Why Would An Surgical Oncologist Recommend Seeing A Radio Oncologist After Surgery?

Basically my mother had an ulcer or lesion on her tongue, the pre op and post op biopsies have said conflicting things. The Pro op biopsy suggested invasive carcinoma, whilst the post op biopsy said no tumour found, and diagnosed the ulcer as sever dysplasia. Which are two different, things, with different implications. The oncologist said it is not possible to say which is most relevant. That the pre op biopsy may have gotten lucky and found cells which had begun to invade on the cells it tested from the ulcer, which was not found later, when the latter test was done. The ulcer was small about 1.5cm by 2cm, and was taken in totality, but the surgical oncologist has said we should see a radio oncologist just to be sure, though reassuring us, no further treatment will be necessary. He said seeing a radio oncologist is procedural. Without wanting to doubt what my doctor has to say, hence the failure to ask him, why would is it advisable to see a radio oncologist after a surgery that has taken everything? There is a latent fear that radio therapy might be needed just by nature of the type of doctor we have been recommended to see. Is the reason he suggests it because some cells could remain and a radio oncologist needs to give it the all clear and should I trust, that no further treatment will be required. The only thing my oncologist has said, is that if it is cancer, which he cannot be sure it is, it is very early stage or stage one.

Dear Friend-

It is alarming that the doctor you are seeing says the POST operative analysis of the ENTIRE tissue mass they removed from you cannot be trusted as concluding you are cancer-free !  In my some ten operations, it was ALWAYS the analysis of the actual complete mass removed that was king. The pre-operative analysis is based on just a tiny sample of tissue and can easily, and often does, miss getting any cancerous cells that are identified as such....  If the analysis of the ENTIRE tissue mass removed showed some cancer, but not at the surgical margins, then I could understand the recommendation to see a radiation oncologist who might radiate you in that general area to kill any stray cancer cells that were left behind in your body...  BUT they say there was no cancer in any part of the removed mass - so then why even consider radiation after surgery ???   Just doesn't make sense !

I STRONGLY suggest you research and find an EXCELLENT doctor (travel some distance if needed to see a real pro) and have the new doctor have his pathology staff re-examine all your tissue mass removed for a second opinion. Be sure to select a doctor with NO TIES to your original doctor NOR hospital....  You want a true second opinion. If they also conclude no cancer was found, then strongly resist the idea of radiation. It may be the surgery wasn't ever necessary in the first place, and your original doctor is attempting to double-speak and mask that fact from you....

PLEASE let us know what you find out.

Good luck and warm regards.... 

 

I have no idea whether the post operative biopsy was done on the entire tissue mass. I have just started learning about cancer, so I don't know the methodology adopted by the pathologist.

I basically wanted to avoid challenging professionals based on any half knowledge I learned, so purposely did not look into cancer very deeply, but in the absence of a straight answer, I do not know how one can avoid doing research for themselves.

We have had the pre op biopsies done twice by different pathologists. What really freaked me out, was that after getting the post op biopsy which diagnosed severe dysplasia, the doctor told us to consult a different pathologist for the pre op biopsy because clearly there was conflict in diagnosis,

 I thought we had a near miss. I did not take it as a free pass, but the fact that after calming down and thinking calamity had been avoided in the short run, to be told not later than a week after the procedure, that what you thought was not cancer may in fact be has freaked me out.

  Anyone who goes into remission probably feels this way. I will take your advice and have the post -op biopsy done again with a different pathologist.

What would be the purpose of seeing a radio oncologist other than for them to provide treatment. The doctor says it is procedural, but obviously one wants to avoid that kind of therapy and the simple fact of the matter by nature of the speciality, having to go see one does not fill me with confidence.

 

 

The pathology report after the surgery SHOULD HAVE BEEN of the entire tissue mass removed from the patient....   You do NOT need a new bioopsy ! The second opinion doctor will have you sign a form permitting them to have your hospital's slides of the entire mass transferred to them for re-examination and analysis.... PLEASE educate yourself !  Read some books on cancer, etc before you mistakenly follow the wrong advice!

 

 

On 8/19/2009 Sharat wrote:

Basically my mother had an ulcer or lesion on her tongue, the pre op and post op biopsies have said conflicting things. The Pro op biopsy suggested invasive carcinoma, whilst the post op biopsy said no tumour found, and diagnosed the ulcer as sever dysplasia. Which are two different, things, with different implications. The oncologist said it is not possible to say which is most relevant. That the pre op biopsy may have gotten lucky and found cells which had begun to invade on the cells it tested from the ulcer, which was not found later, when the latter test was done. The ulcer was small about 1.5cm by 2cm, and was taken in totality, but the surgical oncologist has said we should see a radio oncologist just to be sure, though reassuring us, no further treatment will be necessary. He said seeing a radio oncologist is procedural. Without wanting to doubt what my doctor has to say, hence the failure to ask him, why would is it advisable to see a radio oncologist after a surgery that has taken everything? There is a latent fear that radio therapy might be needed just by nature of the type of doctor we have been recommended to see. Is the reason he suggests it because some cells could remain and a radio oncologist needs to give it the all clear and should I trust, that no further treatment will be required. The only thing my oncologist has said, is that if it is cancer, which he cannot be sure it is, it is very early stage or stage one.

I wouldn't worry too much.  Sounds like your mother's doctor just wants to be sure they got all of the cancer.  A radio oncologist  will most likely order one or more imaging studies -- a PET/CT scan and possibly an MRI to check and see what's going on. If I'm understanding your story correctly, the biopsies found evidence of cancerous and non-cancerous cells. What that sounds like to me is that your mother had a non-cancerous lesion that was in the process of turning malignant. This would  suggest a pre-stage one cancer, so your mother is very lucky as many tongue cancers are not diagnosed so early.  The doctors need to confirm that they got all of the abnormal tissue and that there aren't any cancer cells lingering about that can cause a recurrance down the line.  They may also want to check whether or not this is a primary cancer.  I recall one of the things my radio oncologist said to me prior to starting my treatment for tongue cancer when I had my first PET Scan is whether or not it was the primary site or if the cancer started elsewhere and spread to the tongue. In my case, though, the cancer was much more advanced than what you've described of your mother's condition.  I'm not sure what they would do for your mother even if they do find some evidence of residual cancer. I'm not a doctor, only a cancer survivor, so I can only guess.  I doubt they'd do radiation therapy in your mother's case.  They might just take the "wait and see" approach or  -- worst case scenario - do a couple rounds of chemo.  Chances are, though, that her doctor got all of the abnormal tissue with the surgery and your mother will not need further treatment. Again, your mother is very lucky they caught it before it really developed. Good luck.

I suspect that the reason for the referal to a radio oncologist is because of the high recurrence of lesions developing in cases of severe dysplasia. the fact that the pre-op biopsy was positive while the post-op biopsy was negative is not conclusive. it was possible that only a microscopic portion of the lesion had converted to cancer (probablysquamous cell carcinoma) and that the rest of the lesion was the severe dysplasia and your mother got lucky for now.

These types of lesions are very likely to reoccur or to show up in other parts of the mouth and throat so follow-up is very important. Additonaly if your mother smokes, chews tobacco or drinks alcohol she should stop! As these habits increase her risk for reoccurence.

Both my brother and my husband have had this disease. My brother passed away in 2001. My husband has had significant recurrence of his cancer of the oropharnyx and now has mets to his liver and possibly the base of his brain which did not respond to chemo. It is always best to be pro-active and a referral to a radio-oncologist is an excellent strategy in planning for preventative care in patients with this type of dysplastic cells. I wish you and your mother the best of luck.

Hi,

Thank you all for the responses. I appreciate you all have a lot more experience than I do. It is six week since we had first came to be aware that the lesion could be cancer, despite it having been present for three years. and a further two weeks since surgery.

Really, I haven't got a strategy in place for dealing with it. My instinct tells me on one hand to let doctors do their job, but clearly in the face of ambiguity, education is going to be the only real option.

I take a lot of heart, one view expressed is the least threatening biopsy is most relevant, and followed by other views, that confirm what the surgeon said, which is seeing a radio oncologist is procedural and largely to confirm the view that cancerous cells do not seem to be present, and to have an examination before deciding if or any further treatment is required.I will also heed the advice to be vigilant.

 I feel at a loss, this is a very deep and painful subject,  six weeks ago was my first whiff and you all seem to know lots of stuff,  and I have never had any personal experience. Panic would not be the right word, but I am deeply afraid.

 Thank you all for reassuring me not to fear the worst just yet. That is the best thing I was hoping for. Going forward I will endeavour to learn, regardless of the outcome and I will seek further medical opinions.

I am very sorry for the pain that this disease must have caused.

FIrst, I suggest you see another oncologist, and have your film sent to that doc for a second opinion.  I agree with all other replies that the mass that was removed would be the deciding factor, on whether is a benign or malignant tumor.

 The reason "most" oncologists refer patients to a radiation oncologist is because they think the tumor or remaining cells can be treated with radiation therapy.  Of which there are many kinds.  SO, as the other respondents said, EDUCATE< EDUCATE< EDUCATE yourself.  What I sense is that the oncologist did do his/her job of educating you on whether your mother has cancer or not. So you will need to get the results and see another oncologist, get a referral preferably from someone in your community or church.

Then you can decide what treatment rationale fits the health situation of your mother.  However, please educate yourself on different types of radiation, whether conventional (which irradiates the entire mouth and throat and neck area or stereotactic radiation therapy which can precisely targeted to hit the tiny area where the "alleged" cells remain.  

Lots of info is available online and you can look up all of this on the web.

Good luck!

 

 

 

Sorry for the typo in above message it should be the oncologist "didnt do" his/her job of education you both.

Take care,

SN

Any surgery that disturbs cancer cells should be followed up with radiation.

Surgical instruments redistribute cancer cells. That means a scalpal which has cut thru cancer cells can leave active cancer cells any place it touches.

Therefore, radiation is necessary just to be sure all cancer cells have been destroyed.

MRI, CT and PET scans cannot and will not show cancer cells which have been redistributed during surgery. 

Radiation after surgery is the equivalant of cleaning a dirty wound to prevent infection.

Your doctor may not explain it that way but if you ask he will agree.