Obesity and Cancer

We know some of the traditional risk factors like smoking and genetics.

One of the recent discovery on the risk of cancer is actually obesity. Obesity has been linked to diseases like heart attack, but its link to cancer has been quite recent.

Many big studies has found that risk of breast, colon, kidney cancer etc. are linked to obesity.

Living a healthy lifestyle is very important, regular exercise and good diet not only lowers your risk of heart attack, but also cancer!

Cancer pain

One of the most distressing issue about cancer is the pain cause by the disease. However, now with the better understanding of how cancer causes pain and new ways to treat the pain, cancer patients do not need to suffer from extreme pain anymore.

There is a good article on cancer pain at :

http://www.cancerhelp.org.uk/help/default.asp?page=5883

Causes of cancer pain
Most cancer pain is caused by the tumour pressing on bones, nerves or other organs in your body. Sometimes pain is related to your cancer treatment. For example, some chemotherapy drugs can cause numbness and tingling in your hands and feet or a burning sensation at the site where they are injected. Radiotherapy can cause skin redness and irritation. Remember – pain may have nothing to do with your cancer - you may just be feeling the general aches and pains that some people get from time to time.
Acute and chronic painCancer pain can be acute or chronic. Acute pain tends to only last a short time. Chronic pain is more long term. For example, having an operation can cause acute pain. The pain goes when the wound heals. In the meantime, painkillers will usually keep it under control.Chronic pain can range from mild to severe. It can be there all the time. You may hear chronic pain called ‘persistent pain’. Painkillers or other pain control methods can successfully control chronic cancer pain in about 95 out of every 100 people (95%).If you have chronic cancer pain, you may also have episodes of acute pain that are not controlled by the medication you are taking. This is often called ‘breakthrough pain’. If you are on regular painkillers but still have episodes of pain, let your doctor know. He or she can prescribe extra 'top up' doses of painkillers for you to take when you need to. There is more information about how your cancer pain can be managed in Treating Cancer Pain.Whatever type of pain you have, it can affect your quality of life. Chronic pain can make it hard for you to do everyday things such as bathing, shopping, cooking, sleeping and eating. This is sometimes very hard for your close friends and relatives to understand, as they are not feeling your pain. There is more about how your pain can affect you and your loved ones and how to deal with this in support when you have pain.
Types of cancer painIt is extremely important for your doctor to find out the type and cause of your pain in order to treat it in the right way. Different pains are treated differently. You may have one or more of the 3 main types of pain. These are
Nerve pain
Bone pain and
Soft tissue painAnother type of pain can come on after amputation of a limb or other part of your body. This is really another type of nerve pain and is called phantom pain. Nerve painThis is caused by pressure on nerves or the spinal cord, or by damage to nerves. Your doctor may call it neuropathic pain. It is usually more difficult to treat than other types of pain. People often describe nerve pain as burning or as a feeling of something crawling under their skin. Nerve pain is not usually widespread. You often feel it in a particular place, or perhaps along the path of a nerve. Nerve pain is the one type of pain that can sometimes go on for a long time after an operation. Nerves are cut during surgery and they take a long time to heal because they grow so slowly. Nerve pain is particularly common after an operation to the chest called a thoracotomy. Some people may have pain around their scar for 2 years or more after their surgery. It does eventually go, but can be difficult to treat while it lasts.
Bone painBone pain can affect one specific area or several areas, depending on how much the cancer has spread. People often describe it as aching, dull or throbbing. Bone pain is very common in people who have breast, prostate or lung cancer. The cancer spreads to the bone, and it is the growth of the cancer within the bone that damages the bone tissue and causes the pain. You may also hear bone pain called somatic pain.
Soft tissue painSoft tissue pain means pain from a body organ or muscle. For example, you may feel pain in your back caused by tissue damage to the kidney. You cannot always pinpoint this pain, but it is usually described as sharp, aching or throbbing. You may also hear soft tissue pain called visceral pain. Some soft tissue pain comes from the covering of an organ, rather than the organ itself. The liver does not contain nerves. If it contains cancer, it is usually bigger than it should be. The enlarged liver stretches the fibrous covering, called the capsule. The capsule does contain nerve endings and that is what causes the pain. This type of pain is called liver capsule pain.
Phantom painPeople with sarcoma or osteosarcoma sometimes have to have a limb amputated. You may feel pain in an arm or leg after it has been removed. This is 'phantom pain'. But it is very real and people sometimes describe it as unbearable. You may also have phantom pain after having a breast removed. Doctors are still trying to understand why phantom pain happens. One theory is that the 'thinking part' of your brain knows that you have had a part of your body removed but the 'feeling part' of your brain cannot understand this. Other possible causes of phantom pain are
Changes in the air pressure or temperature
Stress
Not moving around enough and poor posture
Other illnesses such as flu and infections
Having your surgery done by an inexperienced surgeonBetween 6 and 7 out of 10 people (60 - 70%) who have had an arm or leg removed feel phantom pain. About one third of women who have had a breast removed to treat breast cancer feel phantom breast pain. The pain usually lessens after the first year, but some people can still feel phantom pain after one year or more.Phantom pain is quite common. It is real and you are not imagining it. In most people it will go away after a few months. It is as if your brain has to realise that part of your body has gone. Be sure to let your doctor know about phantom pain as it does respond to painkillers.How much pain you might haveThe amount of pain you have with cancer depends on
The type of cancer you have
Where it is
The stage of your cancer
How much pain you're able to tolerateHow much pain you can stand is your pain threshold. Everyone has a different pain threshold. It isn't related to how weak or strong you are. It is just one of those things.

A new lung cancer vaccine

Among all the new therapeutic cancer vaccine in clinical trial now, this one is one of the most exciting. It tackles mucin producing tumour, which is present in many tumours like in the lung, colon etc. Hopefully, it would be available in the next few years. The article also mentions about other battle with lung cancer.

http://www.biopeer.com/biopeer/cancer_vaccines/index.html

Battle against lung cancer continues
In separate studies, researchers have come up with possible treatment options for lung cancer.Scientists are on their way to treating non-small cell lung cancer (NSCLC) with gene therapy and nanotechnology. Scientists from the University of Texas MD Anderson Cancer Center and the University of Texas Southwestern Medical Center conducted a study on mice to test whether gene therapy administered through lipid-based nanoparticles can successfully fight tumors. They sent positively charged nanoparticles to the negatively charged cancer cell membrane. When these nanoparticles are taken into the cell, the genes express the tumor suppressing p53 or FUS1 gene depending on the design. The scientists then found that while p53 and FUS1 individually fought well against cancer, they were most effective when combined. The two together bring about apoptosis, a process wherein the cancer cells self-destruct. Since FUS1 hinders the functioning of a gene that destroys p53, the combination therapy caused more cells to die. In the final analysis, the combination caused a 75 per cent reduction in the number of tumors per mouse and a decrease of 80 per cent in the weight of the tumors. Meanwhile, the lung cancer vaccine Stimuvax that scientists from Cancer Research UK had prepared is now set to enter phase III of its clinical trial. Stimuvax is a therapeutic vaccine that will compel the immune system to kill MUC1, a molecule found in large quantities in tumor cells. This way, no harm will be done to the healthy cells. Merck KgaA will conduct this trial named START (Stimulating Targeted Antigenic Responses To NSCLC). The trial will evaluate the efficacy of Stimuvax in comparison to a placebo. It aims to involve over 1,300 patients across 30 countries. With lung cancer being the most common cancer worldwide, any progress towards its treatment is welcome news.

Green Tea and cancer prevention

There are many studies which showed various products can prevent cancer. One of the most studied product is green tea. This is the theory behind why Japanese lives longer, because they drink green tea.

I have an article here on green tea from National Cancer Insititute which is a reputable independant agency :

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Tea and Cancer Prevention: Fact Sheet
Key Points
The antioxidants found in tea--called catechins--may selectively inhibit the growth of cancer (see Question 1).
In laboratory studies using animals, catechins scavenged oxidants before cell damage occurred, reduced the number and size of tumors, and inhibited the growth of cancer cells (see Question 3).
However, human studies have proven more contradictory, perhaps due to such factors as variances in diet, environments, and populations (see Question 4).
NCI researchers are investigating the therapeutic and preventive use of tea catechins against a variety of cancers (see Question 5).
Tea drinking is an ancient tradition dating back 5,000 years in China and India. Long regarded in those cultures as an aid to good health, researchers now are studying tea for possible use in the prevention and treatment of a variety of cancers. Investigators are especially interested in the antioxidants-called catechins-found in tea. Despite promising early research in the laboratory, however, studies involving humans so far have been inconclusive.
1. What are antioxidants?
The human body constantly produces unstable molecules called oxidants, also commonly referred to as free radicals. To become stable, oxidants steal electrons from other molecules and, in the process, damage cell proteins and genetic material. This damage may leave the cell vulnerable to cancer. Antioxidants are substances that allow the human body to scavenge and seize oxidants. Like other antioxidants, the catechins found in tea selectively inhibit specific enzyme activities that lead to cancer. They may also target and repair DNA aberrations caused by oxidants (1).
2. What is the level of antioxidants found in tea?
All varieties of tea come from the leaves of a single evergreen plant, Camellia sinensis. All tea leaves are picked, rolled, dried, and heated. With the additional process of allowing the leaves to ferment and oxidize, black tea is produced. Possibly because it is less processed, green tea contains higher levels of antioxidants than black tea.
Although tea is consumed in a variety of ways and varies in its chemical makeup, one study showed steeping either green or black tea for about five minutes released over 80 percent of its catechins. Instant iced tea, on the other hand, contains negligible amounts of catechins (1).
3. What are the laboratory findings?
In the laboratory, studies have shown tea catechins act as powerful inhibitors of cancer growth in several ways: They scavenge oxidants before cell injuries occur, reduce the incidence and size of chemically induced tumors, and inhibit the growth of tumor cells. In studies of liver, skin and stomach cancer, chemically induced tumors were shown to decrease in size in mice that were fed green and black tea (1, 2).
4. What are the results of human studies?
Although tea has long been identified as an antioxidant in the laboratory, study results involving humans have been contradictory. Some epidemiological studies comparing tea drinkers to non-tea drinkers support the claim that drinking tea prevents cancer; others do not. Dietary, environmental, and population differences may account for these inconsistencies.
Two studies in China, where green tea is a mainstay of the diet, resulted in promising findings. One study involving over 18,000 men found tea drinkers were about half as likely to develop stomach or esophageal cancer as men who drank little tea, even after adjusting for smoking and other health and diet factors (3). A second study at the Beijing Dental Hospital found consuming 3 grams of tea a day, or about 2 cups, along with the application of a tea extract reduced the size and proliferation of leukoplakia, a precancerous oral plaque (1).
However, a study in the Netherlands did not support these findings. It investigated the link between black tea consumption and the subsequent risk of stomach, colorectal, lung, and breast cancers among 58,279 men and 62,573 women ages 55 to 69. The study took into account such factors as smoking and overall diet. It found no link between tea consumption and protection against cancer (4).
5. Is NCI evaluating tea?
National Cancer Institute (NCI) researchers are also investigating the therapeutic use of green tea. One recently completed but unpublished NCI trial studied the antitumor effect of green tea among prostate cancer patients. The 42 patients drank 6 grams of green tea, or about 4 cups, daily for four months. However, only one patient experienced a short-lived improvement, and nearly 70 percent of the group experienced unpleasant side effects such as nausea and diarrhea. The study concluded drinking green tea has limited antitumor benefit for prostate cancer patients (5).
Other ongoing NCI studies are testing green tea as a preventive agent against skin cancer. For example, one is investigating the protective effects of a pill form of green tea against sun-induced skin damage while another explores the topical application of green tea in shrinking precancerous skin changes. For more information about NCI-sponsored studies on green tea, go to http://cancer.gov/clinical_trials/.
References: (1) Dufresne CJ, Farnworth ER. A review of latest research findings on the health promotion properties of tea. J. Nutri Biochem 2001; 12 (7): 404-421. (2) Hakim IA, Harris RB. Joint effects of citrus peel use and black tea intake on risk of squamous cell carcinoma of the skin. BMC Derm 2001; 1 (3). (3) Sun CL, Yuan JM, Lee MJ, Yang CS, Gao YT, Ross RK, Yu MC. Urinary tea polyphenols in relation to gastric and esophageal cancers: a prospective study of men in shanghai, china. Carcin 2002; 23 (9): 1497-1503. (4) Goldbohm RA, Hertog MG, Brants HA, van Poppel G, van den Brandt PA. Consumption of black tea and cancer risk: a prospective cohort study. JNCI 1996; 88 2): 93-100. (5) Phase II Study of Green Tea Extract in Patients with Androgen-Independent Metastic Prostate Cancer. Protocol Ids: NCCTG-N9951. NCI Clinical Trials http://cancer.gov/clinical_trials/.

Breast cancer recurrence and fruits/vegetables

A very interesting report.

Previously, we think fruits and vegetables can help reduce risk of cancer and recurrence cancer, but his study did not show.

However, as fruits and vegetables in general are healthier choice of food, for the heart and and also less calories compared to meat and other sweet food, we would still advised strongly for all to stick to sufficient amount of fruits and vegetables everyday.

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July 18, 2007, 6:07AMBreast cancer study: Fruits, veggies not the answerBut researchers at M.D. Anderson say a healthy diet, exercise help ward off its recurrence
By TODD ACKERMANCopyright 2007 Houston Chronicle
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A healthy diet and exercise help prevent the return of breast cancer, but meals loaded with fruits and vegetables provide no extra benefit, according to a new study.
The study, conducted at the University of Texas M.D. Anderson Cancer Center and six other facilities, found recurrence and survival rates were no better for those who ate nine or more daily servings of fruits and vegetables than for those who ate five.
"The good news is that a healthy diet is sufficient," said Lovell Jones, a professor in M.D. Anderson's department of health disparities and the study's principal investigator here.
"We always assumed we're not eating enough fruits and vegetables and that the more we ate, the better," Jones said. "Now we know you don't have to eat nine, 10 or 11 servings a day."
The findings, published in today's Journal of the American Medical Association, are a setback to the hope that better diets can prevent breast cancer recurrence.
Cancer recurred in 17 percent of women in the study, regardless of whether they were in the five-serving or nine-serving group. About 10 percent in both groups died, the vast majority from breast cancer.
The study focused on more than 3,000 women — average age 53 — who had been treated successfully for early-stage breast cancer. They were followed for six to 11 years.
An earlier analysis of the study concluded that women who ate five servings of fruit and vegetables and exercised 30 minutes a day had significantly improved cancer-free survival.
Previous research into diet and breast cancer has shown mixed results, but the authors of this study said the earlier ones were not rigorous.
Researchers emphasized such nutrient-dense vegetables as dark, leafy greens, sweet potatoes and carrots and didn't count iceberg lettuce and french fries. A serving was a half-cup.
John Pierce, head of cancer prevention at the University of California at San Diego and the study's lead investigator, said he and Jones will further analyze the study to see whether certain groups — blacks, those with certain genetic profiles and post-menopausal women — benefit from extra servings of fruits and vegetables.
Pierce said that as many as 20 percent of women could fit into a group that benefited. But he also acknowledged the results so far were a surprise.
"I went into the study expecting to see a difference between the two groups," he said. "I don't think anyone expected a washout like this."

Second opinion - Part 2

Today I will discuss more about second opinion, as this is a hot topic.

As a doctor and specialist, I strongly believe all patients should have seek a second opinion, or even more, if you are dealing with a serious illness. The reasons are :

1. You need to know if you are having the best option. Some treatments are irreversible. For example, if you opt for a surgery, if its not done properly, it cannot be re-do again by another surgeon. So, it is very important to get it right the first time.

2. All doctors are good is some areas but not so good in other areas. The doctor who recommends you one mode of treatment may not be familiar with another mode, which could be better. In this case, your second opinion doctor should be good in the other area. For example, if you are not sure if you need radiotherapy or surgery, you should consult both surgeon and radiation oncologist to seek their respective opinions and then decide yourself.

3. A second opinion allows you to understand the illness better.

Having said that, you need to seek a respectable doctor for second opinion, and not ask some other doctors who are not expert in that area, or even non-doctors for second opinion.

You may ask, "Would my doctor be unhappy if I seek a second opinion". The answer is : "Generally they are fine with you seeking a second opinion". This is because the second opinion may concurs with their recommendations which reniforce to you the need to have that recommended treatment. We doctors always believe that ultimately, its the patient who have to make the decision and in order to do that, a second opinion is important.

What is the advantages and disadvantages of seeking a second opinion?

Many of my patients have asked me whether its wise for them to seek a second opinion when their doctor told them they have cancer and provided the various treatment options. As a cancer epidemiologist, my role is to explain to them the various treatment options available and which option is the most suitable for them, based on the latest medical reseach.

I have took a good article from this website :http://cancerguide.org/second_opinion.html
which discussed about second opinions:



Second Opinions: Why, When, and Who

Why

First, you can get a different perspective on your options. Some doctors are more conservative and others more aggressive. There may be good arguments for several different options; getting a second option can be a good way to hear some of them.
Another doctor might come up with a completely different and promising option - one that your first doctor didn't think of, or didn't know about. It happens - no doctor can know everything or make the right decision all the time.
A second opinion can also serve a general quality check - to make sure you're really getting the most up to date, most effective treatment.

When

Here is a list of some reasons why you might want a second opinion. This should help focus your thinking, but there is no cookbook answer for when you need a second opinion. So you'll need to consider your situation and think about whether you might benefit.
If You Have Been Given No Hope
Many patients are told there's no hope and that no further treatment can be of benefit. In this case, there's certainly nothing to lose by getting a second opinion, but there is a chance, however small, for a huge gain, since if your doctor is in error, a second opinion could save your life. Sometimes tumors deemed inoperable by one surgeon are found to be operable by another. Sometimes close examination of the case could change the diagnosis from one kind of cancer to another, more treatable type. Sometimes another doctor will know of a promising treatment that the first one didn't know about. All of these things have happened. You don't know until you check.
If There is Something "Borderline" About Your Case
If your tumor is almost operable, but not quite, or conversely almost inoperable but not quite, you might want a second opinion. You might either save yourself unnecessary surgery or you might save your life. Similarly if your tumor is on the borderline of requiring adjuvant chemotherapy you might want a second opinion.
If You Live in a Rural Area
If you live in a rural area and get treatment as a small hospital, it may pay to get a consult from a major hospital. I'm not saying you can't get good treatment from a small rural hospital, but I have heard some real horror stories.
If You Are an HMO Member
Although HMOs can and do offer fine care in many cases, there is a fundamental conflict of interest between an HMO and its members. The more money the HMO spends on you, the less it makes, so there is an incentive to give less expensive care, and an incentive not to refer outside the network. As a consequence, HMO members may not be told of clinical trials, or other promising new treatments. They may also be discouraged from trying expensive treatments that have only a small chance of success - even if that chance is real.
Actually it's worse then that. Some HMOs actually prohibit their doctors from telling their patients about options that aren't available through the HMO. According to an article in Oncology Times (5/96 P22), "virtually all" HMOs have a "gag rule" in the contract between them and their doctors that discourages them from, "fully informing patients about options not included in their coverage." The AMA calls this practice "unethical" which it surely is. The contract between an HMO and its doctors is not a public document, so there's not even an easy way to tell if your HMO doctor is operating under a Gag Rule. While I think public outcry has probably reduced the number of HMOs which have Gag Rules, the very fact that Gag Rules were once common, and may still exist, is very strong evidence that HMOs are not always motivated to inform patients of the best possible treatment.
Given this, I think don't think any HMO patient can assume that they are getting the best treatment, or that they have been informed of all of their options. Therefore, I think that any HMO member should have their treatment plan reviewed by an outside oncologist. You'll probably have to pay for the opinion yourself, but it's worth the expense. I recommend getting the opinion at a major cancer center or university hospital.
If Your Doctor Wants You to be in His Clinical Trial
If your doctor wants you to take part in a clinical trial that he is participating in as an investigator, then I think you ought to get a second opinion before signing up. One of the toughest things about running clinical trials is finding patients to participate. So the doctor has an interest in having you sign-up that goes beyond his interest in getting you the best treatment. Sometimes there is a financial incentive or other pressure to accrue patients. Don't get me wrong. I'm not saying that all doctors who want to sign you up for their trial are just doing it to have another body. Many if not most, physicians enter patients who they feel would benefit from the trial.
Many trials are "multi-center", that is they are done in many hospitals across the country participate in the trial. If the trial you are being proposed for is like that, the experiment probably wasn't your doctor's idea to begin with. But it is natural for a doctor to be excited about a new treatment especially if it was his idea. An objective second opinion is in order!
Clinical trials vary tremendously in their promise. A trial that was in essence randomly selected (Because your doctor just happens to be participating) may well not be the most promising one out there. For this reason, I also think you ought to research all of your options in clinical trials rather than automatically accepting the one your doctor happens to be offering. For much more, see CancerGuide's Clinical Trials Section.
If You Have a Rare Cancer
If you have a rare cancer, it definitely pays to get a second opinion. What you really want is to find an expert in that form of cancer. If such an expert is local then you should probably switch to that doctor, if the expert is far away, which is likely, your doctor may be able to work with him via telephone consultations. If you have the good fortune to already be under treatment by an expert, then, of course, you don't need a second opinion to get expert advice.
Even if your cancer isn't all that rare, you may very well benefit from finding someone with a special interest in your cancer. My cancer, kidney cancer, is not really rare, but it's not exactly common either. But in my experience, many patients with this cancer do not get the latest and greatest treatment. Finding a real expert is never a bad idea! For more, see my article on Rare Cancers.
If you have "Cancer of Unknown Primary Site"
In some cases, the doctors are unable to tell what kind of cancer the patient has. Typically metastatic tumors are found, the type of which can't be determined from examining the cells, and no primary tumor is found. Or perhaps it's just not clear which is the primary tumor. Cancer treatment varies greatly depending on the type of cancer, so if a diagnosis can be established, you may be able to get much more effective treatment. In this case, I think it makes sense to get a second opinion to make sure that all appropriate tests have been done. You should also consider a pathology second opinion in this situation.
Pathology Second Opinions
Most people never consider the possibility of getting a second opinion on the pathology report from which the diagnosis was made, but the entire plan of treatment depends on what kind of cancer you have and how far it has spread, both of which usually depend in part or whole on the pathologists interpretation of the biopsy or surgical specimen. Changes in the interpretation of the pathology can dramatically change both the treatment and the prognosis.
At the same time, most patients probably do not need a second pathology opinion. There are some common sense cues that can let you know if it might make sense. I think that if you have a really rare cancer, it is always advisable to get a second pathology opinion. It is likely that the pathologist had little or no experience with that particular kind of cancer, so the chance for an error may be higher.
If your pathology report doesn't give a definite diagnosis, a second opinion is probably in order. But also if the pathology report describes something as unusual, or you find that it is unusual based on your knowledge of the disease, it may be more likely than usual that there was an error. I met one patient who had just had surgery for a large kidney cancer. The diagnosis was renal cell carcinoma. He told me that the tumor was "well differentiated" which, while not impossible, is not at all usual for large renal cell carcinomas. He also said that the pathology report described the tumor as an "atypical renal cell carcinoma". He got a second opinion on the pathology, and it turned out that he had a completely different and extremely rare cancer called a "renal carcinoid". This totally changed his follow-up schedule, his prognosis as well as the treatment of any future problems.
As a basic step, you should obtain a copy of the appropriate pathology report from your doctor. See Dr. Ed. Uthman's Biopsy Report for the basics of understanding a pathology report.
One place with an superlative reputation in pathology is the Armed Forces Institute of Pathology (AFIP). You can get contact and other information at AFIP's Web Page
FindCancerExperts is a free, not-for-profit service which will refer you to expert pathologists with special experience in the pathology of your tumor. They also have excellent patient oriented information about when to get a second pathology opinion and about pathology in general.

Who

Independent Doctors
You want your second opinion to be independent - so you should choose a doctor who doesn't have a close relationship with your doctor. Doctors who practice together are likely to think similarly, and might tend defer to the opinions of their colleagues. What you want is a fresh perspective. I'd go so far as to recommend finding a doctor who practices at a different hospital. A research hospital or major cancer center is usually a good place to get a second opinion since they should be up on the latest in treatment and diagnosis.
Tumor Boards
There is a special kind of second opinion that, while not independent, is worth considering because it's a great way to get a wide range of opinions all at once. This is the "tumor board" or tumor conference. Most hospitals have a tumor board which is a regular meeting of a group of doctors to consider the best treatment for specific cases presented by members of the group. Typically, doctors from several specialties such as surgery, radiation oncology, and medical oncology will attend. If your doctor doesn't seem to have a clear recommendation for you, consider asking if he could present your case to the tumor board.
The R.A. Bloch Cancer Foundation has been instrumental in setting up a program of "multidisciplinary second opinions" which works much like a tumor board, but the patient is actually present when their case is discussed. This is intended for patients who have been diagnosed with a new cancer or a recurrence within the last three weeks. Their information on Multidisciplinary Second Opinions includes a listing of participating centers.
A Different Specialist
Many types of cancers are treated by several different types of specialists. For instance, prostate cancer is treated by urologists, who are surgeons, by radiation oncologists, and by oncologists who use drug treatment. After doing some basic research on your type of cancer, you will probably know what specialists treat it. It often makes a lot of sense to see one of the other types of specialist to get a different perspective. For instance, a surgeon may be convinced that "he got it all" and that you need no more treatment. At the same time, an oncologist may have more detailed knowledge of studies that show benefit from adjuvant treatments such as chemotherapy or radiation. Similarly, a surgeon may have a better idea than an oncologist of whether a tumor is operable or not. Very often, one specialist will call in another for a consultation, so you may not have to do anything to get this second opinion. But I have heard from patients who didn't get a needed consultation, and who missed out on potentially life saving treatment.
A World Class Expert
In some cases, what you need is world class expert - a surgeon who does operations most others don't - an oncologist who is in the forefront of research in a new and promising area that applies to you. Or an expert in a rare cancer.
In many cases, expertise is quite narrow - Dr. X is skilled at removing a particular type of brain tumor. Dr. Y is an expert in biological therapy for melanoma. It's not as simple as just finding someone who's got a reputation as a good doctor. I know of no foolproof way to find the expert you need (If you do, please let me know!). Doctors often do know who the experts are, and your doctor may be able to give you a referral. You can also research the medical literature to see who's published papers relating to your particular problem. Often, this will be quite effective.