Two Different Opinions (6/12/12)

First we met with the local oncologist on June 8, 2012.  His recommendation was FolFox chemotherapy regiment for six months + radiation therapy + Avastin (an additional expensive chemo drug).  He also wanted to do a PET scan before beginning chemo to see if there was any other evidence of disease.  We reminded him that we just completed the chest, pelvis, and lung CT scan on May 21^st (about two weeks prior) and questioned why he would want to do another scan so soon, and why a PET scan and not a CT.  He suggested that the PET scan could pick up smaller nodules than the CT scan — per his report the CT scan could detect 10 mm nodules whereas the PET scan could detect 5 mm nodules.  We asked why the PET scan done on Feb 17 didn’t detect the colon tumor as it supposedly was a scan from the base of the skull to the mid-thigh and that tumor was much bigger than 10 mm. He didn’t know why it didn’t show up on the scan. We also reminded him that even the lung nodule was not consistent with cancer per the Feb 17th PET scan and asked why we would expect different results now. Keep in mind that PET scans involve injecting a nuclear die into the subject’s veins.  The technicians stand on an opposite side of a lead wall while administering this scan.  One needs to consider the toxic implications as well as the expensive costs vs. the potential benefits. Additionally, we learned that healing scar tissues (from recent surgeries) would likely light up the PET scan and make it difficult to read as well.  We are not the doctors, however, I am learning that one needs to take a keen interest in their health and question the decisions and recommendations of the doctors. After this June 8 meeting we were resolved to get a second opinion.

The time for the second opinion came on June 12.  We went to meet with an oncologist from University of Michigan Comprehensive Cancer Center.  This oncologist differed in opinion with the local oncologist. He suggested that Fulfox for six months was the only treatment he would recommend. He said there was NO evidence that Avastin would help in my case (Avastin is usually used when there is a non-operable tumor that they are trying to kill/shrink with chemotherapy).  He also reported that given the location of the colon tumor that radiation therapy was not an option.  He also differed in opinion about the PET scan.  Instead of a PET scan he ordered another CT scan of the chest to serve as a baseline.  The difference between the CT scan at U of M vs. the CT scan done in Battle Creek was the resolution of the imaging.  The U of M imaging was done at .8 mm slices whereas the Battle Creek imaging is done at 5 mm slices.  This would give him greater visibility to any nodules that may be small and beginning to grow.

Another comparison of the two doctors is the amount of time they took with us.  We recorded the meetings so we could review and make sure we fully understood everything that was discussed. The Battle Creek Oncologist spent a whopping 8 minutes with us whereas the U of M oncologist spent over 45 minutes making sure all our questions were answered, including many questions we didn’t even know to ask.  He took the time to thoroughly cover the chemotherapy treatment.  He also talked about contingencies and what the data shows and doesn’t show regarding treating colorectal cancer.  He also discussed diet and exercise, and what the data shows about this regarding cancer.

Another key point the U of M oncologist made was that Stage IV colorectal cancer CAN BE CURED. He explained that there are many different degrees of stage IV colorectal cancer and that I had a lot going for me at this time; and that he hoped we will cure this disease with treatment and close surveillance.  I’ll go over more of the data he shared with us in the next post.

The bottom line is the U of M oncologist won our confidence and trust.