What is an MDT?

MDT is an abbreviation of ‘multidisciplinary team’. Every cancer patient is discussed by a team of relevant specialists, to make sure that all available treatment options are considered for each patient.

For bowel cancer, this team will include at least:

Clinical nurse specialist (CNS)

Providing information and support, the CNS is the patient’s representative and advisor throughout their cancer journey, especially at the MDT meeting.

Best practice is for part of the MDT notes to include a very short summary of the patient’s current health, any other health conditions and preferences handed out to everyone at the meeting. These notes take time to prepare but ensure that the best decisions are made and remain relevant. A surprisingly large number of MDT decisions are overturned after the MDT meeting because the patient’s condition and opinions were not fully represented. Pelican strongly believes that the CNS and surgeon should meet the patient before the MDT meeting.

Surgeon

The surgeon should meet the patient before the MDT meeting and carry out a digital rectal examination (DRE). However there is often insufficient time for this to take place – making the CNS notes even more important for the MDT. It is up to the surgeon to decide what operation is most appropriate and whether this can be achieved successfully with or without neo-adjuvant therapy.

Radiologist

A radiologist helps to analyse scans, such as MRI - the visual imaging of a cancer. This is critical information for the team to be able to identify the most appropriate cancer treatment/s and surgery plan for each individual patient.

MRI scans will be taken before the MDT meeting and presented to everyone for discussion. The radiologist prepares before the meeting, carefully considering the position of the tumour from a number of different angles and whether there are involved margins or any metastatic (secondary) disease in the liver.

Dr Gina Brown has revolutionised the way that rectal cancer is imaged, leading to far more accurate information. However, Pelican remains concerned that these results are not reproducible across the country and additional radiology development is necessary so that optimal images are made available at all MDTs. This is not a question of the best equipment, but rather good practice and allowing time to obtain the best views.

Oncologist

An oncologist is a specialist in cancer treatments such as chemotherapy, radiotherapy and biological therapy. The oncologist will advise on what neo-adjuvant therapy (radiotherapy with or without chemotherapy) may be given, depending on the patient’s choice and the surgeon’s opinion of surgical options.

Pathologist

A pathologist is a doctor who diagnoses or characterizes disease in living patients - advising on the type and extent of the cancer - by examining biopsies for example, or by reviewing the removed tissue after surgery.

Biopsies are not recommended for bowel cancer – puncturing the tumour can release ‘seeds’ which lead to dispersed disease, which is incurable. The pathologist’s role in this instance is to inform the MDT after surgery what has been found – answering questions such as: Does the specimen reflect the information provided by the radiologist? Has the surgeon achieved clear margins? How many lymph nodes were involved? Pathology reports can indicate whether a cancer has been successfully removed – this can influence the need for adjuvant therapy.

Gastroenterologist

Gastroenterologists specialise in the treatment of patient conditions affecting the liver, intestine (including the bowel) and pancreas. In some instances, rectal cancers are first seen by the gastroenterologist and they can provide valuable information on the position and state of the tumour.

Other specialists may also be available to help you if necessary, such as: