Podcast with Dr. Roman Meirovich – Colorectal Oncology

Dr. Roman Meirovich:
If I’m honest, it’s usually things that don’t feel alarming at first.

A change in bowel habits.
Constipation, then diarrhea.
A sense that the bowel doesn’t empty completely.

People tend to think, “It’s food,” or “It’s stress,” or “This happens.”

Blood in the stool is another example.
Very often it’s attributed to hemorrhoids.
Even when it keeps coming back.
Even when it’s not just a one-time thing.

I see this a lot in practice. People delay because they don’t want to imagine something serious.
That reaction is human.
But blood in the stool is a reason to get checked — not to panic, just to check.

Sometimes the sign is anemia. Fatigue. A general sense of weakness.
And people don’t connect that to the bowel at all.

The key point is this:these symptoms can have simple explanations.
But when something persists, repeats itself, or becomes the new “normal,” guessing doesn’t help. An examination does.

Dr. Roman Meirovich:
Polyps are, in a way, an early step — a warning sign.

Not every polyp turns into cancer.
That’s important to say right away.
But most colorectal cancers start from polyps.

The issue is that polyps usually don’t cause any symptoms.
People feel fine.
Nothing hurts. Nothing really changes.

And if no one is actively looking for them, they can stay there for years.

That’s why colonoscopy matters so much.
It’s not only about finding cancer.
It’s about preventing it.

When a polyp is found and removed, the process can stop right there.
Cancer never has a chance to develop.

I often tell patients: this isn’t about fear.
It’s about control.
Finding something early and dealing with it is very different from treating a disease later on.

Dr. Roman Meirovich:
When we talk about an early stage, we usually mean disease that is still confined to the bowel wall and nearby lymph nodes — before it has spread to distant organs.

Why this matters is actually very simple.
At an early stage, treatment options are clearer, and the chances of long-term control — or cure — are much higher.

In many cases, surgery can be the main step.
Sometimes it’s surgery alone.
Sometimes surgery followed by additional treatment, depending on the pathological findings.

This is where details become important.
Depth of invasion.
Lymph node involvement.
Margins.

Two patients can both be called “early stage” on paper, but the practical decisions may still be different.

That’s why we don’t treat a stage number.
We treat a specific situation.
And the earlier the disease is detected, the more room we have to choose the safest and most effective path.

Dr. Roman Meirovich:
In colorectal cancer, there are a few molecular markers that really matter in everyday practice.

Most often, we look at KRAS and NRAS mutations, BRAF status, and whether the tumor shows microsatellite instability, or MSI.

These tests are not done “just in case” and not as a formality.
They help us understand how the tumor behaves and, just as importantly, which treatments are unlikely to work.

For example, certain targeted therapies simply won’t be effective if specific mutations are present.
Knowing this early helps us avoid unnecessary treatments and focus on options that make sense for that particular tumor.

MSI status is also important because it can open the door to immunotherapy in selected cases.

So molecular testing is really about precision.
It allows us to tailor the treatment strategy based on the biology of the disease, rather than relying on a one-size-fits-all approach.

Dr. Roman Meirovich:
When the disease is advanced, the goals of treatment become a bit different — and that’s important to say out loud.

We’re usually no longer talking about a single step that “fixes” everything.
We’re talking about control.
About slowing the disease down.
About keeping quality of life as stable as possible.

Treatment decisions at this stage depend on several things.
Where the disease has spread.
How fast it’s progressing.
What treatments the patient has already received.
And, very importantly, how the person is feeling overall.

Sometimes we start with chemotherapy.
Sometimes we combine it with targeted therapy.
In selected cases, immunotherapy becomes an option.

There isn’t one correct path for everyone.
Two patients can have a similar scan and still need different strategies.

At this stage, treatment is often a process, not a single decision.
We reassess, adjust, and move step by step — based on how the disease and the patient respond.

Dr. Roman Meirovich:
In practice, personalized treatment means that we don’t start with a standard recipe and try to fit the patient into it.

We start with the person and the disease in front of us. That includes the stage of the cancer, the molecular profile of the tumor, previous treatments, and also the patient’s general condition and priorities.

For one patient, personalization may mean choosing a treatment that is more aggressive because there is a clear potential benefit.
For another, it may mean a more cautious approach, focused on stability and quality of life.

It also means timing.
When to treat, when to pause, when to change direction.

So it’s not a slogan. It’s a continuous process of adapting the treatment plan as the situation evolves, rather than following a fixed path from start to finish.

Dr. Roman Meirovich:
This is one of the most delicate moments in treatment.

We don’t rely on a single signal.
It’s never just one scan or one blood test.

We look at trends.
Imaging results over time.
Laboratory changes.
And very importantly — how the patient feels.

Sometimes the scan shows progression, but the patient is clinically stable and feels well.
Other times, the opposite happens — symptoms worsen before imaging clearly changes.

So the decision to change treatment is usually based on the whole picture, not on one parameter.

There are also situations where a treatment is still controlling the disease, but side effects become too heavy.
In those cases, changing the approach can be just as important as changing the drug.

The key point is flexibility.
We reassess regularly and adjust when needed, rather than waiting for things to deteriorate.

Dr. Roman Meirovich:
Immunotherapy is a very important option, but it’s not for everyone.

In colorectal cancer, it works best in a specific group of patients — those whose tumors show microsatellite instability, or what we call MSI-high disease.

In this group, immunotherapy can be very effective and, in some cases, lead to long-lasting control of the disease.

For patients without this molecular profile, immunotherapy by itself usually does not work well.
That’s why molecular testing is so critical before making treatment decisions.

I always try to explain this clearly, because immunotherapy has a lot of attention around it, and patients often ask about it early on.

So the key message is balance.
Immunotherapy can be a powerful tool when it’s used in the right context — and knowing when it makes sense is just as important as knowing when it doesn’t.

Dr. Roman Meirovich:
Clinical trials are not a last resort, and I think that’s important to say.

Many people imagine trials as something you consider only when all standard options are exhausted.
In reality, that’s not always the case.

In colorectal cancer, clinical trials can be relevant at different stages of the disease.
Sometimes they offer access to new drugs or combinations that are not yet widely available.
Other times, they help us understand whether a new approach is better than what we already use.

When I think about trials, I don’t think in abstract terms.
I think about a specific patient sitting in front of me.
What has already been done?
What options are realistically left?
And does this trial make sense for this person, not just on paper?

It’s also important that patients understand what participation actually means.
There are protocols, visits, rules — and that needs to fit into someone’s life.

So clinical trials are a tool.
A very valuable one, in the right situation.
But like any tool, they need to be used thoughtfully.

Dr. Roman Meirovich:
Side effects are a major part of the conversation — and they should be.

Treatment today is very different from what it was years ago, but side effects haven’t disappeared completely.
What has changed is how well we can anticipate and manage them.

Fatigue, changes in bowel function, skin reactions, sometimes numbness in the hands or feet — these are things we see.
But in most cases, they are expected.
And when something is expected, we can prepare for it.

If side effects start to interfere with daily life, we don’t just tell patients to “push through.”
We adjust doses.
We change schedules.
Sometimes we pause and reassess.

There’s also an important balance here. A treatment that works well on paper but makes someone miserable is not a success.

That’s why communication matters so much.
When patients tell us early what they’re experiencing, we usually have room to adapt — and keep both effectiveness and quality of life in view.

Dr. Roman Meirovich:
Quality of life is not something separate from treatment.
It’s part of the treatment.

In real practice, we constantly look at how a person is actually living during therapy.
Can they work?
Do they sleep?
Do they have the energy for everyday things?

These factors influence not only comfort, but also how well treatment can be sustained over time.

Sometimes small adjustments make a big difference.
Changing a dose.
Spacing treatments differently.
Adding supportive care.

There are also moments when we need to slow down.
Not because treatment has failed, but because the cost — in terms of daily functioning — becomes too high.

The goal is always balance.
To treat the disease effectively, without losing sight of the person behind it.

Dr. Roman Meirovich:
A second opinion is not a sign of distrust.
It’s a way to gain clarity.

There are situations where it’s particularly helpful.
For example, when there are several reasonable treatment options and no single “obvious” choice.
Or when the disease behaves differently than expected, and the plan needs to be reassessed.

Sometimes patients simply feel that they don’t fully understand what is being proposed.
That, by itself, is already a good reason to ask for another perspective.

In many cases, a second opinion confirms the original plan — and that reassurance is valuable.
In other cases, it brings up nuances or alternatives that are worth discussing.

What matters most to me is that the patient feels informed and confident about the decisions being made.
When people understand their situation, treatment tends to move forward in a calmer and more constructive way.

Dr. Roman Meirovich:
Most patients worry about how treatment will affect their daily life — not just medically, but practically.

Fatigue comes up very often.
People are concerned about whether they’ll be able to work, take care of family, or keep some kind of routine.

There’s also anxiety around nausea, bowel changes, and long-term effects like numbness or tingling in the hands and feet.
These concerns are very real.

What I try to explain is that most side effects are not a surprise to us.
We know what to expect, and we monitor closely.

If something starts to interfere with everyday life, we don’t ignore it.
We adjust treatment, add supportive medications, or change the schedule.

The key is openness.
When patients talk about what they’re feeling early on, we usually have much more room to respond and keep things under control.

Dr. Roman Meirovich:
A sense of control doesn’t come from knowing every detail.
It comes from understanding what’s happening and why certain decisions are made.

I try to make sure patients know what the plan is — not just the next step, but the overall direction.
What we’re aiming for.
What we’ll reassess along the way.
And what signs would make us change course.

Small things matter a lot here.
Knowing when the next check-up is.
Who to contact if something changes.
What is expected, and what is not.

I also think it’s important to acknowledge uncertainty.
There are moments when medicine doesn’t give us a clear answer.
Saying that out loud often reduces anxiety, rather than increasing it.

When people feel they are part of the process — not just following instructions — treatment becomes less overwhelming and more manageable.

Dr. Roman Meirovich:
I would probably say this: don’t stay alone with your questions.

Colorectal cancer is an area where decisions are rarely simple.
There are often several reasonable paths, and not all of them are obvious at first glance.

If something feels unclear, if the proposed plan doesn’t fully make sense, or if there’s a feeling that more explanation is needed — that’s not a weakness.
That’s a normal reaction to a complex situation.

Sometimes one additional conversation is enough to put things in order.
To understand the logic behind decisions.
To feel more confident about the next step.

My role is not only to recommend treatment, but to help people understand what is happening and why.
When that understanding is there, the process becomes calmer — even in difficult situations.