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• Pancreatic and Hepatobiliary Cancer

  Ninja Nerds!In this episode of the Ninja Nerd Podcast, Zach and Rob explore pancreatic and hepatobiliary cancers through four patient cases packed with clinical pearls.We begin with a 63-year-old man presenting with painless jaundice, pruritus, and weight loss. Zach walks through the differential for obstructive cholestasis, covering malignant (pancreatic head cancer, cholangiocarcinoma, ampullary tumors) and benign (stones, strictures) causes. We emphasize RUQ ultrasound's role in assessing for ductal dilation, followed by pancreas-protocol CT and EUS-guided FNA to confirm pancreatic adenocarcinoma. Management hinges on resectability, with Zach outlining surgical criteria and adjuvant chemotherapy options.Next, we discuss a 58-year-old man with cirrhosis and a newly detected liver nodule on routine surveillance. With an elevated AFP and classic arterial enhancement with portal venous washout on imaging, the diagnosis of hepatocellular carcinoma (HCC) becomes clear. We outline curative options for early-stage disease—including surgical resection and radiofrequency ablation—and review the role of transplant under Milan criteria.Case three features a 48-year-old woman with primary sclerosing cholangitis and rising cholestasis, prompting a focused discussion on perihilar cholangiocarcinoma (Klatskin tumor). We highlight the role of MRCP for mapping strictures, followed by ERCP with brushings to confirm malignancy. With localized disease, Zach walks through surgical resection with liver wedge + bile duct excision, followed by adjuvant capecitabine, and offers guidance on palliative strategies for unresectable disease.Finally, we examine a 72-year-old woman with a porcelain gallbladder and new mass—raising suspicion for gallbladder carcinoma. The case underscores the importance of RUQ ultrasound for polypoid lesions and how staging dictates surgery. For early T1a disease, simple laparoscopic cholecystectomy is curative; deeper invasion requires extended cholecystectomy.We close with a summary of diagnostic strategies: ultrasound for ductal or gallbladder disease, triphasic CT or MRI for liver masses, MRCP for PSC patients, and pancreas-protocol CT for head-of-pancreas tumors. Each case reinforces the principle: start broad, refine with the right imaging, and let stage drive treatment.Let’s get into it, Ninja Nerds!Support the show

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• Esophageal & Gastric Cancer

  Ninja Nerds!In this episode of the Ninja Nerd Podcast, Zach and Rob discuss two high-yield, board-relevant cases highlighting the diagnosis, staging, and treatment of esophageal adenocarcinoma and intestinal-type gastric adenocarcinoma.We begin with a 56-year-old man presenting with progressive dysphagia and unintentional weight loss. Zach breaks down the concern for distal esophageal adenocarcinoma in the long-standing GERD and Barrett's esophagus setting. We walk through the stepwise diagnostic process—starting with barium swallow, followed by EGD with biopsy, and endoscopic ultrasound (EUS) and CT chest/abdomen/pelvis for staging. Based on a staging result of T2 N1 M0, we discuss the standard approach of neoadjuvant chemoradiation followed by transthoracic esophagectomy, with comparisons to management of early mucosal disease and metastatic presentations.Next, we pivot to a 63-year-old woman with chronic Helicobacter pylori gastritis, now presenting with early satiety, epigastric discomfort, and melena. The focus shifts to intestinal-type gastric adenocarcinoma, classically found along the lesser curvature. We review the appropriate use of EGD with biopsy as the first test in alarm dyspepsia, followed by CT imaging and EUS to assess depth and nodal involvement. With a staging result of T1b N0, we emphasize the role of subtotal (distal) gastrectomy with D2 lymph node dissection, and outline when perioperative chemotherapy or palliation (e.g., GOO stents, systemic chemo, trastuzumab for HER2⁺ tumors) becomes necessary.Finally, we conclude with a rapid comparison of the two cases, highlighting shared themes: the importance of depth of invasion, nodal status, and the shift from endoscopic resection to surgical and systemic therapies based on stage.Support us below, Ninja Nerds!Support the show

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• Testicular Cancer

  Ninja Nerds!In this episode of the Ninja Nerd Podcast, Zach and Rob discuss testicular cancer, one of the most common solid tumors in young adult men.We begin with a classic clinical vignette of a young male presenting with a painless testicular mass. From there, we explore the epidemiology and key risk factors for testicular germ cell tumors, including cryptorchidism, family history, and Klinefelter syndrome (in rare cases of nonseminomatous tumors like mediastinal choriocarcinoma). We then distinguish between the two major types: seminomas and nonseminomas—breaking down their unique biological behaviors and typical age distributions.Our discussion dives deep into the pathophysiology of germ cell tumors, highlighting tumor markers like AFP, β-hCG, and LDH, and how they guide diagnosis and treatment. We walk through the classic presentations of seminomas (often β-hCG positive and radiosensitive) versus nonseminomas (associated with aggressive behavior and elevated AFP/β-hCG levels).Next, we focus on the diagnostic workup, including scrotal ultrasound, serum tumor marker analysis, and CT imaging for staging. We emphasize the importance of inguinal orchiectomy as both a diagnostic and therapeutic intervention.Finally, we cover treatment strategies based on stage and histology—ranging from surveillance and radiation therapy for early-stage seminomas to cisplatin-based chemotherapy regimens and retroperitoneal lymph node dissection (RPLND) for advanced or nonseminomatous disease.Don’t miss it—let’s get into it, Ninja Nerds!Support the show

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• Urinary Tract Malignancies

  Ninja Nerds!In this episode of the Ninja Nerd Podcast, Zach and Rob dive into the essential clinical and pathophysiologic features of urinary tract malignancies, beginning with renal cell carcinoma (RCC) and followed by urothelial carcinoma of the bladder.We start with a patient case of renal cell carcinoma, exploring the epidemiology and risk factors such as smoking, obesity, hypertension, and inherited syndromes like von Hippel-Lindau disease. The discussion focuses on the pathophysiology of clear cell RCC, particularly the loss of VHL gene function and dysregulation of the HIF pathway, leading to increased angiogenesis.We review the classic triad of RCC—flank pain, hematuria, and a palpable abdominal mass—along with common paraneoplastic syndromes, including polycythemia and hypercalcemia. Diagnostic evaluation includes CT imaging of the abdomen and pelvis, with treatment strategies ranging from partial or radical nephrectomy to immune checkpoint inhibitors and targeted therapies for advanced disease.Next, we shift to a patient with urothelial carcinoma, highlighting epidemiologic risks like tobacco use, occupational exposures, chronic inflammation, and cyclophosphamide.Clinical signs such as painless hematuria, irritative voiding symptoms, and hydronephrosis are discussed alongside the diagnostic approach: urine cytology, cystoscopy with biopsy, and CT urography. Management strategies include TURBT, intravesical BCG, radical cystectomy, and systemic chemotherapy, based on staging and risk.Support the show

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• Prostate Cancer

  Ninja Nerds!In this episode of the Ninja Nerd Podcast, Zach and Rob break down the essential clinical and pathophysiologic features of Prostate Cancer, one of the most common malignancies affecting men worldwide.We begin with the epidemiology and risk factors, highlighting age, race, family history, and androgen exposure. From there, we explore the pathogenesis of prostate cancer, focusing on the role of androgen receptor signaling.The discussion covers clinical manifestations, including urinary symptoms, back pain from bone metastases, and signs of spinal cord compression. We also examine the utility and controversy surrounding PSA screening, along with digital rectal exam findings and the importance of prostate biopsy for histologic confirmation, emphasizing Gleason scoring and its prognostic significance.Next, we analyze imaging modalities like multiparametric MRI and bone scans, and review treatment strategies based on risk stratification, ranging from active surveillance and radical prostatectomy to radiation therapy and androgen deprivation therapy (ADT).Support the show

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