Oncologist and hemato-oncologist and breast cancer treatment
When someone is diagnosed with breast cancer, they will usually be referred to an oncologist.
An oncologist is a doctor who specializes in the treatment of tumors, in other words, in cancers. In the context of the multidisciplinary breast cancer treatment team, the oncologist is the quarterback. The onogologist is the one who typically requests additional imaging and biopsy/pathology studies in order to ‘stage‘ the breast cancer.
The oncologist is also the one who ultimately decides on the appropriate course of treatment, after consultations with the surgeon, the radiologist, the radiation oncologist, and the pathologist.
An oncologist, or more specifically a ‘medical oncologist‘ is also the one who determines and administers chemotherapy. (Chemotherapy is typically taken orally in the form of a prescription drug). The oncologist will also have a good understanding of all the different types of breast cancer, and have an idea of the risk of recurrence and overall treatment success rates for a given presentation of breast cancer.
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The original diagnosis of breast cancer is made by the pathologist
So even though oncologist is the principle focal point in the treatment of breast cancer, they cannot make the diagnosis of breast cancer on their own. It is the pathologist who confirms the diagnosis of breast cancer, and provides biological information on the exact nature of the tumor being treated. The oncologist uses this critical information to decide upon a treatment plan, with input from the surgeon or surgical oncologist, the radiologist, and the radiation oncologist.
The oncologist sets follow-up examination and alters breast cancer treatments
After the initial round of breast cancer treatment, the oncologist is responsible for setting follow-up examinations and follow-up treatments. Ultimately, it is the oncologist who monitors the success or lack of success in treatment, and makes appropriate adjustments. There may be ongoing secondary symptoms of both the cancer and the breast cancer treatments which need to be monitored and treated, and the oncologist is responsible for this.
The breast cancer oncologist also consults the hemato-oncologist
The oncologist may also seek input for a hemato-oncologist (or may indeed already have a specialization in hematology). Hemato-oncologists are physicians with specialized knowledge in blood diseases and blood-related cancers in particular. They may be consulted by the oncologist for differential diagnosis regarding possible leukemia or lymphoma, and also to assess the chemical and molecular features of the blood, both in terms of the presenting breast cancer and also in response to various cancer treatments.
The oncologist usually informs the patient regarding breast cancer stage and grade
The responsibility for ultimately conveying to the patient details about the stage and type of breast cancer they have developed typically falls upon the oncologist. Following the intial discussion about a particular type and grade of breast cancer, the oncologist will generally explain the treatments usually given for that kind of the breast cancer, and any clinical trials which the patient may qualify for.
Oncologists are often asked, understandably, about prognosis. It is true that the oncologist, perhaps more than anyone else, will have the best idea or estimate on the outlook for a given breast cancer patient, based on statistical research and their own clinical experience.
However, oncologists are generally quite reluctant to speak directly about prognosis for breast cancer. They may however be able to explain the general median survival rates and trends for patients given their type and stage of breast cancer, and then to discuss the mechanics and details (the way the cancers tend to behave, the types of treatments usually used, and the typical responses to treatment) in terms that the patient can more easily understand.
Generally, it is the oncologist who speaks to the patient about their breast cancer
In the professional context, i.e. among all the members of the treatment team including nurses and technologists and other specialists, no one will really want to talk to the breast cancer patient directly about their prognosis, except the oncologist. That really is their responsibility, and moreover, it can create a great deal of stress and disharmony is a patient hears different things from different doctors or nurses.
Over time, is has informally been established that discussions about breast cancer prognosis should only come from one source, the oncologist, and not just for clarity. Oncologists tend to be compassionate and sensitive individuals that know the best time and place to talk about prognosis, and who also have established the most personal relationship to the patient.
The ongologist seeks input and ‘stages’ the breast cancer, and may suggest participation in clinical trials
In more advanced stage breast cancers, (cancers which have metastized or are threatening to metastize) treatment will most likely involve the use of chemotherapy, which is administered by the oncologist. (Chemotherapy is sometimes used in early breast cancers ‘pre-surgery‘ in certain cases, and is not restricted to late advanced breast cancer treatment).
Research into chemotherapy for breast cancer treatment is mostly undertaken by large drug companies, and they are always interested in ‘clinical trials‘ for new breast cancer drugs and combinations. As a result of this many oncologists, particularly in dedicated cancer clinics and in ‘university-affiliated‘ hospitals, tend to be research oriented. This is generally a good thing, because oncologists who follow and participate in clinical trials will be up-to-date on the latest information, and the latest science. This is important to note, because reports on breast cancer chemotherapy clinical trials which appear on the internet are generally full of ideas which are up to five years behind research and clinical trials happening right now.
Participation in clinical trials is generally positive for breast cancer patients
In some cases there may be ‘ethical‘ concerns surrounding participation in clinical trials, but these concerns are generally unfounded. Participation in clinical trials is almost always a good thing for patient, as patients are not exposed to any drugs or drug combinations that are inferior to the standard. Drugs used in clinical trials for the treatment of breast cancer will almost always perform at the same rate as the standard regiments, and hopefully a little better.
Oncologists are frequently asked to participate in clinical trials for new breast cancer medications
So there is a bit of a sub-text behind the role of the oncologist when it comes to the staging of breast cancer. Yes, it is their job to stage the breast cancer, consider the best treatment plan, and to organize and implement that plan. But, when given a new breast cancer referral, the oncologist may be quite concerned and motivated to assign that patient into different categories and sub-categories for research purposes.
Diagnostic tests are of course vital to correctly identify breast cancers and properly engage the most prudent treatments, but the oncologist may also be interested in finding patients who fit the specific categories and stages required for certain clinical trials which they either know of, or already are participating in. As mentioned, participation in clinical trials in generally a good thing, and if an oncologist seems particularly thorough and diligent in initiating and gathering diagnostic summaries, even for research purposes, this can only be in a patient’s best interest.
The oncologist is also responsible for palliative care
Although between 80% -90% of breast cancers are curable, unfortunately some women do not ultimately survive breast cancer. It is really the role of the oncologist, though not an easy one, to inform the patient when it appears as though the breast cancer has progressed beyond their abilities to cure it, and to change the focus of the breast cancer management. This is termed ‘palliative care‘, and the main objective is no longer the treatment of the breast cancer, but to provide dignity and comfort for the patient and their families. Palliative care is also becoming more specialized, and in the future we are likely to see this role more and more taken over by speciliazed nurses and doctors who are able to make home visits.
Everything you need to know about oncology is in the information above. However, below are a couple common Q&A…
- What other kinds of cancers can oncologists diagnose and treat? Brain tumors, head and neck tumors, sarcomas, melanoma, kidney cancer, ovarian cancer, other gynecological cancers, heptoma, biliary cancers, pancreatic cancers, as well as neuroendocrine cancers.
- What is oncology concerned with? The diagnosis of any cancer in a person (pathology), therapy (ex. surgery, chemotherapy, radiotherapy and other modalities), follow-up of cancer patients after successful treatment, palliative care of patients with terminal malignancies, ethical questions surrounding cancer care, and screening efforts.
- What are some diagnostic methods? Biopy or resection, endoscopy, x-rays, CT scanning, MRI scanning, ultrasound and others, scintigraphy, single photon emission computed tomography (SPECT), PET scans and other methods of nuclear medicine, and blood tests including tumor markers.
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- Laird, BJA., Fallon, MT., Palliative Care in the Elderly Breast Cancer Patient. Clinical Oncology ( March 2009) Vol. 21, 2., p131-139.
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- Perez, EA., Moreno-Aspitia, A. Treatment Options for Breast Cancer Resistant to Anthracycline and Taxane. Mayo Clinic Proceedings June 2009 vol. 84 no. 6 533-545