Dr. Sharon Peles

In my daily practice, I most often see patients with colorectal cancer, pancreatic cancer, and gastric cancer. These are probably the most common diagnoses I deal with.

But honestly, it’s rarely straightforward. Some patients come right after diagnosis, others after surgery, and quite a few come after they’ve already received treatment somewhere else.

So the first thing I usually do is slow down and review everything carefully. Imaging, pathology, previous treatments — sometimes small details can change the whole picture. And surprisingly often, we do find additional options that weren’t discussed before.

I usually tell patients — the earlier, the better. Even if you’re just diagnosed, an early consultation helps clarify the direction and avoid unnecessary delays.

But in reality, many people come later. Sometimes treatment stops working. Sometimes side effects become difficult. Sometimes patients just want another perspective. All of that is completely reasonable.

In oncology, it’s not unusual to reassess the plan along the way. And honestly, that’s often when we can still make meaningful adjustments.

We have several treatment options, including chemotherapy, immunotherapy, and targeted therapy. But they are not interchangeable, and not every treatment is suitable for every gastrointestinal cancer.
I look at the exact diagnosis, the tumor’s biology, the stage of the disease, and any treatment the patient has already received. These details help us decide which approach makes sense.
Sometimes we use a combination of treatments. In other situations, I may consider a clinical trial. The aim is to choose a treatment that fits the patient’s situation.

Yes — very often. A large part of my practice involves patients with advanced disease or after multiple lines of treatment.

These cases require a careful and thoughtful approach. I usually go through the entire history — what was tried, what worked, what didn’t.

Sometimes new options become available over time. Sometimes the situation changes in a way that allows us to consider something different. So even in complex cases, there are often still things we can explore.

Yes, absolutely. Some patients come after a new diagnosis, while others have already started treatment and want to review their options.
I usually begin by going through the imaging, pathology reports, and previous treatment summaries. I want to understand why the current plan was chosen and whether there are other options worth discussing.
A second opinion does not always mean changing treatment. Sometimes the review supports the existing plan. In other cases, we may identify an additional option. Either way, the consultation should help the patient understand the next step more clearly.

If possible, I usually ask patients to send:

Imaging studies
• Pathology reports
• Medical summaries
• Blood tests
But if some documents are missing, we can still begin. The most important step is to start the discussion.