Surgical oncology

DEFINITION: Surgical oncologists are doctors who have been trained in general surgery techniques and practices and then completed additional training in surgical techniques specific to cancer treatment. They may perform various diagnostic surgeries, such as removing a lymph node to see if skin cancer has spread, or may perform treatment surgeries, such as the removal of tumors and surrounding cancerous tissues. Surgical oncologists work closely with other allied health professionals to ensure the patient receives the best care.

Subspecialties: Surgical oncologists generally specialize in cancers that occur in certain areas of the body. Some specializations include breast cancer, lung cancer, kidney cancer, skin cancer, gastrointestinal tract cancer, colorectal cancer, and system cancers. Surgical oncologists may also specialize in either patient treatment or research.

Research specialists treat patients, but instead of consulting with patients and doing surgeries most of their time, they spend a significant portion of their time working to develop new and better diagnostic procedures and treatments. Improved procedures aim to improve positive patient outcomes or reduce the side effects typically experienced.

Cancers treated: Nearly all forms of cancer

Training and certification: After medical school, surgical oncologists must complete a five-year residency in surgery. After completing the residency, they must complete a surgical oncology fellowship. These fellowships generally last two to four years and must be completed at one of the schools accredited by the Society of Surgical Oncology. After passing the Complex General Surgical Oncology Qualifying Exam and the Complex General Surgical Oncology Certifying Examination, an individual can become board certified in Complex General Surgical Oncology.

During their training, surgical oncologists generally receive instruction in both commonly accepted, frequently performed surgeries, such as a lumpectomy for breast cancer, and less common procedures, such as cryosurgery, a treatment procedure that involves killing the cancerous cells through freezing them with liquid nitrogen or argon gas, or isolated limb perfusion, a treatment for cancers affecting the limbs that is considered an alternative to amputation in some cases.

Research techniques can also be an essential part of the training received by surgical oncologists. Many are involved in research and developing new procedures and techniques for diagnosis and treatment. The development of new procedures often focuses on techniques to treat rare or unusual forms of cancer or those believed to provide a better outcome or have a lower incidence of side effects. Doctors trained in research techniques can participate in research or be better equipped to recommend clinical trials or experimental procedures to their patients if appropriate.

Services and procedures performed: Surgical oncologists perform many different diagnostic procedures, as well as procedures intended to remove or otherwise treat the cancer. Depending on the location of the cancer, a surgical oncologist may be required to take a sample from the area in which cancer is suspected or some cells from a tumor that is believed to be malignant. For this type of procedure, the surgeon will often insert a small instrument into the patient, guided by X-ray or other images, and remove tissue from the area in question.

An important procedure that surgical oncologists commonly perform is the removal of tumors. During this type of procedure, the surgeon makes the smallest possible to allow access to the tumor and the area around the tumor. Then, the tumor is removed, along with adjoining tissue that is also believed to be cancerous. This type of treatment may be used alone, or it may be used along with other treatment options. Radiation and chemotherapy may be delivered during the surgery when the cancerous area is exposed, and it is possible to apply radiation or chemotherapeutic agents very accurately to the cancerous area.

Surgery can also be performed for reasons that are not directly intended to cure the cancer, such as to reduce the size of the tumor or to remove it from a specific area where it is causing damage. It is not always possible to completely surgically remove a tumor because it may have invaded areas that are necessary for the body to function. In this case, surgery may be performed to remove as much of the tumor as possible, with the hope that radiation therapy or chemotherapy will be able to combat what remains.

A surgical oncologist may also perform palliative surgery. This type of surgery is done when the cancer has metastasized extensively and is not expected to provide a cure. If a tumor is causing the patient pain, some or all of the tumor may be surgically removed to relieve pain and improve the patient’s quality of life.

Related specialties and subspecialties: The surgical oncologist works closely with many different members of the health professions. The surgical oncologist may have a patient referred by a primary physician, gynecologist, dermatologist, or other doctor and will work closely with the referring physician throughout the cancer treatment process. During the process of diagnosis, the surgical oncologist may perform surgery to take a sample from the area where cancer is suspected and send it to a pathologist for evaluation. The pathologist can then determine if cancer is present and if it is, which type of cancer is present. The surgical oncologist will also work closely with nurses, medical technologists, and members of the office or hospital staff.

During cancer treatment, the surgical oncologist will work with various other health professionals depending on the type and extent of the cancer being treated and the treatment option chosen. Nurses and medical technologists will assist the surgical oncologist during surgery by providing various services, such as patient and equipment monitoring. Nurses will prepare the patient for surgery by communicating necessary information and instructions and administering any medications necessary preoperatively. The anesthesiologist is present at surgery to ensure that the patient is fully and safely anesthetized using the minimum level of anesthesia. Depending on the type of treatment, the surgical oncologist may work with additional professionals during surgery. For example, if targeted chemotherapeutic agents are introduced to treat residual cancer cells during surgery, a chemotherapy expert will oversee and administer the chemotherapeutic treatment.

After surgery, another set of healthcare professionals will work with the surgical oncologist. Nurses will provide aftercare for the incision or wound site; administer pain, anti-inflammatory, and other medications; and communicate information to the patient about self-care. Physical or occupational therapists may be necessary to assist patients in recovering skills and mobility lost through surgery. A prosthetist may be required to make a prosthetic for any body part removed during the surgery, and a plastic or reconstructive surgeon may be necessary to repair damage or scarring caused by the surgery or the cancer itself. A psychological counselor or therapist may help the patient with any emotions brought about by the surgery or the cancer itself. The surgical oncologist may also work closely with a case manager, who oversees and organizes the patient’s care and treatment throughout the process.

In the twenty-first century, medicine continues to evolve to better diagnose and treat cancer, and surgical oncologists must stay aware of advances. They can do this in several ways. Professional journals, such as the Journal of Surgical Oncology, allow surgical oncologists to keep abreast of the work of others in their field. Continuing to work collaboratively with cancer healthcare teams and actively participating or reading about ongoing clinical trials is also essential. Finally, attending conferences and maintaining membership in professional organizations allows surgical oncologists to remain at the forefront of cancer treatment. 

Bibliography

Chu, Quyen D., John F. Gibbs, and Gazi B. Zibari, editors. Surgical Oncology: A Practical and Comprehensive Approach. New York: Springer, 2015.

“Complex General Surgical Oncology Certifying Examination.” American Board of Surgery, www.absurgery.org/get-certified/complex-general-surgical-oncology/certifying-exam. Accessed 6 July 2024.

Damron, Timothy A., editor. Oncology and Basic Science. Philadelphia: Lippincott, 2008.

Feig, Barry W., and C. Denise Ching, editors. The M. D. Anderson Surgical Oncology Handbook. 5th ed., Philadelphia: Lippincott, 2012.

Jackman, Julia M., et al. "Updates in Global Oncology: Advancements and Future Directions." Journal of Surgical Oncology, vol. 129, no. 7, 2024, pp. 1374-1383, doi.org/10.1002/jso.27633. Accessed 6 July 2024.

Karakousis, Constantine P. Atlas of Operative Procedures in Surgical Oncology. New York: Springer, 2015.

Lyons, Lyman. Diagnosis and Treatment of Cancer. New York: Chelsea House, 2007.

Sabel, Michael S., Vernon K. Sondak, and Jeffrey J. Sussman, editors. Surgical Foundations: Essentials of Surgical Oncology. Philadelphia: Mosby-Elsevier, 2007.

Stroszczynski, C., editor. Minimally Invasive Tumor Therapies. New York: Springer, 2006.

“Surgical Oncology for the General Surgeon.” The American College of Surgeons, 2 July 2021, www.facs.org/for-medical-professionals/news-publications/news-and-articles/bulletin/2021/07/surgical-oncology-for-the-general-surgeon. Accessed 6 July 2024.

Wrightson, William R., editor. Current Concepts in General Surgery: A Resident Review. Georgetown: Landes Bioscience, 2006.

Organizations and Professional Societies

American Society of Clinical Oncology

, 2318 Mill Road, Suite 800, Alexandria, VA 22314

Society of Surgical Oncology

, 9525 West Bryn Mawr Ave., Suite 870, Rosemont, IL 60018