The specialist treating a cancer patient is not the specialist of the affected organ but the medical oncologist. A medical team is formed: an attending physician, a specialist in the organ possibly affected, and a medical oncologist. Why is he a referring physician? Interview with Delphine Topart, medical oncologist at the Montpellier University Hospital.
Hizy: Why is there a medical oncology specialty?
Delphine Topart : The medical oncologist studies all types of cancer . He has a global vision of patients and all pathologies linked to cancer , both genetics and fatigue linked to the cancer itself and to the treatments. During our studies, we are trained on all cancers .
When we exercise, we have to specialize in certain types of cancer , because if the treatments are generally the same, the strategies and the medical follow-up may be different depending on the organ affected.
Conversely, some specialists, for example gastroenterologists, choose to practice only on cancer . When they are recognized by the council of the medical order, they become gastroenterologist oncologists .
In addition, we work closely with the other specialists. For example, when breast cancer develops and sends metastases to the lung, we may call on the expertise of a pulmonologist. We also work with radiotherapist oncologists who deal with radiotherapeutic treatments for all cancers.
What is the common denominator for all cancers?
DT: The cancer cell , whatever its origin, is a cell of the organism (of the self) which transforms itself and whose sole purpose is to proliferate ad infinitum.
There is normally “intelligence” and communication between all cells in the body. For example, when cells are too tight, signals are sent and they stop multiplying.
However, the cancer cell no longer “listens” to any signal and it develops strategies to amplify the mechanisms that are useful to it: to multiply and “colonize” healthy tissue.
The intimate biological mechanisms of cancer cells are common to many cancers. Also, all the training of medical oncologists is devoted to it.
A pulmonologist, for example, knows and treats all lung diseases (asthma, fibrosis, respiratory failure, etc.). He also knows lung cancer , but he is not a specialist except when he specializes only in lung cancer .
Cancer starts in different organs, but it grows with identical processes. Also, the same treatments can treat very different diseases, such as melanoma and kidney cancer, for example.
What is the role of the medical oncologist in the treatment of cancer?
DT: The diagnosis of cancer is most often confirmed after analysis of the biopsy .
Management by the oncologist usually begins at the consultation announcing the diagnosis and the proposed care strategy.
It is the doctor who will follow the patient throughout the treatment and at its end in order to prevent recurrence, unless the latter no longer wants it.
Like the general practitioner, the referring oncologist maintains a fairly strong relationship with his patient. He knows his background, his health problems, his social and family situation.
Indeed, a person being treated for cancer can have excess cholesterol, diabetes, osteoarthritis, for example. He is the care coordinator. In particular, he asks for additional examinations and the opinion of specialist physicians , in order to develop a therapy.
What is the role of the referring oncologist for CPR?
DT: I often tell my patients that I represent them at the CPR ( multidisciplinary consultation meeting ). The doctors who are present there, for example the urologist, the radiotherapist oncologist, the surgeon, evaluate with me the strategy of care which I submit to them. We review the patient’s history and resume their medical imaging results.
The therapy is thus optimized and validated by a quorum of doctors. CPR is mandatory. However, the oncologist who presents his patient for CPR may, provided he justifies it in detail, not follow his decision if it is not suitable.
In what situation does the oncologist make the diagnosis?
DT: Sometimes the attending physician refers a patient to us because he suspects cancer based on certain symptoms. For example, the CT scan he ordered because of pain showed suspicious or suggestive images of cancer, lymph nodes that look like tumors or that cannot be explained. In this case, the oncologist organizes the biopsy or the operation and gets in touch with the other specialists.
Also, fellow organ specialists call on us. For example, a fellow urologist followed a patient for renal colic caused by kidney stones. He spoke to me because the scan performed showed large suspicious lymph nodes that came from an organ that we did not identify. I organized a biopsy of the lymph nodes to verify that they were not cancerous.