What Happens When Your Doctor Suspects You Have Cancer

Maybe you’re experiencing unusual symptoms, like nausea and extreme tiredness. Or, maybe routine lab work revealed abnormalities such as a low white blood cell count.

Regardless, if your primary care provider (PCP) thinks cancer is to blame, what comes next? How is cancer diagnosed?

1. Typically, patients are referred to an oncologist who conducts a series of tests.
2. A biopsy will confirm the presence or absence of cancerous cells.
3. From there, the oncologist will determine the cancer type and stage, offering insight into how the disease should be treated.
4. You should seek out a second opinion from another oncologist to explore all of your treatment options.

In this blog, SERO discusses the patient referral, diagnosis, and staging processes in more detail. Educating yourself on what to expect during these initial steps can ease the anxiety surrounding a possible cancer diagnosis.

PCPs are often the first point of contact for patients experiencing the early signs and symptoms of cancer. However, despite their invaluable role in cancer detection, general practitioners typically don’t offer official cancer diagnoses.

Instead, if cancer is suspected, your PCP will send you to a cancer specialist for more advanced care. This written order to receive care from an oncologist is called a referral.

It’s important to remember that an oncology referral doesn’t mean you have a definitive cancer diagnosis.

Receiving a referral from your PCP may seem like an unnecessary step. However, referrals are required by most health insurance companies to ensure that patients are receiving care from appropriate providers.

Failure to obtain the necessary referral before seeing an oncologist could affect your cancer insurance coverage. In some situations, you may be responsible for the entire cost of the visit.

The first appointment with your oncologist is critical. During this one- to two-hour consultation, he or she will gather more information regarding your medical history. The oncologist will also conduct a physical exam.

Depending on which tests were previously ordered by your PCP, your oncologist may request additional diagnostic imaging tests, including:

• CT scans
• MRI scans
• X-rays
• Mammograms
• Ultrasounds
• Fluoroscopies
• PET scans

Your doctor may also request blood work to look for tumor markers and certain blood proteins.

It may take a few hours to a few days to receive the results of your diagnostic tests. If any of these tests reveal potentially cancerous lesions or other abnormalities, your oncologist will order a biopsy.

This procedure involves removing a sample of tissue. A biopsy is the only sure way to diagnose most cancers.

Depending on your suspected cancer type, the tissue sample may be obtained in several ways.

• With a needle: The doctor uses a needle to withdraw tissue or fluid. This method is used for bone marrow aspirations and some breast, prostate, and liver biopsies.
• With endoscopy: The doctor uses a thin, long tube called an endoscope to examine internal cavities of the body. If abnormal tissue is found, a sample will be collected.
• With surgery: A surgeon removes an area of abnormal tissue during an operation.

Since biopsies vary in invasiveness, some (for example, most skin cancer biopsies) can be performed in a doctor’s office with local anesthesia. More invasive biopsies, like lung biopsies, must be performed in a hospital with general anesthesia.

After the biopsy, your tissue sample will be delivered to a pathologist. The pathologist will examine the tissue under a microscope and conduct other tests to confirm or deny the presence of cancer.

Biopsy results can take up to a week to receive.

When a biopsy shows no signs of cancerous cells, patients often feel a mix of relief and confusion. You may wonder: If cancer isn’t causing my symptoms, what is?

To determine just that, your PCP may refer you to another specialist. If you’re experiencing a chronic cough, for instance, he or she may suggest that you see a pulmonologist. Or, if you’re experiencing stomach pain and discomfort, they may refer you to a gastroenterologist.

When a biopsy shows no signs of cancerous cells, patients often feel a mix of relief and confusion. You may wonder: If cancer isn’t causing my symptoms, what is?

To determine just that, your PCP may refer you to another specialist. If you’re experiencing a chronic cough, for instance, he or she may suggest that you see a pulmonologist. Or, if you’re experiencing stomach pain and discomfort, they may refer you to a gastroenterologist.

After confirming the presence of cancerous cells, your oncologist’s next goal will be to stage your cancer. Cancer staging is the process of determining how much cancer is in a person’s body and where it’s located.

Knowing the stage of your cancer helps your cancer care team create an appropriate cancer treatment plan. For example, the most effective treatment for an early-stage cancer may be radiotherapy, while a more advanced-stage cancer may require some combination of radiation therapy, chemotherapy, surgery, and immunotherapy.

Cancer is typically staged using diagnostic tools like CT scans, X-rays, ultrasounds, and biopsies. Depending on which tests were previously ordered, your oncologist may have enough information to determine the clinical stage of your cancer without conducting additional exams.

The clinical stage is an estimate of the cancer’s progression before any treatment starts. Cancer may also be staged after surgery or treatment.

There are many different systems used to stage cancer. However, the most common is the TNM system.

With the TNM system, oncologists can systematically describe the cancer’s severity using three different categories:

• T stage describes the primary tumor.
• N stage indicates if the cancer has spread to nearby lymph nodes.
• M stage stands for metastasis and indicates whether the cancer has spread (metastasized) to other parts of the body.

Each letter is assigned a Roman numeral I to IV. Stage I cancers are less advanced and have a better prognosis. Stage IV cancers are more advanced. With stage IV prostate cancer, for instance, the disease has spread to areas beyond the prostate and nearby tissue. Download our Prostate Cancer eBook for more information.

After determining your cancer type and stage, you will begin working with your oncologist to choose your cancer treatment. Your oncologist may suggest any number of cancer treatment modalities, from immunotherapy to chemotherapy to surgery. However, before officially starting treatment, consider seeking a second opinion.

It’s very common for patients to get a second opinion. An oncologist with more experience treating your specific cancer may be able to create a more effective and comprehensive treatment plan. They can also provide peace of mind by confirming your diagnosis.

To receive a second opinion from SERO’s team of board-certified radiation oncologists, contact us online or by calling (704) 333-7376.