On The Road Again
A complex urologic cancer case meets its match.
Sometimes experts need experts. As a member of the Mayo Clinic Care Network, St. Clair Health can provide patients with second opinions from Mayo Clinic specialists—without the need to travel for them. Patients are able to continue their ongoing care right in the South Hills at no additional cost.
While each cancer diagnosis usually has an existing framework for a course of treatment, no individual case can ever be considered routine. Other factors always come into play, and doctors must draw on their own expertise and their patients’ preferences to choose the best possible plan of attack. For Shailen S. Sehgal, M.D., a urologic surgeon with St. Clair Medical Group, one patient’s recent diagnosis doubled the complicating factors in choosing a course of action. “Sometimes, the more challenging part is coming up with a plan,” Dr. Sehgal says. “With the advanced technology we have and the expertise we have using it, we’re extremely confident in that aspect, but the key is planning out exactly how, when, and where we utilize it.” That was the case with Dean Santo Colombo, a patient in his mid-50s. “I thought I had a kidney stone,” he says. “It turned out to be a whole lot more major than that.
That was tough to take at first.” Dean met with Dr. Sehgal, who after an exam in his office decided that more testing was needed. Shortly thereafter, Dean was diagnosed with a large tumor in his ureter, one of the tubes leading from the kidneys to the bladder. Additional diagnostic tests also revealed a tumor inside the bladder itself. “Now we had two areas we were concerned with that require very different approaches,” Dr. Sehgal says. “Not only did we have to decide the best strategy for each one, we had to decide which one to prioritize while being cognizant of how we would treat the other.”
“Through the whole thing, Dr. Sehgal has been my contact and advisor– as well as my surgeon. He kept me informed the whole way, and I feel like I’ve been personally involved in the care I’ve received.”
In conjunction with the medical oncology team, Dr. Sehgal put together a plan to cauterize and excise the bladder tumor first, administer systemic chemotherapy to treat the ureteral tumor, and then remove the ureter, kidney, and a larger portion of the bladder. But before discussing this course of action with the patient, Dr. Sehgal sought one more consultation—with the urology team at Mayo Clinic.
“I consulted with a Mayo Clinic urologist, explained the approach that we wanted to take, and he felt that our plan was completely viable,” Dr. Sehgal says. “This level of clinical collaboration is rare and critical to patient success.” “That wasn’t me asking for a second opinion, that was something Dr. Sehgal did on his own,” Dean recalls. “He felt like he wanted every resource that he could have at his disposal and he used them. If that doesn’t give you confidence in your doctor, I don’t know what does.” “That type of clinical collaboration helps to build a high level of trust,” adds Dr. Sehgal. “When the patient knows they have an expert team of surgeons and oncologists working together—and on top of that, a second opinion from a highly-regarded institution like Mayo Clinic—that reinforces their confidence in us and in the outcomes we’re hoping to achieve.”
After first cauterizing and removing tissue from the bladder tumor for biopsy, the St. Clair team’s solution included two surgical techniques. The first was a laparoscopic procedure using the robotic-assisted da Vinci® Surgical System to remove the kidney and ureter. “Urology is a unique field in that a number of surgeries are done with a robotic technique. Visualization is better, we can magnify more definitively, and we felt that was the best option for this stage of the plan,” Dr. Sehgal says. Dr. Sehgal then employed a more traditional incision technique as the most thorough approach for removing a part of the bladder to determine if the ureter tumor had spread further. After those tests came back with negative margins, the next phase of the patient’s treatment began.
On November 1, Dean began the process of receiving six treatments with BCG (Bacillus Calmette-Guérin) to combat his bladder cancer. Originally developed as a vaccine to help prevent tuberculosis, BCG has proven effective as immunotherapy in battling bladder tumors. BCG causes an immune system reaction that directs germ-fighting cells to the bladder, attacking the tumor. At St. Clair Health’s Dunlap Family Outpatient Center, the treatment is given via catheter and takes only 30 to 60 seconds. Patients are usually able to go home in just 10 minutes. “Overall, the prognosis is very good,” Dr. Sehgal says. “Obviously, we’re going to keep an eye on it, but right now, it looks like we’re going to be successful.” “I’m feeling good,” says Dean, a truck driver for 37 years. “That was a major operation and I’m back at work. I owe that to Dr. Sehgal.”
“St. Clair invested in the newest robot last year. It’s the most advanced technology offered anywhere. The fact is: at St. Clair Health, our patients receive tertiary level surgical care from physicians that are easily accessible to them. It’s truly advanced care close to home, and that’s a unique combination.”
COLLABORATION, COMMITMENT & PATIENT-CENTERED CARE
Throughout Dean’s experience, developing a close doctor-patient relationship has been the key. “Through the whole thing, Dr. Sehgal has been my contact and advisor—as well as my surgeon,” he says. “I’m pretty amazed at the amount of contact I’ve had with him. He kept me informed the whole way, and I feel like I’ve been personally involved in the care I’ve received.” Dr. Sehgal joined the St. Clair team in 2013 following six years at University of Pennsylvania Health System. Going from a large urban health system to a community-based system was a welcomed transition. “One of the key benefits of a hospital that is truly embedded in the communities it serves is that patients have much better access to their physicians—they’re more involved in the process. If they have a question, it’s easy to get in touch with a doctor or member of the staff to get an answer,” he says. “I can’t say enough about the people,” Dean adds. “The doctors all discuss the case together and come up with the best plan for me. It’s not just one mind at work—it’s the whole group working together. The same-day surgery folks were awesome and the nurses were great. I really got great care.”
Dr. Sehgal is particularly proud of St. Clair’s relentless effort to provide his urology team with everything it needs to consistently deliver the highest level of care. “One of the unique things at St. Clair is that we have five urologists who all do cancer surgery—and we all work very well together. The organization has a very strong commitment to ensure that we have the best tools to work with in order to provide high-quality treatment options to our patients.” In Dean’s case, that included the most up-to-date iteration of the da Vinci® System. “St. Clair invested in the newest robot last year. It’s the most advanced technology offered anywhere. The fact is: at St. Clair Health, our patients receive tertiary level surgical care from physicians that are easily accessible to them. It’s truly advanced care close to home, and that’s a unique combination,” Dr. Sehgal says.
SHAILEN S. SEHGAL, MD
Dr. Sehgal earned his medical degree at Cornell University and completed his urology residency training at the University of Pennsylvania. He completed a research fellowship at the National Institutes of Health and a robotic surgery fellowship at the University of Pennsylvania. Dr. Sehgal is board-certified by the American Board of Urology. He practices with St. Clair Medical Group.
To contact Dr. Sehgal, please call 412.942.4100.