Treating And Preventing Cancer
Interviewed by Melissa Moniz
Wednesday - December 30, 2009
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Dr. Danny Takanishi
Surgical Oncologist
Where did you receiving your schooling and training?
I’m a kamaaina. I was born and raised in Honolulu. I went to school through the public school system, graduating from McKinley High School. Subsequently, I went on to UH-Manoa for my undergraduate studies. Initially, I wasn’t sure that I wanted to be a physician, so I became a medical technologist. I then decided to go to medical school and attended the John A. Burns School of Medicine. I completed my general surgery residency training here and obtained board certification by the American Board of Surgery. Then I entered a surgical critical care fellowship program to gain expertise and additional board certification in the care of traumatically injured patients and diseases that require intensive unit care. After all of this, given that cancer care was always an abiding interest, I further
decided to pursue cancer surgery specialty training, so I went to the University of Chicago, completed the additional training, and was recruited to serve on the faculty there. I came back to Hawaii in 2001 to assume the responsibility of chair of the Department of Surgery at JABSOM.
Can you mention your professional titles?
Well, the three that immediately come to mind are the chair of the Department of Surgery of the medical school, the program director of the Surgery Residency Training Program, and the director of Surgical Clinical Research at The Queen’s Medical Center. I am also an active cancer surgeon. I also serve as the chair of the Hawaii Medical Board, in addition to serving on a number of national committees related to cancer care, medical education and accreditation.
What have been the biggest or most significant changes within your field since you first started practicing?
Although I think there have been some significant improvements in available drug treatments for various types of cancers, I believe the key areas that have been looked at more carefully involve early detection (when cancers are curable) and prevention.
There have been some significant breakthroughs here. A pill called Tamoxifen, for example, has been shown to prevent the development of breast cancer in high-risk women. There also is research being directed toward identifying individuals who are at risk for the development of certain cancers, and these investigations have the potential to allow for earlier detection of cancer development. Clearly, currently available treatments are not 100 percent curative, so the goal is to detect cancers earlier when they are curable - and better yet, to prevent cancer from developing to begin with. There’s a lot of exciting research going on in these areas.
What types of cancers usually require surgery?
In general, historically, whenever cancer was detected, surgery was the initial step in treatment (and sometimes the only step) because effective treatments in the form of drugs (such as chemotherapy) and radiation were not available. Over time, it has been found that many cancers are not best treated by surgery alone or as the first step, and many cancers are better attacked with a combination of different types of treatments that may also include drugs and/or radiation. For example, for certain cancers, sometimes treating with chemotherapy and/or radiation first assists in shrinking the tumor, which makes it easier to remove with surgery. So surgery is now used in a much more selective manner than in the past. Most cancers, if diagnosed early, are removable by surgery. There are exceptions, such as cancers of the blood, which include the leukemias or lymphomas. Cancers of the skin, breast, thyroid or other endocrine glands, chest or abdominal cavity are generally treated by surgery first. A person is generally not taken to surgery if diagnostic studies we do before surgery show that the cancer has spread to other organs. In these situations, those individuals would only undergo surgery to define exactly what the tumor is (or how it might react to drug or radiation therapy) by doing a biopsy procedure, but they would not undergo a more complex major operation.
Can you talk about minimally invasive surgery and how those types of procedures have changed the way you treat patients?
Minimally invasive surgery has gained widespread acceptance and earned a permanent position in the surgical treatment of many diseases and disorders over the past decade. As the technology improved, what ended up happening is that literally every body cavity became amenable to minimally invasive surgical procedures. As a result, many cancers also are undergoing treatment applying minimally invasive surgery technique. The recovery time is faster, and pain control tends to be better. Cosmetically, it actually makes a difference (smaller incisions), but often-times people with cancer are not so concerned about cosmesis. I think the important feature is that when you compare it to the traditional open surgical techniques, there are no differences in complication rates or survival when performed by individuals properly trained.
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