Palm Beach Florida Weekly

Surgeon brings new hope for cancer patients



Dr. Shanel Bhagwandin returned home to South Florida last September just in time for Hurricane Irma.

The storm didn’t scare away Dr. Bhagwandin, a graduate of Deerfield Beach High School in Broward County and Florida Atlantic University in Palm Beach County. He knows Florida and, more importantly, he knows how to treat cancer.

It was at Deerfield Beach High where his interest in science helped propel him into and through the school’s rigorous International Baccalaureate (IB) program. An interest in medicine was sparked, and he subsequently went on to complete medical school in Bradenton, Fla., at Lake Erie College of Osteopathic Medicine.

“That’s sort of what drew me to surgery, the anatomy of the human body. Everything has a name but recognizing all the different variations makes you anticipate it that much more when you’re operating,” Dr. Bhagwandin said.

Now, he is a distinguished cancer surgeon at Jupiter Medical Center in North Palm Beach. The fellowship trained surgical oncologist also is an assistant professor in the Division of Surgical Oncology at the Mount Sinai Hospital in New York and the Medical Director for the Surgical Oncology Network for Mount Sinai in Florida.

“I’m here on behalf of Mount Sinai, and we are providing first-class surgical cancer treatment right here in South Florida,” Dr. Bhagwandin said.

Dr. Bhagwandin is board-certified in complex general surgical oncology by the American Board of Surgery. He is one of only seven certified specialists in all of Florida and the only one in Palm Beach, Martin, St. Lucie and Indian River counties.

His focus is on gastrointestinal cancers such as those of the liver, pancreas, bile ducts, stomach, intestines and peritoneum. He also treats uncommon tumors such as sarcomas, GISTs and adrenal cancers.

Dr. Bhagwandin brings to his practice for treating cancer a technique likely not well known to many patients or their families. It is also not readily available throughout the country, and until you learn of a cancer diagnosis and this potentially life-saving treatment option, you may not realize how much benefit it can offer. It is called HIPEC.

The medical terminology can be daunting, but Dr. Bhagwandin, his colleagues and staff can explain it in everyday English or Spanish. He speaks both. His family comes from Guyana, a small country in South America. Guyana is the only South American country in which English is the official language.

Now, with a background in medicine and expert surgical oncology training at the Mount Sinai Hospital in New York City, Dr. Bhagwandin is well suited to Palm Beach County. And he brings expertise in new innovative protocols for treating advanced malignancies such as the HIPEC procedure.

What is it?

HIPEC is an acronym for Hyperthermic Intraperitioneal Chemotherapy. Hence, the letters HIPEC. Intraperitioneal refers to the process by which chemotherapy is delivered directly to the abdominal cavity.

Before it is administered, surgeons such as Dr. Bhagwandin, will use standard operating techniques to remove every visible tumor from the peritoneal cavity that can be removed. That is called cytoreductive surgery.

The majority of cancers within the abdomen can spread, or metastasize, to the peritoneum. This is a layer that covers all of our abdominal organs and the underside of the abdominal wall, and it is at risk for tumors to deposit on or invade into other organs. This commonly affects the surfaces of the liver, intestines, diaphragm, spleen, and even abdominal wall scars from previous surgeries.

Once Dr. Bhagwandin has removed all visible tumors, the abdomen is perfused with heated chemotherapy as a one-time treatment in order to also destroy the nonvisible cancer cells that often can lead to the disease coming back. This treatment, in combination with surgery, can increase the chances of long-term survival, remission, or even offer a complete cure.

HIPEC surgery is complex and intense. It often lasts six to eight hours and with limited availability and expertise, patients often have to travel out of state or across their home state to find a specialist and pursue treatment. A chance at cure is often what most patients are seeking, and although HIPEC cannot definitively provide that in every case, it can certainly improve their chances of living longer and even living longer without cancer. That’s better than standard chemotherapy options for metastatic cancers that originate from the appendix, colon, rectum, ovaries and peritoneum, such as mesothelioma.

The most aggressive treatments currently available won’t be as successful in treating certain cancers they aim to rival. Understanding the disease process and patient selection is what makes this procedure successful, and the knowledge and experience of how to determine that is a key component of the HIPEC program at Jupiter Medical Center. Particularly when treatment options for metastatic cancers have been limited locally, it’s important to develop a strategy of when to implement this kind of surgery because there are patients who will live longer with treatment than they would otherwise.

Dr. Bhagwandin trained under other expert surgical oncologists at the Mount Sinai Hospital in New York, where the highest volumes of this kind of procedure are performed in the Northeast. He is currently on faculty there and he confers regularly with his colleagues there about local patients and their current treatment plans as well as alternatives to therapy and clinical trials.

It’s all about the patients for Dr. Bhagwandin and the entire staff at the Jupiter Medical Center. He understands the fear and shock that comes with a new cancer diagnosis. He knows patients and their loved ones want to know as much as they can as soon as they can about the disease.

Now Jupiter Medical Center and South Florida have the HIPEC procedure.

“I feel I can offer some improvement,” Dr. Bhagwandin said.

The procedure improves the chance of improving survival for some patients. He knows all cancer patients deal with the same initial, psychological shock.

“It’s very frightening to know that you have an advanced cancer that has limited treatment options,” Dr. Bhagwandin said.

But HIPEC offers another option.

“The procedure allows us to directly target these tumor cells with higher doses than chemotherapy delivered through an IV (intravenous route),” Dr. Bhagwandin explained.

It also offers another benefit.

“This occurs with minimal exposure and side effects to the rest of the body because of the limited absorption of the chemotherapy systemically.”

Patients with cancer that spreads throughout the abdomen have a marked deterioration in quality of life and shortened survival. This is often measured in months in part due to bowel obstructions, fluid accumulation, and an overall debilitated state with accompanying weight loss. Chemotherapy can have some improvement in symptoms, however, it is short lived due to poor penetration into the peritoneal cavity.

There are, of course, countless variables in medicine and being evaluated by an expert like Dr. Bhagwandin is an important consideration for any patient with peritoneal spread of their cancer. In many cases, HIPEC offers more than just hope.

“We can offer a treatment option that actually improves survivability and individualize care to each patient in order to achieve that,” Dr. Bhagwandin said.

Dr. Bhagwandin and the Jupiter Medical Center, in partnership with the Mount Sinai Hospital, facilitates an important multidisciplinary approach to cancer care. He participates weekly in teleconferences on a secure network with other cancer surgeons and specialists at Mount Sinai where they review his patient’s cases in conjunction with other local oncology experts and figure out the most effective way to treat them.

“Cancer is obviously very complex, and we have to adapt when the ‘standard’ treatment fails,” Dr. Bhagwandin pointed out.

The multidisciplinary cancer conferences with other experts at a wellrecognized cancer center helps Jupiter Medical Center doctors navigate complex cases patients that live here locally in South Florida. Since initiating this program at Jupiter Medical Center, Dr. Bhagwandin and his colleagues at Mount Sinai review images and pathology on a case-by-case basis in order to make appropriate cancer treatment recommendations.

Dr. Bhagwandin often reminds himself that these cases are not mere scientific puzzles.

“This is a person in front of you,” Dr. Bhagwandin said. “What would you do if it were a family member?”

He likes connecting with patients.

“This is a journey we embark on together,” he declared.

Now, Dr. Shanel Bhagwandin’s journey has brought him back to South Florida, back home.

“It’s been wonderful being back home, and to be able to contribute to the already excellent care our patients are getting,” Dr. Bhagwandin said.

And no hurricane is going to scare him away. ¦

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