Surgical Oncologist vs Medical Oncologist: Which Do You Need?

What does a surgical oncologist do?

A surgical oncologist removes cancer by operation. That is the short answer, and it is the one most patients need first.

Their work starts before the operation. A cancer surgeon reads the scan, the endoscopy and the biopsy report, examines you, and decides whether the tumour can be removed completely and safely. If it can, they plan which operation, by which approach, and what else must be removed with it, such as the nearby lymph nodes. If it cannot be removed yet, they say so plainly, and the plan turns to treatment that may shrink it first.

After the operation, the surgeon reads the final biopsy report of what was removed. That report often decides whether more treatment is needed. The surgeon then hands over to, or works alongside, the medical oncologist.

Most cancer surgeons work on one region of the body. Dr Harsh Shah operates on cancers of the digestive system: the food pipe, stomach, colon, rectum, liver, pancreas, gallbladder and the lining of the abdomen.

What does a medical oncologist do?

A medical oncologist treats cancer with medicines. These include chemotherapy, targeted therapy and immunotherapy.

They often give treatment before an operation to shrink a tumour, or after it to lower the chance of the cancer coming back. When a cancer has spread to several organs, medicines are usually the main treatment, and the medical oncologist leads the care. They also look after side effects and the long follow-up that comes with these medicines.

And the radiation oncologist?

A radiation oncologist treats cancer with carefully aimed radiation. For some cancers of the digestive system, radiation is combined with chemotherapy before the operation. For others it is not needed at all. Your surgeon will tell you if you need to meet one.

Which one should you see first?

See a cancer surgeon first if a report shows a growth in an organ and nobody has yet told you whether it can be removed.

• See a cancer surgeon first if a scan, endoscopy or colonoscopy shows a growth, mass or tumour in the food pipe, stomach, bowel, liver, pancreas or gallbladder.
• See a medical oncologist first if you have been told the cancer has spread to several organs, or a blood cancer is suspected.
• Not sure? Either one can see you. Each refers to the other when needed, so starting with one does not close any door.

Why does the order of treatment matter?

Because for some cancers the operation comes first, and for others it should not. The order depends on the organ, the stage of the cancer and your general health.

In food pipe, stomach and rectal cancer, chemotherapy or chemoradiation is often given before the operation, so the tumour is smaller and easier to remove completely. In many colon cancers the operation comes first. In pancreatic cancer, chemotherapy after the operation is common. These are general patterns, not rules for your case. The order for you is decided after your reports are reviewed together by the specialists, not by one doctor alone.

This is why it helps to meet a cancer surgeon early, even when the first treatment turns out to be medicines. The surgeon can then judge, at the right time, whether the tumour has become removable.

Surgical, medical and radiation oncologist compared

What Dr Harsh Shah does

Dr Harsh Shah is a surgical oncologist for cancers of the digestive system. He sees patients at his Gota OPD in Ahmedabad and operates at Apollo Hospital, Bhat, Gandhinagar. When chemotherapy or radiation is needed, before or after the operation, he plans it with the medical and radiation oncologists. Read more about him on the surgical oncologist (cancer surgeon) in Ahmedabad page.

Other cancer surgeons in the same practice: Dr Swati Shah, MS, DrNB (Surgical Oncology), for kidney, bladder, prostate and testis cancers, for cancers of the uterus, ovary and cervix, and for hysterectomy; and Dr Swapnil Sharma, MS, FMAS, DrNB (Surgical Oncology), for breast cancer surgery.

Can I ask for a second opinion?

Yes. A second opinion from a cancer surgeon is reasonable before any major operation, and before you decide that an operation is not possible. Bring the plan you were given, with every report and scan. Often a second opinion confirms the plan you already have, and that is a useful answer in itself.