Surgical Oncology

Overview

“You have cancer.” These three words often cause an eruption of emotions. For newly-diagnosed cancer patients, it can be overwhelming to try to understand everything there is to know about treatment and quality of life side effects. If you or someone you love has been diagnosed with cancer that may require surgery, you need an experienced, compassionate surgical oncologist who can offer you the best treatment options available. One thing you can be assured of is that the team of eight experienced, compassionate surgical oncologists  with UofL Physicians – Surgical Oncology can offer them the best treatment options available.

Not only have these surgical oncologists trained at the top cancer centers in the world, they have dedicated their lives to staying at the forefront of cancer care. UofL Physicians – Surgical Oncology offers more than unsurpassed technical surgery, it’s surgical oncologists who also provide thoughtful, compassionate care that considers the biology of the disease, as well as the overall needs of the individual patient from the time of diagnosis to full remission. Treatment decisions are made in conjunction with multidisciplinary teams of experts weekly, to ensure optimal treatment timing and effect.

The surgical oncologists work hand-in-hand with the other cancer specialists throughout the country, region (Kentucky, Indiana, Illinois and West Virginia), as well as UofL Health – James Graham Brown Cancer Center in multidisciplinary teams, including breast, gastrointestinal, liver, pancreas, esophageal, gastric, endocrine and melanoma.

Treatments & Services

Breast Cancer

Breast cancer is the leading cause of cancer among women and the second leading cause of cancer-related deaths. Great strides have been made in diagnosis and treatment in the past two decades through clinical trials. Breast cancer surgery continues to evolve. It was less than half a century ago when a radical mastectomy was the only option for women with breast cancer. With continued research and innovation, however, much has changed and results continue to improve.

With the adoption of screening mammography and increased public awareness, many women now find breast cancer in its earliest stages, often before it becomes invasive. Patients may now have minimally invasive biopsies done with a needle under local anesthetic. These biopsies are precise, often targeting the lesion in question using either mammographic (stereotactic) or ultrasound guidance. Women have numerous options for the surgical management of breast cancer – from breast-conserving surgery to skin- and occasionally nipple-sparing mastectomy with immediate reconstruction.

UofL Physicians – Surgical Oncology is dedicated to helping our patients make informed decisions. We understand that there can be tremendous confusion and anxiety among newly diagnosed breast cancer patients. With multiple treatment options available, it can be difficult to navigate through a confusing maze of specialists and advice. Working with our colleagues in medical oncology, radiation oncology, breast imaging and plastic surgery at the UofL Health –  James Graham Brown Cancer Center, we focus on the needs of each patient and simplify the process.

Learn more about breast cancer care at UofL Health – James Graham Brown Cancer Center.

We offer the following for the diagnosis and treatment of breast cancer:

  • Partial mastectomy/lumpectomy.
  • Conventional, skin-sparing, and nipple-sparing mastectomy.
  • Sentinel node biopsy
  • Axillary lymph node dissection
  • Breast ultrasound
  • Intraoperative radiation therapy
  • Same day Genetic testing for hereditary breast cancer
  • Infusion port placements and removals
  • Access to Clinical Trials

Colon Cancer

Cancer of the large intestine (colon and rectum) is an aggressive cancer that may be associated with difficulty having bowel movements, bleeding, bloating, and pain. It requires a coordinated treatment plan that includes surgery, chemotherapy and radiation therapy. It is very important that the proper lymph node surgery be combined with the colon or rectal surgery. Many patients with rectal cancer need preoperative (before surgery) chemotherapy and radiation. Many patients may be able to avoid a permanent colostomy with the properly coordinated treatments.

Metastatic colorectal cancer (mCRC) is a common and deadly disease that until recently had few effective treatment options. The past decade has ushered in several exciting advances in the fight against mCRC. UofL Physicians – Surgical Oncology is using many of these discoveries. For example, we were the first to optimize the use of commination chemotherapy and drug eluting beads in metastatic colorectal cancer. It involves microscopic beads delivering chemotherapy right to the tumor. They are injected through that catheter directly into the tumor. Up until now, these tumors were highly resistant to this particular drug, but when delivered in this fashion, it’s extremely effective. The beads can be used alone but depending on the size of the tumor, it can be more effective when combined with other therapies. There are several benefits to using the microscopic beads loaded with chemotherapy. One is it is less toxic, meaning fewer side effects for patients. The other is it is also less invasive because it’s an outpatient procedure. It is designed for patients with a high risk for surgery and those for whom surgery would not be of any benefit.

We offer the following for the diagnosis and treatment of colon cancer:

  • Resection (surgery) of the colon and rectum
  • Extended lymph node dissection
  • Minimally invasive surgery, including laparoscopic and robotic colon and rectal surgery and liver resection and ablation
  • Very-low anterior resection/coloanal resection (removal of very low rectal cancers with preservation of the anal muscle function and avoidance of a permanent colostomy)
  • Pelvic exenteration for very advanced or recurrent rectal cancer

Endocrine Tumors

Endocrine tumors are common and can cause problems for a patient by making hormones that affect the body in a negative way. In addition, endocrine tumors can be malignant (cancerous) and can spread to lymph nodes or other locations. Some endocrine tumors tend to occur together and run in families. Early diagnosis and treatment can prevent the spread of cancer or the negative effects of hormones on the body and can sometimes lead to the early diagnosis and treatment of other family members. For this reason, a tumor of the thyroid, parathyroid or adrenal glands should be fully evaluated by a surgeon with experience in the area of endocrine tumors. UofL Physicians – Surgical Oncology has the only fellowship trained endocrine surgeon in Louisville. In addition to traditional surgery, minimally invasive surgery is often possible.

Thyroid Surgery

The thyroid gland is a butterfly-shaped gland located in the front of the neck just above the collarbones. The thyroid gland makes hormones that regulate the body’s metabolism. Many people have nodules, or growths, in the thyroid gland. A thyroid nodule can be discovered if a person notices a lump in the neck, or if a doctor feels a lump in the thyroid during a routine physical exam, or even incidentally on imaging done for other reasons. Thyroid nodules usually are evaluated with an ultrasound and a biopsy using a fine needle if necessary. Most thyroid nodules are benign. Surgery can be performed if a benign nodule causes symptoms.

Pressure and/or difficulty swallowing or breathing can result from the nodule pressing on other structures in the neck. Anxiety, insomnia, tremor, weight loss, and heart palpitations can result if a thyroid nodule produces too much thyroid hormone. Some thyroid nodules are cancerous, and surgery is usually the first treatment. Lymph nodes may need to be removed at the time of surgery.

Other therapies, such as radioactive iodine, may be necessary after surgery. A certain type of thyroid cancer (medullary thyroid cancer) occasionally can run in families. The prognosis for thyroid cancer is often excellent if it is diagnosed early and the appropriate treatment is given. Therefore, it is important to have a surgeon with experience in thyroid surgery. Studies have shown that especially in thyroid and parathyroid surgery, complication rates are lower when the surgery is done by a high-volume surgeon (>50 thyroid surgeries per year).  Therefore, a tumor of the thyroid, parathyroid, or adrenal glands should be fully evaluated by a surgeon with experience in the area of endocrine tumors.  UofL Physicians – Surgical Oncology has the only fellowship-trained endocrine surgeon in Louisville.

Parathyroid Surgery

The parathyroid glands are tiny rice-sized glands located behind the thyroid in the neck. Most people have four parathyroid glands, although the number and location of parathyroid glands can vary considerably from person to person.

The parathyroid glands make a hormone called “parathyroid hormone,” which regulates the level of calcium in the blood. When one or more parathyroid glands enlarge or develop a growth, too much parathyroid hormone is produced and the calcium level in the blood becomes too high. This is called hyperparathyroidism. Hyperparathyroidism can cause kidney stones, osteoporosis, stomach ulcers, and pancreatitis. It also can cause other symptoms such as fatigue, mental fogginess, body aches, sleep problems, and depression.

Hyperparathyroidism occasionally can run in families. Surgery is the only treatment that can provide a cure. Because the parathyroid glands are often difficult to find, specialized imaging studies are usually necessary before surgery, and it is important to have a surgeon with experience in parathyroid surgery.  Studies have shown that, especially in thyroid and parathyroid surgery, complication rates are lower when the surgery is done by a high-volume surgeon (>50 thyroid surgeries per year).  Therefore, a tumor of the thyroid, parathyroid, or adrenal glands should be fully evaluated by a surgeon with experience in the area of endocrine tumors. UofL Physicians – Surgical Oncology has the only fellowship-trained endocrine surgeon in Louisville.

Adrenal Surgery

The adrenal glands are triangular-shaped glands that lie on top of each kidney. The adrenal glands make a number of different hormones that are necessary for the body to function properly. For example, the adrenal glands produce cortisol and aldosterone, which are steroids that help the body regulate blood pressure and the levels of salt and potassium in the blood. The adrenal glands also produce adrenaline and other related substances that give the body strength, speed, and alertness, especially during an emergency.

Small tumors in the adrenal glands may not cause symptoms and often are discovered when a patient undergoes an imaging study of the abdomen (such as a CT scan or MRI) for another unrelated reason. Some tumors are nonfunctional but need evaluation to rule out cancer, which is rare but possible. Other tumors are discovered because they produce too much of a particular hormone. If too much cortisol is produced, a patient may experience thin skin that bruises easily, purplish stretch marks on the abdomen, fatigue and excess fat over the upper back, around the abdomen and in the face. If too much aldosterone is produced, a patient may experience high blood pressure, fluid retention, low potassium levels and weakness. If too much adrenaline is produced, a patient may experience high blood pressure, sweating, headaches, rapid or irregular heartbeat, anxiety or panic, spells of paleness or dizziness, tremors and weight loss.

Surgery to remove the adrenal gland is necessary if too much of a hormone is being produced or if there is concern for cancer. Although adrenal cancer is very rare, it is often aggressive and requires a coordinated treatment plan that may include surgery, chemotherapy and radiation therapy. It is important a surgeon with experience in adrenal surgery evaluate any tumor of the adrenal gland. A tumor of the thyroid, parathyroid or adrenal glands should be fully evaluated by a surgeon with experience in the area of endocrine tumors.  UofL Physicians – Surgical Oncology has the only fellowship-trained endocrine surgeon in Louisville.

For more information about Endocrine Surgery and to access the AAES (American Association of Endocrine Surgeons) patient information site, please click here.

Esophageal Cancer

Cancer of the esophagus is an aggressive cancer that may be associated with difficulty eating, swallowing and pain. It requires a coordinated treatment plan that includes surgery, chemotherapy and radiation therapy. It is very important that the proper lymph node dissection (surgery) is combined with the surgery, and that proper timing of the radiation, chemotherapy and surgical therapy be done by doctors that frequently treat esophageal cancer. UofL Physicians – Surgical Oncology has highly skilled, experienced surgical oncologists who frequently treat esophageal cancer. We offer the following for the diagnosis and treatment of esophageal cancer:

  • Esophagogastrectomy (removal of the end of the esophagus and the first part of the stomach)
  • Extended lymph node dissection
  • Preoperative (before surgery) chemotherapy and radiation
  • Laparoscopic esophageal and gastric resections
  • Endoscopic management of Barrett’s Esophagus
  • Endoscopic management of benign and malignant strictures

Gastric / Stomach Cancer

Cancer of the stomach (gastric cancer) is an aggressive cancer that may be associated with difficulty eating and abdominal pain. It often requires a coordinated treatment plan that includes surgery, chemotherapy and radiation therapy. It is very important that the proper lymph node surgery be combined with the stomach surgery. We offer the following for the diagnosis and treatment of gastric cancer:

  • Total and subtotal gastrectomy (removal of the diseased stomach)
  • Extended lymph node dissection
  • Laparoscopic Esophagogastrectomy (removal of the end of the esophagus and the first part of the stomach)
  • Robotic Gastric Resections

Gastrointestinal Stromal Tumors (GIST)

Gastrointestinal Stromal Tumors (GIST) are cancers that may be associated with swelling, difficulty eating, bloating, bleeding and pain. GIST are uncommon and often require a coordinated treatment plan that includes surgery and chemotherapy. It is very important that the proper surgery be performed. We offer the following for the diagnosis and treatment of GIST:

  • Resection (surgery) of GIST
  • Laparoscopic and Robotic Surgical Resections

Peritoneal Surface Cancer & Pseudomyxoma Peritoneii

Cancer of the peritoneal surface (from the appendix, colon or the lining of the abdominal cavity) and pseudomyxoma peritoneii (a mucus producing tumor of the appendix that causes large amounts of mucus to collect in the abdomen) are complex diseases that are best treated with a multidisciplinary approach and often require aggressive removal of the tumor and heated chemotherapy delivered into the abdomen in the operating room. We offer the following for the diagnosis and treatment of Peritoneal Surface Cancer & Pseudomyxoma Peritoneii: 

  • Resection (surgery) of the tumor
  • Hyperthermic intraoperative chemotherapy (HIPEC)

Please find our published articles on this topic demonstrating the advanced care that we provide.

Intestine Cancer

Cancer of the intestine (small intestine) is an aggressive cancer that may be associated with difficulty eating, bloating and pain. It requires a coordinated treatment plan that includes surgery and sometimes chemotherapy. It is very important that the proper lymph node surgery be combined with the surgery. We offer the following for the diagnosis and treatment of intestine cancer:

  • Resection (surgery) of the intestine
  • Extended lymph node dissection
  • Laparoscopic and robotic intestinal surgery

Liver Cancer

Liver cancer is a malignant tumor that may cause jaundice (yellow skin and eyes), pain, weight loss or remain asymptomatic. It has a very aggressive growth pattern and must be treated by experienced physicians. Liver cancer requires a coordinated treatment plan that sometimes includes surgery, chemotherapy and radiation therapy. Many liver cancers spread from the liver (colon is the most common) or arise (start) from the liver, including hepatocellular carcinoma, gallbladder and cholangiocarcinoma.

UofL Physicians – Surgical Oncology has been on the forefront of pioneering new treatment options for patients with liver cancer. We were the first to optimize the use of commination chemotherapy and drug eluting beads in metastatic liver cancer. It involves microscopic beads delivering chemotherapy right to the tumor. They are injected through that catheter directly into the tumor. Up until now, these tumors were highly resistant to this particular drug, but when delivered in this fashion, it’s extremely effective. The beads can be used alone but depending on the size of the tumor, it can be more effective when combined with other therapies. There are several benefits to using the microscopic beads loaded with chemotherapy. One is it is less toxic, meaning fewer side effects for patients. The other is it is also less invasive because it’s an outpatient procedure. It is designed for patients with a high risk for surgery and for those which surgery would not be of any benefit.

An exciting treatment technique that is being studied by our surgeons is minimally invasive liver resection. Resection of malignant liver tumors is the most effective treatment available. UofL Physicians – Surgical Oncology possesses the experience and knowledge that is critical to successful liver resection. We have performed many liver resections and have special interest in laparoscopic and robotic (minimally invasive) liver resection. In fact, our surgical oncologists are leading the effort to study laparoscopic liver resection for cancer on a national level. This minimally invasive technique may allow many patients with malignant liver tumors to receive the most effective treatment available (liver resection) while minimizing pain and recovery time. We are delighted to offer this treatment to our patients.

We offer the following for the diagnosis and treatment of liver cancer:

  • Laparoscopic Microwave ablation and Irreversible Electroporation of liver tumors
  • Microwave Ablation uses heat to destroy the tumor without removal
  • Irreversible electroporation (uses small electrical impulses to kill the tumor while preserving normal liver tissue structure)
  • Laparoscopic and Robotic Liver resections
  • Hepatocellular Cancers
  • Cholangiocarcinoma
  • Metastatic Colon and Rectal to the Liver
  • Metastatic Neuroendocrine (from the Appendix, Small bowel, Colon, Stomach, Lung, and Other locations
  • Other Metastatic Disease to the liver (i.e. Breast, Sarcoma, etc.)
  • Laparoscopic Management and Treatment of Benign Liver Tumors
  • Hemagiomas
  • Adenomas
  • Focal Nodular Hyperplasia
  • Cysts
  • Extended lymph node dissection
  • Preoperative chemotherapy and radiation for tumor downsizing (shrinking)
  • Precision trans-arterial chemoembolization with drug-eluting chemotherapy beads
  • Precision Radiation Bead Therapy (Theraspheres or Sir-Sphers)

Learn more about liver cancer care at UofL Health – James Graham Brown Cancer Center.

Melanoma

Melanoma, the most lethal form of skin cancer, is the fifth most common cancer in American men and the seventh most common in American women, killing more than 8,000 Americans annually. Melanoma is an aggressive cancer that may be associated with changes in a mole, a skin tumor, and drainage from a mole. Melanoma can spread very early to the lymph nodes and then to the rest of the body. It is very important that the proper surgery be performed.

UofL Physicians –  Surgical Oncology is part of the UofL Health – James Graham Brown Cancer Center’s Multidisciplinary Melanoma Team, which takes a multidisciplinary approach to the delivery of cancer care with the region’s pre-eminent team of experts in the field. We tailor our treatment plans to each patient’s needs and take a coordinated, multidisciplinary approach to care. We offer a wide range of services, including screening, diagnosis and treatment options, for patients at every stage of melanoma. In addition, patients who have been treated elsewhere are offered follow-up or second opinions/options. We provide patients with melanoma and other skin conditions the latest and preferred treatment options. Patients with melanoma can go to one location — our multidisciplinary clinic — to see all the medical experts they need on the same day — instead of multiple appointments at multiple locations. They leave with a treatment action plan and answers — right away. We offer the following for the diagnosis and treatment of melanoma:

  • Resection (surgery) of melanoma, including sentinel lymph node biopsy
  • Lymph node dissection for metastatic melanoma
  • Isolated limb perfusion for advanced melanoma
  • Resection of metastatic (spread) melanoma, including liver, pancreas, intestine

Learn more about melanoma care at UofL Health – James Graham Brown Cancer Center.

Pancreatic Cancer and Pancreatic Endocrine Tumors

Pancreatic cancer begins in the tissues of your pancreas, which is a large organ that lies behind the lower part of your stomach. Your pancreas, which is about six inches long, secretes enzymes that aid digestion and hormones, including insulin, to help your body process sugar. The pancreas, which is a very important part of your body, also makes pancreatic juices that contain enzymes to help digest food. The liver, intestine and other organs encircle the pancreas.

Pancreatic cancer occurs when cells in your pancreas develop genetic mutations. These mutations cause the cells to grow uncontrollably and to continue living after normal cells die. The collection of cells can form a tumor. There are different types of cells that can develop, and it is important to identify the cells to help assess the best treatment. Types of pancreatic cancer include:

  • Adenocarcinoma, which is cancer that forms in the pancreas ducts. Cells that line the ducts of the pancreas help produce digestive juices. The majority of pancreatic cancers are adenocarcinomas (75 percent). Of these types of cancer, the most common are ductal adenocarcinomas. About 65 percent of pancreatic ductal cancers arise in the head, neck or uncinate part of the pancreas; 15 perfect originate in the body or the tail of the gland; and 20 percent involve the whole gland. Another type of adenocarcinoma is cystic neoplasms.
  • Endocrine cancer, which is cancer that forms in the hormone-producing cells. Pancreatic endocrine tumors are rare tumors that may produce excess hormones (causing high blood sugars, low blood sugars, ulcers) and sometimes are cancerous. They require a coordinated treatment plan that includes surgery and rarely chemotherapy and radiation therapy. It is very important that the proper lymph node surgery be combined with the surgery and doctors that frequently treat tumors of the pancreas do that surgery.
  • UofL Physicians –  Surgical Oncology was the first to perform Irreversible Electroporation (IRE) with the Nanoknife System to treat locally advanced pancreatic cancer in the Southeastern United States. A locally advanced pancreatic cancer has grown beyond the confines of the pancreas to invade surrounding vital areas. Patients with locally advanced pancreatic cancer have limited treatment options. The current standard of care is chemotherapy with radiation therapy. Only 5 percent to 8 percent of patients respond to that type of treatment, and the results are not long lasting. While using ablation to treat these types of cancers has been used, it can cause major complications to the area. IRE is a non-thermal ablation technology that has been shown to be safe near vital parts of the body. UofL Physicians – Surgical Oncology has published and determined that IRE is safe and effective in the multidisciplinary treatment of locally advanced pancreatic cancer.

To learn more about the Nanoknife, click here.

We offer the following for the diagnosis and treatment of pancreatic cancer:

  • Pancreatic resection (surgery)
  • Extended lymph node dissection
  • Combined pancreatic and liver surgery (when the tumor has spread to the liver)
  • Laparoscopic and robotic pancreatic resection options are available
  • Irreversible Electroporation

Learn more about pancreatic cancer care at UofL Health – James Graham Brown Cancer Center.

Sarcoma

Sarcoma is an aggressive cancer that may be associated with swelling, formation of a lump or tumor and pain. Some sarcomas are on the arms or legs, while others are on the chest, abdomen, or even deep inside the abdomen. Sarcomas are very rare and often require a coordinated treatment plan that includes surgery, chemotherapy, and radiation therapy. It is very important that the proper surgery be performed. Some patients with sarcoma need preoperative (before surgery) chemotherapy and radiation. Most patients are able to avoid radical amputations with the properly coordinated treatments.

We offer the following for the diagnosis and treatment of sarcoma:

  • Resection (surgery) of arm, leg or trunk sarcomas
  • Preoperative chemotherapy or radiation therapy
  • Intraoperative radiation (during surgery)
  • Resection of retroperitoneal sarcomas
  • Isolated limb perfusion (chemotherapy delivered directly to the tumor)
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Gary C. Vitale, M.D.

Specialty Areas: Surgical Oncology | Cancer

Primary Practice Location

UofL Physicians – Surgical Oncology
UofL Health - Chestnut Street Outpatient Center
401 East Chestnut Street, Suite 710C
Louisville, KY 40202
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Lauren E. Bahm, APRN

Specialty Areas: Surgical Oncology | Cancer

Primary Practice Location

UofL Physicians – Surgical Oncology
UofL Health - Chestnut Street Outpatient Center
401 East Chestnut Street, Suite 710C
Louisville, KY 40202
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Charles R. Scoggins, M.D., MBA

Specialty Areas: Surgical Oncology | Cancer

Primary Practice Location

UofL Physicians – Surgical Oncology
UofL Health - Chestnut Street Outpatient Center
401 East Chestnut Street, Suite 710C
Louisville, KY 40202
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Amy R. Quillo, M.D.

Specialty Areas: Surgical Oncology

Primary Practice Location

UofL Physicians – Surgical Oncology
UofL Health - Chestnut Street Outpatient Center
401 East Chestnut Street, Suite 710C
Louisville, KY 40202
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Prejesh Philips, M.D.

Specialty Areas: Surgical Oncology | Cancer

Primary Practice Location

UofL Physicians – Surgical Oncology
UofL Health - Chestnut Street Outpatient Center
401 East Chestnut Street, Suite 710C
Louisville, KY 40202
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Kelly M. McMasters, M.D., Ph.D.

Specialty Areas: Surgical Oncology | Cancer

Primary Practice Location

UofL Physicians – Surgical Oncology
UofL Health - Chestnut Street Outpatient Center
401 East Chestnut Street, Suite 710C
Louisville, KY 40202

Accepted Insurance

UofL Physicians participates in most major health plans in Kentucky. Coverage may vary by specialty. Coverage limitations are dependent on the terms of your personal health plan. This is not a guarantee that all services you receive will be covered by your health plan. Review your health plan provider directory and/or consult with your plan to confirm coverage.

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