By: Ruhi Sahu
What does one call the second leading cause of death in the United States and one of the most feared diseases globally? The dreaded “C” word: cancer.
Oncology is the rapidly evolving branch of medicine that focuses on research, prevention, identification, management, and treatment of cancer. Cancer is the uncontrolled division of abnormal cells that may infiltrate and destroy tissue in the body. As these abnormal cells continue to multiply, they form a mass of tissue known as a tumor. The American Cancer Society has predicted 1.8 million new cancer diagnoses and 606,520 cancer deaths in 2020. Fortunately, survival rates are improving as advances in early detection, treatment, and management continue to emerge.
Who are oncologists?
Oncologists are physicians who work in the field of oncology. Not only do oncologists help patients confront the reality of cancer, but they also specialize in diagnosing and treating cancer. These cancer specialists are the primary health provider for patients to coordinate and manage their treatment. Oncologists' responsibilities include, but are not limited to:
Constantly providing quality patient care and support
Explaining the cancer diagnosis and staging process to patients and their families
Providing an overview of all treatment options, while including their professional recommendation
Assisting their patients with the management of the side effects and symptoms of the disease and treatment
Oncologists generally initiate their careers in hospitals and may eventually move into private practice. However, oncologists can also be seen working at outpatient care centers, professional schools, and federal agencies, such as the CDC or NIH. Regardless of their physical workplace, oncologists tend to work long hours and are on-call often, leaving them at particularly high-risk for burnout.
When to See an Oncologist
An individual may be referred to an oncologist if their primary care physician suspects they have cancer, based on diagnostic test results or other cancer signs. Before meeting with an oncologist, the patient’s medical history is gathered along with any previous tests or scans. During the first appointment with an oncologist, the physician may conduct a physical examination and run additional tests, such as imaging tests, blood tests, or biopsies. Such tests assist in determining the diagnosis, including the type and stage of cancer. Oncologists will explain the condition, introduce the patient’s treatment team, provide an overview of the treatment options available, and closely monitor the disease progression. After administering a treatment plan, oncologists will provide regular follow-up appointments to monitor any issues that may arise related to the cancer or treatment plan.
Branches of Oncology
There are three main branches of oncology: Medical Oncology, Surgical Oncology, and Radiation Oncology.
Medical oncologists specialize in the treatment and management of cancer through nonsurgical methods, such as immunotherapy, chemotherapy, and hormone therapy. Medical oncologists are the primary care physician for cancer patients, and therefore, are the physicians that cancer patients see most frequently. This physician organizes cancer treatment plans and closely monitors patients for any symptoms or side effects they may be experiencing. After patients complete their treatment, medical oncologists provide follow-up appointments. For patients who have incurable cancer, the medical oncologist will seek out a palliative or hospice care option.
Surgical oncologists are surgeons who specialize in diagnosing, treating, and managing cancer. These physicians perform biopsies, which entail extracting a sample of abnormal tissue and examining it for cancer cells. Through biopsies, surgical oncologists can confirm cancer diagnoses and determine the cancer stage. When cancerous cells are detected, surgical oncologists may perform surgery to remove the tumor and neighboring or infected tissue. Surgical oncologists may also analyze imaging tests and laboratory work to recommend treatment options to cancer patients.
Radiation oncologists specialize in treating cancer while utilizing radiation therapy, or the use of high energy X-rays or other energy particles to destroy cancerous cells. Radiation oncologists administer both internal and external radiation therapy to cancer patients. Internal radiation therapy (IRT), also known as brachytherapy, plants radioactive sources inside the patient to kill cancer cells and shrink tumors. The radiation material (iodine, palladium, cesium, or iridium) is confined in a "seed", or a non-radioactive metallic capsule used to prevent the contents from moving to other areas of the body. Through brachytherapy, physicians can use higher doses of radiation to treat a smaller area faster. External radiation therapy, or external beam therapy (EBT), directs high-energy X-ray or electron beams at a tumor from outside of the body. The beams target cancer cells while aiming to spare healthy tissue. Cancer patients may receive radiation therapy on its own or accompanied by another treatment.
In addition to the three main branches of oncology, there are numerous subspecialties. For instance, a pediatric oncologist focuses on treating children and adolescent cancer patients. Hematologist-oncologists specialize in treating blood-related cancers, including leukemia, myeloma, and Hodgkin lymphoma. Gynecologic oncologists treat cancers of the female reproductive system, such as ovarian, uterine, and cervical cancer. Besides the various types of oncologists, cancer teams typically include other healthcare professionals such as pathologists, lab technicians, nurses, and social workers.
Common Tests and Treatment Options
Tumor markers: substances produced by cancer cells or other cells in response to cancer used to help with diagnoses
CT scan: (computerized tomography) combines series of pictures at different angles to create a 3D image of the inside of the body using an X-ray machine
MRI scan: (magnetic resonance imaging) uses a powerful magnet and radio waves to take pictures of the body in slices
PET scan: (positron emission tomography) nuclear scan that creates detailed 3D pictures in areas where glucose is taken up, as cancer cells often take up more glucose than healthy cells
Biopsy: procedure in which a tissue sample is extracted and examined for cancer cells
Chemotherapy: aggressive form of chemical drug therapy that travels throughout the body
Immunotherapy: treatment that uses certain parts of a patient’s immune system to enhance immune response and fight disease
Bone Marrow Transplant: medical procedure that replaces damaged bone marrow with healthy blood-forming stem cells
Education
Like most pathways to becoming a physician, the road to becoming an oncologist is arduous yet rewarding. High school students can pursue an interest in oncology through research, shadowing, volunteering in clinical settings, interacting with healthcare professionals, and completing rigorous coursework in biology, chemistry, anatomy, physiology, physics, psychology, sociology, statistics, and calculus. To become an oncologist, one must obtain a four-year bachelor’s degree. During undergraduate studies, individuals should focus on completing prerequisites, pursuing extracurricular activities, maintaining a high grade point average, performing well on the Medical College Admission Test (MCAT), and applying to medical school. Once accepted, students undergo four years of training at an accredited allopathic (M.D.) or osteopathic (D.O.) school. Generally, medical students will spend their first two years in the classroom and the last two years in various medical facilities completing clinical rotations. Throughout the process, students must pass their licensing exams. Allopathic medical students must pass the United States Medical Licensing Examination (USMLE), and osteopathic medical students must pass the Comprehensive Osteopathic Medical Licensing Examination (COMLEX). After medical school, students matriculate into residency programs, or professional training in a hospital or clinic. Future oncologists typically undergo a residency in internal medicine or general surgery, however, this can vary depending on the type of oncologist. Once residency is completed, individuals pursue a fellowship in a chosen oncology subfield, obtain their state license, and become board certified.
Why oncology?
Despite being one of the most stressful medical specialties, oncology remains an exceptional field of medicine to immerse yourself in. Within oncology, patients and families allow oncologists into the most intimate aspects of their lives. Oncology is a rapidly growing field, and new advances have led oncologists to cure patients and help them achieve long-term remission better than ever before. Working in oncology allows for the development of long-term doctor-patient relationships, as physicians care for patients when they are most vulnerable. Although there is still a long way to go within oncology, this unique specialty is constantly growing in a direction towards ground-breaking technology and personalized care.
Sources
www.cancer.net/navigating-cancer-care/cancer-basics/cancer-care-team/types-oncologists
opmed.doximity.com/articles/why-oncology-is-an-intimate-field-d0cf0ce3-287a-46c7-8158-b2776ae4c65c
www.uchealth.org/today/what-does-it-take-to-become-an-oncologist/
www.cdc.gov/chronicdisease/resources/publications/factsheets/cancer.htm