Surgical oncology is the branch of surgery applied to oncology; it focuses on the surgical management of tumors, especially cancerous tumors.

As one of several modalities in the management of cancer, the specialty of surgical oncology, before modern medicine the only cancer treatment with a chance of success, has evolved in steps similar to medical oncology (pharmacotherapy for cancer), which grew out of hematology, and radiation oncology, which grew out ofradiology. The Ewing Society known today as the Society of Surgical Oncology was started by surgeons interested in promoting the field of oncology. Though it has not been ratified by a specialty Board certification, the area of expertise is coming to its own by the success of combined treatment with chemotherapy, radiotherapy, and targeted biologic treatments. The proliferation of cancer centers will continue to popularize the field, as will developments in minimally invasive techniques, palliative surgery, and neo-adjuvant treatments.

Historically, surgery was the only treatment for cancer with pioneering surgeons pushing the boundaries of knowledge down through the millenia . Only in the last century have non surgical means provided an adjunct or more rarely, an alternative to surgery . Despite the advances in medical and radiation oncology, surgery is still the only modality with the potential to cure most solid cancers. Surgeons have a pivotal role in cancer treatments and research, leading the diagnostic and treatment pathways for most cancers from counselling patients about their diagnosis through to surgery and aftercare. They have also led many of the great advances in cancer research.

However, cancer care has evolved very rapidly over the last few decades and therefore a new type of surgeon is needed to keep pace with these changes. No longer is surgery alone the only treatment for most solid malignancies but a combination of surgery and multi-modal therapies (with highly focussed radiotherapy, targeted molecular therapies and poly-chemotherapy) becoming the modern standard of care.

As a result, the surgeon, who 40 years ago would often be the only specialist to have contact with most cancer patients, can no longer work in isolation but must lead a multi-disciplinary team. They must be more than just a technician and must understand the biology and natural history of the disease as well as the contributions made by other disciplines to the cancer patients’ treatment. It is at this point that the surgeon becomes a surgical oncologist.

The technical side of surgery has also been transformed in the past few decades with advances including:

• Minimally invasive cancer surgery, (laparoscopic , Natural Orifice Transluminal Endoscopic Surgery (NOTES5), Transanal Endoscopic Microsurgery (TEMS )
• Improved understanding of  surgical margins (the TME in rectal cancer for example )
• Sentinel node biopsy 
• Robotic surgery,
• Intraoperative chemotherapy and radiation therapy (limb perfusion, HIPEC, IORT)
• Reconstructive surgery (breast oncoplastics, head and neck surgery, bladder replacement techniques),
• Enhanced recovery programmes.
  

SURGICAL ONCOLOGY