Before your biopsy

Who Coordinates — Between Your Specialists?

Being told different things by different doctors before a biopsy is more common than most people realise — and more dangerous to ignore. You do not have to wait for the hospitals to sort it out. There are specific steps you can take today.

Medically reviewed by Dr. Mohammed Imaduddin, Surgical Oncologist, MBBS · MS (General Surgery) · M.Ch (Surgical Oncology) · Last reviewed September 2026

One doctor leads the final call — The specialist performing the biopsy makes the final safety decision, informed by your cardiologist's written input.
Communication rarely happens automatically — Specialist teams work in different hospitals or departments and do not automatically share notes before a procedure.
You are the link — Carrying the right documents to every appointment is the single most reliable way to make coordination happen.
Never stop medication without a written plan — Any decision about blood-thinning medication before a biopsy must come in writing from the doctor who prescribed it.

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The specialist performing the biopsy makes the final call on whether it is safe to proceed. That decision must be informed by written input from your cardiologist. The two teams do not always communicate automatically — you can make it happen by carrying the right documents and asking one clear question at your next appointment.

If a symptom below applies to you, do not wait for a callback. Call 1800-202-8726 or go to your nearest emergency department.

Go to emergency now — do not wait for an appointment

New chest pain, chest tightness or pressure that has appeared since your last cardiac appointment. Do not proceed with any planned biopsy. Go to the nearest emergency department and tell them you have a cardiac history.
Severe breathlessness, palpitations or near-fainting that are new or getting worse. These need emergency assessment before any procedure goes ahead. Go now.
Unexpected bleeding you cannot stop, especially if you are on a blood-thinning medication. Go to emergency immediately and bring the name of your medication with you.
Your biopsy is within 24 hours and no one has told you whether your cardiac medication is safe to continue. Call your oncology team or the biopsy unit now, not in the morning. If you cannot reach anyone, go to emergency and explain the situation.

How urgent is your coordination problem?

Your situation	Urgency	What to do today
Both teams have exchanged notes and agree on the plan	Routine	Attend your biopsy as scheduled
Doctors have not communicated but biopsy is more than 4 weeks away	Moderate	At your next oncology appointment, ask for a referral summary to be sent to your cardiologist
Biopsy is within 2 weeks and no one has addressed your cardiac medication	Urgent	Call your oncology nurse today — this cannot wait for your next scheduled visit
You have been told to stop a blood-thinning medication but have no written instruction	Urgent	Do not stop it on your own — call the prescribing doctor today for written guidance
New or worsening cardiac symptoms have appeared since your last appointment	Emergency	Do not proceed with the biopsy — go to your cardiologist or emergency department
Typically starts	At pre-procedure assessment	When the team reviews your medication list and existing medical conditions before scheduling the biopsy

Meet the Specialists

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Trained at AIIMS, Tata Memorial, and leading international centres. Combined 150+ years of experience. Every complex case is reviewed by 3+ of them — together.

Medical Oncologist

Dr. Naresh Gundu

MBBS, DNB (Internal Medicine), DM (Medical Oncology)

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Dr. C. Raghavendra Reddy

MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)

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Medical Oncologist

Dr. Bharati Devi Gorantla

MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)

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Dr. Owais Mohammed

MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)

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Dr. T. Raghavender Reddy

MBBS, DM (Medical Oncology), MD (Radiation Oncology)

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Dr. N. Kiranmayee

MBBS, DM (Medical Oncology), MD (Internal Medicine)

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Dr. Muralidhar Muddusetty

MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)

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Dr. Raghavendra Naik

MBBS, MS (General Surgery), M.Ch (Surgical Oncology)

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Surgical Oncologist

Dr. Mohammed Imaduddin

M.B.B.S, MS (General Surgery), M.Ch (Surgical Oncology)

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Surgical Oncologist

Dr. Vinay Mamidala

MBBS, MS(General Surgery), M.Ch(Surgical Oncology), FMAS, FARIS(Ongoing)

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Dr. Paila Gowri Naidu

MBBS, MS (General Surgery), M.Ch (Surgical Oncology), FMAS

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Radiation Oncologist

Dr. Venkata Sushma P

MBBS, MD (Radiation Oncology)

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Radiation Oncologist

Dr. Kirti Ranjan Mohanty

MBBS, MD (Radiation Oncology)

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Radiation Oncologist

Dr. Gangadhar Vajrala

MBBS, MD (Radiation Oncology), MPH

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Hematologist

Dr. Basudev Pokhrel

MBBS, M.D (Immunohematology & Blood Transfusion)

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Interventional Radiologist

Dr. Mohammed Imran

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Surgical Oncologist

Dr. Vajja Sandeep Kumar

MBBS, MS (General Surgery), DrNB (Surgical Oncology), FALS Oncology

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Surgical Oncologist

Dr. Sridhar Kamani

MBBS, MS (General Surgery), DrNB (Surgical Oncology)

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Whose decision is it, and how do you make the two teams talk?

The specialist performing the biopsy — your surgeon or interventional radiologist — is responsible for the final safety decision on whether to proceed.

They cannot make that decision well without knowing your full cardiac history, your current medications, and your cardiologist's specific recommendation for this procedure.

Most of the time, that information does not travel between hospitals or departments automatically. You are the most reliable link between the two teams.

At your next appointment with either specialist, ask one direct question: 'Has my cardiologist sent a written summary to the biopsy team — or vice versa — before this procedure?' If the answer is no, ask what needs to happen to make that communication take place before the date.

Questions families ask most about specialist coordination

What exactly should I carry to every appointment?

Carry a printed or photographed copy of your most recent cardiac assessment or clinic letter, a complete list of every medication you take including when you take it, and any previous biopsy or procedure reports. If your cardiologist has given you a written opinion about the planned biopsy, carry that too. Ask the hospital to give you copies — it is your right to have them. A phone photograph of a letter is accepted in most Indian hospitals when a printed copy is not available. If both your specialists are in different hospital systems, this document bag is the only reliable way to ensure each one knows what the other has said.

What if my cardiologist says it is safe but my surgeon is still not sure?

The surgeon is not required to proceed if they are not satisfied that the risk is acceptable. That is not obstruction — it is the system working as it should. Ask the surgeon one direct question: what specific information would change their assessment? That question almost always produces a concrete answer — a recent cardiac investigation, a written clearance letter, or a direct conversation between the two specialists. If both teams are within the same hospital network, ask your oncologist to arrange a joint review. If they are in different hospitals, a written letter from your cardiologist addressed to the surgeon by name, describing the planned biopsy specifically, is the most effective step you can take.

Will this delay my biopsy?

It may, and that is worth understanding clearly rather than assuming the worst. A short delay to get proper clearance is almost always safer than proceeding without it. If your oncologist believes the biopsy is urgent, they will say so — and urgency changes how quickly coordination can be arranged, sometimes within hours rather than weeks. Ask your oncologist directly: 'Is there any risk in waiting a week or two to resolve this?' The honest answer to that question, whatever it is, gives you the information you need to weigh the delay against the risk of an unprepared procedure.

Is it safe to stop my blood-thinning medication before the biopsy?

Whether it is safe, for how long, and whether a bridging arrangement is needed in between are decisions that belong entirely to the doctor who prescribed it — not the surgeon, not a pharmacist, and not information you should act on based on what you have read elsewhere. The answer depends on the specific category of medication, why you are taking it, and the bleeding risk of the type of biopsy being planned. What you can do right now is make sure that question has been formally asked and answered in writing before you stop anything. If no one has brought it up, that is the gap to close today — not the day before the procedure.

Who do I call if I cannot get an answer from either team?

Start with the oncology nurse line or the contact number on your biopsy appointment letter — these teams are used to pre-procedure queries and know how to escalate. If you cannot reach anyone and your biopsy is within 24 to 48 hours, go to the biopsy facility in person and explain the situation at the front desk. Do not assume the problem will resolve itself on the morning of the procedure. A procedure that is started and then stopped, or that proceeds with the wrong cardiac preparation, is a worse outcome than raising the concern the day before.

Did you know?

In multi-specialist cancer care, gaps in communication between teams — not failures within a single team — are among the most frequently identified causes of preventable procedural complications.

A single shared written summary, carried by the patient to every appointment, closes the most common gap.

Source: ASCO guidance on multidisciplinary care coordination in oncology

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Common questions

Frequently asked questions

Whose job is it to coordinate between my cardiologist and my surgeon?

No single specialist is automatically responsible for cross-team coordination in most Indian hospital systems. Your oncologist is the most appropriate person to initiate it, because they hold the overall treatment plan and can formally request a cardiologist's input as part of the pre-procedure workup. In practice, this does not always happen without prompting. Asking your oncologist explicitly — 'Can you send a summary of my cardiac history to the surgeon before my biopsy?' — is often all it takes to set the process in motion.

What should I do if my cardiologist and my surgeon contradict each other?

Do not choose one over the other on your own. Bring both opinions — in writing if possible — to your oncologist and ask them to clarify whose recommendation should take precedence for this specific procedure. If the conflict involves a blood-thinning medication, that question must go back to the prescribing doctor, with the surgeon's specific concern stated clearly. A contradiction between specialists is almost always resolvable when each one knows exactly what the other has said — the problem is usually that they do not.

Will stopping my heart medication before the biopsy put me at risk?

Whether stopping is necessary, for how long, and whether an alternative arrangement is needed during that period are decisions that depend on your specific medication category, your cardiac history, and the bleeding risk of the planned biopsy type. There is no single answer that applies to everyone. What matters is that the question has been formally addressed before the day of the procedure. If no one has raised it yet, bring it up at your next appointment and ask for the plan in writing before you do anything.

Can a biopsy go ahead if I have a heart condition?

In most cases, yes — with the right preparation. A heart condition does not automatically disqualify you from a biopsy, but it does mean the pre-procedure assessment must include your cardiac status. Your cardiologist's role is to assess what risk the procedure poses to your heart; your surgeon's role is to assess whether that risk is acceptable given how important the biopsy is to your cancer care. Those two judgements together, not either one alone, determine whether it is safe to proceed and under what conditions.

How do I ask the two teams to communicate with each other?

At your next oncology appointment, ask directly: 'Before my biopsy, can you send a summary of my case to my cardiologist and ask for a written opinion?' Most oncology teams can generate a referral letter the same day. If you see your cardiologist first, ask: 'Can you write to my surgeon confirming your recommendation for this procedure?' Naming the other doctor specifically in your request — rather than asking in general — makes it significantly more likely the letter reaches the right person before the procedure date.

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