Oncologist Dr. Mary Ondinee Manalo Igot

26/09/2026

Integrating Ward Work into Clinical Reasoning 🩺

After seeing their patient on the wards, we sat down to work on how they should present and integrate the case.

With a patient who has multiple comorbidities, I taught them to prioritize the diagnoses that are clinically relevant and, just as importantly, not to include details that do not add value to the presentation, assessment, or management.

A good case presentation is not about mentioning everything that is present. It is about knowing what matters, what drives the current problem, and what can be left out.

That is part of learning how to think — not just how to report.

25/09/2026

TRAINING MINDS, SHAPING HEARTS

I had the privilege of moderating this session on residency training, resilience, faculty development, and building better systems for trainees.

Several points stood out:

Resident distress is shaped not only by the individual, but by workload, cumulative patient loss, supervision, the hidden curriculum, administrative burden, and loss of meaning or control. Resilience helps, but it has limits.

Faculty development matters just as much. Respectful teaching, psychological safety, supportive leadership, timely private feedback, post-duty rest, and shared responsibility are all part of a healthy training environment.

Interestingly, national residency surveys already measure areas such as duty hours, faculty supervision, evaluation, educational content, resources, and overall trainee perception—including whether residents can raise concerns without fear of intimidation or retaliation.

Another practical concept was GROSS: “Getting Rid of Stupid Stuff.” Identify work that consumes time without improving care or learning, question whether it still serves a purpose, then simplify, redesign, automate, or stop it.

The session also emphasized quality improvement and value-based learning: teach residents to define a problem, understand causes, test small changes, measure outcomes, and sustain improvements—while always asking whether an intervention delivers meaningful benefit relative to its cost and burden to the patient.

Many of these changes are surprisingly no-cost or low-cost: better coaching, interprofessional learning, safer feedback systems, quality-improvement projects, and removing unnecessary work.

A good reminder that residency training is not just about producing knowledgeable physicians. It is about training minds, shaping hearts, and designing systems that allow both doctors and patients to do better.

24/09/2026

FROM HESITATION TO HEALING

There are patients who come to us several times before they are truly ready for cancer treatment.
She was one of them. For some time, she remained hesitant and chose alternative medicines and unproven therapies instead. Eventually, her cancer progressed—she became very symptomatic and lost a significant amount of weight. That was when she finally decided to trust evidence-based cancer treatment.

Today, she has gained 9 kilos, her tumors are smaller, and she is able to do much more again. ❤️

Her story is also an important reminder: please do not be easily persuaded by claims of “miracle cures,” secret treatments, or therapies without good scientific evidence.

Cancer treatment should be guided by properly trained specialists, supported by clinical evidence, and delivered with appropriate monitoring.

When seeking cancer care, consult a board-certified medical oncologist and verify the credentials of the doctors and treatment centers you entrust your health to. In the Philippines, you can look for medical oncologists certified by the Philippine Society of Medical Oncology (PSMO).

I am so happy that, when she was finally ready, my patient chose to trust me—and, more importantly, to trust the science behind medical oncology. 💚

*Posted with patient's consent.

23/09/2026

Some victories are meant to be heard. 💚

It was a long and dramatic journey—a tracheostomy, a prolonged course of chemotherapy, and many difficult days along the way. But today, she is off her tracheostomy and has no evidence of disease (NED).

And perhaps the most unforgettable part for me: for the very first time, I finally heard her voice. 🥹
After everything she and her family have been through, hearing her speak felt like another beautiful milestone worth celebrating!

Congratulations! May this new chapter bring many more conversations, laughter, and good days ahead. 💚🙏

23/09/2026

A beautiful symbol of strength, hope, and transformation! 🦋

Congratulations to my patient on this very special milestone! 💗 The pink ribbon represents breast cancer awareness and the courage of every woman facing this disease, while the pink butterflies symbolize transformation, hope, and new beginnings.

Thank you so much for this beautiful artwork—it makes this moment even more meaningful. I will treasure it as a reminder of your journey, your strength, and how far you have come.

Here’s to healing, milestones reached, and many brighter days ahead. 💕

22/09/2026

National Thyroid Cancer Summit
2026 Molecular Targets in Advanced Thyroid Cancer

Thyroid cancer is not one disease. Its systemic treatment is increasingly guided by histology, disease kinetics, radioiodine sensitivity, and molecular profile.

For RAI-refractory differentiated thyroid cancer, systemic therapy is generally reserved for progressive, symptomatic, or threatening disease. Lenvatinib and sorafenib remain established VEGFR-directed options, while molecular testing may identify actionable RET, NTRK, BRAF, or ALK alterations.

In medullary thyroid cancer, RET testing is central. Germline testing identifies hereditary disease, while tumor RET alterations can guide selective RET inhibition such as selpercatinib.

For anaplastic thyroid cancer, management is urgent. Airway and local-control issues must be addressed in parallel with rapid molecular testing, particularly BRAF V600E, followed by broader profiling for other actionable targets.

Immunotherapy has a selective role, particularly in tumors with biomarkers such as MSI-H/dMMR or TMB-high, but targeted therapy generally takes priority when a clear driver is present.
The current paradigm is simple: histology defines the disease, clinical behavior determines when to treat, and molecular testing increasingly determines how to treat.

22/09/2026

The Nationwide Neck Check is officially open!

In celebration of Thyroid Cancer Awareness Week, participating hospitals nationwide will be holding a weeklong series of lectures and free physical examinations of the neck to help raise awareness about thyroid disease and the importance of early detection.

Please check with the hospital nearest you to see if they are participating in this nationwide initiative.

Check your neck. Know the signs. Early detection matters.

21/09/2026

BREAST CANCER
Oncology Module
Third Year Medical Students

Breast cancer is the most commonly diagnosed cancer in women worldwide and remains a major cause of cancer-related mortality.

Some key points from my lecture:
Breast cancer develops along a continuum—from atypical proliferative changes and carcinoma in situ to invasive disease and, in some patients, metastatic spread.

Risk is influenced by age, family history, pathogenic germline variants such as BRCA1/2 and PALB2, prior chest irradiation, breast density, reproductive and hormonal factors, postmenopausal obesity, alcohol use, and physical inactivity.

Risk factors are not diagnostic. Many patients with breast cancer do not have a single identifiable major risk factor.

Mammography assessment uses the BI-RADS system to standardize reporting and guide management. BI-RADS 3 generally carries a malignancy risk of ≤2%, while BI-RADS 4 and 5 findings usually require tissue diagnosis.
A suspicious breast lesion should undergo appropriate imaging followed by core needle biopsy when indicated.

The pathology report should establish the histologic diagnosis and grade and include key predictive biomarkers, particularly ER, PR, and HER2.

Treatment depends on both stage and tumor biology. Early and locally advanced breast cancer is generally treated with curative intent, while metastatic disease is treated with the goals of prolonging survival, controlling disease and symptoms, and maintaining quality of life.

Breast cancer management is therefore not based on a single treatment pathway. Accurate diagnosis, staging, biomarker testing, and multidisciplinary treatment planning are central to selecting the appropriate therapy for each patient.

21/09/2026

This photo celebrates two victories! 💚

First, our patient—whose PET-CT now shows no evidence of disease, with no major adverse events throughout treatment!

And second, our medical resident, Dr. Gandia, who cared for her closely every step of the way. Good cancer care is not only about choosing the right treatment. It is also about careful monitoring, anticipating problems, managing side effects, and making sure the patient gets safely through every cycle.

Her excellent response and smooth treatment course are also a reflection of the care she received!

So today, we celebrate our patient—and we celebrate a medical resident who took very good care of his patient. Well done, Dr. Gandia!!! 🎓💚

20/09/2026