Who is a surgical oncologist?
What is the need for this branch??
Surgery is a key component of cancer care and 80% of cancer patients will require some form of surgical intervention during the course of their disease. It is estimated that by the year 2030, 45 million surgical procedures will be required. Despite the increasing incidence of cancer and need for surgery, only 25% patients receive safe, affordable and high quality surgery.
Additionally, in some less-developed regions of the world, surgery may be the only viable treatment option for several reasons.
The Origin of surgical oncology was routed to two famous personalities Dr Ewings and Dr Murray Copeland. Dr Ewing was a trained pathologist who had a surgical internship and early on experimented with immunotherapy, chemotherapy, and radium. Dr. Murray Copeland completed a medical internship and surgical pathology fellowship, then took a full surgical residency at the Union Memorial Hospital in Baltimore, Maryland. In the origin of surgical oncology, the roots are in the total care of the patient, meaning surgery, pathology, radiation therapy, and chemotherapy. As each of these components of cancer treatment expanded and took on a more specific definition, the components became a discipline within themselves, and we as surgeons relied on our colleagues in these disciplines to provide their respective expertise to our patients. The surgeon remained, however, the “primary care doctor” for the patients with a resectable solid malignant neoplasm and coordinated their care.
Surgical oncologists are surgeons who devote most of their time to the study and treatment of malignant neoplastic disease. Surgical oncology is more of a cognitive than a technical surgical specialty. Most of the surgeries that are performed by surgical oncologists are similar to those performed by a surgeon not oncologically trained (leave alone adequate nodal dissection and margins). What frequently differentiates these two types of surgeons is not merely knowledge about how to do a specific operation, but an awareness of how and when to do that operation; that is, the cognitive knowledge of contemporary multimodality cancer care.
As part of the larger surgical community, the surgical oncologist is a critical conduit of cancer information to colleagues in general surgery and other surgical specialties.
Surgery operates by zero-order kinetics, in which 100% of excised cells are killed. In contrast, chemotherapy and radiation therapy operate by first-order kinetics, and only a fraction of tumor cells are killed by each treatment. These zero- and first-order processes are complementary. Surgical resection reduces the tumor burden, which hopefully increases the efficacy of nonsurgical adjuvant therapies intended to eliminate microscopic residual disease, thereby decreasing the risk of recurrence. It may appear logical that surgery and surgical oncologists have little role in disease management once a neoplasm has spread from the primary location to a distant site. However, with the evidence from oligometastatic disease and conversion surgery, prolonged survival is possible following the surgical resection of some metastases in the lung, liver, or brain.
Some have a common misperception that surgical oncology is an ill-defined specialty because of lack of system/organ focus. How can a thyroid cancer and uterine cancer be treated by a same person?
Let us understand, the concept of surgical oncology revolves on “Comprehensive Cancer Care”. With due respect to other specialties, most often when the cancer invade other organs/system, they are often deemed unresectable and sent for palliative care, though they are clearly operable/ curable with good oncological outcome. The surgical oncology specialty was established to bridge this particular gap and consider cancer as a single entity beyond organs & system and consider treating it as whole.
A surgical oncologist is a broad-based surgeon and an oncologist in a global sense. Surgical oncologists often perform en bloc resection of tumor with possible extensions, which goes beyond a single organ/system. Multi visceral resections are common procedures in advanced cancers, which mandates anatomical clarity and oncological awareness beyond systems. On the other hand, he or she must know when to apply more conservative surgery where appropriate and safe as a cancer operation, especially when it preserves function, reduces morbidity, or is less disfiguring than more radical surgery.
The most important reason for surgical oncology specialization is the evidence from multiple studies that “high volume” cancer centers and cancer surgical specialists have better outcomes for treating complex or advanced cancers. The surgical oncologist has the important responsibility of coordinating multidisciplinary cancer care. To do this, the surgeon must fully understand the indications, risks, and benefits of using adjuvant chemotherapy, hormone therapy, and radiotherapy, especially when there is demonstrable benefit from prospective clinical trials.
FUTURE OF SURGICAL ONCOLOGY: Surgical oncology is one of the major growth areas in most surgical specialties. Surgical oncologists of the next decade must be knowledgeable about basic science, especially as it relates to molecular and cellular processes. Powerful new tools and techniques will allow us to understand this complex and diverse disease at a much more fundamental level. This, in time, will lead to more precise staging of patients and better cancer care delivery.
In simple words,
Surgical oncologist is
Not a surgeon who operates on cancer patients
But an oncologist who knows to perform surgery.
