Second Opinion Before Cancer Surgery: Is It Worth It?

Yes. A second opinion before cancer surgery means asking another specialist to look at your reports, scans and biopsy and tell you whether they’d plan the same operation. It’s most worth doing when the surgery is complex, the cancer is rare, the operation will change how you live (removing an organ, a stoma, a voice box), or you’re simply unsure about the advice you’ve been given. Sometimes it confirms the plan, which can make the decision easier. Sometimes it refines it, and now and then it changes it.

Dr. Sandeep Nayak, who provides cancer treatment in Bangalore says patients are often hesitant to ask. “A second opinion in oncology isn’t a challenge to your first doctor. It’s another specialist, ideally with a team behind them, looking at the same scans and biopsy to check the diagnosis and the plan. Take the actual scan images and biopsy slides, not just the reports. A report is someone’s summary. The images let the second doctor look for themselves.”

• The cancer is rare, or hard to classify, and the doctor who saw you doesn’t treat many of them. A team that focuses on your type of cancer can see things a generalist might not. You can meet the surgeons on Team MACS.
• The operation is major or life-changing: removing an organ, creating a stoma, or taking out the voice box. It’s reasonable to ask whether there’s a less drastic route.
• The question is the order of treatment. Surgery first, or chemotherapy or radiation first? Sometimes more tests are needed before deciding, such as a keyhole look called diagnostic staging laparoscopy.
• The cancer has come back or isn’t responding, or two doctors have given you different advice.

• Bring the originals. That means the biopsy slides or blocks along with the pathology report, scan images on a disc or file (not only the reports), notes from earlier treatment, and a list of your medicines.
• Ask whether keyhole or robotic surgery is possible for you, and why or why not. Our blog on minimally invasive surgery explains the difference.
• Ask how extensive the operation will be. For breast cancer, that includes how many lymph nodes would come out, which our post on sentinel node biopsy vs full lymph node removal goes through.
• Ask what the alternatives are, and what happens if you take a week or two to decide. Write the answers down, because it’s easy to forget them in the room.

It isn’t the same for everyone. A few things tip the balance.

• How big the operation is. The more major or irreversible it is, the more a second look is worth.
• How certain the diagnosis is. A clear biopsy result is one thing. Unusual or borderline findings are another.
• How experienced the first team is with your type of cancer, especially if it’s uncommon.
• How much time you have. Some cancers need to move quickly, so ask your surgeon how long it’s safe to wait.
• How you feel about the plan. Peace of mind counts, and a second opinion often gives people more confidence in their treatment.
• The practical side. Remote options exist, and some centres, ours included, offer an expert opinion by video, with a written report from at least two specialists. It’s worth checking with your insurer whether the cost is covered.

Reference Links:

• Cancer Fact Sheet, World Health Organization
• Changes in Breast Cancer Therapy Because of Pathology Second Opinions, Annals of Surgical Oncology, PubMed

Disclaimer

This content is published for educational and informational purposes only and is not a substitute for medical advice. Please speak to your oncologist before changing or stopping any treatment.