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The Surgeon’s Role in Oncology Care Apr 11, 2010

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The role of a surgeon in the care of an oncology patient is vitally important.  A patient's cancer treatment often begins with a surgery to remove a tumor or mass, depending on the individual diagnosis.  In this video, William H. Polk, Jr., M.D., shares his thoughts on this topic.

The Surgeon's Role in Oncology Care Transcript

My name is Bill Polk and I'm a surgical oncologist here in Nashville, TN.  As a surgical oncologist, we're integral parts of the team that deal with treating cancer patients.  The patients are often seen by me, the surgical oncologist, at some point and they are often referred if additional treatment is needed to radiation and medical oncologists-and the road goes both ways, and they come back to me.  Many times patients here are evaluated in a multi-disciplinary, case-review format where doctors from all different disciplines gather together, the case is presented and input is given and a treatment plan is formulated for these patients.

I personally think that when a person hears a new diagnosis of cancer or when they are told that they have an abnormality on an x-ray and they are being referred to specialists who specialize in the treatment of cancer is probably one of the more terrifying moments of anyone's life.  As a physician, it is something that I feel privileged frankly to participate in the care and help shepherd patients through these difficult periods of time.  As an advocate of the patient, it is very important that the patient feels comfortable with the team who is treating them.  I think that it is also important for patients to educate themselves with the disease process both through their family doctor, ask questions, search the Internet and become an informed consumer of health care.

Cancer 30 years ago for most solid malignancies - colon, breast, lung - if the lesion was going to have a chance of cure in large part it was due to the lesion being encompassable by a surgical procedure.  As time has gone on, that has changed significantly.  For a number of malignancies, we have great agevent care of neoagevent care means treatment up front with chemotherapy and/or radiation therapy in the setting of neoagevent care.  And post-operatively, in patients who have potentially curable resections - called agenvent care - chemotherapy and/or radiation therapy in addition to the surgery.  This is used not infrequently in colon cancer, rectal cancer, lung cancer, esophageal cancer and breast cancer.  We have seen statistically significant improvements in survival in patients with these malignancies as a combination of therapies for the treatments of these diseases.

We are, as members of this team, very interested in providing a seamless care delivery system to the patients that come through here.  It is something that I feel we do a great job of doing; we interact with each other on a daily basis.  I would say that we are on such close terms that 10 or 15 times a day, I will receive a call on my cell phone from another doctor (either medical oncologists or radiation therapists) talking about a specific patient as we direct that patient through their care and address with any problems that may arise in the setting of their treatments.

As a surgeon, not only have surgical techniques been refined fairly dramatically over that past 10-15 and become minimally invasive surgery - laproscopically, esophogectomy, minimally invasive pulmonary resection - have become day to day events where we choose these methods preferentially as opposed to the open techniques that we loathed to give up 10-15 years ago.  And we do this because patients in general if we are able to choose the patients appropriately that they recover quickly and have much less stress on their system and a quicker return to normal function.  I think that from a curative point of view, for treatment of many of these malignancies, there appears to be the ability to give more aggressive treatment to the tolerance of the patient for the additional treatment.  And hopefully this will translate over time to improve cure rates.  With the minimally invasive techniques, we are seeing in general, at least equivalent cure rates a much better return to a high quality of life for the patients.

What we have found here at Minnie Pearl is that patients that present here have the opportunity to be exposed to a broad sprectrum of potions of support - nutritional, psychological that aid with the coping of the patient with a difficult personal problem.  We know that patients who participate in clinical trials go through the Minnie Pearl and are encouraged to do so tend to do better than patients treated outside of clinical trials for their malignancies.  Not only does participating in a clinical trial further our understanding of the care and treatment of a cancer patient, selfishly for the patient, he may get better care because he is being watched more carefully and receiving support and monitored more carefully.  Not only is there an altruistic benefit going through a clinical benefit, but there is also a selfish benefit as well.  What we have been able to do here at MP is provide patients with many pathways to seek the best possible cancer care.

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