, or deviation of trachea or swallowing difficulty.
  • Considering the condition of the patient, age, cardiac issues.
  • When voice is critical to the patients livelihood, such as teachers, politicians, and singers.
  • Main three complications of surgery include bleeding, change of voice, calcium problems.
  • Non-academic surgeons.
  • Cancer treatment requires a team: surgeons, anesthesiologist, pre-op, radiologist, pathologist, endocrinologists, oncologists.
  • When wind pipe is involved with tumor.
  • When in surgical business a long time, you become humble no matter how good you are.
  • Family present during consultation.
  • God gave you an organ ? you took it away ? now you are on a pill ? since the surgery its ‘just’ not the same.
  • When treatment is out of the box ? many will not agree with you.
  • How to develop a scale to measure quality of life.
  • To avoid scarring, surgery maybe conducted through the armpit in Korea and Japan.
  • Fibrosis
  • Progress in understanding biology of thyroid cancer only cancer, that there is 98% survival.

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