Ninja Nerds!

In this episode of the Ninja Nerd Podcast, Zach and Rob guide you through diagnosing, staging, and management of gynecological cancers using five high-yield, case-based discussions.

We start with a 58-year-old postmenopausal woman presenting with abdominal bloating, early satiety, and weight loss. The workup, including pelvic exam, transvaginal ultrasound, and CA-125 testing, reveals advanced epithelial ovarian carcinoma with omental caking. We walk through the surgical and chemotherapeutic strategies for both confined and advanced disease, plus the role of PARP inhibitors in BRCA-positive patients, and review complications such as ascites, pleural effusion, and small-bowel obstruction.

Next, we cover a 65-year-old woman with postmenopausal bleeding and a thickened endometrial stripe on TVUS. Biopsy confirms type I endometrial adenocarcinoma. We discuss treatment pathways based on stage—from TAH-BSO for early disease to adding radiation or chemotherapy when risk increases—and highlight complications like anemia and pyometra.

The third case features a 34-year-old woman with postcoital spotting, HPV-16 positivity, and biopsy-proven invasive cervical carcinoma. We break down management options from conization for CIN 2/3 to radical hysterectomy or concurrent chemoradiation for more extensive disease. Key complications, including hydronephrosis and metastatic spread patterns, are also reviewed.

Case four presents a 62-year-old woman with vaginal spotting and malodorous discharge, leading to the diagnosis of primary vaginal squamous carcinoma. We focus on the diagnostic sequence—pelvic exam, biopsy, MRI/PET—and the role of cisplatin-based chemoradiation for localized disease.

Finally, we discuss a 72-year-old woman with chronic vulvar pruritus and an ulcerated labial lesion, diagnosed as early invasive vulvar carcinoma. We highlight the importance of biopsy for diagnosis and surgical excision for cure.

We close by emphasizing a shared approach across all cases: begin with a broad differential, select targeted diagnostics based on presentation, confirm histology, and let stage and patient factors guide treatment—all while anticipating complications.

Let’s get into it, Ninja Nerds!

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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!

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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.

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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!

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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.

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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).

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Ninja Nerds!

In this episode of the Ninja Nerd Podcast, Zach and Rob discuss Colorectal Cancer. This comprehensive discussion focuses on the clinical presentation, pathogenesis, and management of one of the most common malignancies encountered in clinical practice.

We start by breaking down the epidemiology and risk factors, covering both sporadic and inherited forms—highlighting Lynch syndrome and familial adenomatous polyposis (FAP). From there, we analyze the adenoma-carcinoma sequence and key molecular mutations such as APC, KRAS, and p53.

The conversation then shifts to clinical features and how tumor location influences presentation—such as iron deficiency anemia in right-sided lesions and obstructive symptoms in left-sided tumors. We’ll walk through the diagnostic workup, including colonoscopy findings, biopsy, and imaging, and review the role of CEA as a tumor marker.

Finally, we discuss treatment strategies based on TNM staging, including surgical resection, adjuvant chemotherapy regimens like FOLFOX, and the importance of routine screening protocols for early detection.

This episode has high-yield insights to help you excel on exams and confidently approach colorectal cancer in clinical settings.

🎧 Tune in, take notes, and let’s conquer colorectal cancer—one polyp at a time.

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Ninja Nerds!

In this episode of the Ninja Nerd Podcast, Zach and Rob explore the complex world of Brain Tumors. We explore the key types of brain tumors—both primary and metastatic—and examine their clinical implications through high-yield pathophysiology, neuroanatomy, and diagnostic principles.

The discussion begins with an overview of tumor classification, distinguishing between supratentorial and infratentorial masses, and covers the most common tumors seen in adults versus children. Zach then breaks down the characteristic features, origins, and imaging findings of high-yield tumors like glioblastoma, meningioma, schwannoma, and brain metastases—including a patient case involving adenocarcinoma with metastasis to the brain. For pediatric tumors, we highlight medulloblastoma, ependymoma, and pilocytic astrocytoma, focusing on their clinical presentations and radiographic findings.

We’ll also discuss the signs and symptoms associated with increased intracranial pressure, focal neurologic deficits, and paraneoplastic syndromes. Finally, the episode reviews diagnostic strategies and introduces key treatment principles, including surgical resection, radiotherapy, and chemotherapy, depending on tumor type and location.

This episode is packed with clinically relevant material to help you crush your exams and prepare for real-world applications.

🎧 Listen, learn, and laugh as we tackle brain tumors—one neuron at a time.

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Ninja Nerds,
Welcome to the Ninja Nerd Podcast with Zach and Rob! In this episode, we discuss Lung Cancer, a leading cause of cancer-related mortality worldwide. We explore the pathophysiology, risk factors, and key differences between non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) to help you master this complex topic.

Our discussion covers the clinical presentation of lung cancer, including subtle early symptoms like cough, hemoptysis, and chest pain, as well as advanced findings such as pleural effusions, superior vena cava syndrome, and paraneoplastic syndromes.

Finally, we break down treatment strategies based on staging and tumor type, covering surgical interventions, chemotherapy regimens, immunotherapy, and targeted therapies such as EGFR and ALK inhibitors. We also review the latest advancements in precision medicine and the evolving role of molecular markers in guiding therapy.

Whether you’re preparing for exams or rotations or seeking a deeper understanding of lung cancer, this episode is packed with high-yield insights to boost your clinical knowledge and critical thinking.

Enjoy the episode and support us below! 🌬️🫁

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Ninja Nerds,
Welcome to the Ninja Nerd Podcast with Zach and Rob! In this episode, we explore Myelodysplastic Syndrome (MDS), a group of hematologic disorders characterized by ineffective hematopoiesis and a risk of progression to acute myeloid leukemia (AML). We also discuss the pathophysiology of MDS, highlighting the clonal stem cell mutations that lead to dysplastic bone marrow changes and peripheral blood cytopenias.

Our discussion explores the clinical presentation of MDS, from common findings like fatigue, pallor, and bleeding tendencies to more concerning signs such as transfusion dependence and infection risk. We also cover the diagnostic approach, emphasizing the importance of bone marrow biopsy findings such as dysplastic cell morphology, ring sideroblasts, and blast percentages. Key scoring systems like the Revised International Prognostic Scoring System (IPSS-R) are discussed to guide risk stratification and treatment decisions.

In this episode, we break down treatment strategies for both low-risk and high-risk MDS, including supportive care with transfusions and growth factors, the role of hypomethylating agents like azacitidine and decitabine, and advanced interventions such as allogeneic stem cell transplantation.

Whether you’re preparing for exams, clinical rotations, or looking to expand your knowledge of hematology, this episode is packed with high-yield insights to help you understand this challenging topic.

Enjoy the episode and support us below! 🔬🩸

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