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Questions for first visit with Onc.

cwork's picture
Posts: 37
Joined: Oct 2010

I tried doing a search for this, but did not come up with anything recent. My sister has her first appointment with her oncologist at Vandy this week. She is stage IV with 4 liver lesions. I am trying to help her come up with a list of questions she needs to ask her doc about. Would some mind sharing important things to ask on first visit? Is treatment for stage IV with liver mets the same as treatment without liver mets? Also should she ask about what treatment they use for the liver mets? I have read there are new things they do for liver mets now, but that a lot of hospitals don't do the new stuff and if you don't mention it, then they won't. She is 3 weeks post surgery, healing very well. She is young and healthy otherwise, so wondering how long typically she would start first treatments? Thanks for any help. BTW, she did join the network under the user id immbeloved. She did not start a new post, rather posted under my original post, so you may not have met her, but she is here. Thanks so much.

lizzydavis's picture
Posts: 893
Joined: May 2009

I have listed some questions which will give you an idea of what to ask. These do not address stage IV or liver mets. I am sure others will answer with more questions to consider. Take your own list and 1-2 people with you so that you will not forget. It is a difficult time to take in all the info presented.

Questions to Ask the Medical Oncologist
1. Why are you recommending this therapy?
2. What are the risks?
3. Are there other ways to treat the cancer?
4. Where do I go for chemotherapy or hormone therapy?
5. Will I be able to drive myself home after treatment, or do I need help?
6. How long does the treatment last?
7. What are the risks and side effects?
8. Will I lose my hair?
9. What about premature menopause and infertility?
10. What should I avoid during treatment?
11. Should I change my diet or lifestyle?

1. How will you determine in the future whether or not the cancer has returned?
2. What kinds of tests?
3. Will the chemo and/or radiation further affect my bowels which are in a state of irregularity since the operation.
4. Chemo – Drug names & what kind
5. Nausea - Will I have a problem with it?
Drugs for Nausea? - Activan? -
6. Will I be getting a port put in your chest or arm?
7. If not, why not?
8. What chemo/rad plan does he/she propose and why?
9. How many cycles?

10. What can you expect for side effects?
11. What is the procedure for getting lab/test/scan results?

I hope this helps. Please let us know what you found to be important questions to ask and keep us updated on your appointment.

Lizzy Davis

cwork's picture
Posts: 37
Joined: Oct 2010

tremendous help. Thanks so much. Any other suggestions?

PGLGreg's picture
Posts: 741
Joined: Jul 2006

What should I be asking you about that I haven't yet asked?


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Buzzard's picture
Posts: 3073
Joined: Aug 2008

you have an Oncologist at home, if Dr Chan could prescribe the chemo treatment or other regimens needed and have them administered at your home oncologists office through her prescribing them. You may save yourself a 5 hr trip every other week. I was going to do that but felt a little odd because of having the same Onc for 2 years then changing..I thought it might be a little crappy so I simply changed to Vandy completely....But, they can do that if you have an Onc office close to your home...Love to ya both, Buzz

cwork's picture
Posts: 37
Joined: Oct 2010

Thanks so very much for all the suggestions. Such great advice here. Buzz, interesting you mentioned about doing chem at home. Sis is very interested in getting treatments in Florence where she lives as it is 2 1/2 hr drive each way to Nashville. However I am afraid if she pushes that option it could change her treatment plan or cut her out of trials etc. Also if she does that would she be in affect changing ONC from Chan at Vandy to another in Florence Alabama? I am not sure how all that works and if it is a good idea to say "Can you formulate my plan and Florence admisister it." Any thoughts?

Buzzard's picture
Posts: 3073
Joined: Aug 2008

Emily Chan would direct the treatment regimen to be administered at Florence but under Emilys direct supervision. Emily would directly control everything done as well as dosage but have it done through the Oncologist there in Florence ...Both parties win in that situation. You are getting the benefit of an Onc that you trust and your hometown Onc is also receiving payment for administration of the drugs as well as maybe learning new options that might be beneficial to others that Florence may have never been able to try before.. It is a win/win situation for both parties. It will not change our options for trials or anything, and yes they will formulate a plan and let Florence administer it. She is not changing Oncs, she is only changing the place for having to sit to have it administered. Mrs. Chan will be directly in charge of every move made..... Why not try it ? Vandys Drs are patient driven , they know what we go through and have our best interest at heart. My Dr informed me that yes it can and would be done if simply asked for....Make it easy for yourself as possible.also your sis has a pm that I had sent to someone else thinking it was sent to her. I sent it to her this morning...Make this journey an easy one as possible. Don't feel bad about asking either. If you don't ask, they will never know what might be a Godsend for you...Love to you and sis....Clift

abrub's picture
Posts: 2158
Joined: Mar 2010

Many nutritional supplements and vitamins are NOT okay during chemo or rads. Anti-oxidants can work against chemo and radiation therapy. Some drs advise limited or no green tea, for example, and very limited other vitamins. (This is from integrative medicine at Memorial Sloan Kettering). Therefore you need to ask about any and all meds and supplements.

Also ask about preventive meds for neuropathy, whether it be supplements of vitamin B6 (the one vitamin I was encouraged to take in mega-doses - 100 mg 3x/day). Find out if vitamin D intake should be increased.

Request anti-emetics before she needs them. If your sister is having a port, she should request Emla cream to numb the area before chemo. For some reason, many drs don't think about the Emla; I heard about it from another patient; and it makes a HUGE difference - no discomfort when the needle is inserted.

Crow71's picture
Posts: 681
Joined: Jan 2010

Hey there cwork and immbeloved,
You've gotten some great feedback here. I love these guys. The only thing I would add is to start the discussion about surgery on the liver. There are new treatments for liver mets, but having a skilled surgeon just get in there and cut the tumors out or remove a lobe is considered the best way to get rid of the cancer. You may not choose surgery, but hopefully it will be an option. Don't be discouraged if your med onc is negative about surgery. It seems like many chemo docs start out telling patients that surgery isn't an option. Each cancer is different. Each body is different. There's no telling how you and your disease will react and respond to chemo.

Stay strong and positive. Cancer hates happiness.

Take care -- Roger

tootsie1's picture
Posts: 5065
Joined: Feb 2008

I don't have any new questions to add, just want to say I'm glad that your sister has joined, as well.


P.S. By the way, your picture is beautiful!

immbeloved's picture
Posts: 37
Joined: Oct 2010

1. why?
2. How?
3. How long?
4. how ugly?
5. how painful?

Nana b's picture
Nana b
Posts: 3045
Joined: May 2009

What's my CEA?
What do I do if I have a fever?
does Chemo remain in the saliva, can kids drink after...do I have to be careful where I put my glass?
Magic mouthwash for mouth sores, can I get an RX?
What is restless leg syndrome?
Hernias and surgery?
Food taste?
Cold drinks and chemo

sorry my nails are wet trying to post before I have to leave

Lori-S's picture
Posts: 1286
Joined: Sep 2010

1. Why? (why not?)
2. How? (how ever we can)
3. How long? (how ever long it takes)
4. How ugly? (as ugly as you can handle)
5. How painful? (hahahahaha)

Sorry, couldn't help myself. I'm feeling pretty crappy and I've been told I use humor as my defense mechanism. Works for me!

Seriously Amber, all of those questions seem to be so different for each person. Make sure you ask them of you onc as they will have the information particular to you.

Buzzard's picture
Posts: 3073
Joined: Aug 2008

Why......because there were cells that once upon a time were not killed off by your immune system...every person in the world has cells that will divide and if left unchecked become cancerous...all of us, we just happen to be the unlucky ones

How.....Cell division faster than immune elimination...

How Long.....If you are speaking of survival, only one person can answer that one. But, we as SURVIVORS, and yes you are one as well, jump from one treatment to the next to extend our lives in both quantity and quality the best we can and basically try to hold out until the next one comes along or until there is a cure.....hopefully the latter, but as for how long, sometimes depends on how drastic measures you are willing to take to survive, sometimes it works, sometimes it doesn't.....

How Ugly.... well if again its cancer specific you talk about, that depends on the level of care and expertise you get...Some places are better at different treatments than others so that also lies with the place of treatment and their staff expertise...

How painful......I can vouch for the lung surgery it is painful...I have never had a liver resection but I do hear that there is a slow recoup time...There are a lot of others that can inform you about the severity and pain that goes with it....Love and Hope to you and yours, Clift

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