Surgical Oncology

Discussion in 'Surgery and Surgical Subspecialties' started by The Hulk, Dec 1, 2002.

  1. The Hulk

    The Hulk Official Green Monster
    7+ Year Member

    Sep 19, 2002
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    Any thoughts on absolute availability and relative difficulty in getting fellowship? On roles of surgery versus radiation and chemotherapy?
  2. jargon124

    jargon124 Senior Member
    10+ Year Member

    Oct 2, 2001
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    Since no one responded I'll offer my 2 cents worth. I'm just a first-year med student but I've been interested in oncology (medical, surgical, and radiation) and have been learning lots about it lately. Surgical oncology is one of the more competetive fellowships after a GS residency. It is less competetive than Plastics for sure but perhaps more difficult to get into than others such as cardiothoracic, vascular, etc. I don't think there are that many fellowships offered per year so that plays into it I'm sure.

    As for the role of surgery in treatment of cancer: The general consesus of docs I've talked to (when you get past their bias for their own specialty) seems to be that many types of cancer will continue to require a multidisciplinary approach. That is to say that medical, surgical, and radiation oncologists should all have significant roles to play.

    I do have a question about surgical oncology myself - Given that nearly every surgical subspecialty has an "oncology" branch associated with it (examples: head and neck oncology/otolaryngology, neurosurgical oncology/neurosurg, musculoskeletal oncology/orthopedics, urologic oncology/urology, gynecologic oncology/OBGYN, colorectal surgery, etc.) - given this great degree of subspecialization, what is the role of the surgical oncologist? Do they resect all sorts of tumors or are they restricted mainly to areas not covered by specialties listed above? If you take those areas away you're not left with much - lung, stomach, pancreas come to mind...Is this the scope of a surgical oncologists practice or does the fellowship training allow them to take on cases that might otherwise go to the subspecialists?
  3. droliver

    Moderator Emeritus Verified Expert 10+ Year Member

    May 1, 2001
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    Attending Physician
    One's practice as a general surgery trained oncologist can vary widely depending upon 1) your interests, 2) your referal pattern, & 3) your partners specialties.
    For instance:
    We have 6 active surgical oncologists @ our institution & their practices are
    - three who do melanoma, misc. skin cancers, breast, pancreas, liver, stomach, esophageal, soft tissue sarcomas, and the ocassional colon and renal CA
    - one does exclusively head & neck (thyroid, parathyroid, upper airway, tonsilar, pharyngeal/laryngeal, squamous cell)
    - one does endocrine tumors + broad based general surgery
    - one (our 66 yo chairman) used to do everything but now does mostly melanoma
    - one who just left to take the chairman's job @ Arkansas used to do eerything but now does only breast CA
    - one who is retiring who did lots of hepatobiliary, colon CA, and photodynamic therapy for esophageal CA. He also did a fair amount of ERCP work & ran a very busy diabetic foot clinic

    As you can see, a lot of variability within the same practice group

    In an academic setting, the relative strengths of other divsions of general surgery or other departments may dictate what you're able to do. A strong thoracic surgery or colorectal division may limit your access to esophageal & general thoracic cancers or colon cancers respectively. In private settings, most general surgeons do not feel that colon, breast, melanoma, and thyroid/parathyroid cancers are beyond their expertise & do not refer them to tertiary centers or subspecialists routinely. Comfort level with certain procedures may dictate referrals for esophageal,hepatobilliary, sarcomas, and ano-rectal carcinomas for which the surgeries tend to be more complex & less frequently done in routine practice.

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