ASK DR. BAUGHAN                                             November 20, 1998

THE MEDICAL MAZE

“I may have cancer.  When should I see a cancer specialist?”

To hear the diagnosis or possibility of cancer is frightening.  The universal reaction is to want to get it taken care of as soon as possible by the best doctor possible.  Seeking treatment for cancer, like other life threatening diseases, often presents patients with the dilemmas, “Which doctor should I trust?  Which doctor is the right doctor?”  The health care “system” can seem like a maze in which the patient can easily become lost.  Cancer treatment is a perfect example of when doctors must function as a team, because no one doctor “does it all” for all cancer patients.  There are definite steps in the process, and different doctors have crucial roles at each step.  Clarifying those steps may make the maze more understandable.

DIAGNOSIS:  The process usually begins with the primary doctor.  A sign, symptom, lab test or x-ray finding will raise the suspicion of cancer.  Conventional cancer diagnosis is based on seeing typical cancer cells under the microscope.  So when the suspicion is raised, the next step is usually to obtain a sample of cells, called a biopsy.  Obtaining the biopsy can be done by a variety of types of doctors depending on where in the body the suspected cancer is.  Sometimes the primary doctor obtains the sample, for example with skin cancers or Pap smears for cervical cancer.  For colon cancer, scopes can be used to see and biopsy suspicious growths.  General surgeons or gastroenterologists are both trained in colonoscopy.  For ovarian or uterine cancers, gynecologists have special scopes to see and obtain tissue samples.  For the lung, the tissue may be obtained by bronchoscopes by lung specialists or general surgeons.  If the scope cannot see or reach the growth, a radiologist may biopsy with a needle.  So the diagnostic biopsy can be done by a variety of specialists, depending on what procedure or instrument is needed.  The tissue is then sent to a pathologist, who specializes in identifying different types of cells under the microscope.

STAGING is the next step.  Staging means determining how far the cancer has advanced.  This is necessary to decide which treatment is necessary.  Sometimes the biopsy removes all the cancer cells and no further treatment is needed.  If that is not the case, the search for the extent of spread can be done by surgery (removing lymphs nodes, for example, in breast, prostate, or neck cancers), by different types of radiology images (x-rays, CTs, MRIs, etc.), or by blood tests.  Once staging is accomplished, the best treatment can be chosen.

TREATMENT choice may be determined by several physicians.  Often doctors meet for Tumor Conference, where all cancers are reviewed by all physicians involved, primary doctors, surgeons, or oncologists.  Oncologists are often thought of as the “cancer specialists.”  Their role is often to be knowledgeable of the statistics regarding the effectiveness of different treatments.  They also usually coordinate the administration of cancer drug medicines (chemotherapy) when they are necessary.  They usually do not perform surgical treatments or biopsies of internal organs.  If radiation therapy is the best choice, another specialist, a radiation oncologist, may become involved.  Successful treatment requires good communication and coordination between multiple physicians.

The diagnosis of cancer always brings up concern about death.  A very common issue is the fear of pain and loneliness is greater than the fear of death.  It is absolutely essential that while navigating the medical maze of cancer treatment, the patient feels they have a personal physician who can be “home base” for information, comfort and care.  The patient need never feel alone and need never tolerate treatable pain.