Chapter 01: Surgical Oncology as a Specialty
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Description
In this Chapter, Dr. Pollock explains that Surgical Oncology is both a technical discipline (that uses surgical techniques to intervene in cancer) and also a cognitive discipline that requires knowledge of 1) the etiologies of different cancers and 2) the therapies that other disciplines can offer a patient. He summarizes: a surgeon knows how to operate on a cancer, whereas a surgical oncologist knows when it is best to operate. Surgical Oncologists serve in a consultative role with general surgeons, and Dr. Pollock also lists other specialties that partner with surgical oncologists. He summarizes the training the specialty requires and notes that Surgical Oncology was only recognized as a Board-Certified Specialty during this past year. He describes why it took so long for the field to be recognized and says that the field will now be more attractive to bright young surgeons.
Identifier
PollokRE_01_20121008-C01
Publication Date
10-8-2012
Publisher
The Making Cancer History® Voices Oral History Collection, The University of Texas MD Anderson Cancer Center
City
Houston, Texas
Interview Session
Raphael Pollock, MD, Oral History Interview, October 08, 2012
Topics Covered
The Interview Subject's Story - OverviewOverview Definitions, Explanations, Translations The Researcher The Clinician On Research and Researchers Understanding Cancer, the History of Science, Cancer Research The History of Health Care, Patient Care
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.
Disciplines
History of Science, Technology, and Medicine | Oncology | Oral History
Transcript
Tacey Ann Rosolowski, PhD:
I’m Tacey Ann Rosolowski interviewing Dr. Raphael Pollock. Am I pronouncing—?
Raphael Pollock, MD:
Raphael.
Tacey Ann Rosolowski, PhD:
Raphael, okay.
Raphael Pollock, MD:
I just go by Raphe.
Tacey Ann Rosolowski, PhD:
Raphe, okay. Dr. Raphael Pollock at the University of Texas MD Anderson Cancer Center in Houston, Texas. This interview is being conducted for the Making Cancer History Voices Oral History Project run by the Historical Resources Center at MD Anderson. Dr. Pollock came to MD Anderson in 1982 as a fellow in surgery. He became an assistant professor in 1985. He is now a professor in the Department of Surgical Oncology with other appointments in Molecular and Cellular Oncology and the Department of Surgery. He is also a distinguished member of the University of Texas Health Science Center and holds the Senator A.M. Aiken Jr. Distinguished Chair. Let me just pause for a moment. Until very recently, he was head of the Division of Surgery, a role he served from 1997. This interview is taking place in the Department of Surgical Oncology in Pickens Academic Tower on the main campus of MD Anderson. This is our first of two planned interview sessions. Today is October 8, 2012, and the time is 10:04. So, thank you, Dr. Pollock, for giving your time to this project.
Raphael Pollock, MD:
My pleasure.
Tacey Ann Rosolowski, PhD:
I really appreciate it. I want to start with a very general question about your specialty, which is surgical oncology. I wonder if you could give a brief overview of what that is, because I suspect, from some of the reading that I’ve done, that it’s quite a different spin on the surgical role of physicians in the management of cancer and since surgeons began as individuals who operated very radically on cancer in the beginning of cancer treatment history. So if you could tell me what surgical oncology is?
Raphael Pollock, MD:
Sure. Well, I think you’ve hit on the apt discriminator—the difference between cancer surgery and cancer surgeons and surgical oncology and surgical oncologists. So the way that I think of this is that a cancer surgeon is a surgeon who is trained to separate tumors from patients, whereas a surgical oncologist is an oncologist who uses surgery as the treating modality. So a surgical oncologist therefore has a much broader mandate than a cancer surgeon because not only does the surgical oncologist need to have the technical skills and training to be able to perform tumor removal procedures, but the surgical oncologist also has an understanding of the natural history of solid tumors and their patterns of progression, the availability and indications for non-surgical therapies, and so the surgical oncologist is able to time the surgical intervention to the broader knowledge of oncology that he or she possesses. One way of thinking of this, and this is not an original thought, is that a cancer surgeon knows how to do a mastectomy. A surgical oncologist knows when to do a mastectomy. It points to the fact that surgical oncology is at heart a cognitive as well as technical discipline and that’s very different from cancer surgery. Most good general surgery residency programs will expose a trainee—a general surgery resident—to cancer surgery and how to perform the common cancer surgery operations, but a surgical oncology fellowship takes it several steps further by exposing the trainee to medical oncology, radiation oncology, preventive oncology, laboratory-based research in contemporary translational oncology, and these types of interactive cognitive activities that make for a much broader basis upon which to function in the fight against cancer. Interestingly, surgical oncology, only this past year, has been recognized as a board-certifiable medical specialty, and work is underway to make the board certification mechanism come to life, which will probably happen sometime in 2013 or 2014. It’s been about a thirty-year evolution.
Tacey Ann Rosolowski, PhD:
Why did it take so long, and what was that—?
Raphael Pollock, MD:
About thirty-five percent of what most general surgeons do in their practice is cancer surgery, and so there have been concerns all along that if surgical oncology became a board-certified specialty this would somehow detract from the cancer surgery component of what general surgeons do. But the reality which the American Board of Surgery came to understand is that there will most likely be no more than forty-sixty finishing surgical oncologists on an annual basis—that compares to more than 1000 general surgeons being trained annually—and that our role will be much more to serve as a consultative service—given the cognitive background that we have—a consultative service to general surgeons. And also to focus in certain types of solid tumors that general surgeons simply don’t have the breadth and depth of exposure to in their training or their practice.
Tacey Ann Rosolowski, PhD:
What’s the implication for the field of surgical oncology, now having board certification?
Raphael Pollock, MD:
Oh, I think it will be that much more attractive to bright, young surgeons finishing general surgery training because now there will be a mechanism by which their additional experience, learning, and accomplishments can be recognized in a manner that the general public will be able to embrace and understand.
Tacey Ann Rosolowski, PhD:
And you said that it’s been about a thirty-year process for the field to coalesce in this way. Is that slow? Is that fast? I don’t know how to contextualize that.
Raphael Pollock, MD:
I think most of us in surgical oncology would say that’s distressingly slow, and perhaps people in the general surgery community would say this is still distressingly fast. So I guess it just depends. Beauty is in the eye of the beholder.
Tacey Ann Rosolowski, PhD:
And it seems as though the growth of the field relies so much on inner connections with different specialties that perhaps—I’m wondering if there were administrative dimensions to that. (phone ringing; phone conversation)
Tacey Ann Rosolowski, PhD:
We had to pause the recorder for just a second. I was wondering if part of that evolutionary process was figuring out how to construct a team with the surgical oncologists serving that role as sort of a consultant.
Raphael Pollock, MD:
Consultant—depending on the specific tumor situation—consultant, team leader, coordinator, but all of these are facilitating functions that are triggered by a corpus of cognitive information.
Recommended Citation
Pollock, Raphael E. MD and Rosolowski, Tacey A. PhD, "Chapter 01: Surgical Oncology as a Specialty" (2012). Interview Chapters. 1313.
https://openworks.mdanderson.org/mchv_interviewchapters/1313
Conditions Governing Access
Open
