Interested in Surg Onc - Nature of surgeries?

[campti01]

Incoming med student interested in surg (all types appealing at this point) + oncology. Compared to other operations, is it possible to characterize the experience of operating on cancer? Are certain skills/temperaments more important when dealing with cancer? Does it vary widely across specialty (head&neck/gensurg->surgonc/orthoonc/gynonc/nsgy/etc)?

Thanks for your time and perspective.

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[rigid]

"Surgical Oncology" is a sub-specialty within general surgery. Other surgical specialties (neurosurgery, ortho etc) will all operate for cancer within their respective scope of practice.

 

[ACSurgeon]

"Surgical Oncology" is a sub-specialty within general surgery. Other surgical specialties (neurosurgery, ortho etc) will all operate for cancer within their respective scope of practice.

Non general surgeons usually do fellowshops to become academic cancer surgeons ( eg ENT, ortho, gyn Onc and uro). That said, generalists within any field can still do some amount of cancer surgery.

 

[ACSurgeon]

Incoming med student interested in surg (all types appealing at this point) + oncology. Compared to other operations, is it possible to characterize the experience of operating on cancer? Are certain skills/temperaments more important when dealing with cancer? Does it vary widely across specialty (head&neck/gensurg->surgonc/orthoonc/gynonc/nsgy/etc)?

Thanks for your time and perspective.

I'd say you need to adjust your definition of success. Most surgeons chose that field to deliver definitive therapy. A lot of cancer surgery is not truly definitive as by definition, you're not cured from cancer unless you die of something else while in remission. You do a beautiful cancer operation with negative margins, but comes back 1-2 years later. This is why I'll never become a cancer surgeon.

Obviously some cancers are more amenable to "curative" surgery (early stage colon/breast/endocrine cancers for example).

You clearly still provide an essential service for patients, give them the best chance at cure and improved quality of life. **I** would only become a cancer surgeon if I was interested in hardcore academics and interested in researching novel ways of addressing cancer (which I'm not hence my statement above).

 

[Winged Scapula]

I'd say you need to adjust your definition of success. Most surgeons chose that field to deliver definitive therapy. A lot of cancer surgery is not truly definitive as by definition, you're not cured from cancer unless you die of something else while in remission. You do a beautiful cancer operation with negative margins, but comes back 1-2 years later.

This is the most difficult part for me as patients fail to understand this. I spend much of my time trying to convince patients that more aggressive surgery (i.e., a mastectomy) does not saves lives in breast cancer and its heartbreaking/frustrating when they have distant mets and don't understand why.

 

[VisionaryTics]

This is the most difficult part for me as patients fail to understand this. I spend much of my time trying to convince patients that more aggressive surgery (i.e., a mastectomy) does not saves lives in breast cancer and its heartbreaking/frustrating when they have distant mets and don't understand why.

The flip side is all the locoregional failure we see in h&n, where the patient goes from partial glossectomy to hemi to composite with laryngectomy and flaps and wound breakdown from radiation. These guys get put through the ringer. They're a mess (or dead) by the time of distant failure.

 

[rigid]

Non general surgeons usually do fellowshops to become academic cancer surgeons ( eg ENT, ortho, gyn Onc and uro). That said, generalists within any field can still do some amount of cancer surgery.

I think you misunderstood my post, I was just trying to point out to OP that a surgical oncologist wouldn't be doing craniotomies for example

 

[ACSurgeon]

I think you misunderstood my post, I was just trying to point out to OP that a surgical oncologist wouldn't be doing craniotomies for example

I understood your post, just wanted to add clarity for the OP.

 

[dienekes88]

Incoming med student interested in surg (all types appealing at this point) + oncology. Compared to other operations, is it possible to characterize the experience of operating on cancer? Are certain skills/temperaments more important when dealing with cancer? Does it vary widely across specialty (head&neck/gensurg->surgonc/orthoonc/gynonc/nsgy/etc)?

Thanks for your time and perspective.

I thought surgical oncology as a field of general surgery was great! In my limited experience, it was a specialty that was very much focused on resection. There is obviously a reconstructive aspect, because for example... it's just plain mean to leave someone in discontinuity after an esophagectomy if you don't have to do it. I very much enjoy doing the dissection on a VATS lobectomy, but I just like doing valve surgery more.

What about oncology do you like? That's something to think about. As a medical student I actually found the science of immunology and cancer biology to be quite interesting, but then I learned more about the therapeutics (allergy/immunology and oncology) and wasn't so interested anymore.

 

[campti01]

I thought surgical oncology as a field of general surgery was great! In my limited experience, it was a specialty that was very much focused on resection. There is obviously a reconstructive aspect, because for example... it's just plain mean to leave someone in discontinuity after an esophagectomy if you don't have to do it. I very much enjoy doing the dissection on a VATS lobectomy, but I just like doing valve surgery more.

What about oncology do you like? That's something to think about. As a medical student I actually found the science of immunology and cancer biology to be quite interesting, but then I learned more about the therapeutics (allergy/immunology and oncology) and wasn't so interested anymore.

Wasn't aware of the reconstructive aspect of surg onc. That's actually great to hear. I'm drawn to onc because of the conversation in the field around end of life issues , the collaboration between surg, medonc and radonc, the gravity of the diagnosis and what it brings to the relationship with the pt, and the research opportunities.

I know it can be a tough gig emotionally. I think I'd be well equipped for this, but certainly have more observation to do before I can really make that claim.

What was great about your experience with surg onc?
What issues did you have with the therapeutics?

 

[Kahreek]

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[Kahreek]

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[Winged Scapula]

if i was an old lady i would gladly trade my breast for the anoyance of having to attend radiotherapy. But that just me.

(not sure if you're female...)

The breast is a symbol of femininity, youth, beauty, motherhood, nurturing, food, sexual desire, etc. in our society and every woman feels differently about losing it. Even "old ladies" may feel a psychological loss. The assumption that post menopausal or unmarried women do not is paternalistic and accounts for the appallingly low 25% who are offered reconstruction.

Many women may feel the same as you. Many may not. You have to individualize treatment.

They also need to realize that with increasing indications for post mastectomy RT, having a mastectomy is not a guarantee that you won't be offered additional treatment.

 

[Kahreek]

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[Winged Scapula]

i know, dear WS, i know.
I am biased, I just saw a patient with a radiation sarcoma, and i cant even tell what i've felt when she told me she regretted not having had mastectomy done.
These cases are rare, large wound and as deep as parietal pleura.

Ah yes my friend Kahreek. I know as well.

It is difficult to see patients suffering from treatments we render, all in the name of improving OS/LRR rates. I see angiosarc about once a year and its always the same difficult conversation.

 

[ACSurgeon]

if i was an old lady i would gladly trade my breast for the anoyance of having to attend radiotherapy. But that just me.

Not all breast cancer patients are old. Few are really young 20-30s, but many are relatively young 40-50s...

 

[ACSurgeon]

nothing in this life is definitive, why would surgery be?

Many surgical diseases are treated definitively with surgery. Hence the dislike for diseases that are not treated definitively.

 

[dienekes88]

Wasn't aware of the reconstructive aspect of surg onc. That's actually great to hear. I'm drawn to onc because of the conversation in the field around end of life issues , the collaboration between surg, medonc and radonc, the gravity of the diagnosis and what it brings to the relationship with the pt, and the research opportunities.

Well, many fields have to deal with end-of-life issues, e.g. critical care.

Can't argue with research: cancer immunobiology seems to be pretty hot.

Many fields deal with end-of-life. It seems like the surgical oncologists have less of a role in the end-of-life care of cancer patients than the oncologists, though we as surgeons are always attached to those patients on whom we operate. One of the benefits of being a surgical oncologist or thoracic surgeon is getting patients who have resectable disease; those are the patients that you can actually cure, e.g. Stage II NSCLC: surgery + adjuvant chemo.

I know it can be a tough gig emotionally. I think I'd be well equipped for this, but certainly have more observation to do before I can really make that claim.

I would recommend doing some shadowing and going into 3rd year with an open mind. Being well equipped to deal with difficult conversations doesn't mean you should have to deal with them every day.

What was great about your experience with surg onc?
What issues did you have with the therapeutics?

My experience with performing oncologic operations has been enjoyable because I like big whacks. I like the dissection. Most of all, I like the opportunity to offer the patient a chance at a cure.

However, as others have mentioned previously, I hate that you can do a perfect operation, and the patient can still recur. I also don't like most research in oncology. The studies never seem big enough to figure out what you want to know. I am never quite sure how exactly someone came up with the chemo regimen for this trial vs. the other (probably my own fault for not reading enough).

I decided on a different field, because I like sewing, and I enjoy cardiovascular physiology.

 

[rigid]

the appallingly low 25% who are offered reconstruction.

Wow that is really awful

 

[JayDoc06]

Like most "awesome cases"- it is different to be a resident and do a sweet case then rotate off service. It is a whole different thing when they are yours until either they die/move/seek care elsewhere or you die/move/retire. Cancer is physiologically disruptive and recovery is a challenge for all "big whacks". That's not even considering what you all have mentioned, that whole recurrence thing. That is why I did colorectal surgery and not surgical oncology- good balance between big cases, good results both in survival and recurrence, and the ability to employ things like loop ileostomies to minimize risk.