New doctor questions

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utahgal7
Posts: 26
Joined: Fri Sep 11, 2020 12:04 pm

New doctor questions

Postby utahgal7 » Thu Nov 12, 2020 10:04 am

Hi,

After 35 years of practice, my oncologist is retiring. He had over 600 patients and the hospital where I get treated reassigned all of his patients. I have been assigned to an oncologist whose specialty is pancreatic cancer. I don't know the reason for this. My guess is there is a lack of oncologists whose specialty is colorectal cancer that practice at my hospital.

My new oncologist has gotten good patient reviews. I have yet to meet him. So, I apologize if this is a dumb question....Can an oncologist whose specialty is not colorectal cancer treat colorectal cancer? If I decided to change to a oncologist whose specialty is colorectal cancer, am I being too picky?

Any advice?

Thank you!
02/20 Rectal Cancer Diagnosis
03/20 CEA 2.7 ST Radiation - 25Gy over 5 days
04/20 LAR surgery w/ ileostomy (6 lymph nodes retrieved, 1 node positive for cancer)
04/20 T3N1M0; MSS
05/20 CAPEOX (had to discontinue because Oxaliplatin caused temporary blindness in left eye)
06/20 CEA 0.9
08/20 Ileostomy reversal
09/20 CEA 1.4, CT chest/abdomen/pelvis; suspicious areas in liver
10/20 MRI liver; dx hemangioma

Koreysue
Posts: 186
Joined: Mon Apr 30, 2018 2:36 pm

Re: New doctor questions

Postby Koreysue » Thu Nov 12, 2020 10:44 am

I do not think that is too picky at all. You need to do what you feel comfortable with!
Ksue
Diagnosed: June 2017 stage 3 colon cancer
Sigmoid colon, 2 nodes affected
CEA at diagnosis: 6
Sigmoid Colectomy and folfox (chemo complete January 31, 2018)
CEA 4/2018: 2.4
CEA 7/2018: 3.7
Colonoscopy 8/2018 clean
PET scan 8/20/18 NED
CEA 11/2018: 3.8
CEA 2/2019: 3.2
CT NED 6/18/2019 / CEA : 3.4
CEA 10/21/19: 3.2
CEA 3/9/20: 3.8
CT NED /CEA 6/17/20: 3.8
CEA 11/4/20 4.6 <——— whyyyy? (will retest in a few weeks)

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Green Tea
Posts: 238
Joined: Mon Oct 24, 2016 10:48 am
Location: Nusa Tenggara

Re: New doctor questions

Postby Green Tea » Thu Nov 12, 2020 2:26 pm

One thing you could do is to check whether the new doctor is Board Certified. The relevant certification sub-specialty is called Medical Oncology.

You can use this web-site to check:

https://www.certificationmatters.org/find-my-doctor/

In the on-line form, enter your doctor's last name, the specialty "Medical Oncology", and your state. If he has a Medical Oncology certification in your state, then it should show up when you click on the FIND MY DOCTOR button.

It's best if his certification is coded "Participating in MOC", which means that he participates in the "Maintenance of Certification" program and attends periodic workshops and refresher courses to keep his Medical Oncology certification up-to-date.

https://health.usnews.com/best-hospitals/rankings/cancer/utah
Last edited by Green Tea on Sat Nov 14, 2020 7:11 am, edited 1 time in total.

roadrunner
Posts: 63
Joined: Sun Jan 12, 2020 8:46 pm

Re: New doctor questions

Postby roadrunner » Thu Nov 12, 2020 3:08 pm

I would not be comfortable with a medical oncologist who didn’t have CRC as a speciality, or at least very extensive CRC experience. As you probably know, this field is hideously complex and constantly changing, and there are a ton of judgment calls. But your situation also matters, and it might be possible to get comfort with the new oncologist through discussion, depending on the circumstances.
7/19: Rectal cancer: Initially staged as IIIA, T2N1M0
Initially approx 4.25 cm, low/mid rectum, mod. well diff. adenocarcinoma
8/22 -10/14 4 rounds FOLFOX neoadjuvant, 3 w/Oxiplatin (lots of side effects/reduced size est. 70-75%)
Switched to neoadjuvant chemorad in 11/19 (Xeloda and approx. IMRT, 60 Gy, 33 fractions)
Trying to achieve cCR.

Beckster
Posts: 422
Joined: Thu Jan 12, 2017 3:01 pm
Location: New Jersey

Re: New doctor questions

Postby Beckster » Thu Nov 12, 2020 3:29 pm

When I was diagnosed 4 years ago, I was given an oncologist who specialized in gastro cancers, which included colon. 4 years later, I sent a friend to him for his treatments, While my friend was going through chemo sessions, he was able to speak to different people while going through infusions. Come to find out, they were seeing our oncologist for pancreatic cancer,not colon cancer. I still see him twice a year and my friend is starting surveillance with him for CC. From what I can understand, the pancreas is part of the gastrointestinal tract. If this is true, your new oncologist should fit your needs.
57/F
DX:(CC) 10/19/16
11/4/16- Lap right hemi(cecum)
CEA- Pre Op (1.9), Pre Chemo (2.5)
Type: Adenocarcinoma
Tumor size:3.5 cm x 2.5 x 0.7 cm
Grade: G3 (path) G2 (pre-op)
TNM: T3N0M0/IIA
LN: 0/24
LVI present
Surgical margins: clear
MSS
12/27/2016 - Capeox, anaphylactic reaction
1/2/17 to 6/9/17- Xeloda monotherapy
6/17,12/17,6/18,12/18, 6/19, 12/19 CT Scan NED :D
CEA- 6/17- 3.6, 9/17- 2.8 12/17-2.8, 3/18-3.1, 6/18-3.0, 9/18 2.8, 12/18 2.5 3/19 3.1 6/19 3.1 9/19 2.6 12/19 2.8 6/20 3.0
Clear Colonoscopy 10/17, 11/19 :D

utahgal7
Posts: 26
Joined: Fri Sep 11, 2020 12:04 pm

Re: New doctor questions

Postby utahgal7 » Fri Nov 13, 2020 8:04 am

Thank you for all of the kind responses! I think I will meet with my new oncologist first and then decide how to move forward.
02/20 Rectal Cancer Diagnosis
03/20 CEA 2.7 ST Radiation - 25Gy over 5 days
04/20 LAR surgery w/ ileostomy (6 lymph nodes retrieved, 1 node positive for cancer)
04/20 T3N1M0; MSS
05/20 CAPEOX (had to discontinue because Oxaliplatin caused temporary blindness in left eye)
06/20 CEA 0.9
08/20 Ileostomy reversal
09/20 CEA 1.4, CT chest/abdomen/pelvis; suspicious areas in liver
10/20 MRI liver; dx hemangioma

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Green Tea
Posts: 238
Joined: Mon Oct 24, 2016 10:48 am
Location: Nusa Tenggara

Re: New doctor questions

Postby Green Tea » Fri Nov 13, 2020 3:06 pm

For your up-coming meeting with the new doctor you could take this as an opportunity to focus on the topic of Survivorship Care Plan.

Since you have finished all your adjuvant therapy treatments by now and are in the 5-year follow-up period, it would be good to have a customized Survivorship Care Plan in place.

The link below contains a rudimentary 2-page Suvivorship Care Plan template. You could use this as a sort of checklist to guide your conversation with the new doctor.

http://www.asco.org/sites/new-www.asco.org/files/content-files/practice-and-guidelines/documents/colorectal-cancer-treatment-summary-and-survivorship-care-plan.docx

The document basically has two parts. The first part covers the history of your CRC cancer diagnosis and treatment. The second part contains an outline and schedule of the various tasks that need to be attended to over the next 5 years.

Ideally, you would want the new doctor to have an in-depth understanding of your diagnosis and recent treatment history to such an extent that he could confidently map out an adequate 5-year follow-up plan for you.

Good luck with your meeting!

EDIT
utahgal7 wrote:...Any advice?
Thank you!

Yes. My advice is that before you have your meeting with the new oncologist you should read all of the sections of the NCCN Rectal Cancer guideline that pertain to T3N1 diagnoses:

https://www2.tri-kobe.org/nccn/guideline/colorectal/english/rectal.pdf
Last edited by Green Tea on Sat Nov 14, 2020 3:49 am, edited 1 time in total.

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beach sunrise
Posts: 299
Joined: Thu Mar 05, 2020 7:14 pm

Re: New doctor questions

Postby beach sunrise » Sat Nov 14, 2020 3:22 am

Be very informed and make sure you are both on the same page with how you feel you need to be treated and push for what you feel you need.
Alot of times oncs are not up to date if they do not specialize only in colorectal. My onc treats a melting pot of cancers so I really have to be my own advocate.
Thank God for this forum!
8/19 RC CEA 86 T3N0M0
Neoadj 5FU/rad 6 wk
Surg 1/20 APR - margins T4bN1a IIIC G2 MSI- 1/20 LN+ LVI+ PNI-
pre cea 24/post 5.9
FOLFOX
8 rds 6-10 CEA 11.4 4 more no oxa
7/20 CEA 11.1, 8.8
8/20 CEA 7.8
9/20 CEA 8.8, 9, 8.6
10/20 CEA 8.1
11/20 CEA 8's
MHL1+
PMS2+
MSH2+
MSH6+
POLD1
Chem-sens test NCI "Test failed, neo adj CR worked. Not enough ca cells to test"

utahgal7
Posts: 26
Joined: Fri Sep 11, 2020 12:04 pm

Re: New doctor questions

Postby utahgal7 » Sat Nov 14, 2020 12:53 pm

Green Tea,

Thank you for the link. This will definitely come in handy.



Thanks everyone for the helpful tips!
02/20 Rectal Cancer Diagnosis
03/20 CEA 2.7 ST Radiation - 25Gy over 5 days
04/20 LAR surgery w/ ileostomy (6 lymph nodes retrieved, 1 node positive for cancer)
04/20 T3N1M0; MSS
05/20 CAPEOX (had to discontinue because Oxaliplatin caused temporary blindness in left eye)
06/20 CEA 0.9
08/20 Ileostomy reversal
09/20 CEA 1.4, CT chest/abdomen/pelvis; suspicious areas in liver
10/20 MRI liver; dx hemangioma

User avatar
Green Tea
Posts: 238
Joined: Mon Oct 24, 2016 10:48 am
Location: Nusa Tenggara

Re: New doctor questions

Postby Green Tea » Mon Nov 16, 2020 2:36 pm

On another thread you asked about tips on preventing recurrences (i.e., diet, supplements, etc.).

There are some tips of this nature in the LifeExtension article shown in the link below. Topics like diets and supplements are discussed in Sections 9 and 10 of that article.

https://www.lifeextension.com/protocols/cancer/colorectal

There are several Stage III patients here on this Forum who followed recommendations like these and who have made it through the 5-year follow-up period without any recurrences and who are now continuing on with the same sort of dietary regimen.

You might want to ask you new doctor what he thinks about approaches like this.

utahgal7
Posts: 26
Joined: Fri Sep 11, 2020 12:04 pm

Re: New doctor questions

Postby utahgal7 » Mon Nov 16, 2020 2:49 pm

Green Tea,

I will definitely look at the information. Thank you so much!

Paige
02/20 Rectal Cancer Diagnosis
03/20 CEA 2.7 ST Radiation - 25Gy over 5 days
04/20 LAR surgery w/ ileostomy (6 lymph nodes retrieved, 1 node positive for cancer)
04/20 T3N1M0; MSS
05/20 CAPEOX (had to discontinue because Oxaliplatin caused temporary blindness in left eye)
06/20 CEA 0.9
08/20 Ileostomy reversal
09/20 CEA 1.4, CT chest/abdomen/pelvis; suspicious areas in liver
10/20 MRI liver; dx hemangioma


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