Which to See First - Radiologist or Oncologist?

Hi victoryismine,

I know, it IS a lot to take in!  I remember feeling overwhelmed by all the appointments and not knowing what to expect.  Treatment will not begin on your first visit with the radiologist - s/he will talk with you, probably physically examine you, and tell you if you are a candidate for radiation therapy, and then recommend a date for your "simulation" appointment.  That's when you go in and the radiation techs have you lay on the radiation table while they adjust all of the settings, to get you and the equipment properly positioned - but without the actual radiation!  At this appointment, they may give you a chest X-ray and/or CT scan, and/or put tiny tattoos on you.  It's slightly different at each treatment center.  Your radiologist will explain it all in detail.  (Or SHOULD!  If s/he doesn't, ask!)

It's okay to have your appointment with your oncologist a few days after seeing your radiologist.  Your radiologist and oncologist will coordinate with each other.  Do you know yet whether or not you will be having chemotherapy?  Or is that a topic to be discussed with your onc on 4/7?  Typically, if you're having chemo, chemo is given before radiation.  So if chemo is still a possibility for you, you might want to put off making the radiation simulation appointment until after you have talked with your onc.

 Good luck and hang in there!

victoryismine, the med onc might want to do a test on the tissue sample called Oncotype. Do you know if this was ordered for you? It helps to determine if chemo would be helpful in early-stage invasive cancer (which is what you have). I'm sorry I don't have more info for you about it but I wasn't early stage so I didn't have it done.

The radiation oncologist will  take all your health issues into account when discussing/setting up your radiation treatments.

BTW the radiation oncologist is the doctor who deals with you radiation treatments. The radiologist is the doctor who reads X-rays, scans, etc. I feel like I learned a whole new language when I began dealing with this. Or actually, for me, two new languages since I'm in Israel so I had to learn this stuff in Hebrew, too!

Best of luck with your treatments. 

Leah

edited to add: if your doc was talking about a pill taken for 5 years, then what you'll probably be offered is something called an Aromatase Inhibitor. This is given when the tumor is estrogen receptor positive (which means it feeds on estrogen).This destroys any estrogen in you body so any cancer cells left would then starve. There is still estrogen produced after menopause in the adrenal glands and in fat cells. One of the side effects is a return of menopause symptoms, which I have declared is Officially Not Fair.

victoryismine, all forms of illness, I believe, concern some form of loss.  Perhaps it may only mean loss of your independence temporarily, but often with breast cancer it may be a number of losses.

My experience with grief is that my first reaction is that numb phase which it sounds like you are presently experiencing.  I imagine that it's a form of self-protection until you have a chance to take in all the information.  When a person is diagnosed it's possible that they are clueless about what it all means.  Maybe our emotions "hold still" for a while until we know exactly what to think and feel.

As far as denial goes it's a natural and normal form of self-defense and without some degree of denial in our lives we'd probably see the world and all it's problems in such sharp focus it would drive us mad.

For me some pretty sharp anger would break through the emptines from time to time.  "My children are independent, my husband will soon retire and I have other plans than holding still for all this bothersome treatment.  No fair to be ill right now!" That was the nature of my rage.

Even midway through my treatment when I thought I understood at a rudimentary level what was going on I'd find myself slipping back into denial and anger.

I expect to experience all the stages of grief - denial, anger, bargaining, depression and acceptance - as I progress through this complicated process of dealing with cancer.  And what I know about grief is that some people never get to the acceptance stage.  That is my goal.

I know that "big hurts" will always remain with us, if only in that closet of lost dreams and broken hearts.  And I don't think there is any closure to grief.  But I also know that I don't have to live my life in the grief process if I allow myself to experience the discomfort of all the stages.  And I know that my response to my illness will define my daily satisfaction with the rest of my life.

I joined a six week grief group through the hospital which helped me sort through my emotions and validate them.  Being gentle with ourselves as we confront our confusion is probably a healing thing.

Sending thoughts for strength and courage your way.

victoryismine2 - I saw on the news you would be having some serious rain but being from Seattle, well, I doubt it approaches what we experience at times.  I have actually come to appreciate it - at least my skin looks younger than my friends in some sunny areas  

Regarding the oncotype, if you are triple negative, it is not available to you as there is a prescribed course of reatment for the TN's.  If you are PR/ER+, it will be available.  Some insurances don't want to pay for it but my understanding is that not only does your medical oncologist have a lot of pull with the recomendation, but the oncotype company will also argue for approval with your insurance company. I have heard of very few who don't get the approval once their oncologist insists.  After all, if the oncotype shows no chemo necessary, think how much the insurance company saves.  However, if someone has mentioned herceptin to you, I suspect you are a TN as the PR/ER+'s don't get herceptin as far as I know.

When will you crack?  I hung tough through active treatment and then faced with that damn bottle of pills for the next five years, I felt less in control than I had throughout.  It took me several weeks to take them and then a few weeks into them, I had a bit of an emotional crash as was predicted could happen by my MO.  All is fine now though.  I just am forever changed by this - some for the bad, but also some for the good.

You are going to the rad onc first?  Maybe you don't need chemo at all! Wouldn't that be lovely ?

All:  I'm so glad I happened upon this group!

Victoryismine:  I had the same questions as you at first.  I didn't know which doctor to see first and I didn't get much guidance.  I ended up seeing surgeon, then MO, then RO.  It turned out fine and afterwards they told me it would not have mattered who I saw first because they coordinate treatment.

Raincitygirl:  My diagnosis looks identical to yours.  I'm now 1/2 way through radiation.

Denial?  I'm really trying to figure out my non-reaction to all of this.  I've strolled through the last 3 months in a fog and I can't seem to summon up any emotion.  Tears occasionally erupt at all the wrong times, but there is no rhyme or reason for it. The few times tears have come, they are close to the surface and pretty irrational.   I'm waiting for some sort of emotion to hit me, but it hasn't.  Sometimes I wonder if my mind is avoiding thinking about it because it's easier to accept that way.    I just can't figure it out. 

Victory, wow, it sounds like you have a great RO!  I'm so glad he was so thorough and kind, and answered all of your questions and more.  I hope your meeting with your oncologist goes well, too!  Keep us posted!  You're doing great!