Get the Right Cancer Care with the Right Cancer Doctor

Cancer treatment involves the teamwork of many medical specialists. This video describes some of the specialized doctors who are and should be involved in cancer care.  This information is not intended as medical advice. Talk with your doctor before beginning any new health practice.

Transcript: 

Hello, I’m Dr. Lisa Schwartz with Cancer Straight Talk where you get cancer information from a cancer doctor.  Today I’m going to introduce you to the many types of doctors that may or should be involved in your cancer care.  Often your oncologist will say, “According to the pathologist…” or “According to the radiologist…” and you might not know who these docs are or what they do.  In addition, you want to make sure that the appropriate specialists are handling your care.  This is probably most important when it comes to choosing a surgeon.  So let’s jump right in…

The doctor who may serve as your “quarterback” in coordinating your care is usually either a medical oncologist, a radiation oncologist, or a surgeon.  These are the doctors that are most commonly involved in cancer patient care.  As you probably already know, a medical oncologist gives chemotherapy and other drugs to treat cancer.  A radiation oncologist delivers radiation to treat cancer.  The surgeon may be the first one you meet since a lot of cancer care begins with a biopsy or other type of surgery.  In many cases, the surgeon will refer you to a medical or radiation oncologist either before or after your surgery.   Now, I’m going to spend a little more time discussing surgical specialists in just a bit but I also want to cover some of the “behind the scenes” doctors that are vital to your care. (slide) You may never meet these folks but your docs on the front line rely heavily on them to determine the best treatment for you.

The first of these is the pathologist.  The pathologist looks at cancers under the microscope.  They are the ones to determine if a biopsy is cancerous so that you get the diagnosis in the first place.  In addition, pathologists play a critical role at the time of surgery and just after surgery.  Often a surgeon will send a specimen to the pathologist during a surgery to help guide the next steps.  This can be done to see where the cancer has spread, whether or not lymph nodes are involved, or if a margin is clear of cancer just to name a few examples.  After the surgery, the pathologist examines the tissues very closely and often does special staining and DNA tests to help determine a patient’s prognosis. 

The next “behind the scenes” doc is the radiologist.  There is a difference between radiologists and radiation oncologists.  Radiologists interpret the x-ray studies, CT scans, MRI scans, and PET scans that you have that are usually involved in staging and assessing your treatment.  Radiation oncologists actually treat your cancer with radiation.  The radiologist can give us important information about whether or not a cancer can be removed with surgery or if it has spread beyond the organ in which it started. 

Two types of doctors that are commonly involved in invasive procedures used to diagnose cancer are the pulmonologist (or lung doctor) and the gastroenterologist (or stomach and intestinal doctor).  For lung cancers, stomach cancers, and colon cancers, the diagnosis is often made from biopsies done during an endoscopy.   An endoscopy involves inserting a tube with a camera on the end into the windpipe, the stomach, or the intestines.  These doctors don’t treat the cancers but they sure play an important role in finding them. 

Now let’s spend some time on the surgical subspecialists.  There are some cancers in which general surgeons commonly remove the tumor.  The most common of these would be breast cancers and colon cancers.  There are general surgeons who either specialize in breast cancer surgery or may have received extra training in breast cancer surgery.  Ideally, if you are going to have a lumpectomy for breast cancer, you would want a breast surgeon who had some training in oncoplastic surgery. This is not a plastic surgeon but usually a breast surgeon who has extra training in improving the appearance of the breast with lumpectomy while maintaining cancer surgery principles.  General surgeons also do resections of stomach and colon cancers but again it would be ideal to find a surgeon with special training in GI cancers. 

There are many surgical subspecialists involved in cancer care and this is not an exhaustive list.  However, these are some of the more common specialists that manage cancer.  Plastic surgeons are not usually the surgeons removing the cancer but they are the ones that improve the cosmetic outcome after surgeries.  Breast reconstruction should be done by a plastic surgeon.

A neurosurgeon is needed to do brain surgery.  A head and neck surgeon may also be referred to as an ENT surgeon which stands for ear, nose, and throat.  These surgeons operate on cancers in the head and neck area like mouth and throat cancer.  Not all ENT surgeons do cancer surgery so you will want to ask about that. A thoracic surgeon (or a cardiothoracic surgeon) operates on cancers in the chest like lung cancer.  There are uncommon tumors called sarcomas that often occur in the extremities and may be treated by an orthopedic surgeon who specializes in these.  Sarcomas can occur in other places in the body as well and are uncommon enough that you should probably be evaluated at a large referral medical center.  Urologists are the ones who treat cancers of the genitourinary tract like prostate cancer, bladder cancer, and kidney cancer.  Gynecologic surgeons treat cervical, uterine, and ovarian cancers.  Not all gynecologists treat these cancers so you should ask about that as well.

So I hope this has given you some direction when it comes to understanding some of the players in your cancer care.  If you are uncertain whether or not you are getting the best options surgical or otherwise, please know that you can always get a second opinion.  In fact, I have a blog post all about getting a second opinion so please check it out.  Feel free to leave a comment below and share this with anyone you feel may benefit from it.  Until next time, take care and be well.