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Therese737

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I want to work with and treat cancer victims and noticed there is hemetology, oncology, and radiation oncology...It's confusing.
What is the difference between what these 3 oncologists do, other than using radiation to treat patents?

If I do not want to be a radiation oncologist, what type of residency would I do?
 

arsenalgunner

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Depends on what you want to treat your patients with...
I did research with medical oncologists & hematologists so I have a good feel for the field. If you prefer to treat with chemotherapy & supportive care-you want to be a medical oncologist, radiation-radiation oncology, surgery-surgical oncology.
The medical oncologists are responsible for treating patients with solid tumors while the hematologist sees those with acute & chronic blood disorders that may or may not be malignant.
I would suggest medical oncology which means you will do your residency in internal medicine followed by a medical oncology fellowship.
Hope this helps.
 

Goofyone

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Originally posted by Therese737
I want to work with and treat cancer victims and noticed there is hemetology, oncology, and radiation oncology...It's confusing.
What is the difference between what these 3 oncologists do, other than using radiation to treat patents?

If I do not want to be a radiation oncologist, what type of residency would I do?

By the way, I think the majority of oncologists train in hematology AND oncology as a combined fellowship; it takes three years instead of two.

You can also do your hem-onc fellowship after a pediatrics residency instead of IM.

I personally think this is one of the most underrated medical specialties today. The $ and the hours aren't terrible at all, and the satisfaction of being able to help people when they need it most could be quite rewarding--if you have the personality for it.
 
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rack

Hi all,

Im just wondering what kind of grades/boards are required to land a residency in oncology, be it medical/surg/radio. In addition to these base requisites, do most applicants suppliment their files with cancer research? I plan on attending a DO school and have been published in Clinical Cancer Research and find oncology to be of interest (although it is way too early to put much faith in any specialty). Is research a requirement for a lot of residencies? Thanks again
 

Pir8DeacDoc

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Medical oncology requires an IM or peds residency. If you pass medical school you can get one of these. Not gonna say it'll be at a big name place, but there are a plethora of opportunities.

Surgical oncology requires general surgery which has become increasingly more competitive in the last few years. Still very doable but more challenging than IM or Peds..

Radiation oncology is extremely competitive because the hours and pay are both very good and there are only a few emergencies that might require you to come in after hours.
 

G'ville Nole

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Also, keep in mind that many, if not most, oncologic surgeries take place outside the purview of surgical oncology. Virtually every surgical specialty (ENT, Neurosurg, Urology, Ortho, OB/GYN) has oncologic training as part of the residency, and many offer fellowships.

A good starting point would be to determine if you are more inclined to do medicine or surgery. If you like medicine, then IM followed by a Med Onc or Heme Onc fellowship would be the way to go. If you like surgery, ALL of the aforementioned residencies include oncologic surgery, but at least you cross IM off your list.

BTW, Rad onc is cool, you should check it out as well.
 

Pir8DeacDoc

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Thanks for reminding me about the other surgical fields!

Sorry I forgot to mention them as there can be a lot of cancer stuff in them as well.
 
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rack

So I guess for a competitive rad onc residency, research is generally expected? As a medical student who has no set aims, how do you know how to spend your M1 summer in terms of research or whatever? I heard taking a year off after M2 for an NIH scientist study thingy is a good idea.
 

3dtp

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rack said:
So I guess for a competitive rad onc residency, research is generally expected? As a medical student who has no set aims, how do you know how to spend your M1 summer in terms of research or whatever? I heard taking a year off after M2 for an NIH scientist study thingy is a good idea.

First, to the OP's question:

Oncology in all of its many forms is a wonderful field, but it is also a field that can be hard. Cancer in some cases can be cured, but it can and often is a very cruel disease as are the treatments.

I'm a rad onc. I wouldn't discount this field. In answering the present post, I think all rad onc programs are competitive. If you are interested, take a walk over to the local rad onc department and meet with one of their residents or attendings to see what opportunities are available. You'll usually find that for a genuinely interested med student there are a wealth of opportunities to be had. There is a lot of work to be done in this field, even though it is one of the oldest of the oncologic specialties. Rad Onc was originally a subset, frequently the orphan child of diagnostic radiology. In more recent years we became our own specialty.

Oncology is first and formost, (or should be) one of the most cooperative interdisciplinary fields in medicine. To be a good oncologist, takes a special mix of knowledge of surgical, radiologic, and medical specialties. As well as a healthy dash of psychiatry, both for the patient and families.

The present pathways to oncology are varied, as the others have suggested. Here are some more specifics:

1. Medical Oncology
This is a subspecialty of internal medicine. You need to complete an IM residency then a 2 year fellowship. Most do a combined hematology/oncology fellowship which gives a bit more knowledge and flexibility. Makes life more challenging and interesting. In medical oncology you will become largely the internist for your patients, treating their disease with chemotherapy, the newer agents such as growth factor receptor inhibitors and vascular growth inhibitors.

Medical oncologists (as do all oncologists) work hand in glove with surgical and radiation oncologists to treat cancer. I seriously considered med onc, but for a variety of reasons, I stuck with rad onc. Medical oncology has a wide variety of new medicines with the relatively recent decoding of the genome and better understanding of cellular mechanisms of proliferation. It is an exciting time in this field, but progress is sometimes agonizingly slow.
For widespread disease, chemotherapy is essential, but radiation and surgery are also used in conjunction to help try to achieve local control or relieve symptoms.

Surgical Oncologists come in a variety of flavors too. Some surgeons specialized in different anatomical areas. I'm not sure what the training requirements are beyond the general surgery, since this has not been a key area of interest. I do know that breast cancer surgeons are specifically trained to recognize sites of dissemination, and how to properly collect pathologic specimens and do appropriate lymph node dissections (surgeons, feel free to bail me out here...) Sometimes I wonder what a general community surgeon was thinking when I get an outside referral, so there is a clear need for specific training of surgical oncology within or in addition to general surgery training.

Gynecologic Oncologists are gynecologists who specialize in treating gynecologic cancers of the female reproductive and peritoneal regions. They (last time I checked) are trained as OB-GYNs followed by a 3 year (which may become a 4 year or maybe already is) fellowship. The 4+3 issue is what steered me to rad onc from gyn onc. I loved delivering babies, even at 2 AM, but the thought of a rather lengthy surgical fellowship made me think twice. If ABOG does lengthen the fellowship to 4 years, it makes it that much more grueling, which is too bad since we need a lot more gyn-oncs. The surgeries are fascinating and technically complex. You will do bowel resections, para-aortic node dissections, hysts, and much much more. You also learn chemotherapy, and more medical oncology techniques. Again, you will work very closely with radiation oncologists since most non-ovarian cancers benefit from radiation therapy.

Radiation Oncologists are trained with a 1 year TY and 4 years of specialty residency. Rad Onc uses radiation to treat cancers, and has been in use for 100 years. These are also exciting times in RT. Prior to the mid '80s we used broad fields to encompass areas where we thought the cancers might be or spread. Then CT based planning was developed and is now standard of care. We can look at the tumors, we know their patterns of spread and can tailor the radiation beams tremendously to treat the cancers to better doses and less toxic doses than before. Rad Onc is a hands on field, you will spend a lot of time with patients, and often (at my institution anyway) the rad onc is the first to have a conversation with a patient about the nature of their illness and how it can be treated.

All of these are very rewarding fields, and regardless of which one you end up in we will be colleagues. Hope this was helpful.
 
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rack

Thanks again for the very detailed response. I'm trying to get a good feel (in theory at least) before med school starts so I can really know what I'm doing and what i should not be doing. If schools dont have a core rotation in oncology during M3, how does one know how much interest it will actually be? THis applies with all fields I guess. I just dont seem to understand the timing of rotations and such as most electives are Fourth year as are residency placement procedures.
 

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rack said:
Thanks again for the very detailed response. I'm trying to get a good feel (in theory at least) before med school starts so I can really know what I'm doing and what i should not be doing. If schools dont have a core rotation in oncology during M3, how does one know how much interest it will actually be? THis applies with all fields I guess. I just dont seem to understand the timing of rotations and such as most electives are Fourth year as are residency placement procedures.
Welcome.

You have just nailed the heart of what is wrong with oncology training. It grew out of the disparate specialties, and now they're contentious. Originally, oncology was mostly a surgical specialty. About 75 years ago, radiologist became "the" oncologists since RT was going to cure everything. It and surgery still work better than anything else, but we can't live without the medical oncologists too. This is why oncology is and should be the most interdisciplinary field there is in medicine.

So, I think we need to change the paradigm on how we do train oncologists. I'm a radiation oncologist. It's my job to know the cancer, know the treatments and use radiation to treat the cancer. Likewise the other specialists have the same goal, but substitute what they use, when in reality, there is so much cross fertilization that needs to be done, that we shouldn't be a separte field. Presently, heme-oncs require internal medicine, gyn-oncs require ob-gyn, surg-oncs require general surgery and rad-oncs require a TY. (or basically anything except pathology). Most of these people get no training in path, which is essential to their practice, little formal training in diagnostic imaging, which is essential to plotting a treatment, and little cross training from their ultimate specialty.

I think the way it should be done is to have an oncology track that would be interdisciplinary. A 3 year residency in oncology, followed by a two year fellowship in the specific are of oncology people are interested in. Maybe an additional year for those in the surgical subspecialties. That way the med onc will know what's involved with surgery, radiation and chemo, and how the various specialties approach the field. The rad-onc, likewise will know these things and so will the surgeons. In reality, this will never happen because the specialty boards will never give up the power they have. But, I can dream!
What I did was on the core rotations, I expressed my strong interest in oncology to each of the rotation coordinators. That put me on the peds-onc unit on inpatient peds, the heme-onc unit on medicine, and when I was on gyne I spent more than half time with the gyne-oncs. I also spent a week of vacation working straight gyne-onc. In my 4th year, I did away rotations in each of the main onc specialties. Our school didn't care that you did four onc rotations, just so you did one each in IM/PEDS/Surg/OB. I managed to hook up with a rural FP who did a lot of hospice and picked up another one that way. My 4th year electives was with a heme-onc, surg-onc, ped-onc, gyne-onc, radiation, hospice. So, I was able to easily tailor what I wanted within the schools variety of specialties requirements. These are not necessarily easy rotations, so they're not for the faint of heart, but I very much enjoyed every single one of them, even when I was dragging my butt out of bed at 5A after being in surgery until 1A. Good luck with your decision.
 
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rack

wow thats some hardcore determination/interest in onc. what you did seems to be a great idea to get a feel for all onc. i guess had a definite idea in your head. for someone who is not so focused on oncology, i suppose it still wouldnt hurt to bring up what your interests are to the rotation directors so that they may at least give you more than average exposure to onc in whatever rotation youre in. cool beans!


who knows, maybe in a decade or two down the road onc will be revamped since cancer research is such a huge boom right now.
 

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Goofyone said:
The $ and the hours aren't terrible at all, and the satisfaction of being able to help people when they need it most could be quite rewarding--if you have the personality for it.

I agree with the second half of this statement. However, medical oncologists (pediatrics and adults) work extremely hard. I worked for a pediatric oncologist (private practice, who ran the hem/onc ward of a private hospital), who was routinely working 12 hours a day 7 days per week, and on top of this was taking home call at night. Granted, his partner had just left the practice for an out of state gig, but that is a tremendous amount of hours being 20 years out of residency. When there were two physicians in the group one person covered hospital one week, while the other did clinic, and then rotated call by the week (one week on, one week off). I thought it was a very rewarding field, and was the main reason why I chose to enter medical school. Keep in mind that fellowships are 3 years long and that there are few (if any) straight hematology or oncology fellowships. Most fellowships require research during training.
 

DarksideAllstar

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3dtp said:
Presently, heme-oncs require internal medicine, gyn-oncs require ob-gyn, surg-oncs require general surgery and rad-oncs require a TY. (or basically anything except pathology). Most of these people get no training in path, which is essential to their practice, little formal training in diagnostic imaging, which is essential to plotting a treatment, and little cross training from their ultimate specialty.

I think the way it should be done is to have an oncology track that would be interdisciplinary. A 3 year residency in oncology, followed by a two year fellowship in the specific are of oncology people are interested in. Maybe an additional year for those in the surgical subspecialties. That way the med onc will know what's involved with surgery, radiation and chemo, and how the various specialties approach the field.

I am in pathology and I find that a lot of the sub-specialists at my institution spend a great deal of time looking at slides with us. The hem-onc guys probably spend the most time of all the subspecialties, usually reviewing peripheral smears and bone marrows. I wouldn't trust them to sign out complex cases, but they are probably just as good if not better at reading a peripheral smear or marrow as a general pathologist who doesn't do a lot of hematopathology. However, its a different story for the solid tumors ( I wouldn't trust any non-pathologist to interpret those).

Regarding "specialized" oncology, there are neuro-oncologists at our institution who see patients with CNS tumors (usually primary). You would definitely have to be at a large academic center in order to see a lot of these types of patients in order to make a practice out of it though.
 
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