Darrin Godin: Hello, and welcome to Talking Hope. I'm your host, Darrin Godin. Today, I'm speaking with Dr. Amir Esparza. Dr. Esparza brings expertise in robotic and minimally invasive colorectal cancer surgery, as well as the treatment of related benign and malignant diseases. As an assistant clinical professor, his research focuses on robotic surgery innovation, particularly remote surgical techniques that expand access to expert care. Dr. Esparza practices at City of Hope Orange County's academic cancer campus in Irvine, and at City of Hope Seacliff in Huntington Beach, part of our Orange County network of advanced cancer care. Welcome to Talking Hope, Dr. Esparza. We're so glad to have you with us today.
Dr. Amir Esparza: Thank you so much, Darrin, for inviting me. Thank you.
Darrin Godin: Well, I'd love to get to know you a little bit and have our audience understand who you are and what brought you into the field of medicine. So can you take us back and talk about what drew you to become a physician and specifically what called you to get into the specialty of cancer care?
Dr. Amir Esparza: Absolutely. It's a long story beautiful and it brings back memories, but I was born in a household where my parents were both physicians, and from the time they were in medical school, their whole life was dedicated to service. And they will go and do mission trips and medical mission trips and go around Ecuador. They met in Ecuador in medical school. My mom is originally from Iran and my dad is from Ecuador. And when I was born, they were already doing a lot of service trips. And I could remember very clearly when I was around eight or nine years old, I was actually taken to one of these mission trips and I really fell in love with the goal and spirit of service. And it really attracted me to do that and I couldn't really imagine any other way to directly serve humanity that it wasn't through medicine.
So my dad is an anesthesiologist, and I am the firstborn and I was his right hand and helping him out and going through the ORs. And mainly it was kind of like the way he would have the nurses take care of me because at that time we didn't have nanny or anyone family around too. So he would just take me to the hospital and hang out. But I got really close to the operating room and I felt really safe and happy there. And from day one of medical school, I knew I wanted to become a surgeon. And after many years I am where I am. I'm very happy with the position I'm now.
Darrin Godin: Wow. What a rich history of both parents being in the medical field, not just demonstrating what you can do as a physician, but I liked what you talked about about service to others and really taking care of people. So say more about what you learned from your parents, watching them and how that influences the way you practice today and the way that you take care of patients.
Dr. Amir Esparza: Absolutely. And that, it continued and now it's over 30 years, 35 years it was a foundation now and we provide medical care to the different countries South America this year 2026 mission trip is into the Amazon of Ecuador. So I'll be going there mainly just to help with the logistics and translations and stuff like that. We're not actively doing surgery there, but it's mainly primary care, but I've been part of it for a long time. And then to answer the question about colorectal, when you do surgery, you want immediately changes. And I feel like the thing that distresses the most people is cancer. And giving the hope of relieving and removing the cancer with surgery and having an immediately response or immediately change in their lives is a very humbling task. And with a lot of preparation now and with the rise of colorectal cancer now, I'm really using my skills to provide that care and that service for sure.
Darrin Godin: So let's talk about that a little bit. You mentioned the rise in colorectal cancer, and we are seeing and the statistics are showing that even younger folks are getting cancer, specifically colorectal cancer, so people below the age of 50, which is a newer occurrence for us. So are you seeing that in your clinic? And if you are, what are some of the reasons you think that we are seeing that and what concerns you about that?
Dr. Amir Esparza: Reasons we can't really pinpoint right now. It's a multifactorial disease related to environmental factors and diet. Very rare we have these related to family. The majority of patients are sporadic cancers that occur without any family history. The problem we find that is not all of them give symptoms. So especially in young adults where you're pretty otherwise healthy and active, it's hard to believe or understand that something like that could be happening. So that's why there's subtle signs that we could see diagnosed early because otherwise the screening test now is 45 years old, but we're definitely seeing a rise in the twenties and thirties, and all of them start with a subtle change. So that's why you have to be very aware of our body and our health.
Darrin Godin: Talk to us about what some of those subtle changes might be.
Dr. Amir Esparza: So subtle changes and change to the shape of the stool, some rectal bleed, abdominal pain, some changes on their appetite, fatigue, weight loss, some things that can be related to that. And that's why you have to make sure you have an overall care for it.
Darrin Godin: When you talk about changes in stool, let's talk about what does that mean? Does that mean prolonged constipation? Does that mean diarrhea? Does that mean a change in what stool looks like? Obviously blood in the stool, people would recognize what that is, I would think, but maybe you want to talk about a little bit what that means. Is it red blood? Is it dark blood? Are there things that we should be looking for?
Dr. Amir Esparza: That's a very, very good question because you can imagine that the majority of actually patients, the majority of the population, especially in the United States, suffer with chronic constipation directly related to diet. A lack of fiber will create that. And change in the habits means that if you have the same kind of diet and then suddenly you start having constipation, difficulty having a bowel movement, the change of the shape of the stool, become more thinner and smaller, especially associated with rectal bleed, is something that we have to pay attention to. If you're noticing some changes, especially constipation because you change the diet, we'll make sure you start having a high fiber diet, but if these symptoms persist despite you changing your habits and paying attention to what you eat, you definitely have to seek for help.
It is really hard to diagnose especially early stages changes with imaging or blood tests. The gold standard is a colonoscopy, which is a very simple 15-minute procedure that you don't feel, remember anything and it really can gives a significant amount of information and a peace of mind. Because if it's negative and you don't have any family history, technically you could wait 10 more years and then you for sure blame other problems like hemorrhoids or diet or constipation, stuff like that.
Darrin Godin: And when you talk about the gold standard being the colonoscopy, there are things on the market, drugs on the market or tests on the market that are non-surgical or I guess non-invasive like taking the Cologuard or something like that. What are your thoughts on that and where is that appropriate versus asking your doctor to order the colonoscopy?
Dr. Amir Esparza: So there's different type of screening tools that we have. As I said, the colonoscopy is a gold standard and then there's other ones that they check the tool. The problem is that there could be a false negative and the false negative could up to 15% of the tests, meaning that you could have a problem and it just came back negative. So that's why it's important to do this test, if you choose to do so, frequently. Some of them require you to do that once a year, once every other year or once every third year. Now if it comes positive, you need to get a colonoscopy.
If you go ahead and do a straight up colonoscopy, you will for sure be able to see if there is any abnormal mucosal or polyps or diseases. And the benefit of doing a colonoscopy is that we can take care of them at the same time. Colon cancer starts with a small outgrowth of tissue that we call them polyps and then they keep growing within their lumen of the colon. But when we see them during the colonoscopy, we can remove them and prevent that growth on becoming cancer in the future. So it's a very, very incredible test for sure.
Darrin Godin: Let's talk about research. Let's talk about clinical trials and the things that maybe you're involved in or things that you're excited about that are on the horizon, especially here at City of Hope that are making a difference for patients who are diagnosed or will be diagnosed in the future with colorectal cancer. What are some of the things that excite you about the research and clinical trials that are being offered now?
Dr. Amir Esparza: I am very excited at City of Hope now that I'm surrounded by geniuses, I will call, there. It's a multidisciplinary approach where colon cancer is one of the examples where you need multiple experts in the field for one patient. And that's what we call multidisciplinary tumor war or multidisciplinary approach, meaning that when a patient comes with a diagnosis of colorectal cancer, the majority of them will see all of the specialists the same day. So it really excites me because there could be a new trial on radiotherapy, new trial on chemotherapy, new trials on immunotherapy. Personally, I'm not guiding those trials in terms of medications, but I am definitely in the upfront on surgery. So there's a completely different world in surgery where we are very, very excited with the technology that has improved, especially in minimally invasive surgery.
At City of Hope, I was gladly made aware a few days ago that we purchased the new SP robot. It's called a single port robot. Basically, it's a robot where you just need a 2.5 centimeter incision. It's a little bit over an inch. We're articulating arms in a camera open inside the cavity and perform surgery like that. So we can individually move each of the arms as well as the camera with a 360-degree view and definitely really good for transanal procedures as well as intraabdominal.
So as you may know, up to 20, 30 years ago, the only way to do colon surgery was open, meaning having a long incision. And we have evolved onto laparoscopic surgery, now robotic surgery and the robotic consult, the DV5, it came out two years ago, we have it available at City of Hope. I believe we have three robots and those are multiple, meaning that they're four little arms. Amazing for different type of procedures, but now with SP as well, we are very happy to have it in our arsenal and be able to use it appropriately. And I'm very, very excited for that.
Darrin Godin: Well, that's a great thing that we have the technology and then we also have the expertise of surgeons like yourself. So talk to us a little bit about your specialty, the things that you do that you're really excited about and the things that you know are making a difference for your patients that you can offer as a colorectal surgeon.
Dr. Amir Esparza: Absolutely. I think it's really important being offered a minimal invasive procedure. So just to broadly understand about the treatment of colorectal cancer, we divide the colon directly in different ways to treat. In general, colon cancer without metastases will need upfront surgery. And rectal cancer without metastases will need the majority of them up-from chemotherapy or radiation or a combination of both and then surgery. So what excites me about my job, especially for the colon cancer part is that, when we do surgery, first of all, it has to be quick. We are very excited to have multiple operating rooms in our hospital and availability where we can get in patients very quickly and offer the surgery, but about the surgery is the minimal invasive approach. We have the experience and the capacity of performing very, very advanced surgery with very fast recovery, meaning that with an average of one to two days after these big surgeries, patients are able to go home and within two weeks start their therapy.
So if you could imagine, this is only feasible if it's done with small incisions. Chemotherapy may delay or may complicate the healing process if the incisions are bigger. So if you're able to do small incisions and have the patient get up and go back to pretty much regular activities, they'll be stronger to receive the chemotherapy after. Not everyone will need chemotherapy after, but the people who need chemotherapy after is essential the timing. Is obviously much better to start within a month versus within six months of the surgery. So that really, really excites me. And the second thing, we're surrounded by other subspecialties. We have high level of hepatobiliary surgeons, high level of gynecologists and urologists that sometimes we combine cases and do it.
The most common site of metastases for colon cancer is the liver. So we have implemented a program where we do these minimal invasive surgeries in a combination with a hepatobiliary surgeon where they will remove the piece of the liver that has cancer and will remove the colon at the same time. And when you do this in a combined fashion and a minimal invasive fashion, patients get to go home again within the next two, three days versus in historically, these will procedures that will be done separately, both of them open and both of them with a long recovery time.
Darrin Godin: Wow. So shorter treatment time, shorter recovery time, or quicker-to-recovery time, it sounds like. That's pretty amazing. Dr. Esparza, I know you speak a few languages. [Spanish 00:16:36]. You speak Spanish and Farsi as well. And I know that I've heard you talk about how those communities are important to you. And can you talk to us a little bit about when you are able to communicate to a patient in their native tongue, what that means for them and how that's important to them?
Dr. Amir Esparza: Absolutely. I am honored and lucky to have that advantage of communicating with them directly into their language. I was born and raised in Ecuador, I'm pretty fluent in Spanish and in a household where my mom is Iranian, is Persian, my home was literally living in Iran. I was being raised in Farsi and the culture in Farsi and obviously outside, the school, everything was in Spanish. So that really, especially for colorectal cancer, it's a very sensitive subject.
The whole idea of someone getting cancer, any type of cancer is very shocking. And I always share this with the patients that I have not met a single person who is okay with that. You could be the president of the company or the mayor or any worker, no one takes that news easy. It's a very hard news, a very hard notice to be aware of. So when you are able to explain that in your own language, it makes a difference. Because, as you know, the process of receiving such a big news comes with denial and then it comes with the understanding. And on those stages of this new diagnosis, you are there and explaining it in Spanish. Because a translator is not the same. I've literally been there when the translator is translating Spanish. It's not just the language, it's just the feeling and the culture. I know in Orange County there's a big population of Persian community and I've been lucky to meet a lot of referral providers as well as patients and as well, I'm very comfortable with that.
Darrin Godin: Well, I think that goes back to how you started the conversation earlier about how you grew up with this idea of service to the community. I think not just being the physician with the expertise, but also being able to communicate in a way that communicates that service and care for someone in their native tongue, as well as understanding maybe some of the cultural sensitivities that go with that, things we normally would talk about or wouldn't talk about. I'm sure those things also are translated better through you directly rather than through a translator. So thanks for talking about that. We definitely do have a very multicultural society and community here in Orange County. And so it's exciting to have physicians like yourself who can bring the expertise, but also bring understanding for those communities to their own cultural needs and desires and preferences and so forth.
Dr. Esparza, I want to ask you a question that we ask everybody on the podcast, which is what does the idea or the concept of hope mean to you?
Dr. Amir Esparza: Hope is, I think it's embedded energy that we have all in our body that needs to emerge, that needs to open and needs to have power. And normally that's given with support. You get that support through many venues, I would say. The most common venue is spiritual. The connection with God, the connection with the other being is one of the venues you will get strength in your spirit and hope. But then as well, your surroundings, you get hope from your doctors, you get hope from your family members, from your friends. So that combination of spiritual and as well professionals as well as friend is what will fill up this quote-unquote "energy tank" and keeps us going. Keeps us going, keeps us fighting and hopefully curing.
Darrin Godin: I like that. Hope fills up that energy tank. I like it. I like it. Well, before we let you go, what is a message that perhaps you have for our audience and those that are watching this podcast or hearing this podcast? What would you want them to walk away with, especially thinking about maybe a new cancer diagnosis or that they have a suspicion of something's going on in their body? What would you say to them?
Dr. Amir Esparza: That they are not alone. They should look for help, ask for help. In the event you are diagnosed with cancer, go to a comprehensive cancer center, City of Hope, one of them, and fill up that hope, energy hope with professionals who are board certified and highly proficient with what they do. And don't be afraid of having second opinion, third opinion, fourth opinion. Just embrace the knowledge. And when you have made a decision, you have to leave everything to trust, to God and to your doctor. And then I think that's one of the reasons I think we are here as humans to take care of each other. We're all brothers, so look for that help and you'll find it for sure.
Darrin Godin: Well, thank you, Dr. Esparza. We have often said about City of Hope that, when we take a patient's hand, we never let go and I could see that in you and I feel that in you and I think our listeners and those that are watching the podcast can see that you're more than just a physician. You care about people at the very core, and that is something that makes City of Hope very unique because you're also not alone in that. You have so many colleagues that across the City of Hope system are just like you and care about people at a very deep level and want to make sure that they have access to the most advanced cancer care in the most compassionate way, but also in the most innovative way. The most challenging a way is to look for the cures and to continue to pursue those cures no matter what. And so we thank you for being a part of our medical staff and taking good care of our patients.
Dr. Amir Esparza: Thank you.
Darrin Godin: And thanks for joining us today on Talking Hope. We really appreciate you spending the time with us.
Dr. Amir Esparza: I really appreciate it. I had a great time. Thank you so much, Darrin.
Darrin Godin: Great. Thank you. We'll see you next time. Thank you. What a great conversation with Dr. Amir Esparza. It's an exciting time to be here at City of Hope as we bring the full continuum of advanced cancer care to Orange County and beyond on our 72-acre academic research campus solely focused on cancer prevention, treatment and cures. To make an appointment or learn more about City of Hope Orange County, visit us at cityofhope.org/oc or call us at 888-333-4673. I'm Darrin Godin. Thank you for making the time to join us today on Talking Hope and we'll see you next time.