Hoag Presents "Ask the Doctor" for Winter 2016

In this edition of Ask the Doctor, Dr. Sadia Khan, Dr. Joseph Weiland, Dr. Daniel Ng and Dr. Babak Rad, provide important information on a variety of topics including breast cancer, healthy living and colorectal cancer.

Sadia Khan, M.D.

Q: I was diagnosed with breast cancer and my doctor told me that I need a mastectomy, but I don’t want to lose my breasts. Do I have other options?

A: If you or a loved one has been recently diagnosed with breast cancer, we understand this is an extremely challenging time. When you receive a breast cancer diagnosis, you may feel a sense of urgency about starting treatment immediately. However, in some cases, such as when a mastectomy is recommended, you may want to do some additional research to confirm that your diagnosis is accurate and that you have chosen the best treatment plan for you.

If your physician is recommending a mastectomy, there are some alternatives you can explore. One option would be to have chemotherapy prior to surgery to help shrink the tumor(s), which may make you more likely to qualify for breast conservation treatments.

Other options include finding a breast surgeon who is trained in oncoplastic techniques. Oncoplastic breast surgery combines two disciplines: cancer surgery and plastic surgery. By combining these disciplines during the same procedure, it is possible to remove the tumor and to often make the patient look better than before, achieving a more cosmetic end result. Additionally, some patients may qualify for “extreme oncoplasty” surgery. This is when the larger multifocal tumors can be removed with the help of a plastic reconstructive surgeon through breast reduction incisions or other modified oncoplastic techniques.

It is important when considering any type of breast cancer surgery to find a surgeon with extensive experience who performs a high volume of breast cancer surgeries like standard lumpectomies, standard mastectomies and skin and nipple-areola sparing mastectomies.

At Hoag, we diagnose and treat almost 800 new patients with breast cancer annually. We have highly trained breast surgeons, many who are fellowship trained in the latest breast-saving oncoplastic surgical techniques. Our breast surgeons work with the Hoag team to ensure a multidisciplinary approach to your care that is seamless from diagnosis to survivorship.

Dr. Sadia Khan is a fellowship-trained breast surgical oncologist at Hoag Breast Center and an Advisor to the Hoag Breast Program. Her areas of expertise include oncoplastic surgery, extreme oncoplasty, intraoperative radiation therapy techniques, young and high-risk women, as well as providing comprehensive and compassionate care for patients with all breast diseases.

Joseph Weiland, D.O.

Q: What vitamins do you recommend for healthy living?

A: For the majority of people, vitamin supplementation is not necessary. Adequate vitamin intake can usually be attained by a healthy balanced diet. However, there are a few situations where vitamins might be helpful. Multivitamins can help decrease nutrient deficiencies, but should not be used as substitutes for a sensible diet and other healthy lifestyle habits. There have been various studies that looked at the effects of vitamins on chronic disease. The consensus so far is that multivitamins do not play much of a role in decreasing one’s risk of cardiovascular disease, eye disease, memory impairments, or cancer.

Studies have shown that vitamins help in some specific conditions. For example, it is recommended that pregnant women (or women who might become pregnant) should take vitamins that include folic acid to prevent neural tube defects in the baby. Another example is that Vitamin D supplementation might help prevent bone disease in elderly patients. Vitamin D is also recommended for babies who are exclusively breastfed. Taking a daily multivitamin might not help in the majority of cases, but if taken appropriately they are not harmful. It is important to note that Vitamin A and Vitamin E can be harmful if taken in excess.

If you are interested in starting vitamin supplementation you should discuss it with your primary care physician first. The decision to take a vitamin regimen comes down to the individual and should be tailored to a person’s age, gender, diet, and risk factors.

For additional information about healthy living, please join me for my free community presentation titled Healthy Living: What to Know on March 1 at the Hoag Newport Beach Conference Center.

Joseph Weiland, D.O. practices family medicine at Hoag Medical Group. He is passionate about preventative medicine, and seeks to assess health issues and mitigate health risks, before problems occur.

Daniel Ng, M.D. and Babak Rad, M.D.

Q: How do you treat colorectal cancer, and why is it important to receive care from a comprehensive program?

A: Hoag Family Cancer Institute offers a variety of innovative and progressive treatment options to treat colorectal cancer patients.

If colon or rectal cancer is detected during a colonoscopy, radiographic studies are ordered to determine if the cancer has spread and assist with staging of the cancer. These tests include CT scans, PET scans, MRI imaging, and/or endoscopic ultrasound.

Surgery is typically the main treatment option for colon cancer. Hoag surgeons utilize minimally invasive techniques such as laparoscopic surgery and robotic-assisted surgery to safely remove the segment of the colon that contains the cancer. During surgery, the section of the colon that contains the cancerous tumor along with the adjacent lymph nodes are removed. Your surgeon will determine which technique is best for you based on the stage and location of the cancer. After the cancer is surgically removed, the tumor will be pathologically evaluated to determine if other treatment options, such as chemotherapy, are needed. This is called adjuvant therapy and is used to improve the results of surgery.

Rectal cancer is treated using a combination of therapies including surgery, radiation therapy, and/or chemotherapy. Based on the location and size of the tumor in the rectum, treatment may begin with less invasive options such as radiation therapy and chemotherapy to shrink the size of the tumor and allow for preservation of the anal sphincter. Treatment before surgery is referred to as neoadjuvant therapy. A skilled Hoag surgeon will then surgically remove the remaining areas of the rectal cancer utilizing minimally invasive techniques such as laparoscopic surgery and robotic-assisted surgery.

To ensure you receive the best treatment possible, it is important to choose a facility, such as Hoag, that offers a comprehensive program. Having a multidisciplinary team of colorectal cancer experts will provide access to a full array of advanced colorectal cancer diagnosis and treatment options, as well as patient-centered care that is tailored for each individual.

Dr. Daniel Ng is a fellowship-trained colorectal cancer surgeon. Dr. Babak (Bobby) Rad is the Program Advisor for Hoag’s Colorectal Cancer Program and a fellowship-trained colorectal cancer surgeon.