Surgical oncologist

Thanks to new developments by scientists and physicians in the field of cancer diagnosis and treatment, the survival rates of cancer patients in Russia and around the world have been significantly improving in recent years. However, the American Cancer Society predicted ^[1]that about 2020 million new cases of cancer will be detected in 1,8. In Russia, more than 600 people are diagnosed with cancer every year, and more than 4 million are registered in oncology dispensaries. On the difficult path of fighting cancer, patients usually collaborate with a team of doctors, including oncologists, psychologists, nutritionists, and others.

Oncologists

Oncologists are doctors who specialize in diagnosing and treating cancer. Among them there are three main specializations:

• oncologists-chemotherapists;
• oncologists-surgeons;
• radiation oncologists who perform radiation therapy.

Today we will talk more about one of them.

Who is an oncologist?

An oncological surgeon may be one of the first doctors a patient sees with suspected cancer. It is this doctor who most often performs a biopsy: removes a small area of ​​tissue for further cytological examination.

Further, if the fears are confirmed, the patient will have to turn to the oncologist again, this time for a consultation about the possible removal of the tumor. The same specialist will help you recover after the operation. Thus, the surgical oncologist accompanies the patient at every stage of the fight against cancer. The task of an oncologist surgeon is not only to remove the tumor, but also to help solve the patient’s problem in a comprehensive manner in cooperation with doctors of other profiles.

A bit of history

Historically, surgery has been the only treatment for cancer, and pioneering surgeons have pushed the boundaries of their knowledge and searched for new ways to help patients for decades. It was only in the last century that non-surgical methods began to be used as an adjunct or, less often, an alternative to surgery. Over the past few decades, cancer treatment techniques have been greatly improved, and a new surgical specialty has emerged. Now surgery is no longer the only treatment for most malignant neoplasms, and the combination of surgery and other treatments (with radiation, targeted, immuno- and polychemotherapy) is becoming the modern standard of care.

As a result, the surgeon, who 40 years ago was often the only specialist in contact with the majority of cancer patients, can no longer work alone. He is now part of a multidisciplinary team. The doctor must now not only have technical skills, but also understand the etymology and history of the disease, as well as evaluate the intended effect of other treatments. It is at this point that the surgeon becomes a surgical oncologist. His work includes collaborations with doctors such as:

• oncologist-chemotherapist – for the appointment of neoadjuvant or adjuvant chemotherapy. The first type is performed before surgery to slow down the growth of the tumor or reduce its volume, the second – after, to reduce the risk of recurrence;
• radiologist – for planning an operation or optimizing resection margins, as well as prescribing neoadjuvant or adjuvant radiation therapy;
• pathologist – a doctor who makes a diagnosis by studying abnormal cells;
• geneticist – to select the optimal strategy for treatment, prevention and screening, taking into account hereditary characteristics.

The technical side of surgery has also changed over the past few decades. In addition to the standard surgical intervention, the oncologist surgeon today performs many related procedures that affect the positive outcome of the treatment. This was made possible thanks to:

• advances in minimally invasive cancer surgery (laparoscopy, transluminal endoscopic surgery, transanal endoscopic microsurgery);
• the emergence of technology for taking a biopsy of the sentinel lymph node in skin melanoma;
• robotic surgery;
• intraoperative chemotherapy and radiation therapy: limb perfusion (method of supplying and passing blood, blood-substituting solutions and biologically active substances through the vascular system of organs and tissues), HIPEC (hot chemotherapy), IORT (radiation therapy method);
• reconstructive surgery (breast oncoplasty, head and neck surgery, bladder replacement methods);
• advanced recovery programs.

Versatility

It is important to understand that no surgeon can perform the full range of oncological procedures, from liver resection to breast reconstruction or radical prostatectomy.

Each surgical oncologist has several additional and related specializations. This can be either the treatment of a specific organ or system, such as mammology, urology or gynecology, or a specific type of surgical intervention, such as endovascular surgery.

Some procedures should be carried out only in highly specialized centers. This applies to cytoreductive surgery with HIPEC, sarcoma surgery, isolated limb perfusion, liver resection, laparoscopic cancer surgery, and others. Knowledge of these and more complex procedures is available to every cancer surgeon, but sufficient experience and practice is required to apply them.

Oncology is one of the fastest growing areas of medicine, which is why continuous professional development and continuous education throughout a career is so important for an oncological surgeon.

Three things a surgical oncologist would like to say to patients

1. Don’t blame yourself

Most cancer patients ask the same question: “Why exactly did I get sick? What is my fault?” Remember that in many cases the illness is not the fault of the patient. Yes, certain genetic traits, an unhealthy lifestyle, bad habits and a few viruses increase the likelihood of getting cancer, but most often the development of a malignant tumor is the result of an unfortunate set of circumstances.

2. Don’t be afraid to get a second opinion.

Sometimes it’s important to take a different look at your treatment plan. Your doctor should encourage this and be open to discussion, compromise, and change. A team of specialists working with the patient on the path to the fight against cancer are his assistants and allies, united by one goal: to achieve the maximum effect of the treatment.

3. Ask questions

Ask your doctor what results to expect from the tests, how they measure success, what predictions are expected, whether the tumor will go away, if not, how much it will shrink and how quickly. Don’t be afraid to ask uncomfortable questions. When the patient is aware of his chances and prospects from the very beginning, it is easier for him to cooperate with the doctor and follow the recommendations.

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