Doctor Visit

Most patients with an invasive melanoma (of any Breslow thickness) should see a surgical oncologist. The main reason being to decide if there are features of the primary melanoma that would indicate a need to assess the sentinel (first draining) lymph node. Essentially all patients with a melanoma of 1.0 mm thickness and above should get a sentinel lymph node biopsy. Below 1.0 mm, there are certain features that would warrant getting a sentinel lymph node including ulceration, mitoses (cell divisions) >1, lymphovascular invasion, thickness >0.75mm, Clark's level 4 (Clark was a pathologist who measured melanomas based on the level it penetrated through the layers of the skin) and sometimes for patient reassurance. This last point is very loose but sometimes the psychological well being of having a 'clean' sentinel node biopsy is worth the very low chance of morbidity (pain, infection, extremity swelling).

Whether you have initiated the visit or another physician involved in your care, has referred you to a radiation oncologist, you are there to learn whether radiation therapy is indicated as a part of your treatment. If indicated, you will also be given information on the area where radiation would be focused on, the total dose of radiation. the number of radiation treatments necessary as well as its potential acute (aka early) and late (chronic) side effects. The radiation oncologist may also share the data supporting his/her recommendation.

How you can prepare yourself for your first visit with a radiation oncologist is very similar to visiting any other specialist but what makes it unique and in some instances challenging, is the many myths around radiation therapy. So the best you can do for yourself and the radiation oncologist you are seeing is to remove any myth from your mind. The experience your grandmother or neighbor had with radiation treatment is totally irrelevant to your situation. Maybe they had a different form of cancer. Maybe their cancer was the same but presented at an earlier or later stage. With the rapid and progressive improvement in radiation technology, comparing radiation treatment your grandmother received 10 or 20 years ago with yours, would be comparing apples and oranges. So do your best to remove the myths and fears and receive the information with an open mind.

The information one can find on the internet is as good as its source. So unless you have been given a reliable source of information, do not trust everything you find on the internet. Acquiring misinformation would not only not be helpful to you, it may increase your anxiety and apprehension about radiation treatments.

In general, I would recommend the following for preparation for your visit:

1. It is a great habit to obtain a copy of all pertinent information prior to your visit. Even though, with your permission, physicians offices communicate these vital information prior to your visit, any missing information can interfere with having a productive consultation.
2. It is extremely helpful to have your own version of your medical and surgical history to include all your past medical issues, the medications you are taking (including the supplements you might have bought at GNC or given by your chiropractor), your allergies, and very importantly your family history of cancer. Your family history of cancer may lead into genetic testing and completely change the recommended treatment for your specific cancer.
3. It is helpful to have someone accompany you. You will be given plenty of new information making it almost impossible to retain all of it. Having a second pair of ears and eyes, especially if your company would take notes, would be extremely helpful in recording and retaining the information.
4. Prepare questions ahead of time and do not hesitate to ask about anything you do not understand. As smart and intelligent as you are, you are not a radiation oncologist and are not expected to understand all the technical details of it.
5. At the end of your consultation, repeat a summary of the information you have received. It is not unusual to misunderstand something and you can only correct that by comparing your understanding with what the radiation oncology meant to tell you.
6. If you feel that you have not grasped all the information or have remaining questions, do not hesitate to ask for a second visit when you can spend more time clarifying those matters with your radiation oncologist.
7. Please understand that that final decision regarding your treatments is yours. If you do not feel comfortable with the information you have been given, do not hesitate to seek second opinion.
8. If you have received radiation in the past, please make sure to have details of your previous treatment, because that is crucial in determining whether you can receive radiation again or not.
9. Please understand that preparation for your radiation treatments may take anywhere from days to weeks. Do not expect to start your treatment on the day of your consultation.
10. Breaks during your radiation treatments would negatively impact the outcome of your treatments. So be prepared to cancel a trip you had scheduled a year ago if your radiation oncologist finds it detrimental to delay start of your radiation treatment.
11. Sometimes radiation and chemotherapy are recommended together. Even though your radiation oncologist and medical oncologist would do their best to coordinate your treatments, consider yourself a member of the treatment team and have all the information you can get to facilitate the coordination.
12. If it alleviates your anxiety ask for a tour of the department, take a look at the radiation machine and meet all the members of radiation team including radiation therapists, the dosimetrist and the physicist.
13. It is often helpful not to rely on your imagination so ask your radiation oncologist to show you some images of radiation plans and beams. It may put your mind at ease.
14. Just as you do at radiology department, please notify your radiation oncologist if you are pregnant or there is any possibility you might be pregnant
15. And last but not the least ask your radiation oncologist for reliable sources (books, websites, brochures) to educate yourself not only on your radiation treatments but also its potential side effects and your nutrition throughout the course of treatment.

As soon as possible. Check in with an integrative oncologist so that you understand the potential interactions between any of your complementary therapies and conventional treatment. Also you should get some information on things you can be doing to help with side effects and get on to living a healthier life. Why wouldn’t you want to do that as soon as possible?

I find Attai's very interesting. I was referred to a breast surgeon by a Dr of Radiology. My breast surgeon told me flat out "you will need surgery for sure" and then she did the surgery. She is a past President of ACS in my area and one of the doctors on the board of directors at the hospital I had the surgery at. It confuses me to see a statement "Once cancer is diagnosed, the breast surgeon will work with the medical oncologist and radiation oncologist as a team to decide in a multidisciplinary fashion what the best treatment is. " It makes me feel that I am having treatment done backward. I don't know. I return to the surgeon on the 30th (my lumpectomy was done on the 19th). The tumor is stage 2A. No spread to the nodes. I have to wonder how my treatment is going to be handled. I don't think the surgeon will be dishing out what a radiology oncologist is supposed to be doing. This surgeon also said she believes I will NEED chemo. I am not accepting that yet. I did find out about Oncotype DX which will help with MY decision to go ahead with chemo or not. I am just confused about what Dr Attai says here. I need to know that I am on the right road to recovery.

Write down your questions, make sure you get all of them addressed and take someone with you. A second set of ears is always helpful!

Great question, Murray! We would suggest making sure you know why you're going to a specific doctor and what you hope to accomplish at the appointment, and going from there. Our feature article, "The 'Handoff': Your Roadmap to a New Doctor's Care" (http://www.preparedpatientforum.org/organizing/handoff.cfm) offers some tips for planning and navigating a visit to a new doctor's office. The article recommends that patients take these steps:

Bring a list of all your medications, including herbal and over-the-counter remedies, to your first appointment with your new doctor.

Repeat back any instructions your new doctor gives you, to make sure you've understood them correctly.

Ask your doctor to demonstrate the use of any new devices he or she may prescribe for you.

If you have a family member or friend who helps take care of your health, bring them to your appointment.

Before you leave, ask about your next steps. Do you need to make other appointments? Do you need to share any information with your primary care doctor?

There may also be other medical records or information you need or want to have on hand, which you may want to consider ahead of time. There are also some general steps that are good to take before a visit to any doctor's office. Some general resources for preparing for doctors' visits can be found here: http://www.preparedpatientforum.org/patient411/communicate.cfm#Preparing

You may also find it helpful to review our article, "Your Doctor's Office, Demystified," which provides information about the different kinds of medical professionals found in many doctors' offices: http://www.preparedpatientforum.org/organizing/droffice.cfm