Now that everyone knows a little about my role as a thoracic oncology nurse navigator, let’s discuss what to expect with your first visit to a thoracic surgeon. I work directly with the thoracic surgeon at my cancer center, but not all nurse navigators have this direct relationship. Most navigators work alone or with a group of navigators and service a team of oncologists. The new trend in Oncology is having a disease-specific nurse navigator. In a sense, each type of cancer has its own knowledgeable navigator to direct patients specifically for that one type of cancer.
As previously mentioned, the referral to the surgeon can happen many different ways. A patient may start in their primary care or pulmonologist’s office based on the symptoms that brought them to the doctor. The reason for referral will determine the work up that is necessary for the individual. If a patient has a newly noted lung lesion/mass/nodule, the surgeon will be most interested in imaging. Chest xrays do not provide enough of a visual for the specifics on size and location, so a CT of the chest is the next step. Some physicians obtain a chest xray, then a CT chest to confirm the abnormal findings. Occasionally you will have a doctor who prefers to obtain a PET CT after viewing the CT findings. The CT chest and chest xray are the two most commonly performed scans that patients have when visiting a thoracic surgeon. If a patient is diagnosed with mesothelioma, a PET is expected to be ordered once a CT scan and pathology have confirmed the diagnosis. In order for a PET scan to be approved, positive pathology is typically needed.
If you are seeing a surgeon that may not have access to the imaging, make sure to obtain a CD with images as well as the radiology reports so your surgeon is prepared for your visit. I would recommend obtaining 2 CD’s of your imaging – one for your own record/ future use and the second for your consultation with the surgeon. If you want to take this a step further, be sure to put the CD into your own computer to make sure this disc loads. Unfortunately, there are times that the imaging does not transfer to the CD. Part of my work as a navigator is to ensure the surgeon has adequate records before meeting the patient. A surgeon’s work is very specific and visual, so it is especially important to have updated imaging – 30-60 days would be ideal.
If your doctor has also scheduled a biopsy before seeing the surgeon, make sure to have a copy of the pathology report for the surgeon. This is very important for the surgeon and oncology team to make important decisions about your individual treatment and care. In many cases, patients are sent directly to interventional radiology for a needle biopsy once the mass or lesion is noted on a CT scan. With a suspicion of mesothelioma, most patients have a thoracentesis to sample the pleural fluid for malignancy. A pulmonologist may perform the thoracentesis in their office or in Interventional Radiology. A thoracentesis is when a sample of fluid is taken as opposed to a sample of tumor. Another type of biopsy for diagnosing mesothelioma is called a pleural biopsy. This is surgical procedure in which the thoracic surgeon takes a sample of this pleural tissue.
Every surgeon’s preference for a workup when seeing a new patient is very different. The surgeon I work with also prefers a full set of pulmonary function studies (PFT’s) performed prior to consultation. Our two main criteria for seeing a new patient with a lung mass, lung cancer, or mesothelioma are recent scans (chest xray, chest CT, PET/CT) and PFT’s. Having a positive pathology does provide additional insight for the surgical oncology team, however, patients are often sent to the surgical team to obtain the pathologic staging. Some surgeons order blood work, cardiac testing and clearance, and updated scans once they meet the patient to decide on further workup. This is a terrifying experience that is new and overwhelming, so I hope that this guide will help you to understand the basic entrance into a visit with a thoracic surgeon.