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have all those factors lined up so you could give a proper assessment and then reevaluate it aer, before the surgery. So you go over all your cases the day before, night before with your team to make sure that you would be as successful as possible with those measures in place. VUE: Some of the types of cancers that you specialize in are uncommon or difficult to diagnose/treat. Is there anything in particular that you do to ensure that your patients have the best chance they can? DR. MCCAIN: I see a wide variety of GI malignancies, you know gastric, small bowel, colon, as well as pancreas and liver. So for the abdominal based cancers, and I do a lot of skin cancer surgery as well, and we get very unique types of skin cancer as well, but again, it's before you proceed, at the end of the day, you want to look at the biology, you want to do multidisciplinary conferences where we go over these pieces so then you have the medical oncologists, radiation oncologists, surgical oncologists on the board so you can then discuss all aspects of the care, whether the patient needs immuno-oncology treatment over chemotherapy, even look at genetics of these tumors to see if there's implications for families, etcetera. So these are all things that we do up front to make sure that the patients get the best care. It's not just you know, proceeding with surgery so the multidisciplinary conference with 40 other doctors having an input on that patient's care does offer a lot opportunities including pathology review. VUE: One of your specialties is metastatic cancer. Micrometastases are o€en difficult to detect because of their small size. Do you find a driving motivation behind your work to be the advancement of medical technology and knowledge to be able to detect them earlier, thus increasing the livelihood of thousands of patients? DR. MCCAIN: Right so, ideally what we want to do, and we're not there, but there's different options for labeling early cancer. Circulating tumor DNA is probably one of the better options because with cpDNA, once we could get the circulating tumor DNA for a variety of different, not just colorectal cancers, but different cancers. You could use that as maybe an eye for treatment for the simple reason that say for a PET CT scan without 8 mm cubed worth of disease, you wouldn't pick that out. Now if someone had much earlier micrometastatic disease, then you want to know that, but based on our limitations for imagery, a lot of it is sometimes, an MRI will pick up a 2 mm at least lesion in the liver, still very sensitive, but again, you're not catching it on that truly microscopic level. So the circulating tumor DNA once it's sort of advanced more and there are more options for other cancers than just colorectal, I think that's where you'll lead now. e extrapolation of that, the localization of where that micrometastatic disease is, whether it's in the liver, lung, or somewhere else, that's gonna have to rely on much more, maybe antibody labeled technology, to give you an insight to where anatomically the site is. VUE: Given that cancer is one of the leading causes of death in the U.S., how do you find the medical field's ability to keep up? DR.MCCAIN: To me, it's somewhat rapid in the immuno- oncology realm where I think a lot of resources are being put. A lot of chemotherapeutic agents haven't changed much over the years so I think the idea of immuno-oncology seems to be more where people have focused for obvious reasons. With chemotherapy in general, you're trying to kill the cancer faster than you're killing the patient right? So having a more patient- specific tailored, whether it's CAR T-cells or whether it's, you know, vaccines for particular antigens of that cancer, but either way, by trying to redirect the immune system to eradicate the cancer seems to be a much more promising methodology for cancer care and also with a better quality of life. So keep in mind, not only do you want to have treatment options, but you have to think that your treatment options should always give the patient the best quality of life. You want to focus on that. I learned that early in life when the patients I had with a big operation. I said, "How are you doing?" and he said, "Well, my eyeballs work." So it gave me a sense early in my career that quality of life is extremely important and it's not how long you live, but how well you live. So even for surgery, if the patient's gonna be terribly debilitated or have a high level of complications, that might not be the best option for that patient as well because clearly, that's what we want to do. I think, honestly, unfortunately a lot of people overlook that and they tend to treat patients like they're some kind of an academic project. I think you have to look at the patient, the family support, the goals of that patient and their family before you proceed with anything so that you could meet all the goals as best you can, rather than just say, "Well, we achieved the goal of getting rid of your cancer," but meanwhile, you're in bed all the time and you can't enjoy life even though you're alive. at's not what I would call the goal. VUENJ.COM 91

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