cancer treatment by specialty

[Gleevec]

I was wondering who treats specific type of cancers. For example, if you have skin cancer, aren't you more likely to go to a dermatologist rather than a heme/onc? Wouldn't someone with Rb go to an opthomologist rather than a heme/onc? Same for someone with a brain tumor (wouldn't they go to a neurosurgeon?)

So I guess my question is, if other specialists treat specific types of cancers, what types of cancers do heme/oncs themselves treat (I would imagine mainly blood cancers, among others?)?

And if I wanted to work on a specific type of cancer, say melanoma or Rb or brain cancers, is it more worth my while to go into derm or opth or neurosurg than into heme/onc?

Thanks for any info!

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[Kalel]

Most metastatic or invasive cancers are treated with a team approach, with the surgeons, rad onc's, and heme onc physicians all meeting in what's usually called a "tumor board" to discuss a plan of action. Sometimes, they even have social workers at these meetings to address the patients social/financial issues.

 

[2ndyear]

That's right about the tumor board, I'll add to it from my experience. At my institution the primary physician typically presents the case as they know the whole pt best and how the disease presented. Typically then the radiologist presents the imaging studies. The pathologist shows slides of any biopsies, needle or surgical. Surgical oncologists (or whatever surgeon operates, ie neuro, etc.) present the operation, results or the plan. Medical heme-onc docs discuss the chemo plan which almost always involves some study protocol and randomization to a group, as well as current studies. Radiation oncologists discuss, well radiaiton mostly. Psychiatrists/psychologists often are present as cancer frequently brings out anxiety/depression sx. Social workers are always present and discuss family and financial issues. Pastoral care is usually involved and comment on the faith and any interventions that they are doing. All of the oncology nurses are always present as well so they can better understand the patients as they probably have the most contact with the patient.

If you are interested in cancer I highly recommend attending some tumor boards. It's great to see physicians and other health care workers working together to care for the patients. It also shows how multi-dimensional cancer care is and how you can be involved on so many different levels depending on the specialty. There is a lot of candid discussion that goes on between docs and planning treatments.

 

[scooter31]

Just adding my two cents--

As far as the CNS side of things are concerned, most of the medonc/neuro onc staff where I work have been trained via a neurology residency and then a one year neuroonc fellowship. I also have seen a couple of people do the IM route, then add on the fellowship afterwards.

As far as your wanting to work with CNS cancers, you will get a lot of patients through either of the disciplines- NSU, RadOnc, or MedOnc. There is also a lot of overlap in the patient populations between them- if you have a GBM, you're going to get surgery, and most likely chemo and XRT following. Other things, like schwannomas, you may get surgery (by NSU or ENT or both), or you may just get some XRT alone, but chemo isnt likely. I guess its just a matter of your personal preference to a residency, and also to the subspecialty you are looking for- if you have a passion for lymphomas, then dont do surgery, that type of thing. But if the eyes have it in your book, then theres always neuroophthalmology.

 

[Gleevec]

Thanks for the respones, they've been very helpful, and the tumor board sounds like a very good idea.

So say Im really interested in a specific type of cancer, like Rb or melanoma. Would that mean I would want to specialize in opth or derm, or heme/onc?

Thanks again!

 

[fourthyear]

Depends on if you're more interested in cutting the cancer out or treating it with chemo or radiation. You take care of the same patient, just in different ways. More likely you'd have a more long-term relationship and see the same patient more frequently if you did the oncology specialty than derm or surgical specialty.

Also depends on how close to death you want to be - surgeons usually see the patient early on and for follow up, but once it's metastatic and no surgery can cure, the patient is kinda passed on to the oncologists, who may continue to try treatments right up till the end almost. Surgeons often have to break the news to patient and family first that the patient has an unressectable cancer, which is tough...but oncologists have to say there is absolutely nothing else to help, no more chemo, rad, anything, you're just going to die.

Personally I think there is a huge need for people who have good communication skills to be able to break any of this news to patients - so regardless of which route you choose, you're filling a great need out there for docs who can build a supportive, informative, relationship with patients and families dealing with cancer.

 

[Kalel]

Originally posted by Gleevec
Thanks for the respones, they've been very helpful, and the tumor board sounds like a very good idea.

So say Im really interested in a specific type of cancer, like Rb or melanoma. Would that mean I would want to specialize in opth or derm, or heme/onc?

Thanks again!

Try not to get caught up in any particular disease early in you medical career (I think that your a first year?), even if you've done research in it in the past (medical research often overlaps between many fields). Even though the pathophysiology might seem fascinating to you right now, treating patients with the disease, whether by surgical, medical or radiological methods, is a very different ball game. It's ok to take an interest in a specialty because you like learning about a particular disease or organ, but try to keep an open mind when you get into your clinical rotations. You really shouldn't even be 100% dead-set on a specialty during your pre-clinical years.