Did you see first a surgeon or oncologist???

melania

 Hi lovely ladies

it's already 2 weeks that i've been diagnosed with IDC , tumor grade 2, 2.7 centimeter , we dunno about lymphnodes but we have to do biopsy. ER/PR+ .

I have seen 3 oncoloigcal surgeons but never met an oncologist . The surgeons think i have to start with the chemo first . I am supposed to see an oncologist whho works with one of these surgeons as a team .Did u first see an oncologist or a surgeon??? I mean did u get 2nd opinions from different oncologists even without first seeing a surgeon?

thanks all

mychoice321

Hi Melania,

 I was just diagnosed with BC (stage1). I have seen only a surgeon who did the biopsy and then the lumpectomy last wednesday. I go back to the surgeon this thursday for a follow up. She said at that time she will tell me if I need just radiation or radiation & chemo. Then she will refer me to an oncologist. I suppose every doctor has their own way of doing things, so I will just have to wait to see where I go from there.

pumela115

Mychoice, hi, i also went to the surgeon first, but they told me after my lumpectomy, that i would need  chemo and rads. But my tumor was very aggressive, so they told me.i would need chemo before my surgery also. I was hoping that would change, but it didn't, anyway chemo is very doable and i want all of it (the cancer) out of me!!!  I hope this  helps, and i wish you good good luck and all the best in this fight!!!!!!! Pam

mawhinney

Your particular cancer diagnosis and the practices of the place you are having your treatment will probably determine in what order you see the various cancer specialists. Also there are many types of oncologists. Some specialize in surgery or radiation or  chemo or managing meds. 

At first I was to have a lumpectomy so I saw a surgical oncologist and then a radiological oncologist. But a 2nd reading on my tests uncovered a 2nd spot so I opted for a unilateral mastectomy. My sentinel node bioposy came back clear so I did not need radiation so I  no need ed a radiological oncologist. My Onco DX test placed me borderline for chemo so with the approval of on my medical oncologist I chose not to do chemo. I see my medical oncologist for my meds and I also see my surgical oncologist every 6 months for follow up testing..

cbm

My oncologist referred me to my surgeon, but we knew I needed chemo as my first presentation was a lymph node.  So I went to one surgeon first and decided I'd made a mistake, then went to a well-known oncology practice.  My take on this is that your oncologist stays with you for the longest stretch so I asked him to manage the whole plan.  We agreed on the goals and strategy and he and his team filled in the blanks.  I think of the oncologist as the one who knows the disease, and the surgeon who is a technical expert at one phase of the treatment.  But that is just me and the way I think about this.

I think the advantage of neoadjuvant treatment, for which I did not qualify, is that your docs can see clearly if chemo is shrinking your tumor.  

I like going to doctors who work with other docs and who are used to communicating with them. That way you don't have to carry info back and forth, and run the risk of something getting lost in translation.

Warmly,

Cathy 

AudreyMak

I had a lumpectomy and now going through radiation.  My score was 1+1+1=3/9, lowest possible.  After radiation do I need chemo as well?  What about this pill"Arimedex" they want me to take for 5 years!  I am thinking of just completing the radiation and do nothing else.

msmpatty

Melania - I went to the surgeon first.  I was told that surgery is the first treatment for BC.  The surgery resulted in a full pathology report and the status of the lymph nodes..  This information went to the Onc who used it to recommend the rest of my treatment plan. 

AudreyMak - Sounds like your tumor was hormone receptor positive.  The Arimidex treatment decreases estrogen so it is not available to fuel new tumor growth.   Arimidex, Femara and others have been proven very effective in preventing recurrence and mets.  I'd check it out with your doctor before rejecting it.

Patty

lago

Saw the breast surgeon first time June 25th
BMX August 31st
Met with oncologist  Sept 14th

Most folks seem to go to a cancer center and get a team. I skipped the center and went directly to the BS because my gyno thought I had a papilloma so I just made the appointment the day before my mammogram since a BS would have to remove it anyway. I'm sure if I was having chemo first I would be meeting with the oncologist sooner.

melania

Thanks everybody ,

I am supposed to see an oncologist who works with the same surgeon telling me to start with chemo before surgery .

pumela115 I have a question for you, what do you mean yur tumor was aggressive?? did they do blood test which showed its aggressive ??? what happened then did u go with chemo before surgery and did it respond?

thanks all

pumela115

Melania, i just read what i wrote, chemo brain. No this is what happened i found out i had BC. First i had a biopsy and some of my lymph nodes looked bad, so they biopsied those at the same time., they sent me to see BS and onc and they worked together. I had a week of test mri, pet/ct, ultrasounds and bone scans.They determined it had not spread. So i had a lumpectomy, after the path came back and my tumor scored the highest grade it could, so they told me they had to treat it aggresive. I'm sorry i did not have chemo before surgery, because they were able to do a lumpectomy with clear margins. so far i have had DD ACx4, i just started abraxane x12 and i will have 6 weeks rad and then a hormone pill for 5 years. If i remember right the path from the biopsy showed the grade and score (how aggresive and somewhat the size of it and how many lymph nodes were involved) however once they got in there, they took out more lymph nodes then they thought. But have you had a biopsy yet? I hope this helps a little more. sorry for the rambling! let me know if i can answer any more questions for you. The SE from the chemo has not been to bad for me. Good luck in this fight, just remember we are all in this together.

Lilah

Melania -- depending on the size and type of tumor there is evidence that having chemo before surgery can shrink the tumor and change what surgery you have.  I had two lumpectomies prior to chemo, then had an MX after chemo (no rads).  I was sent to surgeon first.  At first it was diagnosed as DCIS but then when they did the first lumpectomy found it was both IDC and HER2+.  Because it was HER2+ I had to have chemo.  My ONC felt it was best to do chemo at that point and wait on further surgery (second lumpectomy got three clear and one close margin and so it was SOP to go back and get a clean margin for that one side).  In the end I had the MX because with the time I bought having chemo I did a lot of research and felt that the MX would give me a better chance at avoiding a recurrence.

Definitely can't hurt to talk to the oncologist now and find out what he/she recommends based on your current pathology.

Halah

I saw a surgical oncologist first as well. I questioned that also. He ran a number of tests to include MRI, CT, Bone Scan, PET Scan, etc. which I would think would have been ordered by a med onco but they weren't. I had surgery on Aug 30th and next I see my med onco on 9/30/2010. It was confusing at first for me, too.

LuvRVing

I saw the breast surgeon first, then her staff coordinated my other appointments.  I met with the med onco and the rad once the following week.  I then elected to proceed with a lumpectomy and SNB, which turned out to be the best solution for me.

You can make choices, just do your homework and get informed before you decide anything. 

Michelle

TifJ

Hi,

I saw the BS first and we decided on BMX(with expander) as I had two affected areas in right breast. I am just over 2 weeks past surgery (had a small lift on left side at same time). Because they removed all my breast tissue and 1 node which was clear. I will begin chemo at the end of Oct., but will not have to have rads!!. Hope your journey is problem free!! Hugs!!

otter

melania,

Like many of the other women here, I met with a breast surgeon (surgical oncologist) before I met with a medical oncologist.  When my primary care doc referred me to a Breast Health Center to investigate my lump, he "ordered" a diagnostic mammogram, ultrasound, and a follow-up appointment with a breast surgeon.  My biopsy (an ultrasound-guided core biopsy) was done by an investigational radiologist as soon as he saw some suspicious things on the ultrasound screen.

An hour or so later, I met the breast surgeon, who went over my history and the results of the mammogram and ultrasound.  We didn't know the results of the biopsy at that point, so we didn't even know if I would be needing surgery (or anything else). 

Two days after the biopsy was done, the investigational radiologist called me with the path results.  After telling me the lump was malignant and giving me some details (type and estimated size of the tumor, preliminary staging, etc.), he said, "You need to make an appointment with a breast surgeon as soon as possible." I already had another appointment with the breast surgeon for the following day. (Things were moving pretty quickly at that point.)

It turned out that I met my whole treatment team (surgeon, radiation oncologist, medical oncologist) at that next appointment.  My tumor was thought to be fairly small (estimated at 1.6 cm; turned out to be 1.8 cm), so the plan was to do surgery first (lumpectomy or mastectomy) and follow that with chemo and/or radiation and/or estrogen-blocking therapy, as applicable.

I was sort of disappointed with some aspects of the team meeting.  My breast surgeon was great -- she had been designated the "leader" of my treatment team, so she would be coordinating my care and would have first shot at my tumor (i.e., surgical removal).  I decided to have a mastectomy, which meant I probably would not need radiation (small tumor, wide margins, negative nodes). The radiation oncologist was a fantastic doctor whose patients had given her high satisfaction ratings, so even though I was happy I wouldn't be getting rads, I was sad that she wouldn't be participating in my care.

Meeting the medical oncologist at that early point was, in his own words, "a waste of time."  When his turn came to talk to me about his role in my treatment and what the treatment options might be, he said, "There's no point talking about any of that until we know more about your tumor.  So I have nothing to say."  Huh?  He explained that we didn't have enough information to know what type of chemo I might get, if I would even need chemo.  For instance, he pointed out, we didn't know "ER, PR, HER2, et cetera." (He rattled those off very quickly, as if I would be impressed.)  The tumor had to be removed and examined by a pathologist to get that information.

I saw my surgeon quite a few times (before, during, and after my surgery); but I didn't see "my" oncologist again until the final path report was back from my mastectomy.  Somewhere around that time, I decided I wanted a different medical oncologist.  I met her 3 days before starting chemo, and we got along immediately.

For follow-up care, I see my breast surgeon once a year.  She orders my mammograms and does my clinical breast exams, which she'll continue to do until 5 years are up.  I see my medical oncologist twice a year.  They are at the same cancer center, so everything is shared and coordinated.

The sequence of docs would probably be different for someone who was having "neoadjuvant" chemo (chemo before surgery, to shrink the tumor).  Some women who don't get chemo don't ever see an oncologist.  Others never see their surgeon again, after the surgical site has healed and they go on to the next phase of treatment. And, each cancer center has its own way of doing things.

otter

changes

Hi Melania,

I was diagnosed at a "breast care center" by a radiologist (she did the mammo, ultrasound, and biopsy). They knew from the mammo and ultrasound that it was almost certainly cancer, so they asked me who I wanted my surgeon to be. I knew NOTHING about surgeons, and they told me that my primary care doctor preferred Dr. so and so, and that's who I went with. He was a general surgeon, but did a great job. I saw him within a week and had the surgery 13 days later. He then scheduled appts with the medical oncologist and the radiation oncologist. I am now 4 months out, but the surgeon continues to basically "lead" the team. He ordered a bonescan for me, scheduled the follow-up mammogram, etc.

bennetts1

I went to the Breast Center where my biopsy was performed by my surgeon.  When the results came back positive for cancer, she refered me to an oncologist.  I received my chemotherapy before surgery because of the size of my tumor and since I had lymph node involvement.  the way my oncologist looked at it was it was more important to kill cancer cells that might be spreading than it was to remove the tumor.   After 8 cycles of chemo, I had a lumpectomy, which came back with unclear margins and had to end up having a mastectomy.  My doctors did work together by consulting with each other throughout my treatment.

My cancer was diagnosed in June 2008 and I see my oncologist every 6 months for follow-up and go to the Breast Center every year for my mammogram on my other breast and I also see my surgeon who does an excellent exam

singletona80

Hello all ,

I am a kaiser patient and I was referred to the Breast Care Team . . .I feel fortunate because I met with my oncologist, breast surgeon, and radiologist at the same team.  They take on a team approach ( I met with them all together at the same time).  They each did a breast exam (seperately), looked at all my test results, and they discussed together with me what they thought was the best treatment plan (chemo, surgery, rads).I really like this approach because I feel when doctors work together, you get better care, bcuz they are all on the same "page".

Anonymous

I guess I did it backwards, but hey, no one tells us what order to see our docs.  I got 2 opinions from general surgeons who had done lots of breast surgeries, and prior to that, I saw my oncologist.  Most of the time they say you see an oncologist after the surgery.  I don't think you can do it wrong, just so you do it.  I would really advise if you don't like your onc, to also switch to someone that's upbeat and positive. 

Anonymous

Dear CBM:  Why didn't you qualify to do neoadjuvant treatment?  Just wondering...

Godlistens

melania, it's all so overwhelming, isn't it? Just take a deep breath. YOu will get through this. When I was diagnosed three years ago, I was in such a state of shock that my sister had to call and make all the appointments for me and correspond with my insurance company. I did gain strength later and you will also.

I saw three surgeons for three opinions. they all said the same thing. No one mentioned that I had to do chemo first so I did not see an oncologist until about one month after the lumpectomy. If your surgeon is saying that you need chemo first, then you would need an oncologist now. However, I would advise you always to have a few opinions because every doctor has a different way of looking at this disease and you should hear all of your options. Bring someone along with you to your appointments. i brought my husband along, and he heard things that I did not hear. There is a lot of info to digest, and you need a second set of ears. Do your homework, try to think clearly without panicking.  All the best.......

nora_az

I'M at the Breast Clinic in Mayo in Phoenix. My general surgeon was an oncologist as well so there is no passing back and forth from doctors. I really liked the idea of that 

Soulmates

i am not sure but I am seeking a breast surgeon before my bilateral mammogram. Not sure if that's normal.