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.
- 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.
- 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.
Professor 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.
- 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.
- 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
The pathologist’s role before surgery is to inform the MDT about the type of tumour, which may have an influence on treatment strategy, and if the information is available, about previous malignant disease or other relevant comorbidities such as inflammatory bowel disease. If the patient has had a malignant polyp removed, the pathologist will provide important information about the polyp to the MDT regarding the need for further surgical treatment.
The pathologist’s role after surgery is to inform the MDT what has been found and provide feedback to the surgeon about the quality of the surgical specimen – answering questions such as: Does the specimen reflect the information provided by the radiologist? Has the surgeon removed all of the cancer with clear resection margins? How many lymph nodes were involved? The pathologists will assess how far the tumour has spread in the bowel, which is used in the decision making about the need for further treatment e.g. chemotherapy. They may also provide additional detailed information about the cancer including its individual genetic code, which may indicated whether the tumour is responsive or unresponsive to specific drugs
- 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:
- occupational therapists
- psychologists and counsellors