Second Opinion For Cancer Treatment
A cancer second opinion re-reads the pathology slides and scans, checks the stage and puts the plan before a tumor board. Reviews found the diagnosis, treatment or prognosis changed in 12 to 69 percent of cases and was confirmed in most others. It can be done remotely from your files, or during a three to five day visit.
About This Department
Most second opinions confirm the plan you already have. A meaningful share change it, and nobody can tell in advance which yours will be.
A second opinion in cancer means a fresh, independent look at the diagnosis and the treatment plan by specialists who were not involved in the first. At its best it re-reads the biopsy slides and the scans, checks the stage, and puts the case before a multidisciplinary tumor board. A systematic review of cancer second opinions found that the diagnosis, treatment or prognosis changed in 12 to 69 percent of cases, depending on the study, and was confirmed in 43 to 82 percent. Confirmation has value too, because patients start treatment knowing the plan has been tested.
Asking for a second opinion for cancer treatment is normal practice. Good oncologists expect it, and in many countries insurers pay for it. This page explains what a thorough second opinion covers, what the evidence says about how frequently it changes things, what to send, and how the review works for a patient abroad, whether the answer comes by video or during a visit to Istanbul.
What a second opinion checks
Four questions, four kinds of specialist
A complete review answers four questions, and each needs a different specialist.
This table scrolls sideways on a narrow screen. Swipe or drag to see every column.
| Question | What is looked at | Who looks |
|---|---|---|
| Is the diagnosis right? | Original slides and blocks, re-stained if needed | A pathologist who sees that cancer every week |
| Is the stage right? | The images themselves | A radiologist and a nuclear medicine physician, reading every scan again from the first slice to the last |
| Are the tumor's markers known? | Receptor, gene and immune tests, and whether any are missing | The pathologist and the oncologist |
| Is the plan the best one? | Surgery, radiotherapy and drug options against current guidelines | A tumor board of surgeon, medical oncologist and radiation oncologist |
The diagnosis
Everything rests on the pathology. A lymphoma mistaken for a carcinoma, or a low-grade tumor called high-grade, leads to the wrong treatment however well that treatment is then delivered, and no surgeon, radiotherapist or drug can correct an error made at the microscope.
The plan
With the diagnosis right, opinions differ most over the plan, and in practical ways. Should surgery come first or after chemotherapy? Is a smaller operation possible? Is radiotherapy needed at all? Is there a targeted drug or a clinical trial that fits?
How the review works
From your files to our answer
A remote review
A visit to Istanbul
What the studies show
A wide range, and a reason for itA German systematic review found 13 studies on second opinions in cancer. Between 6.5 and 36 percent of patients sought one. The diagnosis, treatment recommendation or prognosis changed in 12 to 69 percent, and the original was confirmed in 43 to 82 percent. Patients found the process helpful and reassuring, while data on whether changed advice improved survival were missing altogether. Ruetters and colleagues, Journal of Cancer Research and Clinical Oncology, 2016.
This table scrolls sideways on a narrow screen. Swipe or drag to see every column.
| Study | Setting | Finding |
|---|---|---|
| Ruetters, 2016 | Systematic review, 13 studies, cancer | Changes in 12 to 69 percent, confirmation in 43 to 82 percent |
| Payne, 2014 | Systematic review, patient-initiated second opinions, all conditions | Major change in 10 to 62 percent, more often in treatment than in diagnosis |
| Kronz, 1999 | 6,171 pathology cases reviewed on referral, Johns Hopkins | Diagnosis changed in 1.4 percent, with major effects on treatment or prognosis |
| Swapp, 2013 | 71,811 pathology cases reviewed on referral, Mayo Clinic | Major disagreement in 0.6 percent, treatment affected in 90 percent of those followed up |
Why the slides matter most
Rare, and decisive when it happensAt Johns Hopkins, mandatory review of 6,171 outside pathology cases changed the diagnosis in 86, or 1.4 percent, usually between benign and malignant or between tumor types. Changes were most frequent in tumors of the lining of the chest and abdomen, 9.5 percent, and of the female reproductive tract, 5.1 percent. The authors recommended review of the original slides before any major treatment begins. Kronz and colleagues, Cancer, 1999.
The Mayo Clinic series
When to ask for one
When it adds little
What to send
The file that makes a useful answer possible
Documents and images
The essentials
Slides and blocks
When the pathology needs re-reading
The three possible answers
Confirm, refine or change
What each means for you
- Confirm. The diagnosis and plan are right. You start treatment with your current team, knowing the plan has been independently tested.
- Refine. The diagnosis stands, but the plan changes in part, for example a missing gene test, a different order of treatments, a smaller operation, or a trial worth considering. Your team decides whether to adopt them, and most do.
- Change. The diagnosis, stage or plan differs substantially. The report sets out why, with the evidence, so that your own doctors can review it too.
Timing, and a caution
How long it takes
Remote or in person, cost and the trip
Remote or in Istanbul
A remote review
Most second opinions need no travel. The files carry the review. A video consultation follows to discuss the result, and this route suits patients who plan to be treated at home and want confidence in the plan before they begin.
A visit
Coming to Istanbul makes sense when an examination matters, when scans are old or incomplete, or when you are considering treatment here. The length of stay is three to five days, which covers the consultation, any missing tests and the board, and you can fly home as soon as the plan is explained. A typical visit runs like this. On the first morning the oncologist examines you and goes through the history with you and, if you wish, with the family members who came along. The same afternoon or the next morning, any scan that is out of date is repeated, a PET-CT or an MRI in many cases, and blood tests are taken. The board meets on the second or third day with the new images in front of it, and the oncologist sees you again afterward to explain what the board decided, why, and what the options are, in plain words and with an interpreter if needed. You leave with the written report.
Cost and the trip
What decides the cost
Three things decide it. Whether the review is remote or in person, whether slides are re-read and re-stained, and which new scans or gene tests turn out to be needed, since a missing marker test in a breast or lung cancer can change the whole plan and justifies its cost. The first review of your reports is free. Anything beyond it, whether a stain, a scan or a gene panel, is quoted in writing before it begins, and you decide whether to go ahead.
Arrangements
One coordinator looks after everything. Languages include English, Arabic, French, Russian, Serbian, Romanian and Spanish, with an interpreter for others, and the coordinator arranges slide courier, sends the appointment confirmation and an invitation letter naming the hospital and the treating doctor ten days ahead of a visit, and books the hotel and transfers. Two family members may join consultations, meals come in halal, vegetarian and diabetic versions, a prayer room is on site, and a female doctor can be requested at first contact.
What happens next
Whichever way you decide
If you choose treatment here
Moving from opinion to treatment
If you stay with your own team
Taking the report home
Second Opinion For Cancer Treatment FAQ
Should I get a second opinion for cancer?
Will my doctor mind?
Can a second opinion be done without traveling?
How long does a second opinion take?
What should I send for a cancer second opinion?
How often does a pathology review change the diagnosis?
References
- Ruetters D, Keinki C, Schroth S, Liebl P, Huebner J. Is there evidence for a better health care for cancer patients after a second opinion? A systematic review. J Cancer Res Clin Oncol. 2016;142(7):1521-8.
- Payne VL, Singh H, Meyer AN, Levy L, Harrison D, Graber ML. Patient-initiated second opinions, systematic review of characteristics and impact on diagnosis, treatment, and satisfaction. Mayo Clin Proc. 2014;89(5):687-96.
- Kronz JD, Westra WH, Epstein JI. Mandatory second opinion surgical pathology at a large referral hospital. Cancer. 1999;86(11):2426-35.
- Swapp RE, Aubry MC, Salomao DR, Cheville JC. Outside case review of surgical pathology for referred patients, the impact on patient care. Arch Pathol Lab Med. 2013;137(2):233-40.
Editor's note
Written by the Biruni Hospital medical editorial team. Reviewed by Prof. Dr. Özcan YILDIZ, Medical Oncology.
Medically reviewed by
Prof. Dr. Özcan YILDIZ
Medical Oncology
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