Second Opinion from an Oncologist

When to get a second opinion

People seek a second opinion before a serious decision or when the first answer left no hope of surgery. It makes sense to show the documents to a surgeon if:

• you were told that the tumor is inoperable;
• only chemotherapy was offered, and you want to understand whether surgery is possible — now or after the course;
• liver metastases were found, and you were told there are too many to operate;
• the conclusion about inoperability was made several months ago, and you have had treatment since then;
• a major open operation was proposed, and you want to know whether a laparoscopic approach is possible;
• a recurrence appeared after surgery, and it has to be decided whether to operate again.

Asking for a second opinion is normal. It does not mean distrust of your doctor: this is a decision on which all further treatment depends.

Why “inoperable” is not always final

The conclusion that a tumor cannot be removed depends on several things, and some of them change over time.

• The tumor may have responded to treatment. After chemotherapy, lesions sometimes shrink to a size at which surgery becomes possible. So a conclusion made several months ago is worth checking against recent images.
• The organ can be prepared for surgery. For liver metastases this is, for example, portal vein embolization, after which the healthy part of the liver grows, or an operation in two stages.
• What matters is not only the number of lesions but also what will remain. For liver metastases the main question is whether enough healthy tissue will be left after their removal and how the lesions are located relative to the major vessels and bile ducts.
• Operability is a surgical question. If the conclusion was not made by a surgeon, it makes sense to show the images to someone who operates.

At the same time, a second opinion is not a promise of surgery. Sometimes I confirm my colleagues’ conclusion: surgery will not bring benefit or the risk is too high. Then I explain why.

How to get a second opinion

1. RequestYou call or leave a request on the website. We agree on the format: an in-person appointment or remotely.
2. DocumentsYou bring or send the images, the histology report, medical records and the conclusion you disagree with.
3. Review of imagesI look at the CT and MRI images themselves: how the tumor is located relative to vessels and neighboring organs, and what has changed after treatment.
4. ConversationI explain what I see, whether there are grounds to consider surgery and what is missing for a decision. I answer questions — yours and your family’s.
5. Next stepsIf there are grounds — further tests and, in complex cases, a tumor board. The final decision on surgery is made after an in-person examination.

How to send documents if you are in another city or abroad is described on the page “Online Oncologist Consultation”.

What to prepare

• CT, MRI or PET-CT discs — the most recent and the previous ones, to show how the tumor has changed;
• the histology report and, if available, the blocks and slides;
• treatment records: chemotherapy regimens and number of courses, radiation therapy, operative reports;
• the doctor’s or tumor board’s conclusion stating why surgery is not possible;
• recent blood tests, including tumor markers if they were measured.

You can also come with the documents you already have — I will tell you what else is needed.

What the answer may be

In every case I explain what the conclusion is based on and what the next steps are. While a preliminary diagnosis is being formed, I give my answer orally; a written opinion follows once all the additional tests recommended by the protocol have been completed. The final approach is determined after an in-person examination.