The Comprehensive Teamwork of the Disease Management Team Benefits Our Patients
Surgeons at Memorial Sloan-Kettering work closely with colleagues in other specialties to analyze the patient and the disease process as a whole before embarking on a major operation or other treatment. "It's not that I, as one surgeon, decide to do something," says Dr. LaQuaglia. "We are a very close-knit team of physicians who benefit from each other's expertise. We meet and talk on a daily basis, and have a formal tumor board meeting twice a week where we discuss cases. Once there is clear evidence of the cancer, our emphasis is on doing an adequate biopsy and adequate biologic studies both to obtain the diagnosis and to assign the level of severity and aggressiveness to the tumor," explains Dr. LaQuaglia. Working with pathologists and researchers to measure molecular markers of a tumor's virulence provides Memorial Sloan-Kettering physicians with vital information about whether a tumor may simply be removed, or if further aggressive treatment may be required after surgery.
Expert Assessment of Molecular Markers Will Help Determine When Chemotherapy is Necessary
"Sometimes we have a child come to us for a second opinion after the family has been told at another institution that the child needs a year of chemotherapy or a bone marrow transplant," says Dr. LaQuaglia. "However, once we've studied the tumor's molecular markers, and are able to draw a picture of how the tumor may act, we may decide that we are able to treat the child simply with surgery. These children do well and are able to avoid having the extra treatment. If you don't need that dose of chemotherapy, you shouldn't get it."
Making the Right Surgical Decisions
Decisions about surgical intervention require complex evaluation. "Some neuroblastomas, for instance, do not need to be completely removed," says Dr. LaQuaglia. "There are also situations in which if we get an adequate biopsy, we may find we don't even need to remove the tumor. First we assess the biological virulence, the stage, and the grade of the tumor before we embark on therapy. We know some tumors will go away by themselves and will need little treatment. Other tumors will need further treatment. But we always try to use the lightest touch possible."
