Is a "deep tissue biopsy" standard protocol?

Salsify

Hi, I finished CRT on 12/14/15. Had PET scan 3/23/16 which showed all clear. The Colo-rectal doctor who originally found it then said he needed to take a biopsy now, so I made an appointment. So he looked up there, said everything looks good, all healed from radiation, no sign of the cancer.  He takes a biopsy the same way he took back when he found it, in his office. THEN he tells me he also has to do a "deep tissue biopsy" which is a surgical procedure done in the hospital under general anesthesia. I am pretty annoyed. Why did I shell out my $60 deductible (which is about half my grocery budget for the month) if he has to do something else? Why couldn't he do it all while I am knocked out? I am pretty lucky in having reasonably decent bowel control for having gone through the radiation and am afraid that might change if he goes snipping around inside there. I feel like he just wants to make a little more money after all the money the oncologists and radiation and lab, etc. people got to make on the cancer he found.

Does everyone really have to have this done routinely when there is no indication of a problem?

And if this post is doubled, please forgive me. I am not sure how to get rid of an incomplete one I see in preview I did not mean to post....

z

biopsy

I had a punch biopsy initially, then after tx my correctol surgeon at the teaching hospital wanted to remove a skin tag and do a biopsy.  Everything came out good and I had no more issues with my bowel because of it.  I am sure more will answer.  I thnk its standard.  I wish you well. Lori. 

Completed tx on 6-30-09 and so far so good.

 

mp327

Salsify

I had the biopsy which confirmed my cancer back in 2008.  Since then, the only biopsy I've had was on 3 anal condylomas that were removed surgically in 2010.  Neither my colorectal surgeon nor my radiation oncologist are in favor of doing routine biopsies post-treatment and believe they should only be done if there is an indication of residual cancer or recurrence.  Since your PET scan on March 23rd. was normal, I do not see why any biopsies are necessary, but I am not a doctor.  The problem, as explained to me, in doing biopsies post-treatment is the potential for healing problems on the radiated skin, internal and external.  Healing can be slow or incomplete.

As for the reasons your doctor wants to do these procedures, I cannot say.  However, as you say, it will give him an opportunity to make more money--no argument there.  I would suggest that you check out the NCCN guidelines for follow-up at www.NCCN.org.  If you can print these guidelines out and take them to your doctor to discuss them, that would be great.  You (and he) will see that biopsy is only recommended in cases where there is progressive disease 8-12 weeks post-treatment.

Martha

sephie

no, it is NOT protocol----listen to Martha

the only biopsy i had was prior to  treatment to determine if it was cancer.... i went to MD Anderson in may 2009.....i still have a skin tag and the colorectal surgeon would not even remove that due to radiation of the area.....he said very hard to heal after radiation.....i would not do it....i am no doctor either but as Martha said  if you have clear scans and nothing found on DRE, the only time to do biopsy is if there is indication of something reoccuring....just please move slow and read the NCCN guidelines ....sephie

pializ

sephie said:

no, it is NOT protocol----listen to Martha

the only biopsy i had was prior to  treatment to determine if it was cancer.... i went to MD Anderson in may 2009.....i still have a skin tag and the colorectal surgeon would not even remove that due to radiation of the area.....he said very hard to heal after radiation.....i would not do it....i am no doctor either but as Martha said  if you have clear scans and nothing found on DRE, the only time to do biopsy is if there is indication of something reoccuring....just please move slow and read the NCCN guidelines ....sephie

Biopsy post crt

I was reading recently about procedures following cry & posted a link here. I will look back & 'bump' for you, but I am fairly sure that biopsies are contra indicated unless, as Martha says, that there is evidence of progressive disease

Liz

eihtak

pializ said:

Biopsy post crt

I was reading recently about procedures following cry & posted a link here. I will look back & 'bump' for you, but I am fairly sure that biopsies are contra indicated unless, as Martha says, that there is evidence of progressive disease

Liz

Hi,

Just want to add me to the list of NO biopsy unless question of unresolved cancer in radiated skin for reasons mentioned such as potential healing concerns.

The only biopsy I had was in dx of anal cancer and while I have had mets to my lung....the initial anal tumor area has remained clear.

katheryn

RoseC

My experience was different

My experience was different (although I did have health issues subsequent to the cancer). An initial biopsy was done for diagnosis. I remember that at that time my colo-rectal surgeon mentioned that she'd most likely do another biopsy at 6 months out. Four months after I finished treatment I came down with a rare side effect of the mitomycin - TTP - which resulted in a two month hospital stay. Near the end of the hospital stay (during which time I experienced multiple bowel issues) my surgeon performed the additional biopsies (6 areas). It could be that she saw something suspicious, I'm not sure, but then again she had said earlier that she was going to do additional biopsies at 6 months. There's one tiny area that has either never completely healed or that is very susceptible to irritation (bleeds slightly after a difficult bowel movement or a spell of diarrhea), other than that no issues to speak of.

 

Edit: Since you mentioned your concern about additional bowel issues, I should add that after I got home from the hospital stay I had leakage problems for about a month. I'm not sure if it was because of the biopsies or not - it may have been from the extended hospital stay, no clear way to really tell. The incontinency did clear up, but it took quite a while. Not fun.

pializ

pializ said:

Biopsy post crt

I was reading recently about procedures following cry & posted a link here. I will look back & 'bump' for you, but I am fairly sure that biopsies are contra indicated unless, as Martha says, that there is evidence of progressive disease

Liz

Biopsy

previous post 'bumped' yesterday

TraceyUSA

Salsify

My radiologist warned against biopsies post radiation to just "make sure they got it all."  He even contacted my colorectal surgeon and spoke with him regarding this issue.  As it was explained to me, unless there is a suspicion of something abnormal it was best not do biopsy this area due to possible healing and ulceration issues.

- Tracey

qv62

Salsify

I am of the mindset that there is no need to biopsy unless unless someting looks suspicious. I had countless biopsies and surgical  procedures from 2009 until treatment in 2014. Each and every time I had bowel issues, leakage etc... My doctor does anoscopys on me every three months and so far so good, also good scans, I can't imagine she would ever take me back into the OR unless there was something there to worry about. Best of luck with your next appointment, let us know what happens but bring up your concers before scheduling a procedure

Salsify

Thank you all

I want to thank everyone here for their answers.

I have been a bit suspicious of this doctor ever since early on he acted annoyed that I had made arrangements for a second opinion from Memorial Sloan Kettering, even though I had cancelled after biopsy was confirmed as squamous cell carcinoma, therefore anal, & therefore to be treated with CRT. Location hd indicated it could be adenocarcinoma, in which case my doctor said he would surgically remove tumor & I would have a permaent colostomy bag. And I did not want permanent colosomy without a second opinion.

My doctor had biopsy sent to a second lab for a second opinion because the cells were poorly differentiated; it took forever to get the second labs report. It was in that interval that I made the appointment with Dr. Weiser at MSK.

When I told my local doctor I had cancelled an appointment with a surgical oncologist for a second opinion after finding out I would be treated with CRT instead of surgery, he looked at me like I was both insulting him and stupid and said that a surgeon would have advised surgery because that is how they make their money. I am foolish enough to think that some doctors would use their knowledge to recommend the best treatment for the patient, not their own bank accounts. Think I'd be old enough to know better, right? But my doctor's view that other doctors will recommend treatment based on the income it provides them makes me think he might be like that himself.

Again, thank you all.

mp327

Salsify said:

Thank you all

I want to thank everyone here for their answers.

I have been a bit suspicious of this doctor ever since early on he acted annoyed that I had made arrangements for a second opinion from Memorial Sloan Kettering, even though I had cancelled after biopsy was confirmed as squamous cell carcinoma, therefore anal, & therefore to be treated with CRT. Location hd indicated it could be adenocarcinoma, in which case my doctor said he would surgically remove tumor & I would have a permaent colostomy bag. And I did not want permanent colosomy without a second opinion.

My doctor had biopsy sent to a second lab for a second opinion because the cells were poorly differentiated; it took forever to get the second labs report. It was in that interval that I made the appointment with Dr. Weiser at MSK.

When I told my local doctor I had cancelled an appointment with a surgical oncologist for a second opinion after finding out I would be treated with CRT instead of surgery, he looked at me like I was both insulting him and stupid and said that a surgeon would have advised surgery because that is how they make their money. I am foolish enough to think that some doctors would use their knowledge to recommend the best treatment for the patient, not their own bank accounts. Think I'd be old enough to know better, right? But my doctor's view that other doctors will recommend treatment based on the income it provides them makes me think he might be like that himself.

Again, thank you all.

Salsify

I would have to agree that there are doctors out there who will do what's in their best interest and not necessarily the patient's.  I would hope that the threat of a malpractice suit would deter most of them, but perhaps not.  That said, I believe there are still many doctors out there who have their patient's best interest in mind and would not recommend unnecessary procedures or ineffective treatment for the purpose of lining their pockets.  I also believe that any doctor worth his or her salt would not be offended if a patient sought a second opinion.  On that note, it's too bad you didn't go ahead with your plan to see Dr. Weiser.  One of our posters, who is currently inactive on this site, has sung his praises many times and based on her comments about him, I feel certain that he would not have recommended surgery just because he is a surgeon, but rather if it was your only option or would give you a much better prognosis or quality of life than another type of treatment.  Since she spoke so favorably of him, I have saved his information in my favorites "just in case."

I was diagnosed with anal cancer in June 2008 and had next to no knowledge about the disease, treatment, or doctors who are known across the U.S. as experts in treatment of it.  It was my good fortune to have a great local colorectal doctor, medical oncologist, and radiation oncologist who all were up to speed on the diagnosis and treatment of this disease.  Since that time, after participating on 3 different support sites, including this one, I have learned the names of some of the best doctors in this country when it comes to treating anal cancer.  Unfortunately, there are still so many who are not that well-informed.

I wish you all the best as you move forward.

Martha

 

Fran1

mp327 said:

Salsify

I would have to agree that there are doctors out there who will do what's in their best interest and not necessarily the patient's.  I would hope that the threat of a malpractice suit would deter most of them, but perhaps not.  That said, I believe there are still many doctors out there who have their patient's best interest in mind and would not recommend unnecessary procedures or ineffective treatment for the purpose of lining their pockets.  I also believe that any doctor worth his or her salt would not be offended if a patient sought a second opinion.  On that note, it's too bad you didn't go ahead with your plan to see Dr. Weiser.  One of our posters, who is currently inactive on this site, has sung his praises many times and based on her comments about him, I feel certain that he would not have recommended surgery just because he is a surgeon, but rather if it was your only option or would give you a much better prognosis or quality of life than another type of treatment.  Since she spoke so favorably of him, I have saved his information in my favorites "just in case."

I was diagnosed with anal cancer in June 2008 and had next to no knowledge about the disease, treatment, or doctors who are known across the U.S. as experts in treatment of it.  It was my good fortune to have a great local colorectal doctor, medical oncologist, and radiation oncologist who all were up to speed on the diagnosis and treatment of this disease.  Since that time, after participating on 3 different support sites, including this one, I have learned the names of some of the best doctors in this country when it comes to treating anal cancer.  Unfortunately, there are still so many who are not that well-informed.

I wish you all the best as you move forward.

Martha

 

Biopsy

HI Martha, 

I am so thankful to have read the messages on this thread regarding having a biopsy after treatment. My colorectal dr already has me scheduled for a biopsy right after I finish treatment. He explained if there was any remaining cancer he is going to schedule surgery and give me a colostomy. I tried explaining to the dr that is not my Radiogist's treatment plan. I could tell he was not happy with my statement. He looked me directly in the eyes and said "She's only a Radiogist, she's not a Surgeon, she doesn't know what needs to happen." 

I will not even have my PET/CT until a month after treatment to see if the tumor is gone or decreasing size. To say the least, after reading the messages, I am running the other way and will find a new colorectal dr. 

Thank you so much for sharing the information about biopsies. 

Fran

 

 

mp327

Fran1 said:

Biopsy

HI Martha, 

I am so thankful to have read the messages on this thread regarding having a biopsy after treatment. My colorectal dr already has me scheduled for a biopsy right after I finish treatment. He explained if there was any remaining cancer he is going to schedule surgery and give me a colostomy. I tried explaining to the dr that is not my Radiogist's treatment plan. I could tell he was not happy with my statement. He looked me directly in the eyes and said "She's only a Radiogist, she's not a Surgeon, she doesn't know what needs to happen." 

I will not even have my PET/CT until a month after treatment to see if the tumor is gone or decreasing size. To say the least, after reading the messages, I am running the other way and will find a new colorectal dr. 

Thank you so much for sharing the information about biopsies. 

Fran

 

 

Fran

I'm very glad you have seen this discussion.  My radiation oncologist told me that radiation can continue working for up to 6 months after treatment ends.  It makes sense.  Think of Chernobyl and how long the radiation will be present there after the accident--perhaps decades or longer. 

Truthfully, I cannot imagine a doctor going in there to do a biopsy on an area that has just been radiated.  Radiated skin may not heal well.  As you know, in an area that has "traffic" for lack of a better term, it can lead to permanent damage that will never heal.  Biopsies, as has already been discussed, are not part of the protocol for follow-up unless residual cancer remains, as seen on anoscopy exam, and appears to be progressive.  If there is persistent disease, re-evaluation in 4 weeks is indicated.   

I think the comment your colorectal surgeon made about your other doctor being "only a radiologist" is quite pompous.  Such an arrogant attitude by one physician towards another is unprofessional.  I would be looking for another doctor too.

Best Wishes--

Martha

qv62

Salsify said:

Thank you all

I want to thank everyone here for their answers.

I have been a bit suspicious of this doctor ever since early on he acted annoyed that I had made arrangements for a second opinion from Memorial Sloan Kettering, even though I had cancelled after biopsy was confirmed as squamous cell carcinoma, therefore anal, & therefore to be treated with CRT. Location hd indicated it could be adenocarcinoma, in which case my doctor said he would surgically remove tumor & I would have a permaent colostomy bag. And I did not want permanent colosomy without a second opinion.

My doctor had biopsy sent to a second lab for a second opinion because the cells were poorly differentiated; it took forever to get the second labs report. It was in that interval that I made the appointment with Dr. Weiser at MSK.

When I told my local doctor I had cancelled an appointment with a surgical oncologist for a second opinion after finding out I would be treated with CRT instead of surgery, he looked at me like I was both insulting him and stupid and said that a surgeon would have advised surgery because that is how they make their money. I am foolish enough to think that some doctors would use their knowledge to recommend the best treatment for the patient, not their own bank accounts. Think I'd be old enough to know better, right? But my doctor's view that other doctors will recommend treatment based on the income it provides them makes me think he might be like that himself.

Again, thank you all.

Salsify

I am still a patient at MSKCC and would highly reccomend you going to the facility, even if you are in treatment now you will need years of follow up. I was with a local facility from 2009 through 2011 at which point I transferred to MSKCC. I actually was very fond of my "country doctor" but had a whole new perspective from my "city doctor"

qv62

Fran1 said:

Biopsy

HI Martha, 

I am so thankful to have read the messages on this thread regarding having a biopsy after treatment. My colorectal dr already has me scheduled for a biopsy right after I finish treatment. He explained if there was any remaining cancer he is going to schedule surgery and give me a colostomy. I tried explaining to the dr that is not my Radiogist's treatment plan. I could tell he was not happy with my statement. He looked me directly in the eyes and said "She's only a Radiogist, she's not a Surgeon, she doesn't know what needs to happen." 

I will not even have my PET/CT until a month after treatment to see if the tumor is gone or decreasing size. To say the least, after reading the messages, I am running the other way and will find a new colorectal dr. 

Thank you so much for sharing the information about biopsies. 

Fran

 

 

Fran1

Glad to see you will seek new care. I was told as well I may need a colostomy prior to treatment, but I made a switch and luckily escaped that route.

Fran1

qv62 said:

Fran1

Glad to see you will seek new care. I was told as well I may need a colostomy prior to treatment, but I made a switch and luckily escaped that route.

Qv62

Thank you so much for responding. I am going to find a new colorectal dr. I will ask my Radiogist for referrals. My Radiogist is a very nice dr, very supportive. When she entered dr residency, her first case was with a patient who had anal canal cancer. The other Drs could not believe she was given such a difficult case. 

Fran

Fran1

mp327 said:

Fran

I'm very glad you have seen this discussion.  My radiation oncologist told me that radiation can continue working for up to 6 months after treatment ends.  It makes sense.  Think of Chernobyl and how long the radiation will be present there after the accident--perhaps decades or longer. 

Truthfully, I cannot imagine a doctor going in there to do a biopsy on an area that has just been radiated.  Radiated skin may not heal well.  As you know, in an area that has "traffic" for lack of a better term, it can lead to permanent damage that will never heal.  Biopsies, as has already been discussed, are not part of the protocol for follow-up unless residual cancer remains, as seen on anoscopy exam, and appears to be progressive.  If there is persistent disease, re-evaluation in 4 weeks is indicated.   

I think the comment your colorectal surgeon made about your other doctor being "only a radiologist" is quite pompous.  Such an arrogant attitude by one physician towards another is unprofessional.  I would be looking for another doctor too.

Best Wishes--

Martha

Martha

Thank you for replying to my message. I am so thankful I have found CSN. I have learned so much in the last month. Yes, I will be seeking another colorectal dr. His comment towards my Radiogist really turned me off. I felt he was very unprofessional. 

Thank you for all your support. 

Fran

Pilikia55

qv62 said:

Salsify

I am still a patient at MSKCC and would highly reccomend you going to the facility, even if you are in treatment now you will need years of follow up. I was with a local facility from 2009 through 2011 at which point I transferred to MSKCC. I actually was very fond of my "country doctor" but had a whole new perspective from my "city doctor"

Salsify, et al.,

I finished treatment in Feb. 2004. I do not think they knew as much then as now. I had a "tag" after the treatment that my oncologist believed was scar tissue. (I loved my oncologist). My surgeon wanted to biopsy it, 6 weeks after treatment! My oncologist was adamant that I wait. I was scared and didn't really know what to do. After, i think, 3 mos., I had the biopsy, figuring I'd compromise between the 2 opinions. It was, in fact, scar tissue. But having the biopsy, I believe, impeded my progress greatly. I was in agonizing pain for months and developed a fissure. I just thought I was slowly healing from the surgery and was resigned that this was how things were going to be. My oncologist did not want to disturb the area again until I healed. He wanted to wait before doing another internal exam. Anyway, I moved to another state, and after 6 horrible months, my new oncologist referred me to a new surgeon immediately, who did surgery within the week and repaired the fissure. I then began to heal. If you can avoid it, don't have a biopsy unless they can give you a damn good reason for it. As Martha said, it is Chernobyl down there! Don't disturb anything, if at all possible. Good luck to you. 

jcruz

Fran1 said:

Biopsy

HI Martha, 

I am so thankful to have read the messages on this thread regarding having a biopsy after treatment. My colorectal dr already has me scheduled for a biopsy right after I finish treatment. He explained if there was any remaining cancer he is going to schedule surgery and give me a colostomy. I tried explaining to the dr that is not my Radiogist's treatment plan. I could tell he was not happy with my statement. He looked me directly in the eyes and said "She's only a Radiogist, she's not a Surgeon, she doesn't know what needs to happen." 

I will not even have my PET/CT until a month after treatment to see if the tumor is gone or decreasing size. To say the least, after reading the messages, I am running the other way and will find a new colorectal dr. 

Thank you so much for sharing the information about biopsies. 

Fran

 

 

no biopsy

Your surgeon is not the lead for your treatment.  He should be deferring to the oncologists.  And certainly 6 weeks is way to early to scan or cut.  I had a PET scan 2 months after treatment and what looked like it might be cancer turned out to be scar tissue.  The only way to know at that point was a biopsy and 3 months.  If they'd waited longer I would not have to have the biopsy.

Janet

technicolor

biopsy

6 months after finishing my chemo and radiation I went back to my surgeon and told him that for the last 2 months I'd been having increasing pain in my rectal area.  My oncologist thought it might be in my tail bone since I broke that many years ago, but the pain went from slight to unbearable and I sought an answer.  I thought it might be adhesions or scar tissue since my mother had had the problem when healing and my knee developed a lot of scar tissue after surgery on a torn meniscus.  Had surgery but noticed it was listed as a biopsy, no more cancer according to pathologist and so far the pain is gone Thankfully!  Now I do have leakage at times and if I get diarrhea, Watch Out!  But it's been about 7 weeks since second biopsy and no pain yet.  I will wait and see on the leakage and hope for the best but being without pain is a big plus for me.  I wonder if anyone else has experienced this?