What Does an Oncologist Do on the First Visit?
By Sarah Friend, MD
Hearing the words “you have breast cancer” is life-changing. The first visit with your oncologist can feel overwhelming, but my goal here is to help you know what to expect. Knowledge brings confidence, and confidence brings strength. The first oncology appointment is an important step in understanding your specific diagnosis, your treatment options, and the path ahead. Knowing what to expect—and how to stay organized—can help you feel more confident and in control.
Understanding the Diagnosis
During your first oncology visit, one of the most important steps is learning about what type of breast cancer you have. This is much more than just the word “cancer.” Your oncologist will begin by reviewing the details of your cancer diagnosis. For breast cancer, that includes three key components that define your tumor subtype. Your doctor will review key features of your tumor, including:
- Estrogen Receptor (ER): tells us whether the cancer is fueled by estrogen. Estrogen is reported as a % which ranges from 0%— 100%. The biopsy report revealing the cancer diagnosis should list the % estrogen receptor positivity. Request a copy of the pathology report for your records.
- Progesterone Receptor (PR): Similar in ER, the PR is a hormone receptor that is also expressed as a % on the pathology report. Find the % PR on your pathology report, which should be between 0% and 100%.
- HER2 Status: HER2 is a protein that, when present in high amounts, can make the cancer grow faster but also opens the door to effective targeted therapies. The HER2 is tested in 2 ways, IHC and FISH (see table 1). Request a copy of HER2 for your records.
These 3 markers (ER, PR, and HER2) help guide the treatment approach—whether that’s hormone therapy, chemotherapy, targeted therapy, or a combination. Understanding the receptor status is one of the most important steps in learning about your specific cancer type. At the first oncology visit, I recommend starting a folder for the breast cancer diagnosis and journey and requesting a copy of the pathology report. Make sure the pathology report includes all 3 markers (ER, PR, HER2).
Determine The Stage
At the first oncology visit, in addition to determining the tumor subtype based on the ER, PR, and HER2 status, the doctor will likely discuss the stage of breast cancer. The stage of cancer reflects how advanced the cancer is. Staging takes into account the tumor size, lymph node involvement, and whether the cancer has spread (or metastasized to other organs). Stages are typically numbered 0 through 4. This information helps the oncology team tailor your treatment plan and estimate your prognosis. While not exact, in general the breast cancer staging is broken down in the following way.
- Stage 0 breast cancer is DCIS (ductal carcinoma in situ)
- Stage 1 is tumor size <2 cm
- Stage 2 cancers are larger (>2 cm and possibly with lymph node involvement)
- Stage 3 cancers are more advanced, often larger with armpit (“axillary”) lymph node involvement
- Stage 4 cancers have spread outside the breast and nearby lymph nodes (in the armpit) and are found somewhere else in the body, like bone, liver, or lung
Make sure to ask the oncologist “what is the stage of my breast cancer?” Remember that sometimes the predicted stage based on mammogram may turn out to be different after the surgery (lumpectomy or mastectomy) takes place. For example, the mammogram may have shown a 2.5 cm tumor (estimated at a stage 2) but after surgery the tumor may actually be measured at 1.9 cm (which is a stage 1). The way the discrepancy is indicated in medical documentation is “clinical stage 2, pathologic stage 1”. Future oncology notes may clarify the discrepancy or indicate the pathologic stage only.
Building a Personalized Plan of Care
Your care plan may include a combination of surgery, chemotherapy, targeted therapy (or immunotherapy for triple negative breast cancer), endocrine (hormone blocking) therapy, radiation.
- Surgery – typically a lumpectomy (removing just the cancer, preserving the remaining breast) or mastectomy (removal of the whole breast)
- Chemotherapy – IV medications used to target rapidly dividing cells; often comes with more side effects than the pill medications
- Targeted therapy – newer “chemo-free” options generally felt to have less toxicity than traditional chemotherapy; this is an umbrella term that includes many types of treatment
- Immunotherapy – IV medications to boost a patient’s immune system, generally used in combination with chemotherapy for triple negative breast cancer; immunotherapy is being explored for estrogen positive cancer (but as of 2025 has not been approved for hormone receptor positive cancer)
- Endocrine (hormone blocking) therapy – oral medications taken once daily to turn off estrogen in the body; these medications are used for hormone receptor positive cancers, and are extremely effective at reducing the risk for breast cancer recurrence
- HER2 blocking agents – agents often used for HER2 positive tumors; medication names include trastuzumab and pertuzumab; medications may be used with chemotherapy or for the year following completion of treatments
- Radiation therapy – is used in breast cancer after a lumpectomy to reduce the risk of the cancer coming back in the breast (reduces a “local recurrence”). Following a mastectomy, radiation may be recommended if cancer is in the lymph nodes or the tumor was large ( >5 cm); the decision of whether or not radiation should be considered requires the guidance of an expert radiation oncologist
Staying Organized: Create a Cancer Care Folder
Keeping your medical records organized from day one will make a big difference. Create a dedicated folder or binder (digital or paper) and include:
- A copy of your original mammogram and pathology report (from the initial biopsy and then following the surgery; removal to include ER, PR, and HER2 both IHC and FISH if ordered)
- Results of biopsies (any additional biopsies which have been done), MRIs, CTs, or PET scans
- Results from genetic testing
- Genomic testing such as Oncotype (generally only done for ER+/HER2 negative tumors)
- Treatment summaries (any medications which were recommended, including pills, IV medications, and chemotherapy drugs planned to be given, doses, and schedules)
- List any oral medications, such as hormone blocking pills or targeted therapy; ask your team for a printed medication list and drug information list
- Notes from each visit and key contact information for your medical team (how do you connect with them for questions?)
This folder becomes your personal medical record vault, empowering you to easily share accurate information with new doctors or specialists.
Looking Ahead: Documenting Your Cancer Journey
For long-term survivors, keeping a record of your treatment is invaluable. Years later, it may be important for your primary care physician, future oncologist, or other specialists to know the treatments received in the past. Important information to keep for records include:
- Which chemotherapy drugs did you receive
- Did you receive radiation (yes or no)
- Any targeted or hormone blocking therapies used; how long did you take each medication?
- Surgery and reconstruction details (do you have implants?)
Many cancer centers provide “treatment summaries” or “survivorship care plans” so inquire about these after completion of treatments. If a treatment summary is not available, can create your own by making a 1 page summary listing the date of surgery, radiation, and names of medications (including chemotherapy, other IV medications (such as trastuzumab), and pills (like an estrogen blocker)
In Summary
Your first oncology visit is about more than just starting treatment—it’s about education, empowerment, and organization. By learning about your cancer subtype, understanding your stage, and staying organized with your records, you’re taking an active role in your care. Knowledge truly is power—especially when navigating cancer.
