Breast surgeon vs medical oncologist

I totally agree.

The radiologist who diagnosed me referred me first to a surgeon, but the diagnosis wasn't even final yet - I was "probably a stage III" according to the radiologist. The surgeon talked up a BMX and scheduled me for a power port procedure, so I could get chemo to reduce the tumor before surgery. During the procedure they x-rayed my port to make sure it was in properly. That's when they found the fluid around my lungs (indicating a tumor on the pleura). Now I'm a stage IV and - no chemo. So I kind of got the port for nothing.

I feel like I should have had a better diagnosis, given that the testing included physical exam, mammogram, ultrasound, needle core biopsy and an MRI. Finally the x-ray revealed what all the other tests hadn't. And then I got the PET scan for confirmation.

I would think a MO would have more experience with cancer, and a more complete overall picture. I wish I had seen the MO first. It's the problem with the American medical system - they treat us like we're made up of Lego blocks; like you can just pick one block off and change it, and the rest of the structure stays unaffected.

ETA: just saw your post on another thread. To answer your question about the order of things, I think it's just the way radiologists think: we will want surgery first. But neo-adjuvant chemo is quite common, I think, so then we're bouncing back to the MO... Actually, I don't know the answer to your question. Now I want to ask my radiologist. Except I may never see him again. This system is kinda crazy.

Well the reason we see the Surgical Oncologist (SO) first is because they are the ones to perform our biopsies based on results from ultrasound,  mammogram,  MRI or whatever test that she orders for me that I need to do to determine whether the tumor or lump is benign or malignant. The various radiologists who read and analyze the results of the various test "send" these results to my SO at my cancer center (practices may differ from place to place).  Biopsy (there are different methods and incision length) are to take out cores from that tumor/lump for pathological analysis to confirm what  our cancer stage,  grade,  receptor status, her2 status and other critical info that will determine our overall treatment plan (if it turns out to be cancerous (malignant). "Send" here in my case means it's inputted into the system where my SO, OPS and MO and other medical specialists can view them from their own computer because they all are linked to the same cancer center.

Once these are known, the SO will recommend an overall treatment plan:

For instance (this is JUST my example), my

biopsy results showed I was stage IIb, grade 3, IDC with some DCIS, one tumor of either 2.5, 2.6 and 3.0 cm tumor* size (respectively via MRI, ultrasound, and mammogram),  receptors ER/PR as negative  & Her2 +.

* It was during actual surgery that my SO can confirm the actual size of tumor. Generally, MRI gives the most accurate info as affirmed during surgery that it was 2.5 cm. And so, 1 + 2.5 + 1 = 4 cm size (+ margins taken out). Margin clearance determines whether further surgeries are needed or not, including whether sentinel lymph nodes are + or -.

Subsequently,  my SO  recommended the following overall treatment plan:

>>> Neoadjuvant therapy >> then surgery + SLND + ALND even if 1 node is  positive,  + mastectomy if tumor doesnt shrink + discussion of reconstructive surgery (depending on SLND results) >> then chemotherapy (1 year ) >> then radiation therapy (4 weeks daily 10 mins)

Based on my research, I countered with the following overall treatment plan I wanted:

>>>Surgery 1st + SLND + NO ALND (if less than 3 nodes positive )  + lumpectomy (subject to results of SLND) + reconstructive surgery >> then chemotherapy ( 9 weeks weekly herceptin + docetaxel only ) + maybe radiaotherapy. 

Our final compromise overall treatment plan:

>>> Surgery 1st + SLND + NO ALND (if less than 3 nodes positive )  + lumpectomy (subject to results of SLND) + reconstructive surgery >> then chemotherapy ( 12 weeks weekly herceptin + paclitaxel only ) + maybe radiaotherapy (still deciding). 

As a cancer patient, we have the right to authorize or cancer any part of any treatment plan when we find new information to support our decision (generally).  Even if after we sign the consent form, we can still cancel or postpone any part later, just an fyi -

This initial discussion portion with our SO (practices may vary by hospital) is most important as it is OUR CHANCE to tell our SO what we want and to quiz him/her about details of how and what methods s/he will adopt in surgery.  So unless we have taken the time to read and educate ourselves ahead,  it could be difficult to engage in this part of the conversation.  If we didnt pre-read all available literature and info out there,  then one generally goes with standard treatment recommendations. I don't usually accept any standard treatment plans without questioning my SO about it,  including what type of reconstructive surgery my oncoplastic surgeon (OPS) will do to my breast and why s/he selects that method, pros and cons and recovery time etc. The same questions I pose to my Medical Oncologist (MO) on why he recommends that chemo to me. If I am not convinced, I would bring my own findings and asked for that one. Good doctors (whether SO, OPS or MO) will treat you as part of his/her team and respects your wishes (if you can show it).

My thread below can give you some more ideas and details of how I made my decisions and why.  It will be different from yours (since cancers are of numerous types & grades etc). You'll probably search for info that pertains only to your own cancer type to reach your own decision. 

https://community.breastcancer.org/forum/147/topic/831038?page=1#idx_8

Depending on one's decision, one will either :

(i) stay with one's SO awhile, then to the MO, then back to the SO, then OPS, or

(ii) SO >> MO (to determine chemo type for neoadjuvant therapy >> back to SO for surgery or surgeries >> then MO (for more chemo) and then OPS; or

(iii) SO >> OPS  >> MO (chemo) >> ROs (radio), with post treatment follow up visits at various intervals.  

Note: Individual & Group medical practices may adopt different protocol than hospitals.

If you wish to know how to read your biopsy pathological report when you get it, please click my link at this thread:

https://community.breastcancer.org/forum/147/topic/831074?page=1#idx_1

Anyway, all the best to everyone in your journey and sending good wishes to everyone wherever you may be @!!!@.

P.S. I go to a Cancer Center (CC) where all doctors and specialists I needed to see, and all tests, surgeries and treatments are located within the CC. This saves me a lot of time, since time is one thing that is very precious when one has cancer. I also discovered that this CC have all doctors working as a team. This means that they meet every week to talk to each other about their patients, their treatments (cases). When doctors talk to each other, I find these exchanges of information wonderful and comforting because that means they are all on the same page, & each knows what the other are doing. I do realize that  if one lives far from such centers, and have to go from place to place to get different medical specialists for different test, or surgeries or treatments, it's truly a pain in the neck :-((. Thus, wherever possible, might probably be good to scout around for a group practice that has affiliation with a hospital. Considering that one has to drive back and forth to get our treatment, isn't it swell not having to travel all over the place?

Anyway, sending you good luck, great strength everyday to everyone, and all the very, very best :-D ;

P.P.S. Medical surgical methods, treatment plan (TP), procedures and technologies constantly evolve when new breakthroughs occur. What was done and use previously may not be the same as it is now. Therefore, making comparisons of then and now may be harder ...The most important thing is that we get the timely care and treatment we deserve to get us back to our new normal asap, right?...^!!^

Not all have to go to a Surgeon for their biopsies. Mine were done by the Radiologist at the Radiology Clinic immediately after mammo and US. I had the path. report at 8 the next morning. In some cases, they are the one to do biopsies but not always.

I don't know in all cases which Dr should be the first to see, BUT I do believe that we should see the Surgeon, the Chemo Dr, and Rads Dr (plastic surgeon if doing recon at time of surgery) before starting any TX plan. They are all specialist in their individual field but not experts in all fields. So need to have a co-ordinated plan between all.

We do all definitely have to educate ourselves - but what applies to us individually, not what someone else with a different DX (and beliefs) says is 'facts' for all.

hi. I am new to all of this too! I was just diagnosed with IDC 6mm. I received the results of the biopsy from the Breast Center radiologist who sent me to the BS. Because my mom died of ovarian cancer he wanted me to undergo genetic testing which will take 3 weeks to get the results but he also referred me to a MO and RO who I will see on Tuesday. Looking for important questions to ask at the appt.

BTW, you girls are so inspiring! This is not an easy road to travel and I honestly was absolutely clueless until I started this journey

Dear 123JustMe, Welcome to the community. We are so glad that you reached out here as you begin your journey. As you can see you have joined a supportive and informed group of others with shared experiences who can illuminate that path for you. In addition here are some questions listed on our website to consider as you prepare for your upcoming appointments: Radiation Therapy and Chemotherapy.Keep us posted. The Mods

My primary sent me to the BS, who ordered all the tests. At some point during all of that, I met with the MO and RO. My case was taken to the tumor board, who decided chemo first, then surgery, then rads.