Why are some patients not candidates for surgery?
Dr. Nicholas Vogelzang has dedicated his professional life to cancer patients and mesothelioma research. Beginning with his college research project at Argonne National Laboratory, and through a 24-year career at the University of Chicago in cancer care, education, and research, Dr. Vogelzang remains dedicated to curing cancer—one patient at a time. He currently serves as the Research Medical Director of U.S. Oncology at the Comprehensive Cancer Centers of Nevada. Here, Dr. Vogelzang answers a reader question about surgical treatments for cancer patients.
Q: Hi, Dr. Vogelzang! My father was recently diagnosed with mesothelioma and was told he was not “the right candidate” to undergo surgery. However, my uncle was diagnosed with the same cancer five years ago, and his physician performed surgery on him. Why are some patients able to undergo surgery and others are not? Is the decision for a surgical approach usually based on the patient’s age?
Mesothelioma is like most common cancers: It starts in one organ and generally stays there unless you can remove it. But if you can’t remove it, mesothelioma can spread through the body, often to the other lung or lymph nodes. I’ve seen it spread to the liver, the brain, and other places after advancing significantly. We’ve looked at the many combinations of treatments, and chemotherapy first followed by surgery is the best option. Only about 10 to 20 percent of patients are candidates for surgery. The majority of patients with advanced mesothelioma have heart disease or lung disease, or the cancer is outside the expected ability of operation. I suggest chemotherapy, and if the response is successful, then we’ll consider surgery. For the young and healthy patient, surgery is the first option
The question of how old is too old always comes up in oncology. Old is physiologic, not chronologic. You can be 70 and run marathons, or you can be 80 and on the golf course every day, but in general the cut off age is 70. Risks of surgery go up, and we always concern ourselves with potential complications after surgery. I counsel the very healthy 70-year-olds out doing everyday activities like golfing, swimming, and hiking to consider it. But, if they lose a lung or part of a lung at age 70, it makes life pretty difficult. If a tumor grows through the chest into the muscles or the bones causing severe pain, those patients cannot often be operated on successfully.
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Dr. Vogelzang’s CV
- Genitourinary malignancies (prostate, kidney, bladder, and testicular cancer)
- M.D. from the University of Illinois at Chicago
- Internship and residency in internal medicine at Rush-Presbyterian-St. Luke’s Medical Center
- Fellowship in medical oncology at the University of Minnesota at Minneapolis
- Medical oncologist at the Comprehensive Cancer Centers since 2009
- Clinical professor of medicine at the University of Nevada School of Medicine
- Clinical professor at the University of Nevada at Las Vegas School of Medicine
- Director of the Nevada Cancer Institute, 2004–2009
- Fred C. Buffett Professor and Director of the University of Chicago Cancer Research Center, 1999–2003
- University of Chicago faculty member, 1982–2003
Books and Publications
- Associate editor of Kidney Cancer Journal and Clinical Genitourinary Cancer
- Lead editor of the “Comprehensive Textbook of Genitourinary Oncology,” 1994–2008
- Named Distinguished Physician of the Year by the Nevada State Medical Association
- Named America’s Top Doctor by Castle Connolly
- Named Top Doctor by U.S. News & World Report
- Named Everyday Hero from the American Red Cross Southern Nevada
- Awarded the Gold Certificate of Excellence by the National Cancer Institute
- Awarded the Inspired Excellence in Health Care Award by Las Vegas HEALS
- Awarded the Laureate from the American College of Physicians in Nevada