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Oncologist vs radiation oncologist

suebanj
Posts: 16
Joined: Jul 2009

I had my left upper lobe removed on July 7 and all path tests came back clean. My surgeon wants me to see an oncologist just to review all my reports but he feels that they will say I need nothing further. I called my internist to get a name of an oncologist and he gave me one who is a radiation oncologist....
I'm not sure, in my situation which appears that they got all the cancer, that the radiation oncologist is the one to see...Should I be seeing a reg/medical oncologist first??

Thanks for any info....I am so totally confused! but grateful that they were able to do the surgery to get the cancer!

soccerfreaks's picture
soccerfreaks
Posts: 2800
Joined: Sep 2006

Sue:

Oncology means, literally, the study of tumors. An oncologist, whatever else he or she is, a studier of tumors, that is, a cancer doctor.

Frankly, I am surprised you didn't have one on board from the beginning! I have had two bouts with cancer (head/neck cancer and lung cancer) and had the same oncologist on board the entire time, from even before the first surgery.

In both cases, my surgery was followed up with chemotherapy (the first time with radiation as well), to get rid of the 'strays', if you will, and I think it an excellent idea that your surgeon is asking you to at least consult with an oncologist in this regard.

If you are concerned that a radiation oncologist will automatically suggest radiation treatment, and that may be a vialbe concern, ask your surgeon or his/her staff for a recommendation instead regarding an oncologist.

Whatever you do, do not bypass the opportunity to get this additional advice and medical support.

Congratulations on your glowing report, by the way!

Take care,

Joe

cabbott
Posts: 1048
Joined: Aug 2006

I am a two time cancer survivor (breast cancer the first time, lung cancer the second). Both times I was encouraged or just plain shuttled straight to the oncologist a month after surgery. I was lucky. I was in a teaching university hospital center where many kinds of oncologists worked. I thought the expert who I saw for breast cancer could follow me for the lung cancer as well. After all, it was cancer and he was an oncologist (cancer doctor in my book). Actually, he said what he preferred was a pulmonary oncologist to see me for at least once to determine my need for chemo or any other treatment. He said that he knew a lot about cancer from his studies, but as a breast cancer specialist who knew breast cancer better than any other kind of specialist, he had high regard for those who specialized in lung cancer. For the best treatment plan possible and so no stray problems were missed, he recommended I go to the pulmonary oncologist. I had stage 1-A lung cancer of a type that the surgeon didn't think would require any further treatment beyond surgery and regular monitoring unless it re-occured. Nevertheless, I am conservative by nature and decided it was better to do as my breast oncologist suggested and see the pulmonary oncologist. The pulmonary oncologist looked over my records, advised me about the probabilities of reoccurance and told me that I was not sick enough to keep seeing her! My risk was too low to consider chemo (she went over the research as far as I was able to follow), but if it re-occurred I could return to her for treatment. Just doing chemo with all its side effects as a precaution does not necessarily extend life or reduce the probability of re-occurance. The research on chemo indicates that it just isn't that good yet. I wish. Like in breast cancer, the doctors wait until there are symptoms that the cancer is aggressive (that means it is spreading...) before they pull out the big guns. However, the pulmonary oncologist did suggest that I may wish to see a pulmonologist to help my breathing and possibly monitor me over the years after the surgeon dismissed me. My operation was in 2004. I saw the p. oncologist early in 2005. Last fall I got tired of coughing so much and finally went to see the pulmonologist locally/ He helped loads with allergy and breathing treatments that has me almost back to normal for me. (My oxygen level was and is great, but I hated coughing all day on folks! Now I don't cough much at all most days). The surgeon is running tests (either an xray or CAT scan) every 6 months and seeing only 1 time a year if everything is good. I had my six month xray this morning and have my fingers crossed that I won't see the surgeon this summer! The breast cancer oncologist is going to be seeing me as long as I am taking pills for that: at least another two years I think, but it is down to a once a year visit so I can get my prescription. I look forward to a day when we have a preventative like we do with breast cancer to take for lung cancer after surgery when chemo is either finished or not indicated. Right now, the research isn't there yet. The problem is money. Breast cancer hits pretty young actresses that can live long enough to raise lots of dough. Lung cancer just doesn't have the same curb appeal to get the sponsers. But I am getting on my bandwagon. If I were you, I would call the nearest teaching university hospital that specializes in lung cancer treatment and go in for a consultation with the best pulmonary oncologist that you can get.That in plain speak is a lung cancer chemo specialist. They can tell you what your risks are with and with-out chemo. Then they can set up a plan that can be carried out either there or in your local community with the specialists are there. They may even advise you on the benefits of certain supplements (ask about selenium, vitamin C) and exercise on survival and reducing re-occurance.

I would not stick with the radiologist oncologist only because you are not likely to need radiation. That is used mostly for cancer control when cancer is aggressive and needs shrinking either for pain control or so operating can be considered.

I would not go with only a pulmonologist because breathing is their speciality, not chemo and you have questions about whether chemo is beneficial or not. I would ask the pulmonary oncologist about whether a pulmonologist or the surgeon should follow your case now that surgery is completed if he or she doesn't think you need to be followed by a pulmonary oncologist.

Hope that helps!

C. Abbott

soccerfreaks's picture
soccerfreaks
Posts: 2800
Joined: Sep 2006

CABBOT says: "Just doing chemo with all its side effects as a precaution does not necessarily extend life or reduce the probability of re-occurance. The research on chemo indicates that it just isn't that good yet. I wish. Like in breast cancer, the doctors wait until there are symptoms that the cancer is aggressive (that means it is spreading...) before they pull out the big guns."

I have never, I do not believe, disagreed with anything said before by my friend C Abbott. This time, I am compelled, I think, to do so, although it may be nitpicking in the end.

Personally, I had NO EVIDENCE OF DISEASE both times chemotherapy was prescribed following treatment; that is, the 'big guns' were brought out when there was clearly no indication of aggressiveness or spreading: to wit, there was no cancer to kill that one might see.

The fact is, the 'strays' that both C and I reference can be, typically ARE, so small that they cannot even be detected. The hoped-for desire from 'preventive' chemotherapy is to take them out. I cannot argue with C re studies that I have not seen. I can argue against the supposition, tacit though it may be, that chemotherapy is an ineffective strategy.

It is true that it is a rather 'shotgun' approach and clearly not the first choice if others are viable and 100% effective. But if it does not serve some remedy, even as a preventive measure rather than as a last gasp "big guns" approach, then a whole lot of us are being duped.

In fact, there are NO treatments that you can be absolutely certain will "necessarily extend life or reduce the probability of re-occurance." I will concur, however, that some have better chances than others.

It may be that I misunderstood.

In any case, not to confuse you, Sue. It appears that C and I ARE in agreement that you SHOULD consult with an oncologist, and that is the important thing.

I simply didn't want you to come away from C's otherwise excellent post dismissing the potentially positive aspects of chemotherapy outright. Let the oncologist help you decide that.

Take care,

Joe

suebanj
Posts: 16
Joined: Jul 2009

Thanks for the information. Well, I spoke to my GP and I am now going to a medical oncologist. In fact, my friend, who was diagnosed a few years ago with lung cancer uses him and thinks highly of him. Her case was inoperable but through his care, she is still with us. So, I see him on Wednesday. I will see what he has to say and go from there...
Sometimes I feel so out of control, but atleast with this site I can say and ask questions and do feel better.
Thanks again to all.
Sue

cabbott
Posts: 1048
Joined: Aug 2006

My apologies if I came across with the impression that chemo was not effective. That's not acurate at all. Chemo obviously helps or doctors wouldn't use it. Actually, I agree that chemo is effective, especially for some cancers. It is just not as effective as I want nor does the do the experts I'm seeing think it will be effective for me. Probably not ever if I heard them correctly, though I will go back to the pulmonary oncologist for another consultation should this stuff come back and pray that they have sometime discovered that will work for me. Shucks, I want a blanket assurance that the beast is dead and isn't coming back in some nasty sequel ever. Two times is two times too many, as you know! And I want to kill the C without the medicine causing major side effects while I take it. The doctors won't give me that guarentee, but they have promised to give me the best they have. With my breast cancer they gave me a better chance with first tamoxifen and then an aromomatase inhibitor. Many women won't touch either because of side effects. Both are daily pills. I looked at the research and decided that improving my probability of making it ten years was worth it. But they didn't recommend chemo back then and the research since continues to back their decision for my particular kind of breast cancer at my particular stage. Lung cancer doctors base their decisions similarly. The docs sometimes recommend chemo and sometimes don't. As I understand it, they base whether to recommend it on the probability of reoccurance based on the history of that particular kind of cancer. My kind of cancer isn't helped all that much by chemo from what my docs told me. Other kinds are. My type sometimes responds to Tarceva should it reoccur, but they don't recommend I take that as a preventitive. They also said that it will depend on my genetics and that I would have a greater chance of success if I had born oriental. I wasn't and there's no changing that now! They based their recommendation for me on the micro-genetic testing and pathology findings for my particular tumor. Your tumor may be different even though it is also lung cancer. Other kinds of lung cancer are proven to respond better to chemo. I agree that chemo is like weed killer that kills stray cells that surgery miss. If mine was the kind to be helped by chemo I would have stood in the front of the line asking for it. But different cancer cells have different targets and it takes different kinds of ammo to hit those different targets. So in your case they recommended chemo and in mine they didn't. We both listen to our experts and maybe that's the best we can do.

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