1st Appt. Oncologist Tomorrow What to expect & what to ask?

Jimiwithani · July 2018

Hi, I have my first appoint with my oncologist tomorrow. I may have overlooked it but I couldn't find anywhere on what to expect and what questions to ask? Any input is greatly appreciated. Links to info are welcome.

Thanks.

ElaineTherese · July 2018

Hi!

Do you know whether or not your cancer is ER+? Do you know whether your cancer is HER2+? Do you know the size and grade of your cancer? Unless you are triple negative (ER-PR-HER2-), HER2+, or have a large aggressive tumor, you are unlikely to get chemo before surgery. If you do fall into any of these categories, you could ask about what chemo regimen your oncologist recommends and why.

If you are not doing chemo before surgery, your oncologist will be in charge of your adjuvant (post-surgery) treatment. If your cancer is ER+, your oncologist will recommend hormonal therapy. If your cancer is ER+PR+HER2-, your oncologist should order the oncotype test to determine whether the benefits of chemo outweigh the risks. You could ask about hormonal therapy, and your oncologist's recommendation, based on your age, whether or not your are pre- or post-menopause, and any pre-existing medical conditions.

You could ask about genetic testing and whether your oncologist recommends it in your case.

Hope this helps!

Jimiwithani · July 2018

ElaineThere....thanks.

I only know I have mixed invasive ductal and lobular carcinoma..grade 2. My cancer is about 3 cm. Per my surgeon, I'm to get the rest of the results tomorrow including results from a Lymph node core biopsy (he did on the day he told me of the cancer) from the oncologist. In his doctors notes, he said I'm to see her for "neoadjuvant treatment". I googled and it means chemo prior to surgery. I won't know for certain but I'm guessing that this may have gone beyond my breast. Also, I"m scheduled for an MRI tomorrow afternoon and then meet back with the surgeon next Monday. Those things you mentioned help - I've printed an will ask. This is a lot to learn in a short amount of time.

Will she be doing an examination of my breast?

keepthefaith · July 2018

jimi, I would either take a trusted person with you and/or record the appt., at the very least, take lots of notes:). Are they going to do an onco-type test? BRCA test if you have a family history, esp. Get all of the information you need before you start treatment, don't be afraid to ask questions. Do they have a "tumor board" at your medical facility? If so, have them present your case to see if there are differing opinions. If you are not comfortable with what they recommend, get a second opinion. Wishing you the best moving forward. You are not alone and you have a lot of support here if you need it!

ElaineTherese · July 2018

Hi!

Yes, your oncologist will do a manual examination of your breast. I know; it sounds kind-of crude compared to the MRIs and PET scans out there. My oncologist even used a ruler to measure my lump as it shrank during neoadjuvant chemo.

Well, the cancer may be in a lymph node; one of mine tested positive before chemo. But, as long as your cancer hasn't advanced beyond the axillary nodes, it will be considered early stage and has a very good prognosis. I suspect that your cancer may be either triple negative or HER2+. If you are going to do chemo before surgery, definitely ask the MO about chemo regimens and what you can expect. If you're getting a hard core chemo like AC or Taxotere, ask about whether you will be receiving Neulasta the day after to help sustain your immune system.

Most chemos lead to hair loss. I asked my MO for a prescription for a cranial prosthesis (a wig) so my insurance would help pay for part of the cost. Some women try to save their hair through cold caps. If you're interested in that, you might want to ask the MO whether or not she is OK with that. (Some are not.)

Good luck!

Jimiwithani · July 2018

keepthefaith - thank you. My husband and mother will be with me. I've included your post in my questions. I hadn't thought of the tumor board, I know my surgeon said that he would work the my oncologist closely.

ElaineTherese - errgh...My breast and under arm are super sore and bruised from the biopsies...I guess I'm going to have to start wearing my big girl panties and deal with it. Good points on the chemo drugs. I've read a bit about the cold caps and that is something I can let go...hair loss will definately not be a highlight for me but i don't think I want to add one more thing to have to deal with in hope to keep hair that my still fall out all or some. Its all so overwhelming - so I may change my mind. I'm sure after tomorrow I'll know more and be in a better place to make decisions.

Thanks again for answering my post.

Amica · July 2018

Jimiwithani

There is a very good list of questions midway down the following page, in the section entitled "Ask Your Doctor":

https://www.secondopinion-tv.org/episode/breast-cancer-recurrence

Even though the topic is BC recurrence the questions really apply to any diagnosis of breast cancer.

take care,

Amica

mobscene207 · July 2018

The first appointment is pretty overwhelming, because they give you SO MUCH information! My MO laid it all out in simple terms -- she even drew pictures!

My best advice is to listen first, then ask questions. She covered just about everything I had questions about, and brought up things I hadn't considered (coldcapping, which I am doing; and getting a port, which I did).

I immediately liked and trusted my MO, and that has been key for me. If you are not comfortable with yours after meeting them, consider looking for someone else.

Good luck

letsgogolf · July 2018

Jimiwithani There are lots of studies about mixed type breast cancer online. I also had IDC-L. You will want to have your doctor order the Oncotype test. My understanding is that this type of cancer is usually ER+, PR+, Her2-. Nearly always grade 1 or 2 and has a 50% chance of being in 1 node, which is higher than most other types. It behaves differently, however, having a lower rate of spread to other parts of the body but a higher rate of having a second breast cancer later. Most of these tumors are spiculated and have a great prognosis.

Jimiwithani · July 2018

thanks everyone. The first appt went well but we didn’t get much accomplished as many of my paths werent back. My lymph nodes came back positive. Errgh. She discussed a lot of possibilities. I had blood drawn for a tumor marker. Had an MRI w contrast of both breasts later that day and she scheduled me for a bone scan and CT scan (both with contras) the next day. I see surgeon tomorrow and oncologist on Thursday prayfully hoping this has not sprea

letsgogolf · July 2018

Jimiwithani Don't be too alarmed because this was in a node. With this type of tumor you have a 50/50 chance of that. Studies show that usually it is only in 1 node and it actually has a lower chance of spreading elsewhere in the body. Keep the faith!

Jimiwithani · July 2018

Letsgogolf is you can direct me to links to read more about my type of cancer that would be great. The oncologist told me last week I was in between grade 2-3 which surprised me and she said she was fairly sure I would need to have chemo prior to surgery and when I did surgery she would most likely have them remove my ovaries. I guess I'll know more after I get the rest of my results. Thanks so much

1st Appt. Oncologist Tomorrow What to expect & what to ask?

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