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Dr. Praveen Kammar

MS, MRCS, MCH

Surgical Oncologist

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Cancer Blogs | 24 January 2022, Monday

How To Find the Best Oncologist In Mumbai, To Treat Your Cancer?

Is the Specialist You Are Consulting- The Best Oncologist For You

The news that someone dear to you is diagnosed with or in the process of evaluation for a possible cancer can be devastating. While this shocking news surely takes time to sink in and slowly you come to terms with it, the next step appears like an even bigger challenge. That is, finding the best cancer specialist in Mumbai to treat this particular cancer.

It is understandable that you are completely lost. Anyone in your position would be. For a person without medical background it’s an extremely difficult question to answer-who is the best oncologist Mumbai?

In this blog I am trying to guide you in the process of how you can find the best cancer specialist for your cancer.

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Understand the process of evaluation of a cancer (cancer diagnosis), so that you meet the right doctor.

Why is it necessary?

If you understand the process you will be in better position to take correct decisions.

Because of lack of a structured health care and referral system in our country, most of the times the patients and the family do not know who is the best doctor to address the illness and if he is the right person for the job. While an unstructured system gives you the freedom to seek advice from any specialist, there is a possibility of undue wastage of your time.

This happens more when the diagnosis of cancer is still not established clearly. If you are reading this blog or searching for related content and information, then you would have already met at least a couple of doctors (not necessarily oncologists) by now. It is better that you talk to them to get more clarity on “what stage of evaluation is your loved one is in?” This will give you a clearer picture of what’s going on and what’s going to happen next.

If Your dear one is still being evaluated for the possibility of cancer

The diagnosis of cancer requires two things:

  1. A sample of tissue from the organ in question, what we call a biopsy. These small chunks of tissue are closely examined by a pathologist under a microscope to determine if there are cancerous cells in the tissue. The pathologist may also need to run additional tests to confirm the presence of cancer.
  2. A test to see how far it has spread which may be a CT/MRI scan or a PET scan.

Along with these two necessary things, additional blood tests are also required.
So, this whole process means meeting more than one doctor, going to more than one center/lab for all these necessary tests. Hence it takes considerable amount of time and may lead to lot of anxiety. Understand that such evaluations take time everywhere, be it in India or in any western country.

A cancer specialist usually does not feature in the initial evaluation of a suspected cancer. The initial process usually involves the family physician, physician, radiologist, endoscopist depending on what tests need to be done to arrive at diagnosis. However, if you have an experienced family physician taking care of your loved one, there is a good chance that he would have already discussed your case with a cancer specialist.

Only when there is fair amount of certainty that one is suffering from cancer, an oncologist comes in to the picture. What I have experienced in my practice is, it’s usually the cancer surgeon who is the first doctor from oncology background that gets involved with the patient. This is because of two simple reasons. One, he is the one who can take biopsy from the suspected organ most of the times. When he cannot take biopsy (from digestive organs, bones, lungs etc.) he arranges for a specialist from another field to take the biopsy. Second, any curative treatment in cancer involves the cancer surgeon (there are some exceptions though).

The table below shows who takes the biopsy in different cancers: 

Type of cancer  Who does the biopsy?
Oral cancer  Cancer surgeon 
Neck cancer  Cancer surgeon
Thyroid / Parotid cancer  Pathologist / Radiologist 
Digestive system cancer Gastroenterologist 
Bone tumor  Cancer surgeon
Breast cancer  Cancer surgeon
Cervix cancer  Cancer surgeon
Uterine cancer  Cancer surgeon
Ovarian cancer  Radiologist 
Kidney cancer / liver / lung cancer  Intervention radiologist 

While biopsy tells you if there is a cancer or not, we need to scan the relevant sections of the body to see how far it has spread. This needs a CT scan/MRI or a PET scan. An oncologist is the best person to decide what imaging test (CT/MRI/PET) is most suitable.

Because of the easy availability of these tests, often I see that patients have already done them before seeing an oncologist. But the scan may not be the right one or of good quality always. Based on the organ that needs to be evaluated, there are standard recommendations on what type of CT scan or MRI scans needs to be done which also includes machine specifications. Hence it is advisable to consult an oncologist before going ahead with any scans.

If you are already past the stage of diagnosis and staging

Then you should definitely be meeting an oncologist for treatment decisions. Your treatment decisions depend on two things – what type of cancer you are suffering from? (Which organ and what type of cancer at a cellular/microscopic level) and what stage it is in?

If it is an early stage cancer or locally advanced stage of cancer, a cancer surgeon is the primary treating doctor and takes most of the treatment decisions. If someone is suffering from stage 4 cancer, it is very unlikely that a cancer surgeon will play a major part in the management of the disease. A medical oncologist is the main treating doctor in this scenario.

In our country most of the times the cancers are diagnosed in little advanced stage compared to the western world. As a result, most of our patients require more than one modality of treatment i.e. a combination of surgery, radiation and chemotherapy. While a surgical oncologist manages the cancer surgery part, a radiation oncologist is required for radiation and a medical oncologist for chemotherapy.

So it is likely that you may have to meet more than one oncologist for complete treatment.

Ask the right people

Asking around for a good cancer specialist happens automatically in the process. But exercise caution in who you ask. Only a person who has better knowledge or information will be in a position to guide you. So, your family physician should be one of the first people to answer this question. Even if he/she does not know who is the best oncologist in Mumbai to treat this cancer, he will have better resources and contacts to get the answer.

If you know anyone in your circle that had contact with cancer treatment, they may be able to recommend a few cancer specialists.

Remember that all the references for top oncologists in Mumbai you are getting from your contacts need not match your requirements. A friend may suggest a top radiation oncologist to you, but the cancer your loved one is diagnosed with may not be the one which needs radiation.

Last comes the Google search. You may have used search queries like “top oncologist in Mumbai” or “best cancer specialist “and would have drawn a list of names. It goes without saying that you have to filter the ads given by hospitals, doctors and results shown by platforms like practo.

Ascertain authority: Once you have a few Oncologists in the list, Try to find out

If the top oncologist in Mumbai you are planning to consult is an expert in treating this particular cancer.

There is tremendous of development happening in the field of cancer management. Thousands of scientific papers are published every year and the management of cancers keeps changing and evolving. The technological advances in the treatment be it surgical technology like robotic surgery, vessel sealing devices, staplers or cutting edge radiation machines are happening regularly. And it’s impossible for one specialist to master all.

That’s why you would need an oncologist who specializes in your cancer. For E.g. If your loved one is suffering from an ovarian cancer and needs surgery, you should go to a specialist who an expert in Cytoreductive surgery (CRS) and in giving chemotherapy inside the abdomen (HIPEC, PIPAC, IP port chemo etc). If your loved one is suffering from rectal cancer you would need a specialist who is an expert in laparoscopic and robotic rectal cancer surgery and knows how to integrate chemotherapy and radiation into the treatment program.

Cancer treatment is sometimes complex even for people from medical background to follow. And at times you understand that you are in good hands only after meeting your oncologist.

  • Credentials of the oncologist

If it is available online, go through the training, certifications and experience of the doctor. Also pay attention to the research the doctor is undertaking. If an oncologist has research pertaining to your cancer, then he is more likely to be focusing on that particular type of cancer, has sufficient experience and is up to date with his knowledge about your cancer and would be in a position to give you the best possible treatment.

  • Look for affiliations (where the doctor practices)

In Mumbai most of the top oncologists are attached to several big hospitals. This affiliation is also a good indicator of doctor’s credibility. All these famous hospitals would have done thorough evaluation of the doctor’s credibility and experience. So you can take these affiliations as a good measure of the oncologist’s competence. You don’t want to go to an oncologist who is not affiliated to good hospitals.

You can also look at the affiliations with medical bodies the oncologist has. Affiliations to medical bodies (e.g. European Society of Surgical Oncology, Indian Association of Surgical Oncology etc.) shows the oncologist’s interest and intent in keeping himself up to date with advances in cancer management.

 

  • Experience of the doctor

It goes without saying that experience is one of the key components of a successful cancer treatment. Several of the cancer surgeries are complex and challenging. They require skills, training and experience. Experience also reduces the risk of complications.

Meet your doctor – what to expect in your first consultation with your oncologist

What you gather before meeting an oncologist would be a very basic understanding of the disease and treatment. Only when you meet an oncologist you get more clarity and you would be able to get a fair idea if he the best oncologist for the treatment. But, it may not happen in one consultation.

Before you meet the oncologist, prepare yourself well so that the time you spend in the consultation gives you answers for most of your questions.

Here is a checklist of what you should do in the first consultation:

what to carry

  • Biopsy report
  • CT scan/MRI/ PET scan
  • Other blood tests
  • Arrange these things in chronological order
  • Carry CT films /CD
  • Remove all unnecessary items (bills, receipts)
  • Make just one folder

What to tell your oncologist besides the present illness

  • Medications
  • Allergies
  • Prior treatments (unrelated to present illness)
  • Complications in prior treatments (may be unrelated to present disease)
  • Habits: drinking, tobacco, smoking etc.
  • Major ongoing health concerns (severe arthritis, significant thyroid deficiency, uncontrolled blood pressure, heart conditions etc.)

What to ask your oncologist

  • What kind of cancer is it?
  • How far it has spread?
  • What is the best treatment for it?
  • Are there more than one treatment options?
  • Does the cancer need combination of surgery, radiation and chemo?
  • What will be the sequence of treatment?
  • Which is the best place to take this treatment?

Qualities you should be looking in your oncologist:

Cancer treatment is unbearably long. It’s not a battle; it’s a full scale war. The oncologist treating the cancer will play a major part in this war. So you want a cancer specialist who is by your side in this fight.

  • The humanitarian aspect:

So when you meet an oncologist, look not just for his ability to treat your cancer but also for his ability to connect with you, empathize with you, understand your expectations and prepare a plan that suits you. A famous oncologist in Mumbai may not give you sufficient time and attention you deserve, which may prevent you from building trust. So, you have to find the oncologist who is best to treat your cancer and not just the top oncologist.

  • Ability to listen patiently:

A good cancer specialist will patiently listen to what you have to say. It’s natural that while giving details you may include details that are not really necessary. But a good cancer specialist will be able to filter them. Patient listening is required to get to minute details which may have a bearing on the treatment. And it will build trust. In my OPD, a first consultation usually lasts at least 30 minutes. The first consultation is usually the longest. But I also insist on a re-visit if there are unanswered queries.

Make sure you ask lot of questions. The idea is to get a clear picture of what is happening. I suggest my patients to write the questions down so that they don’t forget to ask, in the second consultation. Your oncologist should be able to answer all your queries patiently. We from medical field use lot of medical jargon while explaining things and you may not follow everything we say. Don’t hesitate to stop the consultant and ask him to simplify the topic. Whenever I am discussing a complex treatment plan, I always ask my patients and relatives to repeat what we have discussed so that I get to understand how much they have understood.

  • Open to suggestion and ideas:

You may have already found a few treatment options before your consultation with the oncologist. Sometimes, the treatment suggested by the oncologist may not match the information you have gathered. In that case, it is always better to tell the doctor what you are thinking. An experienced oncologist would be able to clear your doubts.

  • Ready to talk to other doctors:

Your oncologist should be open to talk to your family physician and other doctors who are involved in the treatment. This is necessary so that all the doctors are on the same page as far as treatment plan is concerned. Sometimes other doctors may also discuss alternate options with the oncologist. Such discussions are needed especially in the first few consultations when you have still not built a rapport with the oncologist. Your family physician and other treating doctors can act like a bridge of communication between you and the oncologist. Also, at times you are probably more comfortable discussing your doubts with your family physician than the oncologist.

  • Value added services:

When you visit the oncologist for your consultation, notice the clinic space. See if the clinic has comfortable seating, toilet, and drinking water and lift facility. Since you will be visiting the place more than once all these factors increase the comfort of your visit and you can just concentrate on the treatment.

Many a times, you would need additional tests and scans. Arranging for all these is a real hassle. It would be really helpful if the oncologist’s clinic could obtain appointments for scans and tests. It’s much easier for them arrange these things than for you.

  • Gives you more than one option:

For certain cancers and stages, more than one type of treatment are available that have similar results. In such cases, it’s the duty of the oncologist to provide all the treatment options to the patient. Based on non-medical factors like, costs, duration, logistics you can decide what treatment option suits you the best.

 

  • Shares referrals:

Always ask your oncologist if they can share contact details of the patients he has treated for similar cancer. An experienced oncologist would have treated several similar cases. By talking to previous patients you will gain more confidence in the treatment.

When you decide to get treatment with one particular oncologist

Besides the cancer treatment and oncologist, you need to look at several other factors before beginning the treatment.

  • Insurance issues:

If you have a health insurance, please check if your treatment is covered in the insurance. It is vital that you also check that the hospital you are planning to get the treatment in, accepts your policy. It is better to sort it out in the beginning. Cancer treatment is long and financially burdensome. So you have to get your finances in order right in the beginning.

  • How close the oncologist and the hospital is to you:

This is one of the factors which are never actually taken in to account.

If you are supposed to undergo a major surgery and you have a chosen a top cancer surgeon in a good hospital which is too far from your residence, it means long commutes and arranging food for accompanying members during the stay of your loved one in the hospital. Though you may still be able to get around this thing, once the patient is discharged home, you may have to travel long distances for minor issues in the recovery process. Remember, an operated patient is also less willing to travel long distances due to pain and other issues. An alternative solution is to check if the oncologist also provides home care services that can avoid visits to hospital or clinic for minor issues.

IF you are advised to undergo radiation for cancer, it is best to select a center that is closest to your residence. This is because radiation requires daily visits for radiation and you are most comfortable if it is closer home and does not take much time to reach.

Same goes with chemotherapy. Most of the standard chemotherapies require half a day. So you don’t want spend additional time in the admission and discharge process. You will be better off in a hospital which has day care center or a standalone day care center for your chemotherapy as it saves you lot of time.

 

  • Arrange your leaves:

Ask your oncologist about the exact dates and durations of treatment so that you can plan your leaves. You may also have to request other family members to support you. In that case as well you would need to give them exact dates of treatment so that they can be available to help you out.

Request to hide diagnosis is a ethical and moral dilemma for doctors. The doctor and the family can establish a middle path.

Disclosing the diagnosis has several benefits the most important of which is preserving the patient’s dignity and acknowledging that he/she is valued as an individual.

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