Who Should I See First: Surgeon or Medical Oncologist?

I have the same question…. I decided to get in to oncology first because maybe they can tell me first what a plan would be as far as if a lumpectomy is possible before a full mastectomy. But that was just my reasoning… I feel the same about not much communication after the diagnosis. It has been stressful to try to navigate finding doctors. 🙁 Best of luck to you!

I had the same reasoning. But just left the appt with the surgeon, and he said the surgery will provide the info the oncologist needs to direct treatment. Surgeon recommended surgery w/in 6 weeks of diagnosis. I was expecting this undertaking to be more like a wagon wheel with a doc at the center to oversee it all, like I’m used to with the PCP. But this is more of a relay where we get handed off to the next doc— oncologist will be next. I was feeling pretty lost so I appreciate your letting me know I’m not the only one. My PCP and the radiologist recommended surgeons, and I feel confident with my options. I believe that if you keep looking, you WILL find the answers and hopefully some peace of mind. Never ever imagined I’d hope someone could get a lumpectomy but I hope you get the answer you want. Hugs!

What I found in my situation is that you need results of tests to determine the treatment plan. Biopsy, MRI, blood work, etc. Get answers to stage, grade, size of tumor, location of it, how many. Is the BC estrogen and progesterone positive or negative? What is the HER2 status. It's it fast or slow growing, DCIS or IDC or both? What is the Oncotype result? Oncotype will tell you if you benefit from chemotherapy and the percentage chance of a recurrence. Also if you have surgery and plan on implants but may need radiation, implants interfere with radiation (I don't really understand that part, I just know it was a hindernce to my to radiation treatment reatment plan because I already had implants). When I first got dx I just started seeing whatever doctors I could get in to see first, and kept notes. Then I did second opinion.

So much to learn. Thanks for the heads up!!

All this makes my head spin. 😬I figured if i got in to an oncologist they would recommend a surgeon and help set up a team. Guess I will make more calls and keep scheduling opinions.

It’s really hard. Hang in there.

I went to a surgeon first and he gave me a great oncologist referral which made things more very quickly and it’s great because my oncologist and surgeon are in the same healthcare system and communicate with each other as to my progress which makes things soooo much easier! Less stress. After you get all your tests completed (mammograms, ultrasound and MRI) your oncologist will give you ALL the information you need. I have a whole team at my oncologist office. Nurse navigator (who helps with all kinds of things from printed information and financial support ). A PA who I can ask questions and get answers in an easy to understand language and then my oncologist who is amazing about answering all my questions as well. I just finished my 10th week of 12 chemotherapy and keytruda and then I’m going to start my second treatment immediately. I have stage 2 TNBC. Rarer than most people on this site, but everyone will have a different plan for treatment. Stay positive and keep your faith

That’s really helpful. In the consultation, surgeon said he would refer me to a good oncologist, but I think that situation is less comprehensive than another surgeon I’m considering. She is with a hospital that has a coordinator like your PA and a lot of auxiliary services — a lot more support available. But I could have the lumpectomy before I get to see her. So I appreciate your input on how much of a difference that coordination makes. You sound strong! And it catches, thanks!! 😊

My husband found a really great article from the Mayo Clinic that is definitely worth reading. Very informative https://www.mayoclinic.org/tests-procedures/chemotherapy-for-breast-cancer/about/pac-20384931

Great, eager to get more info as I have surgery scheduled for 6/19. That will put me exactly 30 days past diagnosis so I’m going to try to get moved to 6/12 or that week even if I have to go to a different hospital. Thank you for the link!! Best to you!

Hi Megan, My journey has been different from those I've read here. Dx with breast cancer 1/30, saw breast surgeon for a biopsy 1/19. Results 1/30. Referred to oncologist 1st appt. early Feb. Pet scan 2/8. Results showed 2 more areas of concern. Had biopsy on both 2/28. Dx with 3 primary tumors for lung, kidney, and the original bc. Had surgery 4/8 to remove lung cancer. Also, started AI in Mar for the breast cancer as the surgeon needs the tumor to shrink to be able to get it all. My bc is es/pr + her2-. Tomorrow 4/20 meet with my bc surgeon to see if surgery is now an option. Through all of this my care team has all been referrals through my medical group (hmo) coverage. They have all been awesome, so no complaints there. Got connected to a case manager through my insurance so that was great too. I have dubbed myself a "unicorn" because I have stumped everyone with my dxs. It will be a long road for me, but I'm ready to face whatever comes. FYI I'm 65 and still working. I hope and pray you get the answers you are seeking and the treatment you need. As I do for everyone fighting a cancer battle. The Unicorn

Thank you! Surgery got moved up, and did it a week ago today. So far good news but waiting a cpl of weeks for the oncotype and FISH test for more info/confirmation. Chemo and then radiation? Or straight to radiation?Not getting ahead of myself and will be patient. I’ve learned that while all of this is complicated, my situation is simple and “easy” and I’m very fortunate. Your story drives that home. This is a bum club to be in but I see so much resilience, determination, grace and caring. I had a drain for a week and I did stay composed but there were a few moments — and then I see what you’re handling! Unicorn, I admire your dignity, you inspire and I hope you find your inspiration, answers and good news. 💕

Thank you Megan. So glad yours is easy. Stay strong and move on!

Definitely much to learn but my advice is to take it one step at a time. I was fortunate that my primary physician is connected with Hoag Breast Center where I was immediately assigned a surgeon and before I met her, I had all the mammograms, biopsies, MRIs done before I met my surgeon. It was swift and within 7 weeks, I had my surgery. I didn’t even want to think about radiation or chemo. All those answers came after the pathology was done and then met with my oncologist and radiation oncologist. Sending my best wishes for a smooth and successful journey. There most definitely are ebbs and flows in the process, but taking it one day at a time worked for me.

Ebbs and flows strikes home, thank you. I was so giddy with good news yesterday even thought I was obnoxious, but I couldn’t help it LOL. Your point is taken — I recognize that this is just one moment and not to hang my determination /expectation/hope on this one report. And to focus in what’s now or just ahead. You sound like youve got it together. Wishing you a smooth road too. Stay well friend!

I have an entire team “ working” for me - but have only met with the surgeon who did the lumpectomy a week ago, and the Nurse Navigator. After all the tests my case was revised by the Tumor Board and a tentative plan made. I’m waiting for the pathologists report on the tumor and sentinel nodes—will find out Monday. Then I’ll meet with the radiologist. My hospital has a Patient Portal so I’ve been able to see test results as they come in and also communicate easily. Worst part has been recovery from the Sentinel node removal!

Generally, you start with a breast medical oncologist for diagnostic confirmation and treatment planning. Neoadjuvant chemotherapy (chemo or chemo and immunotherapy infused before surgery) is very common today for all but stage 1 and some stage 2 cancers, so seeing the medical oncologist first starts these treatments

Thanks Walliegene C! I wasn’t aware of those distinctions. My best to you.

Hi D’Vorah K! Glad you have a team behind you! My surgeon options that included a nurse navigator would have taken too long so I’m going it alone so to speak and working just with doctor’s office. And so far so good. Had surgery 2 was ago and have appt with med onc next week. I expect a sense that someone sees the whole picture instead of the piecemeal approach this has felt like. My extra tests came back, HER2+ so i expect chemo, but will find out next week. I 100% agree about node removal! I don’t have PAIN, but a lot of discomfort: sore like a bruise and skin is sensitive like sometimes when you get the flu. (Oh and speed bumps! Turning into a parking lot over the sidewalk!I’m driving with one hand while I hang on to the girl with the other) I thought It would hurt after surgery, and then start feeling better. But surgery didnt hurt at all. After about 3-4 days, it started getting uncomfortable and is getting worse, and it’s spreading. Hoping to get some understanding of all that at next appt. AND I know after hearing some of the ladies’ experiences that I have been dealt a decent hand. Wishing you aces. PS I’m not good at apps and my replies may be late or attached to the wrong message. Sorry!

Megan- I forgot to take Tylenol before going out and like you, felt every bump in the road! Sometimes feels like a little critter is inside my armpit pinching me! You are one week ahead of me! I will also find out next week. Keep breathing in hope, love, and calm! 🌺

I was diagnosed with invasive ductal cancer on June 3rd. I didn't hear from anyone for two weeks about it. I found out by checking my health portal online. It is scary waiting not knowing the next step.

Hi Kathy, Yes, the waiting is the worst part. My journey has been since 1/8. I had a big speed bump when testing showed I actually had 3 separate cancer tumors. I had so many tests, wait for results, then Dr. visits to find out what would be first. I now have 2 tumors left - breast cancer and kidney. The bc is being addressed 7/5 with a lumpectoy. Then radiation then the kidney. I nicknamed myself the Unicorn because I have stumped my drs. All this to say hang in there. Janet the Unicorn

The key issue in breast cancer is that there is no rush. The diagnostic process is complex and long because a great deal of research has been done and it brings us to the place of having VERY specific treatment options. The biopsy and all of the staging studies plus your genetic profile and the tumors specific chemical/hormonal profile plus s review of your preexisting comorbidities and an assessment of your overall health status......this is the starting point. Until you know all of this you cannot really participate actively in making a treatment plan for your own life. And you deserve that! How do you get it? As a Nurse Midwife and Professional Healthy Coach I've help women navigate this journey first by informing them which tests and studies they have to insist are done and then guiding them through interpretation of the results. Now I'm writing a Guide to Breast Cancer For the Newly Diagnosed based in the latest guidance from the International Conference of Breast Cancer Oncologists and MD Anderson and the Curie Institute's new algorithms. But what is really critical is knowing that the decisions are your's to make. Remember that lumpectomy and sentinel node biopsy are available today because women boldly demanded an alternative to modified radical mastectomies. Lymphatic rerouting and shunting is available because women refused to accept lymphadema as inevitable. You have the right to look at your total life when making these decisions. Can you stop working? For how long? How will you survive financially if you do? How much change to your body are you willing to accept? How much risk are you willing to take? Which is larger; the risk of death from the cancer or the risk of death or disability from the proposed chemotherapy, surgery, immunotherapy, radiation? Your body. Your life. Your choice. It doesn't pertain only to reproductive rights. Sometimes it makes sense to be agressive. Sometimes it doesn't And sometimes modifications or ways of protecting your body while doing agressive treatment makes sense. I repeatedly heard at an international conference this week that AI is going to be used increasingly to determine standard of care. That's good in that it will mean not overlooking the steps needed to make s full diagnosis and treatment plan. But I don't believe it will ever put your personal life implications into play and you are far more than your body.

This was excellent thank you!

Susan, Well said. The waiting was scary, but necessary. My best to all of us fighting this battle. Janet the Unicorn