The Art of Surgical Oncology: An interview with Evan Glazer, MD

Many thanks to Evan Glazer, MD, a colleague at Regional One Health in Memphis, TN, part of the University of Tennessee Health Science (UTHSC) system. Dr. Glazer is a practicing surgical oncologist and Associate Professor of Surgery at UTHSC. He also received Memphis Magazine's 2024 Innovator Award.

 

During our 25-minute conversation, Dr. Glazer described the extensive training that led to his current position as a surgical oncologist at Regional One Health. He completed four years of college, four years of medical school, five years of general surgery residency, two years of a research fellowship on liver and pancreas cancer, and then two years of clinical fellowship at the Moffit Cancer Center, Tampa, FL, a total of 17 years of training! Dr. Glazer is now a Board-Certified Surgical Oncologist.

Dr. Glazer explained that in the US, general surgeons provide most surgical cancer care. However, some cases are complex and require additional skills, which is where a surgical oncologist can step in. Surgical oncologists routinely operate on cancer patients, which gives them a level of experience and expertise not always possessed by general surgeons. 

Dr. Glazer explained how advances in neuroimaging, including CT, MRI, and PET scans, have aided surgeons by better identifying anatomical structures that vary from patient to patient. Collaboration between medical oncologists, surgical oncologists, radiologists, radiation oncologists, pathologists, and others can lead to optimal clinical results. Cancer is not always a "death sentence" as it used to be.

To learn more, please watch on YouTube or listen on your favorite streaming device!

To contact Dr. Glazer, please call Regional One Health: 901.545.7100.

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Transcript

AW

Welcome to the Art of Medicine, the program that explores the arts, business, and clinical

aspects of the practice of medicine. I'm your host, Dr. Andrew Wilner. Today, I'm pleased to

welcome Dr. Evan Glazer. Evan is a colleague at Regional One Health here in Memphis,

Tennessee. We pass sometimes in the hospital corridors. But frankly, we're both too busy to

stop and chat, so I'm glad to have his attention on the podcast.

Dr. Glazer is a practicing surgical oncologist and associate professor of surgery at the University

of Tennessee Health Science Center. He also received Memphis Magazine's 2024 Innovator

Award, and he'll tell us why. But first, a word from our sponsor, locumstory.com.

Locumstory.com is a free, unbiased educational resource about locum tenants. It's not an

agency. Locumstory answers your questions on their website, podcasts, webinars, videos, and

they even have a Locums 101 crash course.

Learn about locums and get insights from real-life physicians, PAs and NPs at locumstory.com.

And now to my guest. Welcome, Dr. Evan Glazer. Thank you very much. It's my pleasure to be

here. Evan, it's great to see you outside of the hospital.

You know, you're so busy, and frankly, I'm pretty busy, that when we pass in the halls, can't talk,

right? It's like, yeah, hi, you know, and it's like, I don't really want to blow you off, but I got

patients to see. So probably this will be our longest conversation for at least the next 12

months.

So I'm going to make the most of it.

EG

Absolutely. It sounds great. It is always a pleasure to see you in the hallway, but it's almost

always, it's on the way to rounds, from rounds, or during rounds with our residents and fellows.

So always something going on, always someplace to be. And when I'm not in the hallway, I'm

usually in the operating room. As a surgeon, that's kind of where I belong.

And so we're going back and forth. Right. So I see it looks like you're not working today.

Is that right? That's right. What I wanted to say is because of the weather outside, I rounded

this morning and took a little bit of time off this afternoon to spend with family and worked out

well to schedule this conversation.

AW

Right. So for those of you who don't know where we are, we're in Memphis, Tennessee, and we

have a very unusual snowstorm. And it's quite cold outside.

And so the powers that be have shut everything down that can be shut down. So it gives us a

little bit of a breather. But of course, the patients in the hospital do get what they need.

But nobody's going there if they don't have to today, I think.

EG

That's right. I ran it for a few minutes this morning for the patients. Everyone's doing well,

fortunately.

And now we just wait for them to heal up. All right.

AW

So you mentioned you are a surgical oncologist. How does that happen? Where does that

begin?

EG

So as a surgical oncologist, I did a fellowship in surgical oncology. And this was after residency

in general surgery after medical school. I did my medical school at George Washington

University in D.C. and residency at the University of Arizona in Tucson. I did some fellowships at

Moffitt Cancer Center and MD Anderson Cancer Center. A surgical oncologist is really a surgeon

who primarily focuses on cancer care and some other types of benign diseases that require a

certain level of expertise that we develop in our fellowship. A surgical oncologist is actually a

relatively new fellowship.

It's been going on for many years, but it's now board certified. So my board certification

number is number 147. I'm the 147th board certified surgical oncologist in the U.S. As it turns

out, the fellowships existed for many, many years. There's thousands of surgical oncologists

over the years. But as a boarded specialty, it's relatively new.

AW

So just to put that in perspective, that's four years of medical school and five years of general

surgery?

EG

Correct.

AW

And one year for the first fellowship?

EG

I actually did two years out of a research fellowship in liver and pancreas cancer at MD

Anderson and two years of clinical fellowship at the Moffitt Cancer Center in Tampa, Florida.

AW

So that's four plus four plus four. So to develop the training to do what you do now, you've

spent 12 years preparing. Is that correct?

EG

That's right. After undergrad.

AW

Right. After finishing college, where you probably it wasn't a breeze because you were like me,

a premed, which isn't the most not the most fun. Usually, you know, it's not like American

Studies or something where, you know, which they nothing against American Studies.

But it usually at least where I trained, it was not as rigorous as what the premedical students

had to do. OK, so now you're out there, you're a surgical oncologist. Why would a why would a

patient come to you?

EG

That's a really good question. And in the US, most cancer care is surgery. Most cancer surgery

care is provided by general surgeons and those are surgeons that have five years of training in

surgery.

But there are certain cancers or certain problems that require more expertise that general

surgeons don't have that expertise, aren't trained for it. Or what's common is surgeons

generally are better at doing what they do a lot of. And surgical oncologists do a lot of cancer

surgery.

And so I'm more I'm more experienced, more training, for example, in pancreas surgery and

liver surgery, bile duct surgery, whereas I have less experience in, say, hernias. And so as a

surgical oncologist, I don't do a lot of inguinal hernias. Those are groin hernias.

Those are done by general surgeons a lot more, whereas a general surgeon does not do a lot of

pancreas surgery. And so he or she, as a general surgeon, would do the inguinal hernia on

patients. And I do the pancreas or liver surgery as a surgical oncologist.

We generally get better at things we do. And so it's important that we patients see those who

have the expertise necessary to take care of them, whether it's cancer or not cancer or anything

in between.

AW

I'll just make a comment that I remember, you know, as a medical student, I studied a lot of

diagrams in books. We had books in those days to learn about those. I've heard about books.

To learn anatomy and the liver and the pancreas and the bile duct, it was a little wasn't all that

straightforward. But I remember going as a third year medical student, I would go to the OR

when I was on surgery rotation. You know, my job was to hold the retractor, usually in the

middle of the night.

But when I would sort of peer over the surgeon's shoulder, it was a mess. You know, nothing

was colored. Nothing was numbered.

Everything was moving around. There was blood everywhere. There was fluids.

There was sucking. And it was like, this doesn't look anything like the book. And I think that's

not generally appreciated.

And correct me here if I'm wrong, but it seems to me that a big part of the skill of the surgeon is

actually just knowing where they are and knowing where the things are that they don't want to

touch and where the things are that they do want to touch and what they can reach and what

they can't is a big part of what you learn. Is that right?

EG

That's right. And so I think over time, over the last many years, we've been the physicians and

surgeons have become a lot better at doing the operations and recognizing what are important

and how to be better surgeons or better doctors. So, as you say, it's not quite always a mess.

And you're certainly right that there's no diagrams and no barcodes or numbers in patients.

And a lot of time is spent understanding and learning about that anatomy that's there. We have

CT scans and MRI scans that are better now than they were five years ago and better than five

years before that.

And as these get better, we get more information before the operation to really understand

what we expect to see and find and then how to do the operation. I think your point about

knowing what should stay and what should go is a really important concept I try to teach the

residents and fellows that one has to be very sure about what should stay and what should go

and not confuse those because that's where problems arise. I think you also bring up a really

good point about, you know, in the textbook, something looks as it does.

And then in real life, it looks very different. And as we've had better CT scans and MRIs and PET

scans and lots of fancy imaging modalities, we as surgeons get better at doing our job. But we

also work with radiologists and other healthcare professionals much more closely than we did

five, 10, 15, 20 years ago to understand and interpret all that data.And probably five or 10 years from now, AI will be helping us interpret data even more and help

us put pieces together in a way that arguably was unimaginable 10 years ago. And hopefully 20

or 30 years from now is something I can't even imagine.

AW

Now, oncology is really a technical term, I think, that translates to cancer. Is that right? Yeah,

that's right.

And I'm old enough to remember when I studied in France when I first started medical school.

And it was not uncommon for the doctors there not to even tell the patients, not to use that

word, cancer, because that just meant they were going to die. And they felt that that was just

too overwhelming.

So they would sort of skirt around it. I mean, the patients usually figured it out. But, I mean,

that's how bad it was.

So you mentioned there's been improvements in sort of identifying anatomy. I mean, that's

good. So at least you're chopping out – I use that term loosely – delicately removing the parts

that need to go.

But in terms of prognosis, is cancer still the death sentence that it has the reputation for?

EG

It's not. And it's always difficult to talk about cancer for lots of patients or lots of people and

then talk about cancer for one individual person. Because we can talk about groups of people

improving survival, improving treatments, having different types of therapy now,

immunotherapy, where we get the immune system to rev up and attack the cancer.

But if those treatments don't work for the one person or the one patient we're talking about or

the family member we're talking about, it doesn't matter about the other 10,000 patients that

have benefited from it if that one patient isn't. I think we're becoming – I know we're becoming

more and more personalized about our understanding of individual's tumors and how to treat

them. And those treatments have made huge leaps and bounds in improving survival.

Melanoma of the skin used to be something that once it spread, it was a death sentence. Even

I'll say when I was in medical school, so 15 or so years ago, when meniscus melanoma came

along, that was often, as you say, a point out a death sentence. Over the last 15 years, we

developed two fantastic therapies, one of which is immunotherapy, which means the immune

system is revved up.

And now patients with skin melanoma often live a very long time. And some are even cured. I

think former President Jimmy Carter is a fantastic example of someone that had what one

would consider miraculous response to immunotherapy 10 years ago is now kind of common.And lots of patients with meniscus melanoma live a very long time, many, many years with a

very high quality of life. Unfortunately, that's not everyone. And so we have to also keep on

doing research, keep on pushing things forward to understand tumors better, develop better

therapies, more effective therapies for those patients that don't respond as well as he did to

treatments.

Pancreas cancer is one of the cancers I deal with a lot, and we've developed better tools to

identify it earlier. Earlier stage usually means patients live longer. That's been collaboration

with medical oncologists, surgical oncologists like myself, geneticists, radiologists, and all of us

putting our heads together to develop different techniques and tools to help patients.

The medical oncologists use chemotherapy now that wasn't even available 15, 20 years ago.

And all those things help patients live longer, although many still die, unfortunately, so our

work is not done yet.

AW

All right, let's say a little bit into a public service announcement that a big part of survival and

better outcomes has to do with early diagnosis. Is that correct? That's right.

And early diagnosis often means routine examinations like regular mammograms or

colonoscopies. And this is top of mind now because I just turned the age where I'm due, so I'm

waiting for a call from the GI doctor so I can sit on the toilet for two days in preparation for his

very unpleasant but potentially lifesaving treatment. Procedure that has to be done every 10

years.

So if you don't do it, you know, you're probably fine, right, because most people don't get colon

cancer. But if you do do it and you're one of those people who did get colon cancer but you

didn't know it, then the difference between finding it early and finding it late is the difference

between a 20-year survival early or a one-year survival finding it late. So for me, at least, the

choice to have the routine study seemed pretty obvious.

Would you like to add to that?

EG

Yeah. I think it's really an interesting way you put that into perspective, that a colonoscopy you

hope finds an early cancer with a very long survival. And that's completely correct.

I'm going to put another idea forward there. What if you do the colonoscopy and you found a

pre-cancer lesion, you took it out, and you never developed cancer at all? That sounds even

better than finding an early cancer.

And that's what really colonoscopy is about. There's lots of different screening modalities we

have for colon cancer. Some can find lesions before their cancer.Some find earlier stage cancer. And everything you said is 100% true. We certainly want to

identify these cancers earlier, get treatment, aggressive treatment to the right patients sooner

than later, not jeopardize delays in care, not jeopardize delays in diagnosis.

But for colon cancer, which is a very interesting cancer, because we know it becomes cancer

after a series of steps. These polyps are these little growths. They're tumors, but they're not

cancer tumors.

They're generally very small. If we can remove those before they grow into cancer, we've

actually prevented a cancer. And you won't become that statistic that we quote about cancer

this or cancer that.

And by not being a statistic, you've never had cancer. And so as a cancer surgeon, that's really

my goal, is to help patients never develop cancer, put myself out of business, so to speak, by

doing everything we possibly can to prevent that. Now, often we can't.

And often when we see patients, they already have a diagnosis. And so certainly we want to

identify it as early as possible and get as much treatment in the appropriate patient as possible

to them.

AW

All right. Let's push a little further down that path of preventing cancer in the first place, which,

you know, might give you more time to spend with your family, you know, leave work early. It

wouldn't be a bad thing.

And but probably be a while before we put you out of business. So what can is there anything

we can do in terms of prevention?

EG

Yeah, there's a number of things. And so I would start with good exercise. Don't smoke.

Limit alcohol intake. Eat healthy exercise. Those are all things that really decrease inflammation

and decrease those signals to the cells that become cancer.

Cancer fundamentally is our cells that have a change in them. As we grow older, our cells

change. That's normal.

Sometimes they change so much that they become uncontrolled. They grow uncontrollably.

And when that happens, it usually is called cancer.

And then we can have cancer form in different types and different organs and things like that.

And those are things that often happen in humans. And we want to minimize that effect or

prevent it if at all possible.And so smoking is something that's been going on for very long, thousands of years if not

longer. But it does cause cancer, increases your risk of cancer. And so we aggressively over the

last 50 years have decreased smoking rates.

And that's decreased cancer rates, including lung cancer, pancreas cancer, and other cancers.

Sun exposure is directly linked to melanoma and other skin cancers. And so both of my

children, I'm very aggressive.

In the summertime when they're at camp and whatnot, they wear a lot of sunscreen, myself

included. As you can see here, I have a beautiful, smooth head here, not quite as protected as

yours from the sun. And so every day I put on sunscreen because I don't want to get skin

cancer of my beautiful head here and have to have a surgeon like myself do something there.

I'm being a little facetious, but the idea of taking a little action to prevent cancer I think is really

important. There's other things with nutrition. A high-protein diet with vegetables are

important.

I try not to obsess about the next fad diet. I think healthy eating is healthy eating. But

fundamentally, avoiding things that look, I don't want to say too good, but if it looks good, be

careful how much you eat.

I think it's unrealistic to say don't eat anything. A little chocolate is quite all right. I still drink

coffee.

But I do think that being able to live a good, enjoyable life is important for a lot of people that it

means eating a lot of food. It doesn't mean we always have to eat every bit of fat and grease

and dessert and all this stuff that lots of people do. Right.

AW

The corollary to that is if you don't like it, say like steamed broccoli, then you can eat as much of

it as you want.

EG

Absolutely. Well, I think there's also a trick to sort of find out what you like. So for example, my

family and I, I especially really like spinach.

And so we'll try to eat more spinach. We also found that grilling is something I enjoy grilling

outside. Like we mentioned, it's snowing right now, so not today.

But during springtime and summer, we grill a lot. And generally, you can be a little bit healthier

where it's not fried, it's grilled. And so little things can be done in your home to make things

just a little bit healthier.

I think that matters.

AW

All right. So let's suppose you have, I don't know, a 60-year-old guy. He's got a lump on his neck.

He goes to the doctor. I don't know. Let's do a CAT scan.

They do the CAT scan. There's a lump in the neck. I don't know.

Somebody's going to have to biopsy it somewhere, maybe ENT because it's the neck. Neck's

kind of a no-man's land, right? It could be kind of anybody who gets to biopsy.

EG

Shared responsibility. So there are general surgeons that go there. ENT is certainly in that

neighborhood.

Some surgical oncologists operate on the neck. It depends on who's in your neighborhood, so

to speak.

AW

All right. Well, and the bad news is it's cancer. So should that patient just go to the surgeon or

whoever did the biopsy and say, okay, take it out, or should they go to a cancer center?

How do they know?

EG

I think it's really important that really what you're asking, what the patients ask is, how do I

know that I'm getting the right treatment at the right time for the right thing? And that really is

about multidisciplinary care. More and more cancers, almost all cancers, patients with almost

any cancer benefit from having a multidisciplinary care.

And so you want to see a medical oncologist who's a cancer doctor who does care with

chemotherapy. And you want to see a surgeon, whether it's a general surgeon or a surgical

oncologist or an ENT, depends on exactly where it is, but someone who has experience and has

taken care of patients like yourself multiple times before. And you want them to talk and get

together.

And to have that collaboration usually requires a cancer center type setup or close

collaboration. And both are available in Memphis and both are fantastic. But those are the

questions you want to ask is, and I have to be a little careful how I say this, all patients are

special, but you don't want to be too special.

You don't want to be too unique. And your care team never seen or heard of anything like this

before. And that really is what expertise comes down to.And I think that's important. I think having a team that's collaborates and works together and

communicates is really important. And that they get together in the same room or in this case

now it's virtual.

So I'm involved in multidisciplinary tumor boards or conferences every week. And it's made up

of surgical oncologists and medical oncologists and radiation oncologists and radiologists and

geneticists and lots of other healthcare providers where we discuss patients and their cancers

and discuss what the treatment is. There's also something called the National Comprehensive

Cancer Network.

And this is an organization that the University of Tennessee where I'm on faculty belongs to.

And we're about 30, there's about 33 or 34 institutions in the country that get together at least

once a year, often more frequently. So you discuss the best available evidence and data that's in

hand and publishes essentially guidelines that different insurance companies use and patients

use and doctors use to help guide therapy.

These aren't meant to replace that doctor-patient relationship, but how to generally approach

each of these cancers. And this is a fantastic resource. It's free.

And obviously I enjoy being part of this. I enjoy being on the cutting edge of care and learning

about this with my colleagues. And those are things that you want in a healthcare provider,

someone who's up to date on the resources, up to date on the information, up to date on the

clinical trials, can provide that expertise of all types, chemotherapy, surgery, radiation, anything

in between.

AW

All right. So I think we've established that healthy lifestyle, regular checkups and cancer

screenings. And if it turns out that is something you have, you want to make sure that you're

getting state-of-the-art care from your physician or ask your physician to refer you to a center

where there's a whole bunch of people that do this kind of thing every day.

Does that sound right? That's right. All right.

Well, Evan, this has been an informative conversation for me. Is there anything you'd like to

add?

EG

I'd say thank you very much for the invitation. It's great to see you again and chat with you for

more than five seconds in the hallway. And thanks for the opportunity to share some of this

information with the world.

And I think this is a great venue to sort of talk about the art of medicine, the art of surgery,

perhaps, art of surgical oncology.

AW

Dr. Evan Glazer, thanks for joining me on the art of medicine. Thank you. And now a final

thanks to our sponsor, locumstory.com.

Locumstory.com is a free, unbiased educational resource about locum tenants. It's not an

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Andrew Willner. See you next time.

This program is hosted, edited, and produced by Andrew Willner, M.D., FACP, FAAN. Guests

receive no financial compensation for their appearance on the art of medicine. Andrew Willner,

M.D., is associate professor of neurology at the University of Tennessee Health Science Center,

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