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2nd Opinion - How do you do this? 2nd Opinion - How do you do this?

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Unread 10-06-2008, 05:21 AM
2nd Opinion - How do you do this?


I receently received a pathology report (post cone biopsy) from my GYN Oncologisgt and they are recommending a radical hysterectomy. I agree with the recommendation and was even happy to hear that my surgeon planned to have the senior gyn oncologist join her in the surgury (around the beginning of November). However, I would feel more comfortable getting a second opinion. I would hate for something to go wrong and then find later that I could have prevented it had I gotten a second opinion.

My problem: I have never done this before, how do I go about this? Do I just find any GYN Oncologist and call them and send them my pathology report? Is it likely that I could get a second opinion before the anticipated surgury? I don't want to postpone the surgury to do this.

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Unread 10-06-2008, 05:36 AM
2nd Opinion - How do you do this?

Toni - I got a second opinion before my surgery. My regular gyno recommended a gyn-onc that was very highly regarded, but I had to wait over a week to see him. In the meantime, an oncology nurse I knew recommended another doctor at a different hospital. I actually saw my second opinion doctor first...he did some of his own tests and wanted to do the more traditional abdominal surgery. His tests came back much better than the original path reports from my D&C. When I went to my first choice he said he could do the DaVinci surgery, which made me feel more comfortable. I was glad to have gotten 2 opinions even though they didn't differ that much. It made me feel so much more confident going into surgery. I ended up using my first choice not so much because of his surgery plan, but because he had such a positive attiude. I think being comfortable with your surgeon in very important, so having a comparison is a good thing.
Is there anyone you know that can recommend a doctor for you? Maybe your primary care doctor?
Unread 10-06-2008, 09:07 AM
2nd Opinion - How do you do this?

Toni, I researched online for local gyn/onco's and visited my primary care physician. Turns out the Doctor I found online that seemed most educated and experienced was the exact one my PCP ended up recommending. You may check out the refer a doctor site as well.
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Unread 10-06-2008, 01:04 PM
2nd Opinion - How do you do this?

I was sent to one gyn/onc in Dallas. He made me mad and upset with what he suggested (that I have surgery with my gyn and if cancer was found to come to Dallas for a 2nd surgery for staging.. or have abd. surgery with him from the getgo). I didn't like either idea so I went searching on the internet for alternatives to an abdominal hyst. I found a gyn/onc in Houston who did DaVinci's and asked my gyn to refer me.

The first date she could see me was the date I had set with my gyn for a LAVH. I cancelled the first surgery and went to see the gyn/onc in Houston. She was WONDERFUL. Very positive and caring and her credentials were great (chief resident ~you've got to be very good to make chief resident~ and also did a fellowship at MD Anderson).

She said that there was 75% chance that she could do the DaVinci on me and that surgery would probably be the only treatment I would need.

I've since come to the realization that the fact the soonest she could see me was my original surgery date was a sign. I had my surgery in Houston and while things didn't go perfectly (pre-op nurses were MEAN), it was very doable.

That's how I handled it.
Unread 10-06-2008, 02:57 PM
2nd Opinion - How do you do this?

Today I called my original OBGYN doctor who refered me to the first doctor and asked for another referral for a second opinion. She gave me a name and I scheduled an appointment with dr 2 for the second opinion. They are requesting my records from Dr 1 so it will be easy for me.

My appointment with dr 2 is scheduled for October 30th I know Dr 1 is planning on doing the surgury about the 2nd week in November but it isn't scheduled yet. To me this is perfect because if I learn anything during the 2nd opinion that causes me to change my mind I can still cancel the surgury but I dont' anticipate that at this time.

As always .. Thank you very much ladies .
Unread 10-07-2008, 08:17 AM
2nd Opinion - How do you do this?

I got 2nd and 3rd pathology opinions and 2nd and 3rd surgical opinions. Two different things. My brother is a pathologist and I happen to know from him that mistakes are made frequently, so I wanted to make sure my dx was confirmed.

First, I requested that the path department provide me with recuts of the uterine biopsy slides, paid about 2.00 each for them (there were 3 sets of 8) - I picked them up from the path department myself. I then figured out where I wanted to send them to, contacted that institution and filled out their "path 2nd opinion intake form", and fed exed the slides to them on my dime. They viewed the slides, issued their report (about 200.00 each, my insurance picked up 1-2nd opinion, I paid, using Flexible Spending dollars, for the other). I also kept one set of path slides for myself - they are in a safe at home.

Once I got the 2 path reports (took about 2 weeks), I then took those reports to 2 different surgeons. I researched gyn/onc's all of the way back to their medical schools. I found 2 second opinion docs that did not go to the same medical school. I felt better knowing that the docs (who were very well know in the gyn/onc field) weren't roommates or something in college.

There were many frustrations along the way, but I got it done. Hope that helps.
Unread 10-09-2008, 05:26 AM
2nd Opinion - How do you do this?


When you sent the films to other labs, did the pathology reports come out the same? What about the surgical second opinions, were they the same? If not how do you decide which is the right one?

Unread 10-09-2008, 05:35 AM
2nd Opinion - How do you do this?

Hi Toni,

I wasn't as thorough as IluvChicago, but I did have a re-read of my endometrial biopsy at a lab that specializes in looking for cancer.

And yes, not surprisingly, they found what they were looking for. My original diagnosis of hyperplasia with atypia moved over to adenocarcinoma.

As to which report to believe and act upon.. well, I think when it comes to cancer you probably should act upon the most serious result/report.

Hope this helps.
Unread 10-09-2008, 05:49 AM
2nd Opinion - How do you do this?

Before coming to my decision to have my surgery on October 10th. I went out and got a third opionion. Just research for another doc. Call insurance, ask friends go on the internet. When you find one contact your previous doc and get all medical recods to be forwarded to new doc. I am glad I did I found a very good doc. You need to get another opionion and compare notes. That way you will be confident of the choice you make. It will give you peace of mind.
Good Luck to you!
Unread 10-09-2008, 09:15 AM
2nd Opinion - How do you do this?

To answer your question, no. The path reports yielded different diagnoses.

I had a D&C to stop irregular bleeding. As part of the D&C my gyn took a biopsy (snips) which is standard procedure. I was not expect a dx of cancer at this time. The gyn then did a Radio Frequency Ablation and the ablation removed 75% of my uterine wall.

The snips were sent to pathology as they routinely do, and the path report gave a primary dx of "adenosarcoma" with differentials of leiomyosarcoma, low grade and high grade endometrial stromal sarcoma. Which was a HUGE surprise to me. Differentials are "other possible diagnoses".

I wanted to confirm my primary diagnosis of adenosarcoma. The reason why is that one of the differentials - high grade endometrial stromal cell sarcoma has a different treatment protocal (they add radiation instead of just doing surgery).

My original path report was wrong, the pathologist made a mistake, I ended up with LGESS. So it helped me to get 2nd and 3rd path opinions.

My surgical opinions were all the same, everyone unanimously said a TAH/BSO, lymphadectomy and pelvic wash - with vertical incision. Everyone also agreed (tumor board, surgeons, oncs, etc.) that surgery was the only thing that I was going to have to undergo - no rads or chemo.

During my hysterectomy, they did a frozen section of my uterus to stage me during surgery (intraoperative consultation by a pathologist). I sent my hysterectomy slides out for 2nd and 3rd opinions too. They came back negative for cancer - probably because the D&C removed so much of my uterine lining.

My situation was kinda complicated and I would encourage you not to freak about what I went through. I work in a large hospital, so I am familiar with the processes, I see what happens up close and personal.

It is easy with the internet to find different doctors for 2nd opinions, it is also easy to get 2nd pathology opinions too. Just focus on one thing at a time and do the best that you can do.

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