Support for families dealing with cancer and other serious illnesses (Part II)

jadetinker85 said:I'm wondering—and I honestly don't know where else to ask—if a biopsy can actually trigger metastases?

From what I understand, it’s possible, though I'm not sure which specific types it applies to; it probably depends on the type and stage of the malignancy. For instance, if a sample is taken poorly and the fluid spills into the surrounding tissue, it could contaminate the area with malignant cells if they are present. There are also certain tumors that become more aggressive and start spreading rapidly just by being disturbed. Take glioblastoma cells, for example—they behave exactly like that, multiplying at an exponential rate.

jadetinker85 said:I'm trying to wrap my head around something and I honestly don't even know who to ask—can a biopsy actually trigger metastases?

Look, a biopsy is a risky move, and yeah, it absolutely can kickstart metastasis. Honestly, the same goes for any time you're cutting into tumor tissue. This isn't some groundbreaking news either; people have known this for ages.

Angela Wright said:As far as I know, it’s possible, though I’m not sure which specific types—it likely depends on the type and grade of malignancy. For instance, if a puncture isn't performed correctly and spills into the surrounding tissue, it can contaminate the area with malignant cells if they're present. There are also tumors that become more aggressive and spread faster just by being touched. Glioblastoma cells, for example, behave that way and multiply exponentially.

This is awful. My mom had her biopsy today for a 2 cm lump in her breast. Her doctor at the Tumor Clinic told her all these lumps need to be removed and listed all the tests she needs to get done. However, our primary care physician refused to write any referrals except for the biopsy, and now she won't issue anything else until the results come back. Can anyone recommend a decent GP in Washington, D.C. who would actually provide the necessary referrals before surgery?

Hey everyone, I just had to share some good news with you all. My MRI shows the glio has shrunk from 5.5 cm down to 2.3 cm. 🎉🎉

jadetinker85 said:This is awful. My mom had a biopsy today for a 2 cm lump in her breast. The doctor at the Tumor Clinic told her all these lumps need to be removed and gave us a list of all the tests she needs to get done. But our primary care doctor won't give her a single referral for anything except the initial biopsy, and now she refuses to issue anything else until the results come back. Can anyone recommend a sane primary care doctor in Washington, D.C., who would actually provide the referrals needed before surgery?

Tell her to have the doctor write down the specific reason why they are refusing to issue the referral. Take that documentation straight to Medicare and let’s see how that plays out. It’s entirely possible they are following some strict Medicare guideline they aren't allowed to break—maybe they have to wait for the biopsy results before they are legally permitted to trigger a referral for more testing. They have to have paperwork to justify it. There are so many mindless regulations in this system that you honestly wonder who wrote them; it doesn't feel like it was drafted by someone with medical training, but rather some brainless bureaucrat.
Look, there are plenty of doctors out there, it’s just a question of whether there is space to switch providers, since they have patient quotas they can't exceed.

Usually, at an institute, a specialist might be able to write an internal referral for a procedure. You should check if that's an option, because technically a biopsy is a diagnostic procedure. Another thing is that they often just remove everything right away. It's possible the specialist will eventually need to write the referral for the follow-up exams.

Jamie Rivera78 said:A biopsy is a risky procedure that can potentially trigger metastasis. The same logic applies to any kind of cutting into tumor tissue. This isn't some new discovery; it's something we've understood for quite a while now.

Beyond that, you can't always rely on a biopsy to be 100% accurate, since there's always a chance the sample won't actually capture the malignant cells.

LOM doesn't have the professional authority to go against a specialist's recommendation.

Angela Wright said:Tell her to get it in writing—have her write down exactly why she won't issue the referral, then take that straight to Medicare and let's see what happens. It’s entirely possible they’re following some specific Medicare guideline they aren't allowed to break; for instance, they might need to wait for the puncture results before they can officially clear a biopsy referral. They have to have paperwork to justify it. There are so many nonsensical regulations that you really have to wonder who wrote them. You don't get the sense it was someone with a medical degree, just some mindless bureaucrat.
Look, there are doctors available; the real question is whether they have the capacity to transfer you, since they have patient quotas they can't exceed.

Otherwise, at the institute, a doctor might be able to write an internal referral for the procedure. That needs checking, because technically a biopsy is a diagnostic procedure. Another thing is how quickly they clear everything out. It’s possible the primary care physician will eventually need to write the referral for the exam and testing.

My mother is dealing with this, not me. She received a report from the surgeon stating the growth looks suspicious and requires a puncture, along with another document where they've circled all the tests needed before surgery—I can't recall them all offhand, but one is blood typing, plus a consultation with the anesthesiologist and so on. Would a photocopy of that suffice to justify the referrals? Unfortunately, the primary care doctors act like they just fell off a spaceship; apparently, they're audited every single week, so they seem terrified to write any kind of referral. 👎 How do you pressure a primary care doctor into writing all the necessary referrals, even if the biopsy turns out not to show malignancy, as sometimes happens? We should know the results in three days, though.

jadetinker85 said:My mom is dealing with this, not me. Her surgeon gave her a report stating the growth is suspicious and needs a biopsy, plus this checklist of everything required before surgery—blood typing, an anesthesia consult, you know the drill. Would a photocopy of that be enough to justify the referrals? Honestly, these local clinic admins act like they just landed on Mars; they claim they’re audited weekly, so they seem terrified of signing off on any single referral. 👎 How do we force a clinic admin to write out all the necessary referrals, even if the biopsy hasn't officially confirmed malignancy yet? We won't have the actual results for another three days.

I see what you mean now. I realized you were talking about her constant trips to the doctor, which is why I phrased it that way. 😁
Look, if the specialist still suspects a biopsy is needed regardless of what the initial puncture shows, the clinic admin is legally obligated to provide those referrals based on the specialist's written request (where they document exactly what needs to be done in the medical history). They have to issue them. If they refuse, file a complaint with Medicare and let them deal with the fallout.
Nothing life-altering is going to happen in three days regarding her condition. Just hang tight until you get the results and see what the specialist actually recommends.

Angela Wright said:I see what you mean now. I phrased it that way because she’s heading to see the specialist. 😁
Look, if the specialist still thinks a biopsy is necessary—regardless of how good the puncture results look—they are required to provide the referral based on their own clinical notes. If they refuse, you can just file a complaint with Medicare and let them handle the argument.
Nothing life-altering is going to happen in three days. Her condition isn't going to spiral overnight. Just hang tight until you get the actual results and hear what the doctor officially decides.

Got it. I'm not positive, but it looks like the medical records only list it as suspicious and suggest a puncture. 🤔 We'll see how things play out in Chicago...

jadetinker85 said:I get you. I’m not positive, but looking at the medical history, it looks like they just flagged it as suspicious and recommended a lumbar puncture. 🤔 Anyway, we’ll just have to wait and see what happens next...

Are we talking a puncture or a biopsy? They already did the puncture, right? So now you're just waiting on the results.

By the way, if it helps you sleep better, most lumps turn out to be benign.

My husband finally brought home my father-in-law's latest test results yesterday:

The follow-up X-ray shows satisfactory intrathoracic status with no signs of complications or recurrence of the primary disease.
CYFRA 21-1: 3.04 ug/L - result within the reference range.
Follow-up in 3-4 months with a new chest X-ray (AP and lateral views), referral for [redacted], and a CYFRA 21-1 tumor marker test.

I forwarded everything to his oncologist to see if we should schedule a follow-up with her specifically, and I also asked if it would be wise to monitor the marker monthly—just in case—so we can catch any upward trend immediately. Her response was:

In accordance with standard medical guidelines, tumor markers are not performed at such frequent intervals. I would recommend a follow-up in 3-4 months, including a CT scan of the chest and abdomen if one hasn't been performed recently.

Fair enough; we’ll get that scheduled since he hasn't had a recent CT since the surgery.
So, does this mean that even though the report says he's currently in remission, we should strictly stick to the 3-4 month check-ups, or is it acceptable to go rogue and monitor the marker ourselves more frequently?

Angela Wright said:Biopsy or puncture? They did the puncture, right? Now you're just waiting on the results.

Btw, for your own peace of mind, most lumps turn out to be benign.

Yeah, we’re waiting on the biopsy results. Also, looking back at her medical records, everything clearly states she needs to get all her pre-op exams done. My mom’s doctor at the local clinic told her she wouldn't issue the referrals because there wasn't enough "justification" in the diagnosis yet, even though the records are perfectly clear.

Basically—she gave her some orders for an abdominal scan and blood work, but she’s insisting the scans happen at a local community health center, even though my mom could have handled everything in one go at the Mayo Clinic. 👎

Amanda Miller69 said:Does this mean that even though his results show he's in remission, we should just stick to checkups every 3-4 months, or should we just go ahead and test the markers on our own terms?

According to the official guidelines, what she said is the rule...but personally? I’d follow my gut. Look, you know as well as I do that these markers aren't exactly the gold standard for reliability. If it were me, I’d probably be heading in every single month—that’s just how I’m wired 🙂—but when I actually stop to think about it, does it really make sense to get blood drawn every month based on something so fickle? You end up stuck in this constant cycle of anxiety, waiting for results, and if something ticks up even slightly—even if it's still within the normal range—you spiral into total drama, only to find out later it was just a minor infection or a common cold...
...Stick roughly to the guidelines, sure, but if your intuition tells you to go sooner, then go.

You have to learn to step back from all of this and actually live your life, focusing on normal things... honestly, he handled everything incredibly well. My God, after all the complaining he did in the hospital and those infections he went through, I was genuinely worried his immune system would completely give out and everything would flare up again... he’s going to be fine.

Angela Wright said:According to the official guidelines, things should go exactly the way she described... personally, I’d follow my gut. Look, we both know these markers aren't the most reliable thing in the world. If I were in her shoes, I’d probably be heading in for tests every single month (that's just my 🙂 nature), but when I actually sit back and think about it—is it really worth drawing blood every month for something that isn't even foolproof? The psychological toll of waiting for results, only to have some value tick up slightly—even if it's still within the normal range—and then dealing with the inevitable drama and waiting all over again... especially if it was just caused by a minor inflammation or a common virus...
...stick roughly to the guidelines, but if you feel like you need to check sooner, just do it.

One has to learn to relax a bit, focus on life and the usual things... honestly, he handled everything incredibly well. Goodness knows how much he struggled in the hospital with those infections; I was genuinely worried his immune system might completely give out and everything would flare up again... he'll be fine.

That’s exactly what I was thinking too. A marker isn't always a perfect indicator of what's happening, yet cancer is such an unpredictable beast—what if things take a sharp turn for the worse in a three or four-month window?
Thank God, he's doing well now. We're supporting him with beta-glucan, beet juice, royal jelly, and we've cut out red meat, white flour, white sugar, and all sweets from his diet. I truly believe it's helping... he's eating normally, walking, and even taking the dog for walks (that dog is such a chaotic little energy ball that sometimes even a walk is a challenge for me 😁).

I felt the same way while he was in the hospital following all those complications—that he might not even make it out—but well, life turns things around and he's okay 🙂.

jadetinker85 said:Yeah, we're just waiting on the biopsy results now. Also, looking at her medical history, it’s clearly stated she needs all her preoperative screenings done. I checked. Her primary care doctor won't even give her the referrals because they claim they can't justify them based on the diagnosis, even though everything is documented right there in the charts.

In reality, the doctor just gave her some orders for abdominal imaging and blood work. They're insisting she gets the abdominal scan done at her local community clinic, even though Mom could have finished everything in a single day at the Mayo Clinic.👎

Hmm, what you're describing sounds a bit off.

I mean, why bother with a needle biopsy if the plan is to surgically remove the mass anyway? You'd just perform the surgery and send the tissue to pathology then. It doesn't make sense to run a biopsy and start prepping for surgery before those results even come back. That's not how things usually work. 🤷

Furthermore, under the current Medicare guidelines regarding preoperative testing, anything that can be handled at a primary care office should be. I'm not sure what kind of "abdominal exam" they are referring to here. What does that actually entail?

It feels like you might be recalling this from memory or something you heard second-hand, and there might have been a breakdown in communication somewhere.

Maria Fisher46 said:What you’re saying here feels a bit off to me.

Look, I don't get it. Why would anyone bother with a needle biopsy or some invasive puncture if they’re already planning to cut the whole thing out anyway? It seems totally redundant. You just perform the surgery, send the tissue straight to pathology, and call it a day. Why go through the hassle of a biopsy only to start prepping for surgery before you've even seen the results? Honestly, I've never heard of anyone doing it that way. 🤷

Under the latest Medicare guidelines, they’re pushing for as much pre-op testing as possible to be handled through your local primary care clinic. Honestly, I’m a bit lost on what they mean by an "abdominal exam" in this context. Is that just a standard physical, or are we talking about something more specific?

I think you’re all just writing from memory based on something you overheard or skimmed through somewhere, and frankly, it sounds like a massive game of telephone has taken place.

Honestly, when you're dealing with an institution like this, nothing really surprises me anymore. I’ve heard some pretty wild stories about what goes on behind those doors. You can probably get a rough idea of what's actually happening if you know what to look for, but you have to follow the standard medical protocol—start with the initial biopsy and then see how they proceed from there.
So, what’s the deal with this abdominal ultrasound? They want to run markers for colorectal cancer along with everything else? It feels like they’re trying to rule out every single possible thing before they actually get to the point.

Angela Wright said:Given that this is the Mayo Clinic, nothing really surprises me anymore... I've heard all sorts of stories about that place. Though, one could probably make a rough estimate of what's happening here, provided they follow the protocol—the biopsy, then everything else following that.
Regarding the abdomen: An abdominal ultrasound? Colorectal cancer markers, among others?

But if there’s a specific protocol to follow, shouldn't he have noted that surgery is being planned pending the biopsy results? It seems a bit odd to document a pre-op workup plan before the biopsy findings are even in. Especially since we're talking about a window of just a few days for those results to arrive, as jadetinker85 mentioned.

Either way, that surgeon needs to review the biopsy or puncture results; he'll certainly be performing another exam before any surgery takes place.

As for the abdominal ultrasound and the markers, those fall under standard insurance coverage. With standard insurance, a patient can choose their provider. You won't get cancer markers at a local walk-in clinic, though you might find an abdominal ultrasound at certain specialized centers.

My brother-in-law is considering getting a flu shot, but given his underlying health issues, is that actually a smart move?
He’s scheduled for an abdominal CT scan in about two months, and since I know how long wait times can be for these things, I was wondering if he should just go ahead and ask his primary care physician for a referral now, or does he strictly need a recommendation from his oncologist first?

Since he’s feeling better lately, he’s actually suggested stopping the beta-glucan supplements altogether, but I told him there's absolutely no way he's cutting that out just yet.😵

Amanda Miller69 said:Would it be smart for my husband to get the flu shot given his underlying condition?
Since he needs an abdominal CT scan for his follow-up (which is about two months out), and I remembered how long those appointments take to schedule, should I ask his primary care doctor for the referral now, or does he need a specific recommendation from his oncologist first?

He’s actually feeling decent right now, so he’s under the impression he can stop taking the beta-glucan, but I told him there's absolutely no way we're stopping that.😵

The local clinic will probably suggest it to him... and honestly, if I'm being totally candid, I'm not a fan of those flu shots. My reasoning might not sit well with the medical establishment, but here it is.😁

I only ever got the flu shot once in my entire life, and that year, I caught such a brutal strain of the flu that I was completely wiped out for twenty days straight. I haven't touched a flu vaccine since then, and strangely enough, I haven't been hit by the flu once either.

Maria Fisher46 said:Plus, under the updated Medicare guidelines regarding pre-op testing, everything possible should be handled through a local community health center. I’m not sure what kind of "abdominal exam" we're talking about here. What does an "abdominal exam" even entail?

It feels like you might be writing from memory based on something you overheard or read, and there was probably just a breakdown in communication somewhere.

She had her abdominal ultrasound done at the Clinic, and she was also given extra referrals. The hospital demanded she get bloodwork at the local clinic, an EKG at the Heart Center on Drašković, markers over at Vinogradski, and her blood type determined at Petrov. My mom couldn't handle running all over town, so she took all the referrals to the Clinic and knocked out every single test in under an hour. Now the hospital is throwing a fit. 😠 Because heaven forbid a patient tries to consolidate their care in one place.
The results show atypical cells.