Discussion with Danish Surgeon

The endoscopic ultrasound with biopsy that was done in the US is not common in Denmark. The surgeon confirmed that the CAT scan results with the minor lesions in one lung and the liver probably is nothing, but in Denmark the followup would be another CAT scan 3 months later. I think this is pretty much in line with what I was told in the US. The surgeon agrees to that this is stage 3, based on the lymph nodes that came back positive. In Denmark they would make an MRI scan in order to determine if the cancer has worked through the wall and based on that, the oncologists would decide if chemoradiation up front is needed. In denmark you would only use ultrasound for minor tumours. If the tumor is bigger, the danish opinion is that an MRI scan would be better. In Denmark it is typical that once the Colonoscopy and MR has been done, there will be a meeting among: the surgeon, the oncologist, sometimes the pathologist, and radiologists, where they study the results and take a look at the pictures. Based on this they will together agree on a suggested treatment that will be presented and offered to the patient. If they find that this is a big tumor that has broken through the wall, they would up front offer chemoradiation for 5 months. (This statement conflicts what we have read and heard from the danish cancer association). As he says the traditional treatment is the 5 months chemoradiation, but the 5 weeks chemoradiation could also be offered as it is normal in the rest of europe, and on its way to get more common in Denmark. He says that the chemoradiation treatment is standardized all over the world. He also says that all of the hospitals in the capital area of Denmark are very good at treating rectal cancer. No need to find a particular hospital. He says that usually there will be a very short wait for the chemoradiation, but the surgery has a wait. It will not be a problem if chemoradiation is needed first. This is due to the new law that starting in 2014 required that anyone turning 50 years old would be offered a test with a poop sample, This test has shown more cancers that needed surgery than originally expected. Surgeon: “The quality of the danish system is high”. As this is public health care, the staff is busy, but the quality i good. Usually two or four bed rooms at the hospital. We discuss the prostate biopsy and treatment options in case it comes back being positive. He says that in Denmark they would usually re-evaluate the treatment, and then offer a plan for treatment that would take both into consideration. We discuss colostomy and if this is needed. In my case he agrees that if necessary then it will only be temporary. I ask if two weeks to start chemo is possible in DK. He says that this would theoretically be feasible, but I would have to register to become a resident in Denmark immediately (I can do this because of my danish citizenship). We discuss the transfer of the CAT scan, and other tests. The CAT scan can be hard to send, but the rest should be possible. CAT scan are big and require a lot of data. He offers me to call him back if I have more questions or need help.