Enough people have now written to me with a pathology report, a sequencing panel and nobody to read it with them that it seemed dishonest to keep pretending there was nothing I could offer. So there is: an hour, booked, paid for, and spent on your situation rather than on the general case.
Most of those letters ask a version of the same question. The report says MSI-high, or KRAS G12C, or BRAF V600E, or tumour mutational burden of 14 — and the appointment where it was handed over lasted eleven minutes, half of which went on something else. What does it actually mean? Is it good news or bad? Why does it change which drugs are on the table? What is being tested in trials for exactly this, and how far off is any of it?
Those are molecular biology questions, and they are the ones I am qualified to answer. I read the report, I read the literature behind it, and then we sit down and I explain it in language that does not need a genetics degree — so that you walk into your next appointment knowing what you are looking at and what to ask about it.
What I am, and what I am not. I am a molecular biologist with a Ph.D., a research scientist, and a colorectal cancer patient. I am not a doctor of medicine, not an oncologist, and not a dietitian. Nothing I do here is medical advice.
What I actually know about. Five things, and I will tell you plainly when a question falls outside them:
- Cancer genomics. Reading a tumour’s molecular profile and knowing what each marker does to a cell, why it rules a drug class in or out, and what is being tested against it.
- The microbiome. What the gut bacteria have to do with colorectal cancer, with how treatment is tolerated, and with how well immunotherapy works — a field where the good evidence and the marketing have very little to do with each other.
- Diet. What the published research supports during and after treatment, and what it does not, separated from the confident nonsense that collects around a frightening diagnosis.
- Exercise. One of the few things with genuinely strong evidence behind it in colorectal cancer, and one of the least specifically explained.
- Supplements. Graded honestly for evidence quality, effect size and safety — including the ones that interact with chemotherapy, which is the part the label never mentions.
That is the whole list. Prognosis, imaging, surgical decisions, drug dosing and anything that amounts to changing your treatment are outside it, and they stay with your medical team.
Read this part twice
I am not a doctor, and this is not a second opinion. I hold a Ph.D. in molecular biology, not a medical degree. I cannot diagnose anything, I cannot tell you whether to have the surgery, take the chemotherapy, join the trial or stop any of it, and I will not. Every one of those decisions belongs to you and the oncology team who know your history — and a session with me is meant to make that conversation better, never to replace it or to argue with it.
I explain the science. I do not recommend the treatment. The difference sounds like a technicality and it is not. "BRAF V600E tumours respond poorly to standard first-line chemotherapy, and here is the biology of why, and here are the three trials testing something better" is science, and I can give you that. "You should ask to switch" is medical advice, and it is not mine to give.
On clinics abroad, I will be blunt rather than encouraging. People ask about treatment in another country more than any other single topic, and it is usually because somebody is selling hope at a price. I am glad to go through what a clinic actually claims, what evidence sits behind it, and what the published data say about whether it works. Often the honest answer is that it does not, and you will get that answer from me even though you are paying for the hour.
I cannot read a scan. Radiology is a medical speciality and it is not mine. Send the radiologist’s written report if it matters to your question, by all means — but nobody should be interpreting the images themselves except the people trained to do it.
This is not urgent care. If something is wrong right now, or a decision has to be made this week, please do not wait on me. Ring your team. I answer requests within five days, and five days is sometimes four too many.
Four things you can ask for
In order of how much work each one is. Nobody arriving here knows what is reasonable to ask a stranger for, so here it is written down — and the form at the bottom asks you to tick whichever you are after. Tick more than one if you are unsure where you sit, and I will say which I think fits when I reply.
- A short conversation about where you are. The least involved, and genuinely often enough. Good for getting your bearings after a diagnosis, or for the one question that has been going round in your head for a fortnight. No preparation, no documents needed.
- A focused conversation, with your material sent over first. You send the reports beforehand and I read them properly before we speak, so the hour goes on your situation instead of on me catching up. This is what most people want.
- An analysis of your tumour genetics, written up as a report. The panel gone through marker by marker: what each one is, what it means for you specifically, what the published evidence says, what is being tested in trials, and what to ask your team. In writing, so you can keep it, re-read it when you are less overwhelmed, and show it to the people who were not on the call.
- A full diet, exercise and supplement plan built around your situation. The most involved thing I do, and the one that takes longest. Everything in the analysis above, plus diet, exercise and supplements worked out around your tumour’s biology, the treatment you are on, and what you can realistically manage while you are on it — with every recommendation graded for evidence quality and effect size, and interactions with your treatment checked rather than assumed away.
The last two are written work rather than an hour in a diary, though they normally end in a conversation about what is in them. If none of the four is quite what you had in mind, tick the nearest and describe what you actually want in your own words — the form has room for it.
The ground it covers
- Your tumour’s molecular profile, line by line. MMR and MSI status, KRAS, NRAS, BRAF, HER2, PIK3CA, tumour mutational burden, consensus molecular subtype — what each one is, what it does to a cell, and why your report bothers to mention it.
- Why the profile changes what is on the table. The biological reason a marker rules a drug class in or out, rather than the one-line version on the report.
- What the literature says about your particular situation. What has been published, how good the studies are, and where the honest uncertainty sits — including when the answer is that nobody knows yet.
- Trials that match your biology. What is recruiting for tumours like yours, what each one is actually testing, and what the entry requirements mean in practice.
- The microbiome. What the gut bacteria actually have to do with colorectal cancer, with how treatment is tolerated, and with whether immunotherapy works — and which of the things sold on that basis have anything behind them.
- Diet, exercise and supplements, graded honestly. What has evidence behind it, what has none, and what could interfere with the treatment you are already on. Exercise is one of the few things here with genuinely strong evidence, and one of the least specifically explained to anyone.
- The questions to take back to your oncologist. Often the most useful thing that comes out of the hour, and the part I would keep if we only had ten minutes.
How it works
- You send the form below. It asks for the situation, the reports if you have them, and what you want out of the hour. Nothing is booked and nothing is owed at this stage.
- I read it and tell you whether I can help. Within five days, and sometimes the answer is no — because the question is a medical one, because it is outside what I know, or because the honest reply fits in an email and does not need an hour. I say so when that is the case.
- If I can, I quote a fee. A flat price for the whole thing — the reading beforehand as well as the call — agreed in writing before anything is booked. You are free to say no, and saying no costs nothing.
- We find a time and we meet. By video call, at an hour that works across the time difference. Bring whoever you want with you — most people bring the person who has been coming to the appointments.
- You get something in writing afterwards. A short summary with the references, because nobody remembers an hour of new terminology, and because the people you want to show it to were not on the call.
The fee
Agreed case by case, quoted after I have read your request, and confirmed in writing before we book anything. It depends on how long the session runs and how much reading sits behind it: a single question about one marker is not the same job as a full panel with a treatment history attached.
If money is the thing standing in the way, say so in the form. I would rather know than have somebody quietly decide not to ask.
What happens to what you send
The form goes to my own inbox and nowhere else. Documents you attach travel with that email and are deleted from this website as it is sent — no copy is kept here, none of it goes into the site’s media library, and nothing you write appears anywhere public. There is no tracking on this page and no third party in the middle of it.
Email itself is not a secure channel, and you should know that before you attach a pathology report to one. If you would rather tell me the situation in general terms first and send the documents later, that is completely fine — write the request without them.
Ask for a session
It is a long form, and it is long on purpose: the more I know before I answer, the less of the hour goes on catching up. Answer what you can and leave the rest — only the starred fields are needed. I reply to every request within five days.