Q. My brother had a malignant tumor removed from his shoulder five years ago. His cancer specialist recently told him that it has now spread to his lungs. He has a spot on his lung the size of a lemon. His surgeon told him that nothing further could be done, neither surgery, radiation therapy nor chemotherapy. This sounds too hopeless to me. I encouraged my brother to get a second opinion, and would like to know whether you think this is a good idea or not.
A. It depends on how your brother feels about it. If he shares your concern at all, the answer is yes.
However, he may feel satisfied with his doctors' advice. If so, he may need to convince you that doing nothing further, grim as it may sound, is what's best for him. You could also talk with his doctors, who should answer any questions you have and address your concerns.
It sounds like your brother is seeing at least two doctors, the cancer specialist (oncologist) and a surgeon. If he also has a family doctor, that physician could probably meet with you both to explain what the other doctors are recommending and why. If your brother feels as you do, his family physician could then recommend a cancer specialist for another opinion. If so, I'd recommend going to a local cancer treatment center.
In general, there are two reasons to get another opinion. The first is to reassure yourself that your doctor's advice makes sense. If the second physician agrees with your doctor, you'd have more peace of mind. The other reason is to see if the second physician has a different opinion about the best course of treatment. Sometimes, another physician may even recommend something that the first doctor hadn't mentioned.
The tricky thing about second opinions is that just because you may get a different opinion doesn't mean it's a better one. You'll still have to decide what makes the best sense to you. That's where your family doctor can help. He or she can take a step back and help you look over your options.
Second opinions about cancer treatment are somewhat different from other types of second opinions. The reason is that there are new cancer therapies coming out all the time. A cancer team at a local cancer center may have a new treatment to recommend. And when there isn't any good standard treatment available, you may be able to enroll in an experimental treatment program designed to test promising new remedies. In other words, there's always room for hope when it comes to cancer therapy.
The Washington area has many good cancer centers, including those at university hospitals (Georgetown, George Washington and Howard), Children's National Medical Center, Washington Hospital Center, D.C. General Hospital and government hospitals (V.A. Hospital, Bethesda Naval Hospital and Walter Reed Army Medical Center). In addition, the National Cancer Institute has many treatment programs, which are free of charge to patients who enroll in them. You can ask your cancer specialist whether you would qualify for any NCI treatment program.
Jay Siwek, a family physician from Georgetown University, practices at the Fort Lincoln Family Medicine Center and Providence Hospital in Northeast Washington.
Send questions to Consultation, Health Section, The Washington Post, 1150 15th St. NW, Washington, D.C. 20071. Questions cannot be answered individually.