New doctor questions

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utahgal7
Posts: 201
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 dx - 4 cm mass; located 9 cm from AV
03/20 CEA 2.7; 0.9; 1.4; 0.9; 0.9; 1.2; 1.0; 0.8; 1.1; 1.0; 1.1; 1.7; 1.8; 1.8
1.9; 2.4; 2.3; 2.8; 2.2, 2.8, 3.2; 3.0; 1.6; 2.0; 1.2
04/20 ST Radiation; 04/20 LAR surgery w/ileostomy; ypT3N1bM0; MSS, KRAS G12A
05/20 CAPEOX; 08/20 Ileostomy reversal
12/20 CT scan; lung nodules (watch and wait);
11/22 lung nodule biopsy positive for RC met;
1/23 VATS right lower lobe wedge resection
FOLFIRI 10 cycles

Koreysue
Posts: 258
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
Dx: 6/2017 stage 3 CC
Sigmoid, 2 nodes
CEA at dx: 6.1
Sigmoid Colectomy/folfox (last chemo (1/31/18)
CEA 4/2018: 2.4
CEA 7/2018: 3.7
Colonoscopy 8/18 clean
PET scan 8/20/18 NED
CEA 11/2018: 3.8
CEA 2/2019: 3.2
CT NED 6/18/19 / 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)
CT NED 12/1/20 CEA: 3.5
CEA 5/21 4.2
CEA 10/21 3.4
colonoscopy 10/21 10mm polyp
CEA 4/22 3.7
CEA 7/22 3.8
CEA 12/22 4
CEA 1/22 3.2 and NED 5yr scan

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Green Tea
Posts: 451
Joined: Mon Oct 24, 2016 10:48 am

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: 460
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: RC: Staged IIIA, T2N1M0
approx 4.25 cm, low/mid rectum, mod. well diff.; lung micronodule
8/19-10/19 4 rds.FOLFOX neoadjuvant, 3 w/Oxiplatin (reduced 70-75%)
neoadjuvant chemorad 11/19
4 rounds FOLFOX July-August 2020
ncCR 10/20; biopsies neg
TAE 11/20, tumor cells removed
Chest CT 3/30/21 growth in 2 nodules (3 and 5mm)
VATS 12/8/21 sub-pleural met 7mm.
SBRT nodule 1/22
6/20/22 TAE rectal polyp benign)
NED from 3/22 - 3/23
4 cycles FOLFIRI
LUL VATS lobectomy for radio resistant met 7/7/23

Beckster
Posts: 438
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
TNM: T3N0M0/IIA
LN: 0/24
LVI present
Surgical margins: clear
MSS
12/27/2016 - Capeox, anaphylactic
1/2/17 to 6/9/17- Xeloda
6/17,12/17,6/18,12/18,6/19,12/19,12/20,12/21 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 12/20 2.7 6/21 2.9,[color=#000000]12/21 2.7[/color]
Clear Colonoscopy 10/17, 11/19,11/21 :D

utahgal7
Posts: 201
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 dx - 4 cm mass; located 9 cm from AV
03/20 CEA 2.7; 0.9; 1.4; 0.9; 0.9; 1.2; 1.0; 0.8; 1.1; 1.0; 1.1; 1.7; 1.8; 1.8
1.9; 2.4; 2.3; 2.8; 2.2, 2.8, 3.2; 3.0; 1.6; 2.0; 1.2
04/20 ST Radiation; 04/20 LAR surgery w/ileostomy; ypT3N1bM0; MSS, KRAS G12A
05/20 CAPEOX; 08/20 Ileostomy reversal
12/20 CT scan; lung nodules (watch and wait);
11/22 lung nodule biopsy positive for RC met;
1/23 VATS right lower lobe wedge resection
FOLFIRI 10 cycles

User avatar
Green Tea
Posts: 451
Joined: Mon Oct 24, 2016 10:48 am

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.

User avatar
beach sunrise
Posts: 1034
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 82.6 T3N0M0
5FU/rad 6 wk
IVC 75g 1 1/2 wks before surgery. Continue 2x a week
Surg 1/20 -margins T4bN1a IIIC G2 MSI- 1/20 LN+ LVI+ PNI-
pre cea 24 post 5.9
FOLFOX
7 rds 6-10 CEA 11.4 No more
CEA
7/20 11.1 8.8
8/20 7.8
9/20 8.8, 9, 8.6
10/20 8.1
11/20 8s
12/20 8s-9s
ADAPT++++ chrono
CEA
10/23/22 26.x
12/23/22 22.x
2023
1/5 17.1
1/20 15.9
3/30 14.9
6/12 13.3
8/1 2.1
Nodule RML SUV 1.3 5mm
Rolles 3 of 4 lung nodules cancer
KRAS
Chem-sens test failed Not enough ca cells to test

utahgal7
Posts: 201
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 dx - 4 cm mass; located 9 cm from AV
03/20 CEA 2.7; 0.9; 1.4; 0.9; 0.9; 1.2; 1.0; 0.8; 1.1; 1.0; 1.1; 1.7; 1.8; 1.8
1.9; 2.4; 2.3; 2.8; 2.2, 2.8, 3.2; 3.0; 1.6; 2.0; 1.2
04/20 ST Radiation; 04/20 LAR surgery w/ileostomy; ypT3N1bM0; MSS, KRAS G12A
05/20 CAPEOX; 08/20 Ileostomy reversal
12/20 CT scan; lung nodules (watch and wait);
11/22 lung nodule biopsy positive for RC met;
1/23 VATS right lower lobe wedge resection
FOLFIRI 10 cycles

User avatar
Green Tea
Posts: 451
Joined: Mon Oct 24, 2016 10:48 am

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: 201
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 dx - 4 cm mass; located 9 cm from AV
03/20 CEA 2.7; 0.9; 1.4; 0.9; 0.9; 1.2; 1.0; 0.8; 1.1; 1.0; 1.1; 1.7; 1.8; 1.8
1.9; 2.4; 2.3; 2.8; 2.2, 2.8, 3.2; 3.0; 1.6; 2.0; 1.2
04/20 ST Radiation; 04/20 LAR surgery w/ileostomy; ypT3N1bM0; MSS, KRAS G12A
05/20 CAPEOX; 08/20 Ileostomy reversal
12/20 CT scan; lung nodules (watch and wait);
11/22 lung nodule biopsy positive for RC met;
1/23 VATS right lower lobe wedge resection
FOLFIRI 10 cycles


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