Frustrated

Scaredmommy1971723 · February 2018

On January 2 I had a lumpectomy. Pathology report came back good according to nurse practitioner. 2.1 cm, margins clear, micro mets in sentinel lymph node but other two clean. She said (and I asked her to repeat!) no needfor chemo. Go onto radiation in 4-6 weeks after healing. Then make appointment with MO. I'll be prescribed hormones to start after radiation.

Radiation oncologist would not even consider starting anything with me until I spoke with the medical oncologist. I made the appointment with him and he said I probably would benefit from chemotherapy. Wait, what?? He ordered the Oncotype DX and 3 weeks later, I still have no answers/results. I emailed my surgeon and then meeting with him this week. He wants to know exactly what transpired and to make sure I'm on the right track . I don't understand how his office could be so sure I wouldn't need chemo and the medical oncologist feels I do.

LisaAlissa · February 2018

Treatment modalities change as research continues. Generally, the MO is the specialist with respect to chemo and anti-hormonal treatments; the RO is the specialist with respect to radiation treatments and the SO (surgical oncologist--surgeon) is the specialist on surgical treatments.

Traditionally (typically?) women have been referred to a SO either for a biopsy, or after a biopsy has diagnosed cancer. They have surgery, then on to a RO for rads if needed, and finally, on to the MO for any treatment (chemo & an anti-hormonal if called for) and then follow-up.

Presumably, "no need for chemo" was the standard your SO was familiar with for cases like yours. However changes do happen. In fact, now, with certain kinds of cancer, chemo happens before surgery. So after DX (diagnosis) patients will sometimes confer with a MO (and sometimes a RO) before surgery to discuss planning.

If you are at a smaller community-based hospital or clinic, this might be a good time for a second opinion from a NCIC-designated cancer center or a university affiliated cancer center. They can review your pathology slides to confirm the diagnosis, as well as your various other tests and suggest how they would go forward with your case.

HTH,

LisaAlissa

Beesie · February 2018

Further to LisaAlissa's post, the nurse practitioner you spoke with at your surgeon's office was completely out of line in telling you that you wouldn't need chemo. That is not her job nor her area of expertise. It is also not the job of the surgeon. It was inappropriate for her to say anything. The doctor who is responsible for recommending and managing all non-surgical treatments is the Medical Oncologist. Your Radiation Oncologist was right to send you to the MO. That's your first stop after surgery, and anything the MO says overrides any opinions you may have received from your surgeon's office.

Sorry that you've had this surprise.

Scaredmommy1971723 · February 2018

thank you both for your response! I met with my surgeon today and he's ordered the mammaprint. My oncologist ordered the Oncotype DX (3 weeks ago). We'll see!! ((Hugs))

Okkate75 · February 2018

This happened to me too, @Scaredmommy. Everyone I met with suggested I wouldn't need chemo given the size of my tumor and nothing in the sentinel node. I met with the MO and was suddenly doing chemo a week later! It was very shocking and abrupt, but I trust my oncologist, and when my Oncotype came back at 29 I knew we'd made the right decision. I wish my radiologist and surgeon hadn't acted so sure I'd be skipping chemo. Cancer and treatment have turned out to be way less predictable than I would like them to be! Hang in there--we can do this, even if we decide to do chemo. I hope your Oncotype and Mammaprint give you good guidance.

Frustrated

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