You had a mammogram, and got a call back: They see something “suspicious.” Your second mammogram fails to clarify the issue, and your doctor schedules a biopsy. You’re asked to report to radiology; you mistakenly show up at the radiation check-in desk. Whoops!
Welcome to the confusing world of cancer care.
If you’re diagnosed with breast cancer, you’ll see many medical professionals beyond your primary care physician (PCP). Here’s a guide to who does what, and the typical order in which you might see your new team of doctors and specialists.
This is the person who performs your biopsy. Radiologists are doctors with special training in diagnosing diseases via medical imaging, such as X-rays, MRIs, or CAT scans. After taking a sample of the specific tissue in your breast, the radiologist will hand that sample off to a pathologist.
You’ll probably never meet your pathologist. But s/he plays a critical role in your treatment, examining your breast tissue to determine if you have cancer. If the tissue shows cancer, your radiologist (or sometimes your PCP) will contact you to deliver the news, and schedule an appointment with one of two people: a surgeon, or an oncologist.
For most women with breast cancer, surgery to remove the tumor is the first step. Your surgeon will outline the procedure. Depending on the size of the tumor, s/he’ll offer you the choice of breast conservation surgery (lumpectomy); or mastectomy (removal of the entire breast). The smaller and simpler the tumor, the less need there is to remove your whole breast.
If you opt for a mastectomy, the surgeon will probably refer you to a plastic surgeon to discuss reconstruction options.
If you opt for breast reconstruction (rather than simply moving forward without a breast, or wearing an external breast prosthesis) you’ll meet with a plastic surgeon. Reconstruction can involve silicone implants, or a woman’s own tissue, grafted from elsewhere on the body. Your plastic surgeon will discuss the different types of surgery involved, and show you photos of reconstructed breasts to help you decide which type of reconstruction is best for you.
Your oncologist is your cancer PCP: s/he’ll be the leader of your medical team, the doctor with whom you’ll collaborate on a treatment plan, and the person you’ll visit regularly during active treatment — and then annually for a checkup. You’ll probably be assigned an oncologist shortly after you learn you have cancer, but you may or may not see this doctor until after surgery.
If there’s one person with whom you really want to develop a good relationship, it’s your oncologist. Other doctors will come and go, but your oncologist is in it with you for the long term. Some oncologists are brilliant, but lack bedside manner; some are wonderfully warm and friendly, but aren’t up on the most current treatments. Find a good balance of both of those attributes, and you’re golden.
If you have breast conservation surgery followed by radiation, you’ll be connected to a radiation oncologist, a doctor specializing in radiation treatment for cancer patients. This doctor will determine the exact area of your breast or trunk to receive radiation and will supervise the radiation techs who deliver it. You’ll probably meet with your radiation oncologist once a week during radiation treatment, to make sure you’re feeling OK, and to treat any side effects.
More helpIf you undergo chemotherapy, you may meet with a** dietitian** or** nutritionist** to help with eating issues; or a** pain specialist**, if any pain-related side effects become severe. If you’re scrambling to keep your life together — work, daily responsibilities, insurance coverage — a** social worker** can be very helpful.
A physical therapist can help you with shoulder issues post-surgery, and will treat any lymphedema. If you’re suffering from depression, anxiety, or any other difficult-to-deal-with feelings, you may wish to speak with a psychologist or psychiatrist. Many cancer centers have a department of** patient/family relations**, which can help your family deal with your illness.
Finally, nurses and** physician assistants (PA)** — from your oncologist’s PA to the special nurses who deliver your chemotherapy — will be a significant part of your treatment. It’s often easier to reach a nurse than a doctor, so you’ll find yourself developing special relationships with these hands-on caregivers.
Cancer can be a long and complicated journey. But you have a team of medical professionals with a single goal: making you well again. Learn who your team members are, and what they do. Then work on building positive relationships with each and every one. The better team player you are, the smoother your cancer experience will be.
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