What is an Oncologist?
Table of Contents
Oncology is a branch of science that deals with tumors and cancers. Onco literally means bulk, mass, or tumor, while logy means study. An oncologist, sometimes called a cancer specialist, is a physician or surgeon who specializes in the diagnosis and treatment of cancer, the disease caused by an uncontrolled division of abnormal cells in a part or parts of the body.
The three primary types of cancer physicians are medical oncologists, surgical oncologists, and radiation oncologists. Medical oncologists specialize in the administration of drugs to kill cancer cells. Surgical oncologists, as the name implies, perform surgical procedures to identify and remove cancerous tumors. Radiation oncologists treat cancer with radiation therapy.
In modern cancer therapy, the different kinds of oncologists work together, in collaboration with the larger medical community, including pathologists, oncology and other specialty nurses, and lab technicians.
What does an Oncologist do?
Oncologists treat cancer and provide medical care for people diagnosed with cancer. They accompany their patients from diagnosis through treatment, and through recovery, relapse, remission, or palliative care.
The field of oncology has three major areas: medical, surgical, and radiation.
Medical oncologists treat cancer using chemotherapy or other medications, including targeted therapy and immunotherapy. For many patients, their medical oncologist acts as their primary care physician during cancer treatment. It is often the medical oncologist who coordinates the care and treatment provided by other doctors and specialists. These physicians also manage the symptoms of cancer and the side effects caused by treatments. In cases of incurable cancer, the medical oncologist finds palliative or hospice care for the patient. In short, the primary job of a medical oncologist is managing cancer.
Surgical oncologists are the physicians who diagnose and treat cancer with surgical procedures. Their work includes performing biopsies that allow them to examine removed tissue and determine the presence, cause, or extent of a patient’s cancer.
Radiation oncologists specialize in treating cancer with radiation therapy or the use of high energy x-rays or other particles to kill cancer cells. Planning, also known as mapping, is an integral part of the work of radiation oncologists. It involves using sophisticated software and computers to delineate and accurately target how radiation should be delivered to the patient’s anatomy. Radiation oncology is an increasingly popular specialty. With rising cancer rates and significant advances in medical technology, the field offers extensive opportunities for research and for entry into practice. While radiation oncologists are focused on the use of radiation in cancer treatment, it is important to note that they are oncologists first, and must understand cancer as a disease, its biology, and its patterns of spread.
Other types of oncologists are:
Gynecologic oncologists focus primarily on the care and treatment of women with ovarian, uterine, and cervical cancers. In some cases, they also assume the roles of medical and surgical oncologists, in that they design chemotherapy protocols and perform surgeries to treat these cancers.
Pediatric oncologists specialize in the treatment of children and adolescents (newborns to 18-year-olds) with cancer. The three primary kinds of oncologists – medical, surgical, and radiation – may also be pediatric oncologists, who practise their respective specialties exclusively with pediatric patients. Since some types of cancer – certain brain tumours, acute lymphocytic leukemia, osteosarcoma, and Ewing sarcoma most often occur in children and teenagers, it is not uncommon for adults who contract these cancers to be referred to a pediatric oncologist.
Hematologist-oncologists have completed a fellowship in hematology and oncology and specialize in the diagnosis and treatment of blood-related cancers, such as leukemia, non-Hodgkin lymphoma, Hodgkin lymphoma, and myeloma.
To varying degrees, depending on the specific patient and diagnosis, the oncology specialists described above will play a part in:
- Explaining to the patient the cancer diagnosis and stage; describing where the cancer is located, if or where it has spread, and whether it is affecting other parts of the body
- Discussing all treatment options and recommending the best course of treatment
- Delivering quality and compassionate care
- Helping maintain the patient’s quality of life by managing cancer-related pain and other symptoms and side effects of cancer and cancer treatment, such as constipation, nausea, vomiting, and fatigue
The most effective overall patient treatment is almost invariably the result of collaboration, of combining different types of therapy. Often, a cancer patient will need some combination of surgery, chemotherapy, and radiation. This integrative approach to care is provided by what is called a multidisciplinary team, including a pathologist, who determines the results of tests done on tissue samples; a diagnostic radiologist, who reviews and interprets the results of imaging tests; and an oncology social worker, who helps patients cope with cancer and the challenges that the disease presents.
Oncology teams use various tests to make a cancer diagnosis:
The most important diagnostic tool remains the clinical history of the patient. Oncologists pay particular attention to the symptoms that point towards cancer: fatigue, weight loss, unexplained anemia, fever of unknown origin.
To help locate biological or tumor markers
Removal of tumor tissue to be tested
A non-surgical procedure to examine the gastrointestinal tract
Radiological imaging techniques including:
- CT scan
- MRI scan
Nuclear imaging techniques including:
- Single Photon Emission Computed Tomography (SPECT)
- Positron Emission Tomography (PET)
Many oncologists participate in cancer research. Research is conducted on the biology of cancer cells; differing treatment regimens, including chemotherapy; and optimal palliative care and pain relief. Depending on the specific area of research, the process may involve screening the general population for cancer and, for types of cancer that are thought to be hereditary, screening the relatives of patients. As research and clinical trials progress, therapies and treatments advance, making oncology a continually morphing field.
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What is the workplace of an Oncologist like?
The U.S. Bureau of Labor Statistics (BLS) reports that these are the most common workplaces for oncologists:
- Doctors' offices
- General medical and surgical hospitals
- Federal agencies (National Institutes of Health, Centers for Disease Control and Prevention, etc.)
- Colleges, universities, and professional schools
- Outpatient care centers
Most oncologists start their careers in hospitals and eventually move into private practice. Regardless of their physical workplace, they typically work long hours and are often on call.
While the work is important and rewarding, oncology is one of the most stressful of all medical specialties; and among healthcare professionals, oncologists are at a particularly high risk for burnout. The stress associated with the field stems from the nature of the disease that is being treated. Of course, there are cases that end positively, with a cure or remission, but the fact remains that oncologists must repeatedly give bad news to patients. They witness patients’ severe medical reactions to treatments. They watch patients deteriorate session by session and see their physical suffering. They often have to manage very complicated situations and difficult encounters with angry and distraught patients and families.
Oncologists and pathologists are physicians who are linked by cancer. Oncologists treat the disease. Pathologists diagnose it. The two specialties are connected, yet significantly different.
Pathologists are, in essence, the detectives of the medical field. They spend their days in the lab. They examine body fluids, cells, and tissues to help identify diseases. Although pathologists are instrumental in determining what may be physically wrong with someone, they have little, if any, direct contact with a patient. Oncologists, conversely, spend a great deal of time with patients. Both, however, may be involved in a patient’s care. Pathologists also perform autopsies to figure out why someone died.
Oncologists are cancer specialists who may be medical, surgical, or radiation oncologists, and who may further specialize within the discipline. Pathologists diagnose all medical conditions and diseases, not just cancer. They may specialize in the diagnosis of pediatric or genetic disorders, skin diseases, diseases of the nervous system and skeletal muscles, diseases that affect blood cells; or in transfusion medicine or forensic pathology.
Also relevant for Pathologist
Oncologists face several stressful and/or ethical issues in delivering cancer care. In their day-to-day practice they encounter dilemmas regarding diagnosis, extent of patient information, planning treatment, and follow up. These challenges call for a high degree of sensitivity and respect for both patients’ rights and choices and the laws of non-maleficence (no harm to the patient).
Detection and diagnosis of cancer
There are many screening and diagnostic tests used to detect cancer. False positives – positive results indicating cancer when there is actually no cancer – unnecessarily raise anxiety in patients and their families and may lead to further unnecessary testing and investigation. Advising patients and their families of detection of a genetic risk of cancer is another stressful situation that oncologists may find themselves in.
Extent of patient information
One of the most common responsibilities of an oncologist is presenting the cancer diagnosis to patients. This never gets easy. And while it is generally important that the patient knows everything about what they are facing, it is sometimes in their best interest, at least initially, to be shielded from the extent of spread of the cancer, especially if the physician believes that full disclosure could be detrimental to their emotional state and to their potential healing process. For the oncologist, this is a stressful decision that also has ethical implications.
Some patients may not be willing to undergo specific kinds of treatment, despite their physician’s recommendation. For example, they may refuse chemotherapy, because of its often severe adverse effects of hair loss, nausea, and susceptibility to infections. In such cases, oncologists must strike a balance between respect for a patient’s wishes and autonomy and recommended medical advice.
Inclusion in clinical trials for novel therapies
Cancer clinical trials must involve cancer patients. New medical therapies and strategies, though, have not been proven to be safe and effective for humans. Patients must be made aware of the risks of participating in these trials. Even when a patient accepts these risks, the oncologist often bears the ethical burden of participation.
The use or choice of alternative therapies like homeopathy or herbal treatments may also need to be addressed by oncologists.
Withdrawal from active treatment
When to withdraw treatment is a large ethical issue. In most cases, the decision is made jointly by physician and patient, due to the non-responsiveness of the cancer to therapy. This course of action may lead to an alternative therapy or to palliative care. The process is a difficult one, with both emotional and ethical repercussions.
End of life issues
By their nature, ‘Do Not Resuscitate’ orders and euthanasia come with ethical concerns.
Other ethical issues
Cancer care also involves ethical issues related to a patient’s personal choices, religion, culture, socioeconomic status, and family life.
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