A Physician’s Passion For Research
Renu Dhanasekaran, MD, PhD
For Renu Dhanasekaran, MD, PhD, assistant professor of gastroenterology and hepatology, being a physician-scientist isn’t merely a profession. “It’s a calling,” she says. Dhanasekaran began her career as a physician in India, then went back to graduate school at Stanford and earned a PhD in cancer biology. Her lab at Stanford School of Medicine studies the molecular biology of liver cancer, with the goal of identifying novel biomarkers and molecular-targeted therapies for the disease.
Liver cancer is the fastest-rising cause of cancer death in the United States, according to the American Association for Cancer Research. And rates are expected to continue to rise through at least 2030. Risk factors include viral hepatitis B or C, fatty liver disease, and alcohol use. Worldwide, hepatitis B is the most common cause of liver cancer, but thanks to routine vaccination that began in 1982, fewer than 5% of liver cancer cases in the United States are caused by the virus. Obesity and diabetes are part of the reason, but “we’re not talking enough about it,” she says. “It’s an underrecognized issue. Liver cancer can happen to anyone.”
Dhanasekaran chose to be a physician because she wanted to help people. But it was only in medical school that she truly began to understand the “gravity of the profession” — how physicians can change and save lives.
"I hope more women choose to come into science... One of the most satisfying career pathways is to be both a physician and a scientist. And I’m glad I had enough support to help get me here."
– Renu Dhanasekaran, MD, PhD
After medical school, Dhanasekaran moved from India to the U.S. with her husband. Differences in training between the two countries meant she had to do some retraining, so she accepted a research job when she first moved to America. “I was always curious, but I didn’t have much experience in research. Then my first mentor said something that really stuck with me: If you’re a doctor, you will help those people that you see personally in your lifetime. If you’re a researcher, and you discover a new cure or test, you could end up helping millions of people,” she says. “The scope is potentially much larger, because it’s not just the person in front of you.”
Driven by her desire to make a bigger difference, she wanted to pursue research. “I loved it,” she says. “It was such a joy to publish and see my papers out there. I’d track my papers and think, wow, somebody cited my work.” She began her gastroenterology fellowship at the Mayo Clinic in Rochester, Minnesota, and at the same time began doing basic lab research. “In the beginning, I was just curious: What are they pipetting?” she remembers. Initially she was apprehensive about starting a new career track in bench research, since she was already at the fellowship stage of medical training, and going back for a research PhD meant learning things that students typically study in their undergraduate years.
But Dhanasekaran was undeterred. “I decided I was just going to try,” she says. “And I really loved it.” She ended up at Stanford, accepting a faculty position at the university, and says the culture there supported her path to pursue her PhD at the same time. “There was so much diversity in the student population and so many opportunities — nobody asked, ‘Why
now, why you?’ There were other students who were on a nontraditional path as well. Stanford was a really open community, and I felt very supported by my mentor and my division.” As faculty at the university, she had her own clinic already, but she managed to complete her PhD while maintaining her commitment to her clinic as well as teaching students and residents. “It was very interesting because I was going to early-morning classes with 20-year-olds,” she says. “I had two kids already, and I had so many hats to wear while doing all that. But I think Stanford is unique in that a faculty member is able to pursue a PhD.”
Dhanasekaran’s research is focused on liver cancer for two reasons: There are not many treatment options available for the cancer; and there is stigma around liver cancer because sometimes patients already have alcoholic liver disease or hepatitis C and may be, or have been, IV drug users. Because of the stigma, Dhanasekaran says, there isn’t as much attention or funding for liver cancer as other cancers.
Patients at the Heart of Research
Besides her research, Dhanasekaran runs a liver cancer clinic. This allows her to keep track of how her patients are doing. She says this has been humbling, because her patients often don’t survive past five years. “It’s very disheartening that I don’t have a set of patients I can follow long-term because of this disease. I come back into the lab after clinic and think, We really need to do something about this.” Keeping the science so close to the patients is important to her. “It’s so connected because these are the patients I see,” she says. “They inspire me.”
Dhanasekaran also feels that she learns from her patients, sometimes finding a clue from them that can lead her research in a particular direction. She recalls one patient who had a very aggressive type of liver tumor and was expected to survive only weeks or months. But a month later, the tumor had spontaneously resolved. “I had never seen anything like that,” she says. She explained to the patient how unusual her case was and that she wanted to try to understand why. The patient agreed to enroll in a study, and they determined that her immune system was extremely robust and was able to fight and clear the cancer. “We were able to do the science to show how this might have happened,” says Dhanasekaran. “I continue to follow her.” Her story is now published as a case report.
Because of the stigma... there isn’t as much attention or funding for liver cancer as other cancers.
– Renu Dhanasekaran, MD, PhD
The lab that Dhanasekaran runs studies exactly that: the immune responses to liver cancer and how a tumor escapes the immune system and is able to grow. By understanding the mechanisms underlying these processes, Dhanasekaran and her colleagues in the lab hope to understand how to prevent tumors from escaping the immune system. Understanding tumor recurrence is another major focus for her lab. Many treatments work on the cancer initially and shrink the tumors, but often the tumors come back, whether right away or sometimes even 10 years later. This phenomenon is known as dormancy. Some of the cancer cells hide in the body, staying there until something
triggers them to start growing again. “We don’t know exactly how they can survive for so long, where they hide, and why they come back,” she says. “It’s a very common phenomenon, and it’s the biggest cause of cancer-related deaths. It is also the biggest source of anxiety for patients because we have to scan them every three months.”
One of the lessons Dhanasekaran takes from her patients is to live life now, versus waiting for retirement to pursue dreams or desires. And she is glad that she was able to pursue her dream of becoming a physician-scientist. “I think, especially as a woman, there’s a subtle message that it might be too much for your work-life balance to be a physician, a scientist, and run a lab. No one openly tells you not to do it, but there’s this message that it’s very tough and you may not really know what you’re getting into,” she says. “I hope more women choose to come into science. I don’t think having a family should stop you or make you think twice. It will not somehow make you less of a mother or a wife or daughter or whatever other roles you play. One of the most satisfying career pathways is to be both a physician and a scientist. And I’m glad I had enough support to help get me here.”