Seeking Second Opinions in Oncology: A Guide for Patients

Regarding Second Opinions

Hello Dr.
Yang.
My father was recently diagnosed with a tumor approximately 2 cm in size in his kidney due to hematuria at New Taipei City Keelung Chang Gung Memorial Hospital.
I will summarize his condition as follows: a 2 cm tumor in the kidney, with no evidence of metastasis, and the doctor has determined it to be malignant, although it seems this was not confirmed by a pathological biopsy.
The diagnosis was made through a urethral catheterization to collect urine for culture and examination (I am unsure of the specific medical term for this).
He has also undergone CT scans and ultrasounds.
The doctor has recommended surgical removal of the kidney and part of the bladder.
After researching various sources, it appears that this may resemble transitional cell carcinoma.

I have a couple of questions:
1.
I would like to seek a second opinion at Hsinchuang Hospital.
Could you please advise what kind of information I should request from Chang Gung? How should I approach them to ask for this information? Will this request upset the doctors at Chang Gung? How does the medical community generally view the practice of seeking second opinions?
2.
If surgery is performed, does this typically eliminate the cancer threat immediately, or is there a need for ongoing chemotherapy or radiation therapy? What are the usual follow-up treatments required?
Thank you for your patience in reading this, and thank you!

jason, 20~29 year old female. Ask Date: 2000/11/15

Dr. Yang Youhua reply Oncology

If your father has renal cell carcinoma and it is only two centimeters, surgical removal is very important.
Subsequent treatment should consider "immunotherapy" to enhance personal immune function.
If it is transitional cell carcinoma, chemotherapy and radiation therapy may also be necessary.
I strongly support the idea of seeking a second opinion and recommend doing so.
The relevant pathology reports and surgical reports are very important and can be directly discussed and requested from the physician, as this is the patient's right, and the physician should assist accordingly.
If you have any other questions, you can inquire at our oncology center.

Reply Date: 2000/11/15

More Info

Dear Patient,
Thank you for reaching out with your concerns regarding your father's recent diagnosis of a 2 cm renal tumor. It’s understandable to seek a second opinion, especially when it comes to cancer treatment, as it can significantly impact the course of care. I will address your questions in detail below.

1. Seeking a Second Opinion:
It is perfectly acceptable to seek a second opinion, and most medical professionals understand that patients want to ensure they are making the best decisions regarding their health. To facilitate this process, you should gather all relevant medical records and imaging studies related to your father's condition. This includes:
- Pathology Reports: If available, this is crucial for understanding the nature of the tumor.

- Imaging Studies: CT scans, ultrasounds, or any other imaging that has been performed.

- Clinical Notes: Any notes from the treating physician that detail the diagnosis, treatment recommendations, and rationale.

- Laboratory Results: Any blood tests or urine tests that have been conducted.

When requesting these documents from the hospital, you can simply explain that you are seeking a second opinion for further clarity and to explore all treatment options. Most healthcare providers will not take offense; rather, they will appreciate your proactive approach to your father’s health. In fact, many institutions encourage patients to seek second opinions as part of comprehensive care.

2. Post-Surgery Treatment:
If surgery is performed to remove the tumor, the next steps depend on several factors, including the final pathology results. If the tumor is confirmed to be malignant and there is no evidence of metastasis, the surgical removal may be curative. However, the need for further treatment such as chemotherapy or radiation therapy depends on:
- Tumor Type and Stage: For example, if it is confirmed to be transitional cell carcinoma (urothelial carcinoma), the treatment plan may differ from other types of renal cancers.

- Margins: If the tumor is completely removed with clear margins, additional treatment may not be necessary.

- Risk of Recurrence: If there are high-risk features, adjuvant therapy (chemotherapy or radiation) may be recommended to reduce the risk of recurrence.

In many cases, oncologists will monitor the patient closely after surgery with regular follow-ups, including imaging and laboratory tests, to ensure that there are no signs of recurrence. If there is any indication of residual disease or recurrence, further treatment options can be discussed.

In conclusion, seeking a second opinion is a wise decision, and gathering comprehensive medical records will aid in this process. After surgery, the treatment plan will be tailored based on the pathology results and the overall health of your father. It’s essential to maintain open communication with all healthcare providers involved in his care to ensure the best possible outcomes.

If you have any further questions or need assistance with the next steps, please feel free to reach out.

Best regards,
Doctor Q&A Teams

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