The value of a cancer diagnosis second opinion

Here are words any patient awaiting cancer surgery would be thrilled to hear: “We are canceling your upcoming operation! It turns out that the suspicious changes we saw on your recent biopsy are completely benign.”

This happy turn of events happened in my life recently, thanks to a second opinion from a type of physician few patients realize plays a critical role in their care: the pathologist.

Pathologists are medical doctors who look through microscopes and use a variety of lab techniques to determine what disease(s), if any, are present in blood or tissue obtained with a biopsy. Their task is not as straightforward as putting a key in a lock and turning. (“Aha. The key turns, so this is cancer.”) Pathology is an art that depends on sleuthing skills and judgment calls.

When talking about cancer, some biopsies are straightforward because all the changes are obvious and typical for one specific type of cancer. Even a medical student could make the correct diagnosis. Other biopsies, like my most recent one, are difficult to interpret. In these cases, a second opinion from another pathologist helps both the patient and the patient’s physicians.

Considering how much rests on the pathology, it is surprising more patients and physicians don’t take the “second opinion” path at the time of diagnosis. After all, a wrong diagnosis leads physicians to prescribe the wrong therapy—garbage in, garbage out.

When the original diagnosis is confirmed by a second opinion, everyone feels confident they know what is wrong. This confidence makes it a bit easier to accept the risks of recommended treatment than if there were any uncertainty about the diagnosis.

When a second pathology opinion yields a different diagnosis, the stress level may rise in the short run. “Which opinion is right? What should I do now?” But with everyone working together to get the patient the best care, further discussion and, maybe, a third or fourth opinion eventually leads to the most likely diagnosis. Then, no matter what happens with the patient thereafter, everyone takes comfort in knowing they did the best they could.

Three reasons to think about getting a second opinion from another pathologist, preferably one who specializes in the disease that is suspected, are (1) if the biopsy tissue shows only subtle changes, (2) if the diagnosis is notoriously tricky and difficult to make, or (3) if the proposed treatment is especially risky.

It is important to discuss the patient’s medical condition and how much time is safe to take for additional pathology readings, so the added time does not compromise the patient’s chance for improvement.

Until sophisticated tests are developed that make pathology an exact science, a second opinion from a pathologist may play an important role in getting good care.

As a Healthy Survivor (namely, a survivor who gets good care and lives as fully as possible), I hope and pray for accurate news. And if the accurate news is also good news, that’s even better.

Wendy S. Harpham is an internal medicine physician who blogs at Dr. Wendy Harpham on Health Survivorship.

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