Tumor Boards - What Are They, Who Are They, Why Are They Looking At My Case?

by Jane Ashley

Perhaps you’ve heard of a tumor board or tumor committee and wondered, “What is a tumor board?” A tumor board is a group of medical professionals from many specialties who meet regularly to review cancer patients’ records and recommend the most effective treatment for a particular patient. Think of the tumor committee as a “group second opinion.”

The Tumor Board

Types of specialists that comprise a tumor committee

A diverse group of physicians and medical specialists make up the tumor committee. They always include surgeons, radiology oncologists, medical oncologists and pathologists. Depending on the patient, other experts may be invited to the tumor committee — plastic surgeons, gynecologists, thoracic surgeons, reconstructive surgeons, urologists, interventional radiologists or even, a genetic expert. The tumor board may include a social worker or nurse navigator who would help coordinate transportation and scheduling for the patient.

What’s the purpose of a group meeting like this?

When patients have advanced/metastatic cancer, their medical situations are complex — complicated by cancerous tumors that are growing in distant parts of a patient’s body. The most common sites for cancers to metastasize are the brain, liver, lungs, and the bones. The functions that our brain, liver and lungs provide can’t be replaced; these organs are essential to life itself so the tumor committee brings new perspectives and additional options for a patient’s medical situation.

• A general surgeon may tell a patient that they have too many tumors in their liver to have surgery. But an oncology surgeon who specializes in the liver has expertise from their years of experience. They can perform life-saving surgical resections of the liver. The liver regenerates itself — many patients have 60 percent of their liver removed and make a full recovery.

• Radiology oncologists have advanced expertise in several types of radiation that is non-invasive and may offer hope to patients who are not strong enough physically for surgery or these radiologists may be able to spare a patient an additional surgery for metastatic lung nodules with the use of SBRT  radiation.

• A pathologist might recommend additional testing on a tissue sample removed during surgery. The additional tests might reveal genetic mutations or biomarkers to guide treatment after surgery. 

• A tumor committee might recommend a new clinical trial which may be beneficial for a patient.

• The patients gets an individualized treatment plan.

• Each specialist knows the latest treatment options so the patients benefits from the newest treatment options available.

Larger facilities have multiple tumor boards, with each focusing on a different kind of cancer, especially the more common types of cancer like breast, colorectal and lung cancer.

Reviews Options

What are the benefits of having our case presented to the tumor board?

The tumor committee is a multidisciplinary team with each member bringing their expertise and experience to the table. Each member of the board brings their unique experience to benefit the patient’s set of circumstances.

Think of the tumor committee as multiple second opinions provided in one meeting without the patient having to travel to several different specialists’ offices. Because these medical professionals are all seated at the same table, they have a rigorous, but thoughtful, discussion of all of the pros and cons that might be available for a patient and come to a consensus opinion.

Confused

What was my experience with the tumor board?

Just imagine being diagnosed with Stage IV rectal cancer — no pain, no cramping, no weight loss — just intermittent bleeding. My husband and I were stunned. My surgeon helped us select an oncologist. Finally, the appointment with our oncologist arrived. She impressed us with her professionalism and her enthusiasm. She looked at my scans on the CD that I brought and disagreed with the radiologist who read them originally. She believed that I only had one cancerous nodule in my right lower lobe and the other nodules were scar tissue.

That led her to treat me aggressively from the beginning. She told me that we’d have six cycles of FOLFOX with Avastin and then scans to evaluate response. If I had shrinkage (even 20 percent), then she would take my case to the tumor board. I was immediately relieved and began to have hope.

We began chemo. I tolerated it well. The time passed quickly … it seemed. And then, it was scan time. At my next appointment, she asked me if I wanted to hear “good news.” My primary tumor had shrunk, and she was taking my case to the tumor board.

I came back in two weeks. My oncologist shared the tumor board’s recommendation. She had suggested that I could have a wedge resection at the same time as the primary tumor was removed. I had never heard of such a thing, but it turns out not to be uncommon in Stage IV cancer patients.

However, the tumor board recommended a different treatment path that would be physically easier for me. The board radiologist recommended pelvic radiation with oral chemo (known as chemoradiation ) to further shrink my primary tumor and help prevent local recurrence. The radiologist also recommended SBRT radiation for the cancerous nodule in my lung instead of a wedge resection. After those two radiations, I would have surgery for the primary rectal tumor.

With the three of them (medical oncologist, radiology oncologist and surgeon) all on board with my new treatment plan, they coordinated appointments and the timing. I got phone calls for all the new appointments with the “team” coordinating everything. My stress level decreased dramatically after the tumor board meeting.

And, the bottom line for me … four years later, I am still NED … after my team (whom I named the Holy Trinity – the medical oncologist, the radiology oncologist and the oncology surgery) worked together to try to give me the best possible outcome.

So WhatNext?

If you have advanced cancer or a complicated tumor location or rare genetic mutations, ask your doctor if they’ll present your case to the tumor board. If you are being treated at a small, community hospital, then consider obtaining a second opinion from a multi-disciplinary tumor board at an NCI-designated hospital. A tumor board could save your life.

Do you have experience with a tumor board? Please tell us a little about it in the comments below

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