How to get a second opinion for stage 4 cancer.

Step 1. Request your complete medical record

You have a federal right to your complete record under HIPAA. Request the following from each treating institution.

• Pathology slides and the full pathology report
• Imaging studies on disk (CT, MRI, PET) with the radiologist reports
• Complete treatment summary including drug names, doses, dates, and response assessments
• Lab results from the past six months
• Operative reports for any prior surgeries

Request these before scheduling the second opinion appointment. Most academic centers will not see you without them.

Step 2. Choose where to seek the second opinion

For stage 4 cancer, the highest yield second opinions come from NCI-designated comprehensive cancer centers. There are 56 in the United States. The list includes MD Anderson (Houston), Memorial Sloan Kettering (New York), Dana-Farber (Boston), Cleveland Clinic, Mayo Clinic, Stanford, UCLA, Johns Hopkins, and University of Washington.

For molecular profiling, consider Foundation Medicine, Caris, Tempus, or Guardant. A second opinion that includes a current molecular profile opens access to targeted therapies and clinical trials that your community oncologist may not be tracking.

Step 3. Ask the right questions

• What is the current standard of care for my exact subtype and stage?
• What clinical trials am I eligible for at your institution and elsewhere?
• Has molecular profiling been done on the most recent biopsy?
• What is the projected line-of-therapy roadmap if the current regimen progresses?
• Are there expanded-access or Right-to-Try pathways for investigational therapies that match my biology?

Step 4. Consider investigational pathways

For refractory stage 4 disease, three federal pathways exist beyond standard care: clinical trial enrollment (searchable at ClinicalTrials.gov), FDA Expanded Access under 21 CFR Part 312 Subpart I, and the federal Right to Try Act of 2018. International access is available through COFEPRIS-authorized partner sites in Mexico and the TGA Special Access Scheme in Australia.

For voltage-gated sodium channel over-expressing solid tumors, Targeted Osmotic Lysis is one investigational option being studied. See the per-cancer-type pages on this site for histology-specific eligibility considerations.