Oncologist Consultation

When to see an oncologist

A consultation is most useful when there is already a test result that needs to be turned into a treatment plan. Come if:

• an ultrasound, CT, MRI or colonoscopy showed a mass, and you were advised to “see an oncologist”;
• histology confirmed cancer, and it has to be decided where to start treatment;
• you were told that the tumor is inoperable or that “only chemo” will help — a surgeon’s view may be different;
• after treatment for bowel cancer, a follow-up examination found liver metastases;
• a course of chemotherapy is finished, and you need to understand whether it is time for surgery;
• a follow-up after surgery revealed a recurrence or a new lesion.

If there are no test results yet but something worries you, call as well. I will suggest where to start, so that you do not spend time and money on unnecessary tests.

Oncologist or surgical oncologist: whom to see

“Oncologist” is a name for several different specialists. A medical oncologist prescribes anticancer drugs, a radiation oncologist delivers radiation therapy, and a surgical oncologist removes the tumor. When a tumor can be removed surgically, the main question — whether it can be removed completely and by which approach — is a surgical one. It is answered by the surgeon — the one who will perform the operation.

This does not mean that treatment will be limited to surgery. Malignant tumors are often treated with a combination: surgery, chemotherapy, sometimes radiation therapy. I discuss complex cases at a multidisciplinary tumor board together with medical oncologists and radiologists, so that you have one agreed plan rather than three different opinions.

Which tumors patients come with

I operate on organs of the abdominal cavity and the pelvis. Patients often search for a “colorectal oncologist” or a “gynecologic oncologist”. If a tumor of these organs can or will have to be operated on, go straight to a surgical oncologist.

The full list is on the page “Diseases treated by a surgical oncologist”.

How the consultation goes

1. ConversationI ask what is bothering you, what tests and treatment you have had, what other conditions you have and which medicines you take.
2. ExaminationA physical examination — its scope depends on the diagnosis and complaints.
3. Review of imagesI look at the CT and MRI images themselves from the disc, not only at the written report: details that are missing from the report often determine whether surgery is possible.
4. ConclusionI say whether surgery is possible now, by which approach (laparoscopic or open), and whether chemotherapy is needed first. If there is not enough data for a decision, I name the tests that are missing.
5. PlanYou receive a list of next steps. If the case is complex, we discuss it at a tumor board and make the decision together.

If additional tests or examinations are needed, you can have them done at any clinic of your choice.

What to bring

• CT, MRI or PET-CT discs — the discs with the images, not only the reports;
• reports of all examinations: ultrasound, CT, MRI, X-ray, colonoscopy;
• the histology report and, if available, the blocks and slides;
• discharge summaries from other hospitals: on operations, courses of chemotherapy or radiation therapy;
• recent blood tests, if you have had any, and a list of the medicines you take.

If something is missing, do not postpone the visit. Come with what you have — I will tell you what is lacking.

What to ask an oncologist at the consultation

There is a lot of new information at the first consultation, and some questions come to mind only on the way home. Write them down in advance. Here are the ones worth asking a surgeon:

• Can the tumor be removed now? If not, what has to change for surgery to become possible?
• Which operation exactly is needed, and can it be done laparoscopically?
• Will chemotherapy be needed — before or after the operation?
• How many days will I spend in the hospital, and when will I get back to normal life?
• What are the risks and possible complications in my particular case?
• Will I need a stoma, and if so — temporary or permanent?
• Who will follow me up after the operation, and how often are check-ups needed?
• What does the cost of treatment depend on, and is payment by installments available?

How much an oncologist consultation costs

If surgery is needed, at the consultation I will explain what its cost will depend on: the extent of the procedure, the approach, the number of days in the hospital and the tests before surgery. The exact amount can be named once the treatment plan has been defined. The payment can be split into parts — installments are available. A year of follow-up after surgery is a separate paid service; I will explain the terms at the appointment. More details are on the page “Cost of Surgery: What It Depends On”.

Where I see patients

If you are from another city, start with the documents: the trip to Kyiv is a separate expense of time and money. Send the images and records in advance. I will review them and tell you whether it makes sense to come for an in-person consultation and which tests are better done locally before traveling. Patients from Ivano-Frankivsk start with an online consultation; if needed, a follow-up visit at 10 Hutsulska St. can be arranged.