Women who don't have BRCA mutations could have other high-risk genes that affect treatment choices
by Sarany on Thu Mar 22, 2007 12:00 AM
This message is mostly addressed to "Witchdoctor," but anyone is welcome to answer it. Thanks for your input. What is the difference between a radiation onc and a medical onc? In my dad's case, his care is currently being managed by a surgical onc and a medical onc. Could this be why they aren't recommending radiation?
by 2cats on Thu Mar 22, 2007 12:00 AM
From my experience, with my mom, the two (rad and medical) should work together. When my mom had breast cancer 8 years ago she was sent to the med. onco by the surgeon that did the biopsy and following mastectomy. The med. onco did his rounds of chemo, then sent her to the rad onco afteward. This time around, with the EC, the surgeon gave her case to both the med. onco and the rad onco knowing she would need both, at the same time. The two offices worked together to get her treatment plan set up so they could both do what they needed to do.
Thankfully their offices are pretty close together, and both at the same hospital campus. The chemo doc is the one that has scheduled her PET scan, hospital stays etc. But, really the two work pretty closely together.
by Witchdoctor on Thu Mar 22, 2007 12:00 AM
Radiation Oncology is between Surgery and Chemotherapy. Surgery is local (exceptions to this but just to make it simpler) radiation is local and regional although occasional we treat large areas, hemibody and whole body etc. There are systemic forms of Radiation ie Iodine 131 and Metastron for bone mets. Chemo treats the whole body, which sounds good and is depending on the diagnosis and how effective the various agents are. But, it is not as effective as many believe in most cancers particularly in the palliative setting. My training included one year of surgical oncology and one year of medical oncology and 3 years of radiation oncology so that is different from the norm. Most of the time Surgeons, Radiation Oncologist and Medical Oncologists don't know much about their other specialties. This is especially true in Radiation Oncology. Radiation Oncology is not taught during a standard medical education and therefore many physicians have the same misconceptions about it and its effects and side effects. So patients should most of the time see all three OR at least be seen by one and presented to a multidiciplinary tumor board.
I do have some trouble, if you noticed, with multiple cycles of chemo even when there is no documentation of efficacy or the patient is symptomatic. Multiple times I see cases like esophageal or other who come in for palliation for massive tumors after getting chemo for a year! Sometimes with no studies to check if it is effective. Sometimes they do and keep giving it anyway even when the tumor is progressive. I get stuck trying to salvage the situation , the patient does poorly and of course gets told it was the radiation that killed him. So I have a tough time swallowing it especially when they needed treatment upfront and were never told Radiation was an option or when they give the "old" blood counts excuse.
Palliation is relief of symptoms and in some cases it can prolong ones life. But care always should be taken that the treatment is worse than the disease and certainly should regularly be evaluated for efficacy especially if it causes life threatening sxs.
by Eve52 on Thu Mar 22, 2007 12:00 AM
by jeonard on Wed Jun 17, 2009 12:00 AM
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