Surgeon or oncologist first?

Joining this conversation a little late. I too, assumed that if one is diagnosed with cancer, that the first step would be to see an oncologist. I was surprised that I was firstly referred to a general surgeon after my DCIS diagnosis. 

The doctor and clinical nurse specialist at Breast Screening Queensland told me that I would firstly require surgery as part of my treatment. So I was directed to see my GP and get a referral to a general surgeon. The Breast Screening team also said I would see a radiation oncologist and a medical oncologist at some point. I do wonder if it works differently in the public system. Perhaps one may see the oncologist prior to being referred to a surgeon. Though I suppose it does make sense that the surgeon comes first, as the lesion needs to be removed and histopathology results of the removed tissue will determine the next step. 

Similar to you I had two lumpectomies - one for diagnostic purposes then the second to get clear margins which included sentinnel lymph node removal.  After that I met with a radiation oncologist and had 15 sessions of radiotherapy. Only after that did I meet with my oncologist to start hormone suppression medication. 
I was told at the time that if the treatment for your type and stage of cancer is primarily surgical (in my case Stage 1 invasive lobular carcinoma) then your treatment is directed primarily by your surgeon. 
Best of luck to you x

Lizzie27​ 

https://www.breastcancertrials.org.au/wp-content/uploads/2024/09/CJ12494_BCT_PatientDecisionAid_A5_2024_FINAL.pdf?srsltid=AfmBOordE3QVSFeFYvQ0cC3eHnqqg4CqOYm_yY6kAtEUHuk6aChNo6wo

HiLizzie27​ 

It’s a good question but please don’t feel foolish, you have every good reason to trust the process and of course we are in a complete whirlwind of information when our diagnosis is made. 
In my case my GP referred me to a specialist breast surgeon and explained the surgeon would very likely request another ultrasound and a biopsy (to gain more insight) and then very likely would involve an oncologist (along the lines your husband suggested). That is indeed what happened for me. 

But my sequence of treatment was different to yours, as I had  4 months of chemotherapy and immunotherapy (‘neo adjuvant treatment’) prior to surgery. Not knowing very much about breast cancer and it’s various types, I asked why I would have chemotherapy first (or at all) and it was explained to me that the sequence was shaped by several factors, including my particular cancer type. I was HER2 positive, Er + and Pr + and my tumour size 3.8 cm.
My oncologist did liaise closely with my breast surgeon at the start and she was my regular point of contact throughout the chemo, and I saw the breast surgeon midway through the neo adjuvant chemo to assess how my tumour was responding to the chemo and to affirm a recommended surgical plan (I stayed on track for a lumpectomy).

After the lumpectomy surgery and based on my pathology, the breast surgeon determined I need not have further surgery and my oncologist affirmed that. However, as there were some latent cancer cells present in the lump that was removed, I was recommended more chemotherapy, together with immunotherapy. 

My oncologist managed my subsequent chemotherapy and endocrine treatment (I started an oestrogen suppressing aromatase inhibitor) and they both liaised with my radiation oncologist for radiation therapy. 

I hope you’re feeling comfortable about how you’re progressing through treatment. I feel like my specialists all had a strong patient centric approach and helped me keep a realistic and open mind about what to expect but also, were open about what would be uncertain (which of course was the hardest to deal with!) and to be ok with that until a milestone (say pathology) was to hand. 
After I had been through the first 8 or 9 months of treatment I started to read up on the way breast cancer is usually treated - it was not to second guess the treatment I had - I just found it helpful to understand what I had been through. It was also helpful to understand my cancer type - which is less common - because some of my friends who had also had breast cancer treatment, but for different breast cancer types, asked me questions about my treatment and it helped me to understand what was similar, what was different, and why.  I found a really interesting decision making pamphlet for people in the early stages of a diagnosis, comparing options and treatments, I will pop into a link in a separate reply for you. 

Hi Lizzie​ 

Surgeon first, and my surgeon referred me to my oncologist. My GP (first port of call) decided wisely she needed someone who knew more about breasts - her second try could see me in two days. My surgeon arranged the mammogram and ultrasound, then a biopsy (all in one session). The result was a mastectomy and axillary clearance (removal of several lymph nodes). In some cases, adjuvant chemotherapy (to reduce the tumour size) is proposed before surgery, but mine was quite advanced, so surgery first, chemo for the mop up. 

My surgeon and oncologist worked quite closely together, with frequent discussions about patients which I found very useful and reassuring. It's not essential though. Best wishes.

Hi Lizzie27​ 

Sorry to see you joining our select little group here ... do you know what type of BC you have?  We have some private groups on some of the trickier ones that you could join, if it is one of them (check out the Groups Page in the pink banner at the top of the page.)

I was lucky & only had the one lot of surgery .... if further surgery is required, you pretty well always see the surgeon first. 

The surgeon is a cancer specialist too!  ;)  It is the surgeon's job to do the surgery and After they've done the followup surgery, you'll then see the Medical Oncologist, as the Onc needs to know that the surgery was successful & along with the Pathology Reports (from both surgeries), they'll then set out the plan for your ongoing meds.  They'd only be guessing if they saw you before the surgery.  You may well see a Radiation Oncologist as well (if they believe you should have radiation as well), and this is usually done before going onto the AI medication - or it was in my case.

Listening to Charlotte Tottman's and Raelene Boyle's stories are very educational ... Charlotte Tottman is a specialist breast cancer counsellor - and has had a double mastectomy herself, so knows exactly what everyone goes thru, from diagnosis to surgery, chemo & ongoing treatments ..... 
Listening to Raelene Boyle's podcast is well worth it, as well as Charlotte Tottman's! | BCNA Online Network

Feel free to jump onto this thread - there is lots of good information about the forum, including tick sheets on how you are going physically & emotionally during your treatment.  

A big welcome to all New Online Network Members ..... | BCNA Online Network

take care & all the best - make sure you have a trusted friend or family member with you at all your 'early' appointments - and consider recording them on your phone too, as it can be difficult to remember everything that is said at the time.

Thank you GorgyS.

I have an excellent surgeon and feel like I’ve been in good hands with everyone I’ve seen so far. It’s just interesting that a surgeon has the coordinating role in the team (it seems), rather than a cancer specialist. TBH I don’t mind who I see when, as long as I’m progressing! 

My treatment path was a lumpectomy followed by further surgery to achieve clear margins. After the surgery, I saw a medical oncologist who prescribed chemotherapy, and a radiation oncologist for radiation therapy. The breast surgeon was the one who decided whether further surgery was needed. And you're right—they work together and consult with each other as a multidisciplinary team. I was well guided through the whole treatment and didn’t worry much because I trusted the medical team and their expertise. They had experience in treating breast cancer, but for me, everything was so new and unknown. Take care