Why Getting a Second Opinion Matters 

Expert physicians get the diagnosis and treatment right for patients when others get them wrong.

A young man was diagnosed with prostate cancer and underwent three rounds of chemotherapy without success. So he sought the expertise at Sylvester Comprehensive Cancer Center, part of UHealth — the University of Miami Health System, and saw Gina D’Amato, M.D., assistant director of clinical research at Sylvester and an associate professor at the Miller School of Medicine, to obtain her opinion. 

Patients come from around the country and even the world to consult with specialists at Sylvester, which is a National Cancer Institute-designated cancer center recognized for its rigorous standards and research to improve cancer prevention, diagnosis and treatment.

Cancers can be incredibly complex, and test results can be interpreted differently. 

Getting the diagnosis and treatment right depends on the expertise and experience of the physician. A second opinion may make all the difference. 

“It’s extremely important to have a second opinion; actually, I like to use ‘expert opinion,'” says Dr. D’Amato.

One of Sylvester’s genitourinary cancer doctors referred the patient whose cancer had started in his prostate gland to Dr. D’Amato because molecular testing showed Ewing’s sarcoma. 

Dr. D’Amato has been researching sarcomas and treating patients with sarcomas for more than 20 years. 

These cancers of the bone and soft tissue account for only 1% of all adult cancers. Yet the variety — 175 distinct types — makes sarcomas incredibly challenging to diagnose and treat. 

Ewing’s sarcoma affects about 200 people between the ages of 10 and 20 every year.

In the past, sarcomas were lumped together and addressed similarly. Now, because of physician-scientists like Dr. D’Amato, we know more about sarcomas and how to treat them. She says that Sylvester’s medical oncologists, surgeons, and the sarcoma team have been involved with the majority of drug treatments available today. They have also conducted clinical trials on effective treatments, which led to U.S. Food and Drug Administration approval or their availability. 

Studies have shown that patients treated by sarcoma experts have better outcomes than patients not treated by an expert.

Dr. Gina D’Amato

When the treatment for the patient misdiagnosed with prostate cancer was changed under her care, the tumor shrank and was successfully removed.

Unfortunately, misdiagnoses happen regularly. Get your diagnosis confirmed.

 Initial results of a study published last October show that myelodysplastic syndrome (MDS), a bone marrow cancer that can evolve into acute leukemia, is commonly misdiagnosed. 

Led by Mikkael Sekeres, M.D., M.S., chief of the Division of Hematology at Sylvester and professor of medicine at the Miller School, the MDS study involved 150 cancer centers around the country and enrolled a total of about 2,000 people when they were first diagnosed with MDS by a local community pathologist. 

To understand the discrepancy (and the difficulty) of correctly identifying MDS, the bone marrow samples from the patients were sent to study-affiliated centers and reviewed by pathologists with significant expertise in MDS.

“It turns out that about 20% of the time, the local pathologist gets it wrong,” says Dr. Sekeres. “So, they tell somebody they have cancer when they don’t, or they tell them they don’t have cancer when they do.” 

Such was the case when a patient diagnosed with acute leukemia came to see him. Dr. Sekeres ran a few more tests, repeated the bone marrow biopsy and sent the sample to Sylvester pathologists. 

The bone marrow biopsy came back stone-cold normal. It turned out that he had a vitamin B deficiency, which can mimic acute leukemia in some bone marrow biopsies.

Dr. Mikkael Sekeres

He found published studies proving misdiagnoses occur in other cancers too, including breast cancer, lung cancer, and melanoma.

“All of this builds into the same story, which is the importance of making sure your cancer is really your cancer,” he says. 

And if the diagnosis isn’t correct, that can lead to the wrong treatment.  

In the MDS study, Dr. Sekeres and two other experts reviewed the treatments the patients received locally based on their original diagnosis, and they compared these treatments to their own recommendations, given the study-affiliated pathologists’ diagnosis. 

“Almost 10% of the time, people got the wrong treatment,” Dr. Sekeres says.

Among the tumor boards at Sylvester, where multidisciplinary specialists meet regularly to review patient cases, there are ones that focus on sarcomas, MDS, and even neuroendocrine cancer (NETs).

Only 12,000 cases of NET tumors are diagnosed each year. These tumors begin in the neuroendocrine cells, which are found in almost every organ of the body. 

Thanks to the NET tumor board, a gentleman with metastatic NET was rediagnosed with Merkel cell carcinoma and given immunotherapy — a biological therapy that uses the person’s immune system — which reduced his tumor to be barely recognizable. 

This aggressive cancer of the skin affects only about 3,000 people a year. It was the cancer that singer-songwriter Jimmy Buffet had.

Aman Chauhan, M.D., leads the NET Tumor Program at Sylvester and is an associate professor of clinical medicine at the Miller School. He meets weekly with surgeons, pathologists, radiologists, geneticists, endocrinologists, and others who specialize in NET tumors. 

“It gives us a very efficient way to provide the best care and best possible plan because we have multiple experts,” says Dr. Chauhan.

And because of these experts and the number of people who come to Sylvester, researchers can develop and test promising new therapeutics. 

Dr. Chauhan is conducting clinical trials to investigate new radiopharmaceuticals, which are radioactive drugs that bind to cancer cells and destroy them with radiation. 

For rare cancers like neuroendocrine cancers, patients should seek a specialist opinion.

Dr. Aman Chauhan

He recommends a long-term plan and relevant clinical trials and works closely with the patient’s local oncologist, who continues to see and treat the patient and conduct the needed scans. 

“It’s teamwork,” he says. “The goal is to provide the best care. So, it’s a win-win for everybody.” 

Elizabeth Sharpe is a contributor for Sylvester Comprehensive Cancer Center.

Tags: cancer care in Miami, Dr. Aman Chauhan, Dr. Gina D’Amato, Dr. Mikkael Sekeres, sarcomas