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.