Host
Heather Simonsen, MA
Public Affairs Senior Manager
Huntsman Cancer Institute
Clark Gamblin, MD, MS, MBA, FACS
Surgical Oncologist, Huntsman
Cancer Institute
Professor, Chief of the Division of Surgical Oncology, University of Utah
Episode Transcript
Inside Surgical Oncology (00:39)
Heather Simonsen: You're listening to Delivering a Cancer-Free frontier podcast.
Assorted Voices: To create and provide better treatments. Today, we can bring these discoveries and the science-based medicine to people in need around the state, region and the world. I feel like the future is very bright, and I can't even imagine what cancer care is going to look like over the next 50 years. To continue that journey to eradicate cancer from the face of the earth.
Heather Simonsen: Hello, and welcome to Delivering a Cancer-free Frontier. Today, we're talking to one of Huntsman Cancer Institute's physicians.
Clark Gamblin: My name is Clark Gamblin.
Heather Simonsen: He's a professor of surgery at the University of Utah.
Clark Gamblin: And I'm a surgical oncologist.
Heather Simonsen: As you may have noticed from his accent, Dr. Gamblin is not originally from Utah.
Clark Gamblin: Believe it or not, it's much softer than it used to be. I grew up in Mississippi, so I went to undergrad and medical school in Mississippi, did some surgical training in Georgia, which didn't help my accent. And then I spent almost 10 years in Pittsburgh and 15 in Milwaukee.
Heather Simonsen: Do you say y'all?
Clark Gamblin: I do say y'all. I say yes ma'am to a lot of people. Some ladies don't like for me to say yes ma'am. I've tried to minimize it on this talk, but it's just a habit.
Heather Simonsen: Yeah, I'm from Texas originally. So y'all is a good word.
Clark Gamblin: It is.
Heather Simonsen: He came to Huntsman Cancer Institute in 2025 to head up the new surgical oncology group.
Clark Gamblin: You know, I've known about the University of Utah my entire academic career. When I was a medical student in the late 90s, I interviewed here to do a residency, even. And at that time, the Huntsman was in a little glass box, and they were talking about building a cancer center behind the university, and I thought, "wow, that would be a beautiful place to have a cancer center.” And so, they were looking for a leader, and it just seemed like just the perfect time to come and join the group.
Heather Simonsen: On today's episode, we're having a wide-ranging conversation with Dr. Gamblin. We'll discuss some of the specialized surgeries we offer here at Huntsman Cancer Institute, his approach to patient care, and how his own health journey has affected his practice. Let's dive in.
Heather Simonsen: What is a surgical oncologist? How are they different from surgeons?
Clark Gamblin: You know, if you want to give chemotherapy, for example, you have to be a medical oncologist. If you want to give radiation, you have to be a radiation oncologist. But if you want to do cancer surgery, you don't have to be a surgical oncologist. A lot of the cancer surgery in our country is done by very well-trained, well-qualified general surgeons. And so, it's not just that we wanted to do more training, it is that we really wanted to build collaborative efforts in a dedicated cancer center, and we wanted to teach other general surgery residents how to perform cancer surgery. So, it's about thinking about the future of surgery for cancer patients. It's about evolving the therapies, not just practicing what we learned in our training, but continuously learning about what is the next thing, and pushing that envelope a bit, if you will, for cancer patients.
Heather Simonsen: And when would a patient need to see a surgical oncologist instead of, say, a regular surgeon?
Clark Gamblin: Sure, we see a lot of patients that have complex surgical challenges that maybe the general surgeon doesn't see on a routine basis, and so we see a lot of unusual cancers that require a certain level of experience that a general surgeon in the community doing a lot of benign surgery, as well, just might not ever acquire in the course of their career.
Heather Simonsen: And so when you say kind of some rare cases, can you give me examples?
Clark Gamblin: Sure, things like appendiceal cancer or a gallbladder cancer, for example, are seldom seen by a general surgeon. There's certainly some complex surgeries, too, that, although they're not as unusual, they really require additional training beyond general surgery to be able to perform. So, a lot of pancreas surgery and liver surgery, for example, esophageal surgery, or rectal surgery, have evolved to really require either a colorectal surgeon, or a surgical oncologist, or a thoracic surgeon, for example, so someone that's obtained additional training beyond just the five years of general surgery.
Heather Simonsen: So, you're like extra specialized?
Clark Gamblin: A little bit. Yeah, I mean, we are, and we firmly believe it's worth the extra drive to have someone take care of you that has seen and done it many times before, so volume and experience matter, and training matters, I think.
What is HIPEC? (04:46)
Heather Simonsen: For sure, we wanted to ask you about a few different treatments offered here at Huntsman Cancer Institute. Let's start with HIPEC. What does it stand for?
Clark Gamblin: Sure, it's hyperthermic Intraperitoneal chemo profusion. So, it's hot therapy into the abdomen that has chemotherapy associated with it. So, there's really two kind of modes that are fighting the cancer. The heat, in and of itself, damages some of the cancer cells and allows the chemotherapy that's given—also at the same time— to enter those cells and kill some of the cells that we just can't see. The heat of the chemotherapy that we give is about 102, 103 degrees. If you're a metric fan, it's 42. But our country's been a little slow to adopt the metric system, I guess.
Heather Simonsen: True, and so traditionally that is done like by opening the patient up, right? It
Clark Gamblin: It is. There's certain cases where we do it robotically or laparoscopically, but that's really rare. And you'll hear people talk about HIPEC they'll call it CRS and HIPEC. And CRS is cytoreductive surgery. But the goals the operation are to make an incision, often open, and then to strip out any visible cancer or cytoreduce them. Removing all of the cancer following that reduction, while they're still asleep, putting a couple of catheters into the belly, sewing the skin shut temporarily for 90 minutes, and giving heated 102 degree chemotherapy into the belly, bathing the intestines and the areas inside the abdominal cavity with this chemotherapy for 90 minutes, then flushing and washing it all out, taking the catheters out and enclosing the patient. In some instances, this is the only chemotherapy that they'll receive, they won't receive any other chemotherapy. So, it's really been an evolution of removing the cancer, but now also giving the heated chemotherapy at the same setting in the same operation. You can imagine it's a long day in the operating room. It's a six or eight hour operation at least.
Heather Simonsen: Yeah, and so what types of cancer are we talking about, and in what stage patients?
Clark Gamblin: Often it’s stage four cancers, so it's spread beyond where the cancer started to distant organs, and we really consider the peritoneal lining, or the lining of the abdominal cavity, almost an organ in and of itself. Originally, it was appendiceal, ovarian, mesothelioma. We've extended that now to selected patients that have gastric cancer or colorectal cancer. Often we use a laparoscope. So we make a small incision near the belly button to put a camera inside and look around and see how much cancer is there, and can we remove it all? So we almost use like a scan, put the camera aside, look, and then send them home the same day, have them come back and talk to us about the extent of their cancer in their abdominal cavity. Could we strip it all out? Could we give them HIPEC? Are they eligible for something like that?
Heather Simonsen: Yeah, and what does recovery look like for these patients?
Clark Gamblin: Patients are generally in the hospital for about a week. We put them in the ICU the first night, just to make certain that we're giving them enough fluid and their kidneys are well protected, and such. The recovery is usually four to six weeks before they feel back to their normal self. I should just explain, too, a little bit that the patients that are eligible for this therapy, they have disease confined to their abdomen. So, they don't have things outside the abdomen going on, like no lung problems, and they're relatively fit. So, patients that are dependent on oxygen or have had multiple heart attacks or have bad vascular disease may not be good candidates for HIPEC. So, patients that don't have a lot of what we would call comorbidities and have disease confined only to their abdominal cavity, and then with a scope, we've at least assessed them to think we can remove all the cancer.
Heather Simonsen: And what do you say to people who might be a little scared of this?
Clark Gamblin: It's a great question. We approach it with a lot of different kind of opportunities, I think. One, we talk about our wealth of experience here at Huntsman, and you can imagine if you're the first couple of patients that have an operation like that, you'd be extra nervous. And when we say we've done hundreds, literally approaching over 1000 patients that the group has treated, then you recognize that that calms them down some. Secondly, we have, we've been blessed with a lot of patients that have really benefited from the surgery and the approach and are more than willing to talk to someone who might be nervous and instill some confidence in them.
I think most of the nervousness and the anxiety comes from the unknowns, and so information and experience probably calm a patient more than anything, I think. I mean you want to be super transparent with people, you want to share the information with you, you don't want to deny certain challenges of this kind of operation. But you want to make certain that they come in with eyes wide open and their expectations kind of meet our deliverables. If their expectations are very different than what we think of as very good outcomes, then then there's a very different outcome, I think, in their, in their mind. So, just sharing with them our experience, sharing with them some of the patient experiences, sharing with them the goals. And then also the data, there's a lot of good data to support it, and some people want to know that data more than others. But to say to patients, "Hey, there are randomized trials to show you would benefit if we can offer you this therapy. There are randomized trials to show that your quality of life will get better after the operation. I think those are important things to share with patients as well.
Heather Simonsen: Yeah, and you can't get that everywhere. I mean, this is a specialized surgery.
Clark Gamblin: You're right. It's not only a specialized surgery, it's a specialized team. So, you can't just go get a surgeon that can do the operation and say, okay, now we have a HIPEC program, and we can offer this to anyone. You really think about it more as, do we have the anesthesia team, do we have the nursing team, do we have the dietary, do we have the prehab and post-rehab facilities, and do we have the ICU staff? And I mean, it just goes on and on. So, it's not just the surgery. The surgery is a big part of it, but honestly, that's just like one short day in this patient's journey, on their cancer journey, and the rest of our team at Huntsman is really vital, because it's not just the operation.
Heather Simonsen: So, it's like the recovery and the care after is just as important.
Clark Gamblin: It is seldom that we operate on someone that hasn't gotten chemotherapy before. It's seldom that we operate on someone that doesn't see a dietary person before to optimize them, because we really want to put them in the best shape to maximize that intervention of HIPEC.
What is PIPAC? (11:56)
Heather Simonsen: Wow, and there's another one that we're going to be offering called PIPAC. And so similar questions, what does it stand for?
Clark Gamblin: So PIPAC is a laparoscopic approach. So, it's an aerosolized chemotherapy. So again, we're delivering intraperitoneal chemotherapy into the abdominal cavity that's aerosolized, so it's almost like a Lysol spray that has the chemotherapy within it, and it has a few advantages. It does not include the cytoreductive portion, so the cancer is not removed. These are patients that cannot undergo cytoreductive and HIPEC surgery, and unfortunately, those are more patients than we actually offer HIPEC to. We can't remove the entire tumor. And so, by aerosolizing the chemotherapy, we can actually instill it laparoscopically without a big incision, can be done as an outpatient, can be done multiple times. And so, this offers a certain group of patients that before had very few options other than just continuing to receive systemic chemotherapy, a new therapy.
Heather Simonsen: Wow, so are these patients who the cancer is just too far advanced for HIPEC?
Clark Gamblin: That's correct. There are really a couple of things that make a patient ineligible for HIPEC. One, the cancer really involves so much of the small intestines that we cannot remove at all, because you really need some of your small intestines to be able to eat and survive. And secondly, sometimes there's actually cancer around the blood vessels that lead into the liver, and we can't remove some of that disease sometimes, and we cannot sacrifice those blood vessels into the liver. So, the blood vessels into the liver and the small bowel are areas that can make patients ineligible for HIPEC. Again, these are patients that are fit for general anesthetic. They're also have a problem in their abdomen, they don't have a lot of other problems, comorbidities or other problems in their lungs or elsewhere. And because it's done with a band-aid incision with a laparoscope, it can be done several times. So, it can be repeated three or four times, and usually in HIPEC we do it one time. I've done it twice, and I've even done it three times on some patients, but that's a very rare case. And so usually HIPEC is a one type treatment, whereas PIPAC can be done multiple times.
Heather Simonsen: And so, this really is offering hope when there was none before.
Clark Gamblin: Absolutely. So, it's offering treatment for patients that could still receive systemic chemotherapy, perhaps. But the problem with the cancer that occurs in the abdominal cavity, there's really not a good blood vessel to get that chemotherapy where it needs to be. PIPAC and HIPEC are both opportunities to deliver the treatment where it's needed most.
Heather Simonsen: But PIPAC, it sounds like if successful, can restore quality of life, extend life.
Clark Gamblin: Yeah, the goal is to extend quality of life, extend life, and preserve quality of life. So, we get no credit if we put someone in a bed and they can't get their head off the pillow and we've treated their cancer. We want them to enjoy whatever time they have, and we want to push the event of their cancer as far away from them as we possibly can. And PIPAC has been used in Europe for over a decade and really has just gotten traction in the United States in the last year. And we're excited to be really the Mountain West leader for that, so like we've gotten the equipment now, we've assembled the team, we're quite close now.
Heather Simonsen: What other types of procedures do you do?
Clark Gamblin: So, I'm really fortunate that I do a lot of surgery in the abdomen, so I do a lot of liver surgery and pancreas surgery, bile duct surgery. I do some sarcoma and gastric surgery and HIPEC surgery, but we have a big team. I mean, we cover everything from skin cancer and endocrine cancer to breast cancer and colorectal cancer. So, there's over 20 of us in the group that work collaboratively. We commonly operate together and help each other in the operate room. We certainly rely on each other's experience. I cannot tell you what a privilege it is to lead the group.
Heather Simonsen: You talked a little bit about how you put the HIPEC patients at ease. What about these other procedures? I'd imagine that's a big part of it is, you know, helping them understand the risks, helping them understand the benefits, and managing expectations.
Clark Gamblin: No, it's true. I mean, I think that when we talk with patients, we want to put ourselves in their position, understand that they're scared, that they have high hopes, and our clinical excellence is an expectation. It's not a goal. It's what we have to do. So our standard is incredibly high, but I really believe we deal in hope, and hope can only be communicated, you know, by the way we speak to people and the way we communicate with patients. So, taking care of patients, but also taking care of their families, I mean, their families sometimes are more nervous than the patients. Patients can be very brave, and families can be distraught, and our roles as surgeons are not just to take care of the surgery.
Heather Simonsen: Tell me more about that. What do you mean by that?
Clark Gamblin: Yeah, I think that patients are looking for...want confidence in what they do and the decisions they're making. They’re faced with opportunities of different treatment algorithms; they're not necessarily medically educated. It's like we're speaking a little bit of a foreign language when we try to navigate them through the system. And we don't, we're not trying to dumb it down, we're trying to make certain that they understand, though, what we're offering, and that they're an active participant in the decision making.
"I Was Quite a Good Patient, Actually" (17:43)
Heather Simonsen: I’m going to ask a little bit of a personal question, and if you don't want to go there, we don't, we don't have to. But I understand you were also a cancer patient.
Clark Gamblin: So I was. So about eight years ago I was a big runner, and I was running a lot, and I thought maybe I'd had a varicocele, which is just a little blood vessel malformation that guys have sometimes. And I thought maybe I have a little hernia or something, but I have a little mass, and I checked it out immediately, you know, I didn't ignore it. I went and got an ultrasound, and an hour later I was getting a CT, and an hour after that, I was talking to a urologist about having surgery. And I had testicular cancer. And if you looked at the top, the 100 cancers that were most common, it's the most common cancer that occurs in men 14 to 50, easily.
And it's 95% curable when found early, and I was very fortunate that I had a very early-stage cancer. I had a surgery. I took a little bit of chemo, but it wasn't all a bed of roses. I had a recurrence at two years, I'd have a second operation, a bigger operation during the middle Covid. But you know, it is what it is. I was blessed because I had medical knowledge. I can only imagine how terrifying it is to people that have no medical knowledge, and I had a lot of medical knowledge, and I knew I was in a good place, and I was in a very good center to be taken care of. And so, even when I shared with my kids, you know, I told my three kids I had this problem, and my oldest said, “well, Dad, you don't seem afraid, and if you're not afraid, we won't be afraid.” And I thought, wow, that's good, that's comforting as a parent to hear that.
But I've been very blessed in the last six years to have clean scans, and now I have folks that look after me here at Huntsman, and very grateful for that. And so, yeah, my life is... there have been ups and downs, and there been some challenges, but that was, that is not the biggest challenge I faced. And I was a quite good patient, actually. I'd like to brag a little bit. I think my wife was very prepared for me to, you know, torture my medical team, and read all everything, and check my labs, and check my scans, and do everything in. You know the book that you're probably not supposed to do, but I didn't.
Heather Simonsen: Yeah.
Clark Gamblin: I mean, my team was like, "do you want us to do this or do you want us to do that?” They were trying to give me choices, and I said, "I just want you to just do what you think I should do, and I'll do whatever you tell me to do.” And I just built a team I trusted, and then I gave them the reins, and I think that that is a huge part of it. And I'm very, very indebted. I got a chance to go back to Indiana University, where they treated Lance Armstrong and lots of people with testicular cancer, and I gave their grand rounds just a couple of months ago. And the urologist that operated on me came and had dinner with me the night before. It was just special to go back at five years out from cancer and realize how grateful I am that I had a treatable cancer. I found it early. I trusted my team, and they did a fabulous job taking care of me.
Heather Simonsen: It's beautiful.
Clark Gamblin: Yeah, it's great.
Heather Simonsen: Thank you for sharing that.
Clark Gamblin: Of course.
Heather Simonsen: It wasn't always treatable, though. It wasn't always that high of a survival rate. I mean, do you ever look back at that too, and you know, see the research, the cancer research that's going on, and the clinical trials that that lead to breakthroughs like the survival rate of testicular.
Clark Gamblin: It's very true. We see the needle moving in cancers. Larry Einhorn was my medical oncologist. He invented the chemo regimen for testicular cancer. I mean, he literally was the person who put it together through clinical trials and proved it was incredibly curable. We see the same happening in a lot of other cancers we take care of. We see colorectal cancer mortality going down. We see that because we see colonoscopies going up, so we're finding things earlier, perhaps even before their invasive cancers. We see the survival of pancreas cancer being influenced in patients living longer. It used to be that if you told someone you had pancreas cancer, you know people thought this person won't be here in three months. And we see patients living longer and longer. And also, the sequencing of treatments. It used to be that you would charge right to the optic room and operate on everyone who had pancreas cancer, and now we understand giving them chemotherapy, perhaps giving them radiation before surgery benefits the patients, and then we operate on them. So, even the sequencing of the treatments has evolved over the last few years.
Heather Simonsen: And how has that experience changed you as a doctor? Being a cancer patient yourself?
Clark Gamblin: Being a cancer patient is different. You can take care of cancer patients all your life, and if you've never had to have an operation, or you've never been put to sleep, or you've never had chemotherapy, then it's theoretical in your mind. But I will say that, like, until recently, when I raised some funds and some awareness for testicular cancer, I didn't really share it. Like in Milwaukee, I never really shared I was a patient. And maybe I should have, I don't know. I just felt like every patient had their own unique story, and I never wanted a patient to feel like, “oh, my doctor said, you know, don't worry about that, because he didn't worry about it,” or my doctor said...I mean, I've had a great outcome, everyone doesn't get the same outcome I've had, and so I think everyone's journey is different.
And again, as I mentioned, I had so much medical knowledge. There was not a term that was ever said to me in my visits, or in my pre-op, or my post-op, or anything that I didn't know what it meant. I never had to ask a question, really. And I didn't take that for granted, but also didn't think that my story necessarily translated to anyone else's, because every one of them is so unique. I mean, you see some patients coming in without family support by themselves on the journey. You see some, you see panic in some people's eyes. And I was just...I was very fortunate that I had not three things working for me. I had my faith, I had my family, and then I had my friends. And those three things I leaned hard on, and they took me through it, you know. And regardless of the outcome, I was convinced that those three things were in place for me. And family doesn't have to be blood family. We all have lots of family support to lean on if we're really cognizant of it. But I was very, very fortunate to have very strong elements of all three of those pillars.
"The Gift of Communication" (24:25)
Heather Simonsen: Do you take that with you when you're speaking with patients and understand that, like, knowing more and understanding more is going to help them?
Clark Gamblin: I definitely think it does. I think the gift of communication with patients and understanding the language. You know, medical school is like a, it's like vocabulary school. You're learning a foreign language, and residency is like learning how to put those words together and speak it. They haven't done either of those, and I kind of often think about my mom and my dad. They're in their 80s, they're still living. Fortunately, they're in good health, but my dad's an architect. My mom taught fifth grade. They don't know the difference between any of the terms in medicine. So, sitting down with a patient and saying, you have a mass, you have a lesion, you have a spot, you have a tumor, those are all the same thing in many cases. And talking to a patient, these are all the same terms, and you're going to hear them every room you go in to talk to different people, so somebody may use a different term. Just trying to understand that they may be very educated, but not about this. And again, not trying to dumb it down or insult their intelligence, acknowledging their intelligence, and saying, you know, I want to explain it as best I can, and then you let me know the questions you have. I think it's incredibly important.
Heather Simonsen: And I would imagine it gives you greater insight, like you said, you know, knowing it's scary. Like any kind of cancer diagnosis or treatment is scary, right? And so, understanding that does it help you have extra empathy for each patient?
Clark Gamblin: I'm sure it does. I mean, I don't know that it changed me drastically. I had a lot of empathy before. It's one of the reasons I went into surgical oncology, but I'm sure it did. I mean, and we were in clinic today, and I saw patients that maybe the patient looks fine, but the wife is scared to death, you know. And I say, “I know you look scared, I know you're worried.” Just talking about it, even you could tell, and she was very quick to say, "well, we were so grateful we could get in quickly to be seen and have some of our questions answered.” Even if you say, "I don't know, just to be able to ask them meant a lot to us, and you seem hopeful.” And I am. I go to work everyday hopeful, you know? I mean, and do we have some outcomes we wish were better? Absolutely, that's what keeps us, keeps us going. We are striving to get better every day.
Heather Simonsen: Dr. Gamblin, what a pleasure it has been speaking with you today, and how fortunate your patients are to have a doctor who cares so much about them and their families, and who is so skilled and talented as well.
Clark Gamblin: Oh, you're very kind to have me, and I'm the one that's really fortunate. I get a chance to really intervene and help people in the most critical time in their life. So thank you for having me.
Heather Simonsen: Thank you to Dr. Clark Gamblin for joining us today. To our dedicated listeners, we are thankful for your support. For additional resources, be sure to check out the show notes. If you want to stay connected with us and be the first to know about upcoming episodes, subscribe on your favorite podcast platform. Please log on to Apple Podcasts and leave us a five-star review. This helps other people like you find this podcast. If you have questions, comments, suggestions for future episodes, or a personal story you'd like to share, please visit our website, Huntsman cancer.org This episode is produced by Nina Earnest. Theme music composed by Mix at Six Studios. Additional music from Warner Chapell Music. I'm your host, Heather Simonson. A special thanks to the Huntsman Cancer Institute Communications and Public Affairs team.