What Is a Surgical Oncologist?
A surgical oncologist is an oncologist that has specialized education and training focused on the surgical removal of cancerous tumors. A surgical oncologist often contributes in many other aspects of oncology beyond the surgery itself. They also serve as part of a multidisciplinary care team that provides their expert opinion in many different areas of care. Surgical oncologists often provide their expert opinion and advice on anything from the optimal biopsy techniques that should be used to giving guidance on the best approach that should be used to obtain optimal image results from testing. Surgical oncologists also verbalize the likelihood of successfully achieving clear margins before a surgery. They also give expert advice and guidance on surgical management for other advanced diseases that patients need surgically removed.
This is just one of the three major fields of oncology and it’s important to understand that each field of focus has different types of oncologists. The three major areas of focus in oncology can be broken down into medical, radiation, and surgical. A medical oncologist focuses on treating cancer with various medications. Medications used by medical oncologist often involve some form of chemotherapy such as immunotherapy or targeted therapy. Another form of oncologists is a radiation oncologist. These doctors are typically focused on treating cancer using radiation therapy.
Surgical Oncologist training and education
A Four-Year Degree and Passing the MCAT
The path students must take to become a surgical oncologist begins at a four-year college. During this time student’s may choose to complete a bachelor’s degree in any major they choose. During these four-years, students must complete premedical courses that include organic chemistry, physics, biology, and chemistry. These courses are typical requirements for students to meet medical school admissions requirements. These four courses are also vital in preparing students for the MCAT. The Medical College Admission Test (MCAT) is a requirement for every student to pass before they can be accepted into a medical school. Most students often choose to take the MCATS during their junior year in the spring or summer semesters.
An additional step that students may take that helps them, in the long run, is to volunteer during this time. Volunteering at a health clinic or local hospitals gives students hands-on experience by working with patients. Volunteer experience at a hospital or clinic can provide students with field experience, leadership skills, and it will help them stand out when they apply to a medical school admissions board.
Medical School
After students complete their 4 years of undergraduate studies and are accepted into a medical school they will need to complete 4 additional years at a medical school. Students will have the choice between two degrees that they could pursue. Students can choose from either a Doctor of Medicine (M.D.) degree or they can choose to pursue a Doctor of Osteopathic Medicine (D.O.) degree.
Regardless of which degree they choose to pursue the first two years will be the same for all students. During the first two years of medical school, medical students will spend all of the time taking classes and completing laboratory work. These courses and labs focus on subjects such as biochemistry, pathology, anatomy, physiology, pharmacology, microbiology, and ethics of medicine. Following the first 2 years, students begin the second part of a medical school which focuses on teaching students how to diagnose and treat illnesses. During these two years, students will learn how to treat and diagnose by completing rounds of clinical rotations in various medical specialties. Students will have clinical rotations within places such as family practices, surgery, pediatrics, psychiatry, obstetrics, and gynecology.
Earning a Licensure
Following completion of medical school before students can begin practicing medicine they are required to pass a licensing exam. Depending on which degree a medical student obtained during medical school will determine which exam they will need to complete. Students that completed their Doctor of Medicine (M.D.) are required to take the United States Medical Licensing Examination (USMLE). Students that obtained the Doctor of Osteopathic Medicine (D.O.) are required to take the Comprehensive Osteopathic Medical Licensing Exam (COMLEX-USA). Both of these exams have three separate parts which can be taken at different times. The first and second parts of the exam can actually be taken while students are still in medical school. The third part of the exam can be completed as soon as a student graduates from medical school or during their first year of residency.
General Surgery Medical Residency
After a student has graduated from medical school and also obtained their medical license they are required to complete a residency training in general surgery. This residency will typically take students 5 years to complete surgery training. Some students can also decide to take an additional year of residency with one additional year focused on providing students with research experience.
The mandatory 5 years of surgical residency consists of clinical rotations focused on general surgery. These rotations are spent in different specialty areas of medicine and provide students experience for the various types of surgery available. Rotations often involve students spending time in trauma, vascular, transplant, oncological, pediatric, and cardiothoracic. During students third and fourth years of residency, they may also conduct their own clinical or scientific research.
Students that complete their residency in general surgery may now take another exam. The American Board of Surgery’s General Surgery Certifying Examination is a board certification in the field of general surgery. Currently there is not a board certification designed specifically for surgical oncologists, but a surgical oncologist that is board certified in general surgery will stand out from the crowd.
Becoming a surgical oncologist
A general surgeon can pursue additional training after their residency. However, a surgeon does not have to complete a fellowship to become a surgical oncologist. If a surgeon specializes long enough in a particular discipline they may develop their own expertise in cancers in that site. For other surgeons looking to become a surgical oncologist the last requirement to become a surgical oncologist is to successfully complete a fellowship in surgical oncology. This is another two years of additional training specifically focused on the surgical component of removing cancer. Students may also take an additional year of fellowship that will focus on research of surgical oncology. If students decide to take an additional year of residency to focus on research they will typically conduct their research on genetics, immunology, cancer therapies, and pharmacology. During the time of a surgical oncologist’s fellowship, they will complete another round of clinical rotations. These clinical rotations are focused specifically on giving students experience on cancer surgery. The clinical will cover different aspects of cancer surgery including skin, gynecologic, thoracic, breast, and gastrointestinal.
Continued education and career advancement
Oncology is a rapidly developing and changing field so surgical oncologists must continually keep their education up-to-date on all the latest medical breakthroughs or developments. Surgical oncologists are required to obtain Continuing Medical Education (CME) credits before they are allowed to renew their licensure or any certifications. These Continuing Medical Education credits can be obtained by surgical oncologists one of two ways. Surgical oncologists can choose to attend an approved meeting or conference or they may further their education through an advanced course. Oncology surgeons having difficulty finding ways to obtain their CME credits can find opportunities for meeting or conferences through professional organizations like American Society of Clinical Oncology.
The field of surgical oncology has plenty of room for growth for new surgical oncologists. The growing cases of cancer provide surgical oncologists different opportunities for a career path that is suitable for them. Some surgical oncologists may decide to work their way up at an organization to develop their leadership skills and later become a manager or supervisor. Other surgical oncologists may choose to gain enough experience in order to feel comfortable enough to open their own independent practice to hire their own staff.
The History and evolution of surgical oncology
Surgery has been a form of medical practice as early as the 7th century. During the 7th century, the ancient Egyptians detailed different techniques used for surgically removing tumors from within breasts. Later in the year of 1809, a man by the name of Ephraim McDowell conducted the first documented surgery. Ephraim McDowell was the first to reportedly conduct a resection of a tumor on a patient’s ovary.
During the late 1800s, there were significant advancements in anesthesia. The medical field was able to develop safe and effective forms of anesthesia for patients that were about to have surgery. During the year 1890 with the help of the advanced anesthesia, a Dr. William Halsted was able to conduct a revolutionary surgical technique for a breast cancer patient. Dr. Halsted was the first doctor to ever complete a mastectomy. This mastectomy was a surgery that involved the complete removal of an entire breast. The surgery also removed draining nodes and most of the pectoral muscles. This extensive surgery was effective in the treatment of cancer by completely removing the affected area and surrounding tissues. The downside to Dr. Halsted’s surgery was the terrible cosmetics results with which patients had to live. Such a drastic surgery often brought about long-term issues later in life further reducing the quality of life for patients.
The surgery by Dr. Halsted proved to be effective against cancer in patients and other surgeons began to think of ways to improve the surgery results. Surgeons soon started to wonder if they could perform surgeries that were just as successful without the extensive cosmetic damage or disfigurement. It was in the 1970s before another surgeon was able to perform a surgery with the same effective results while also reducing the dramatic cosmetic damage. Dr. Veronesi from Italy was about to perform the first breast-conserving surgery in the 1970s. As opposed to Dr. Halsted’s radical mastectomy surgery, Dr. Veronesi performed a quadrantectomy. A quadrantectomy was essentially the removal of a single quadrant of breast tissue that was affected by cancer. This less extensive surgery took a few decades to prove that it was effective in the treatment of cancer, but it paved the way for modern today techniques for breast cancer surgery.
Modern-day surgical oncologists, in particular, breast surgeons, were able to modify a quadrantectomy into a smaller surgery known as a lumpectomy. Lumpectomies were even smaller portions of the breast being removed. This smaller removal of tissue proved to be much more cosmetically acceptable to patients but it did have its drawbacks. Although the surgery would eliminate most of the cancer cells, it was still required to be followed-up with breast radiation. Lumpectomies in combination with radiation treatment has proven to be an effective way to control cancer for patients with breast cancer.
In the past surgery was the only effective way to treat cancer and surgical oncologists were always pushing the envelope in an effort to expand their knowledge of more efficient surgery techniques. Non-surgical methods for cancer treatment has only become an alternative to surgery just within the last century. Modern-day advances in radiation oncology and medical oncology provide have proven to be an asset in cancer treatment. Despite all of the advances in these two areas surgery itself is still the only method to completely eliminate solid cancers such as large tumors.
The Importance of surgical oncology
The modern-day treatment of cancer traditionally involves rounds of chemotherapy and/or radiation therapy used either before or after surgery. Chemotherapy and radiation therapy are still not advanced enough to completely treat cancer so a high-quality surgery is a critical component in the treatment of cancer patients. The surgery a surgical oncologist decides on will heavily depend on what stage of cancer the patient is currently in and where cancer itself is located within each patient. Surgical oncologists also must take into account the physical fitness of the patient and decide on a course of surgery. The oncologist will then typically meet with the patient and discuss the upcoming procedure and also go over all the risks and benefits of the surgery. These risks associated with oncology surgery is expected to diminish as surgical techniques evolve and technology becomes more advanced.
Other oncologists and specialists that may be involved.
Other forms of oncologists may be the preliminary stop before reaching the point of needing a surgical oncologist. These other types of oncologists include a hematology oncologist that specializes in the diagnosing and treatment of blood cancers such as lymphoma, myeloma, and leukemia. A pediatric oncologist has specialized training when diagnosing and treating children that have various types of cancer. Other specialists that will often precede an appointment with a surgical oncologist include a pathologist and a diagnostic radiologist. A pathologist has specialized training in analyzing laboratory test results. They are able to diagnose diseases like cancer through examining cells, tissues, and other body organs for signs of cancer. A diagnostic radiologist may have to complete some image testing, especially in scenarios that involve some form of tumor. Diagnostic radiologists are able to provide images through x-rays and ultrasounds that are vital for surgical oncologists to review before performing surgery.
There will always be a need for other doctors and specialists to be involved in the treatment plan with a surgical oncologist because of the sheer volume of types of complex cancers. A single surgical oncologist could not possibly be able to obtain the expertise, training, and education required to perform the full spectrum of oncology surgeries that come up today. A surgical oncologist would not be able to perform breast reconstruction and also be able to perform a complete prostatectomy. A single surgical oncologist could not be able to effectively train and perform liver resection surgeries and be able to conduct neck dissections alone without the help of other specialists and expert opinion.
Surgical Oncology and the Role of Surgery.
The surgical field of oncology focuses on two different aspects of cancer treatment. Surgical oncologists not only surgically remove cancerous tumors and its surrounding tissue, but these oncologists also help in diagnosing cancer. Surgical oncologists are able to diagnose various cancer types by performing biopsies of an affected area. These biopsies usually consist of a small tissue sample removed from an area suspected to be cancerous and sent off to be tested to help identify what type of cancer is present in the patient.
A surgical oncologist will need to obtain a complete family medical history and a physical examination of the patient prior to any testing or diagnosing can be conducted. Following a medical history and physical exam, a surgical oncologist can begin diagnostic testing and staging studies to further determine the severity of cancer. During these studies and testing, a surgical oncologist will be able to determine if the tumor or cancer can be removed through surgery. This determination is followed-up with a surgical oncologist determining the best way to surgically remove the affected area and making a plan of action to approach the removal.
The surgery itself can involve additional precautionary steps taken by the surgeon to improve the quality of the surgery and obtain better results. One step that surgical oncologists take during surgery when removing the cancer is called a clear margin or a clear excision. A clear margin or clear excision is when a surgical oncologist removes the affected cancerous are in addition to removing the healthy tissues in close proximity. By removing the healthy tissue surrounding the affected area of a tumor the surgeon will reduce the chance for cancer to return to that same area causing what is called a local recurrence.
Other precautionary steps surgeons may take involve the size of the tumor that needs to be removed. There are certain conditions in which the tumor is too large and it is impossible to remove the entire tumor. This is when a surgical oncologist may conduct a surgery known as debulking. Debulking is a surgery in which the surgeon will go in and remove as much of the tumor as possible to alleviate complications the patient is experiencing. Complications for large tumors could involve a combination of symptoms such as bleeding, airway obstruction, and severe pain. Depending on the location and size of the tumor is removed there may be additional steps taken by surgeons to reduce defects.
Following the removal of a large tumor a patient may have a defect as a result that can physically unappealing or have a significant impact on the patient’s ability to function. Surgical oncologists often work closely with plastic surgeons in a combined effort known as oncoplastic surgery. Oncoplastic surgery is a reconstructive method gaining popularity in recent years and the goal of the surgery is to improve the quality of life for the patient following surgery.
There are two ways a patient can decide to have oncoplastic surgery conducted. The first is called an immediate reconstruction that takes place at the same exact time the tumor is removed. A patient may also decide to wait for a few weeks or a month after surgery to have reconstruction done and this is known as a delayed reconstruction. An example of a surgical oncologist working closely with a plastic surgeon would be a surgery for breast cancer. Often times a surgical oncologist will need to remove a breast entirely with a surgery called a mastectomy, but with the aid of a plastic surgeon, an immediate reconstruction surgery can take place. This example of oncoplastic surgery involving immediate reconstruction will not only eliminate cancer within the patient’s breast, but there will be visibly no change in the patient’s appearance.
Following Surgery
Considering surgery is, in fact, the oldest form of treatment for cancer it has become increasingly effective as technology advances in the screening process continue to improve. These advances have already made it possible to cure disease such as cancer just by going into surgery to remove the affected area. Typically following a surgery to remove cancer a patient will need to remain under close observation. These patients may also be required to continue radiology testing or other lab tests to determine how successful the surgery was for each patient. This continuous monitoring will enable oncologists to find early signs of recurring cancer.
References
https://www.essoweb.org/what-is-surgical-oncology/
https://www.oncolink.org/cancer-treatment/surgery/overview/surgical-oncology-the-basics
https://www.cancer.net/navigating-cancer-care/cancer-basics/cancer-care-team/types-oncologists
https://study.com/articles/Become_a_Surgical_Oncologist_Step-by-Step_Career_Guide.html
