Surgical oncology - definition

Surgical oncology has been defined by ESSO as the part of surgery that covers the treatment of solid tumors of the oro-eosophago-gastrointestinal tract, of parenchymal and endocrine organs and of skin, mesenchymal, neurogenic, bone and soft tissues. Surgical oncology also includes prevention, genetic counselling, specific diagnostic and staging procedures, rehabilitation and follow up care. Surgical oncology is focused on multimodality therapy.

Surgical oncology - examination

An international qualification in surgical oncology is present. In the Union Européenne des Médecins Spécialistes (UEMS) the surgical section, European Board of Surgery, has recognized different surgical subspecialities, among them surgical oncology. Examinations and assessments for qualification have been developed to a European Board of Surgery Qualification (EBSQ). The examination takes place at the annual ESSO or ECCO conference.

Surgical oncology – training

The number of patients diagnosed with cancer increases for each year in Europe and the role for surgeons to diagnose and treat these patients is central. The subspecialisation within general surgery has important consequenses for the training and qualification of surgical oncology specialists. Not only individuals exclusively working with surgical oncology in a cancer center will benefit from a surgical oncology qualification, but also surgeons who go through a training program in general surgery, if they have spent a certain period in a multidisciplinary cancer setting, including some time in medical oncology and radiation therapy.

Problems

EU works on opening up the borders of higher education and labour but so far national requirements prevent much of this. One reason is the lack of adequate language skills. Another barrier is the variable level of work qualification, which is also true for surgical oncology. The integration is not made easier by the fact that most european countries do not recognize surgical oncology as a surgical subspeciality. An UEMS-EBSQ examination is not recognized throughout Europe. The consequence is that there are few countries with specified requirements what is needed for a surgeon to be qualified in surgical oncology. Because surgical oncology has a multidisciplinary approach to cancer care the requirements set by surgical oncologists does not always equal those set by an organ-based society or by national surgery societies.

For an adequate education in surgical oncology a surgeon must work in a multidisciplinary environment where interactivity between surgeons, medical oncologists, radiotherapists, radiologists, pathologists and basic scientists are present. State of the art cancer care also includes the use of modern, advanced and expensive equipment. Taken together there are difficulties for many surgeons to get an appropriate education in surgical oncology without attending other hospitals.

From av teaching providers view there are many cancer centers and surgical departments within Europe that provide good cancer care but we have so far not defined any common criteria to become a teaching unit in surgical oncology. Furthermore, we do not have a system for validation and accreditation of their teaching capability.

Consequenses

There is a need for a common core curriculum in surgical oncology in Europe. A core will provide criteria for the individual who wants to become a specialist in surgical oncology as well as for the teaching unit. Many surgeons with surgical oncology as subspeciality most likely already fulfill the requirements in a common core curriculum. It is not for those that a core curriculum is needed but it would make it easier for young surgeons to plan their postgraduate education, where to work and where to make shorter or longer visits.

Secondly it would facilitate the work by ESSO and national societies to get recognition of surgical oncology as a formal surgical subspeciality in European countries.

Thirdly, cancer centers and surgical departments will get a clearer picture of the educational efforts needed to become a recognized center for cancer care. The center also has the possibility to get accreditation of their education and cancer care.