Who do you consult when you have cancer?

Dr Cassandra Mbanje expands on the different types of oncologists and ultimately who you would consult with if you suspect you have cancer.

You can listen to this article below, or by using your favourite podcast player at pod.link/oncologybuddies

Medical terminology has a long, varied history with predominantly Greek and Latin roots. In fact, most of the medical terminology we use today can be attributed to both Hippocrates, who is widely considered the father of medicine, as well as Claudius Galen, a prominent doctor during the reign of the Roman Empire.

At the most basic level, a medical term comprises three parts: word root, prefix and suffix. The word root is found in the middle and conveys the term’s basic meaning. The prefix comes before the word root and reveals further information about location or area of the body. The suffix, at the end of the term, helps express the term’s grammatical category. Additionally, terms also use Greek and Latin adjectives or compounds to connect nouns, verbs or combining forms. So, why does this matter? What is the point of this brief history-turned-English lesson? Well, by breaking down the components of a medical term, you can gain a baseline understanding of what it means, thereby demystifying something that can seem so scary and intimidating.

Oncologists

Onco means relating to tumours whilst logist combines logy and ist to denote someone who studies or treats within a specific field. Thus, an oncologist is a doctor who diagnoses and treats cancer. However, there are various types of oncologists and this is where confusion can set in. Oncologists can be broadly divided as working within one of four main divisions of oncology: namely medical, surgical, radiation and clinical oncology, respectively. The most nuanced difference is that between medical and clinical oncology.

Specifically, medical oncologists treat cancer using systemic therapies (chemo-, immuno-, targeted- and/or hormonal therapy) while clinical oncologists are qualified to deliver both systemic and radiation therapies.

Further, a surgical oncologist is a general surgeon with specialty training in diagnosing, treating and managing cancers while a radiation oncologist specialises in delivering external and internal radiation therapy to people with cancer.

Sub-specialists

Like all other specialties, oncologists can also sub-specialise to treat specific populations of patients across the fields of internal medicine and surgery. Important to note is that in many countries, including SA, surgical oncology isn’t recognised as a formal specialty but rather encompasses or cross-cuts a number of disciplines across several surgical specialties. For example, a specialist breast surgeon is essentially a surgical oncologist who diagnoses, treats and manages cancers of the breast (in addition to managing other breast conditions).

Similarly, an otolaryngologist who has a sub-specialty interest in the surgical treatment of ear (oto), nose and throat (laryngo) cancers can also be regarded as a surgical oncologist. In contrast, South African medical and radiation oncologists, respectively, aren’t so anatomically restricted as their surgical counterparts. That being said, all oncologists obtain between four to seven years of specialist training post-medical school.

So, which oncologist do you see if you suspect a cancer?

To be honest, this is a bit of a trick question because the truth of the matter is that depending on the type of cancer you have, you may have to consult with a surgical, medical and radiation oncologist. Let me explain. If you present with an overt atypical mass to a general practitioner, they would likely refer you to a surgeon who would then perform a biopsy (amongst other tests) to confirm a diagnosis. If this diagnosis is cancer, then you would also consult both a medical and radiation oncologist as well.

This is because, along with a surgery to remove this cancer, you would also likely need some form of systemic and/or radiation therapy. If you don’t have a mass, then you would likely be referred to a medical and radiation oncologist plus any other relevant specialist. Therefore, the most important point is that the best management of cancer is multi-disciplinary: you consult with and are cared for by a team.

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