choosing a surgeon

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aterry
aterry Member Posts: 290
edited November 2016 in Just Diagnosed

I was diagnosed, by needle biopsy, a week ago. I have invasive ductal carcinoma, grade 6, triple negative, undifferentiated. comedo and cribriform types. I've seen one surgeon and have an appointment for an MRI tomorrow and an appointment for a second opinion with another surgeon on Wednesday.

My question is how to choose between the 2 doctors. I did a search on this site and neither name came up. The two are: Dwight Derisi at North Shore/St Francis on Long Island and Christina Weltz at the Dubin Breast Cancer center at Mt Sinai, Manhattan. My gynecologist recommended Dr Derisi and 2 friends who have had breast cancer recommended Dr Weltz. Is this just a matter of intuition? Who you like best and who seems most capable? Is it a matter of what approaches they suggest? Waiting for the second opinion is making me stressed. Part of me just wants to go with the first Dr (Dr Derisi) and get the surgery scheduled.

Thanks in advance if you have ideas for how to choose.

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  • mustlovepoodles
    mustlovepoodles Member Posts: 2,825
    edited October 2016

    I think you are wise to get a second opinion.  Every surgeon is different and they all have a different approach to breast cancer.  About all we can do is listen to what they have to say and then choose the surgeon and the path, based on how we click and whom we trust. The first MO that was recommended to me was the head of oncology at a very big hospital in a very large city.  He is highly thought of around here. Unfortunately, I found him difficult to work with . At first I thought it was just me, since everyone else thought he was the bees knees. So I saw him a second time and, nope! Not me.  He really was a bozo.  I got another opinion from a radiation oncologist and the second onocologist was very good. I had done a lot of research by then and I knew that the path she was recommending was the right one. 

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  • Moderators
    Moderators Member Posts: 25,912
    edited October 2016

    Welcome aterry, We second what Mustlovepoodles has said. A second opinion may help you feel more confident with your decisions.However, you are looking at very reputable treatment centers, so whatever you decide, just make sure you feel okay with the decision.

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  • aterry
    aterry Member Posts: 290
    edited October 2016

    Thanks for the replies. I know that having more information is better than less but I'm finding the waiting for the 2nd opinion stressful because I imagine the cells multiplying away like mad (it's grade 6). I'm sure others have experienced this. Today is my MRI so that feels like progress.

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  • aterry
    aterry Member Posts: 290
    edited October 2016

    So far I've decided to use Dr. Derisi and I've received some positive reviews of him. Yesterday I met with Dr Cynthia Weltz at Mt. Sinai. She referred to the cancerous tissue as 2.5 centimeters, based on the MRI report; she didn't have the images, just the report. There are two areas that show up on the mamo and sonogram--the biopsied tumor is 6 millimeters--there is "assymetrical fibroglandular tissue" surrounding the area that is 2.5 centimeters. When I met with Dr. Derisi we only discussed the 6 millimeter tumor as needing to come out in a lumpectomy. I have a call in to him but it now seems that the lumpectomy may need to be 2.5 centimeters + how ever much they take out to get clean margins. 2nd dr said that sometimes they do chemo first to shrink the tumor so the surgery can be smaller. Now I'm very confused. I hope Dr. Derisi can clear up the confusion. I was really very calm about the whole thing until this discrepancy crept up.

    Any thoughts on this? Does 2.5 centimeters vs 6 millimeters seem like a big difference to any of you? Or is that still quite "typical" for a lumpectomy?



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  • aterry
    aterry Member Posts: 290
    edited October 2016

    I'm having second thoughts about Dr. Derisi although I have a tentative date for surger--Nov. 9th. I feel he should have told me about the change in surgery plan. His nurse said he plans to take out all of the tissue which I'm sure is correct but I asked if he'd seen the images from the MRI or was just basing his decision on the report and she said, "Would you like him to look at the images?" I said, "YES". She said he'd call me after he reviewed the images but that was 3 days ago. Meanwhile the surgeon at Dubin/Mt Sinai emailed me to make sure I brought the MRI images to her office so she could review them.

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  • Nanpop
    Nanpop Member Posts: 75
    edited October 2016

    I used someone from Mount Sinai. I was told a definite no to Dr. Derisi by someone in the field and from my own experience. I was also told you have to go with the doctor you trust.

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  • aterry
    aterry Member Posts: 290
    edited November 2016

    Thanks for the information, Nanpop. Did you work with an oncologist from Mt Sinai, too? Was this at the Dubin center?

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  • Racy
    Racy Member Posts: 2,651
    edited November 2016

    Hi, just to let you know a lumpectomy is very possible for a tumour of 2.5 cm. My tumour was 2.2 cm at 2 o'clock and my breast shape looks very normal after lumpectomy. I did have to have a second surgery though, to get clear margins, which is quite common.

    Shrinking the tumour with chemo before surgery is a newer approach. I'm not sure it's necessary for a 2.5 cm tumour.

    You sound a bit confused by the communication from the two doctors. It's important that you understand their recommendations and reasoning so that you can make informed decisions. Don't hesitate to ask further questions.

    It is important that you have good communication with and trust in your doctor. I only met with one surgeon. I liked him and his approach straight away and I still see him six years later.

    Best wishes with your decision and upcoming treatment.

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  • Sjacobs146
    Sjacobs146 Member Posts: 770
    edited November 2016

    The surgeon is just a piece of the puzzle. IMHO You want to be in a situation where the surgeon, medical oncologist and radiation oncologist work together. Do the hospitals that you are considering have dedicated Breast centers? I found that being at a hospital with docs who specialize in Breast cancer makes everything go much more smoothly. All of the docs discussed my treatment plan, not just my 3 docs, or just my surgeon. The Breast center has a dedicated social worker who helped organize all of my appointments, and visited me at each stage of treatment. Even now, when I meet with one doc, they check on my next appointment with one of the other docs (I rotate appointments every 3 months between surgeon, MO, and RO).

    Also, you should get some clarification on your diagnosis, there is no Grade 6, there are only 3 grades. Don't want you to panic thinking that your Cancer is much faster growing than anyone else around here. There is a lot of information on the main BCO site regarding your diagnosis. I know you feel that you want the Cancer out as soon as possible, but a few weeks will not make a difference in outcome. Take your time to find docs you are comfortable with

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  • tennischick888
    tennischick888 Member Posts: 18
    edited November 2016

    Like you, I struggled between two surgeons. Both were very reputable...one at a very large teaching institution and the other from a smaller world class hospital. I had a surgery date scheduled with the one from the larger institution although I didn't "like" her as much but was thinking bigger institution was better. I ended up cancelling that appointment because I really felt much more comfortable with the other and liked her so much more. You have to go with your gut and feel good about your choice. However, I am going with an oncologist from the larger institution. Good luck

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  • exercise_guru
    exercise_guru Member Posts: 716
    edited November 2016

    Wow what a shock for you. I think the size is not as big of a stress as the Grade and that it is triple negative. IT would maybe be a good idea to meet with an MO first before you make your decision. BUT if you are young, node negative and high grade it also makes sense to get that out of you as fast as possible and treat the chemo as an extra precaution. I know women who are TN that the tumor grew on Chemo.

    As for a surgeon for me I was having a mastectomy in a smaller town and there was a breast surgeon who was highly experienced. I felt it was necessary to go with her to make sure she got every bit of my breast tissue she could. I had two spots of DCIS in my breast and if I had a lumpectomy I would have had a deformed breast.

    I say go with your gut. What will give you the most confidence and relieve the most anxiety in the long run?

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  • aterry
    aterry Member Posts: 290
    edited November 2016

    Thanks for the many replies. Your replies and what I've learned on this site are helping me sort this all out. I probably used the wrong terminology regarding "grades". On the biopsy report (they did a report and then two addendums after further testing) It lists BI-RADS category: Left breast: Six. So it's a category, not a grade. I don't see a grade listed in the biopsy report. Does that come after surgery, maybe?

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  • Sjacobs146
    Sjacobs146 Member Posts: 770
    edited November 2016

    aterry, your biopsy report should have a grade, this is different than stage which is usually discovered after surgery.

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  • aterry
    aterry Member Posts: 290
    edited November 2016

    My biopsy report does not have a grade. It has a Bi-Rad category of 6 which I was confusing with a grade. And there is other information, of course, but no grade. I met with a medical oncologist today and she said it is high grade, which I took to mean 3. I have decided to be treated at the Dubin Center/Mt Sinai. The MO is Dr. Irie and the surgeon is Dr Weltz. They are planning to do chemo first. I appreciate your advice, Exercise Guru, that it is good to get it out immediately but they explained their reasoning and I'm going ahead with chemo starting Nov 9th. Dr Irie also enrolled me in a study that she is conducting where they are testing mouse models as a precursor to develping more targeted chemical approaches for triple negative. The study is not double blind. It will not affect the choices made in my treatment. A mouse avatar will have cells from my tumor and will get the same chemo. They want to see if there is a difference in reaction to the chemo in me and in the avatar. They have enrolled 36 women, so far, in this study. I don't know what their target size is for the study. Dr Irie specializes in triple negative breast cancer.

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