Surgical oncologist vs colorectal surgeon?

[Chayo]

Saw an oncologist for the first time this afternoon (just got biopsy results on Thanksgiving Day for a large mass in colon). I liked him a lot, and he wants to schedule PET scan for Wednesday and potentially triple phase CT the following day. Because of potential liver involvement, he suggested a local surgical oncologist, who would do the resection and then also check liver, biopsy, or whatever needed to be done. I've read a lot on here about making sure to have a board-certified colorectal surgeon, and am just wondering about the pros and cons of colorectal surgeon vs surgical oncologist. Thoughts?

[plastikos]

I'd imagine a colorectal surgeon would be the best option for resecting the primary tumor but not the the liver involvement. A surgical oncologist might be skilled enough to do both. But I think the "best" option, which is what I opted for in my first surgery, is to have a colorectal surgeon resect the primary tumor then have a liver or liver transplant surgeon scrub in to do the liver resection.

[weisssoccermom]

A surgical oncologist is a subspecialty of general surgery. I don't believe (but am not 100% certain of this) that they must go through any fellowships, more rigorous training, etc. than a general surgeon......it's just that they have 'specialized' in surgery related to cancer. That being said, a surgical oncologist can and often will do surgery related all sorts of different cancers....breast, colon, perhaps lung, etc. A board certified colorectal surgeon, although technically a general surgeon plus....ONLY operates on the colon and/or rectum and nothing else. I am certain that there are highly qualified and respected surgical oncologists just as there are highly qualified and respected board certified colon and rectal surgeons. If it were me, I would want a surgeon who ONLY works on the colon and/or rectum and nothing else. The extra time and fellowship are just, IMO, icing on the cake.

[ANDRETEXAS]

If my colon was resected (and it was), I would want a board certified colorectal surgeon for that particular surgery. As stated, that's all they do (colon and rectum), and they have to have many years of experience.

[SurvivorsSpouse]

With the prevalence of colorectal cancers, it is not difficult to find a colorectal surgeon that is also a surgical oncologist. It is generally easier to find such a surgeon at a major cancer center with a GI cancer specialty. Again, this shouldn't be difficult to find based on the number of cases of colorectal cancers, then combined with gastric and esophageal these GI cancer centers are well staffed and easy to find.

Also, I cannot stress enough going to a high volume center, if available. The surgeons there are practiced and have experience in case the surgery turns difficult. One of the keys to a clean resection and preventing peritoneal, abdominal or pelvic mets/recurrence is good technique on cancers still contained in the colon/rectum. Studies are starting to show that seeding from poor surgical technique has a more than minimal effect on the recurrence rates.

[Bob_Weiss]

I have read that a Colorectal surgeon is highly desirable for a Rectal tumor, but a good surgeon not specializing in Colorectal tumors is OK for colon tumors. That is because rectal tumor removal is difficult due to the small space in which the surgeon works; and the rectum contains nerves, blood vessels, and muscle tissue within this small space.

I would not have chosen anyone other than a Colorectal surgeon for my rectal tumor surgery.

[weisssoccermom]

Survivors spouse - I have to disagree with you on your comment. A surgical oncologist has no 'specialized' training other than the fact that they have opted to only do cancer surgeries. That being said, some of them, yes, do concentrate on one particular area...for example, GI tumors....however, that may very well mean that they will do pancreatic, colon, stomach and rectal cancer surgeries. IMO, particularly if the patient has rectal cancer, I would ONLY want a surgeon who does colon/rectal surgery. Even if I had colon cancer, I wouldn't want a surgeon working on me who doesn't 100% concentrate on the colon/rectum. Yes, a board certified colorectal surgeon would also do other colon/rectal surgeries that aren't cancer related but....that same surgeon would ONLY be working on the colon/rectum and nothing else.

A board certified colorectal surgeon wouldn't be a surgical oncologist and I while one might find a surgical oncologist who has board certification in colorectal surgery, I'm not sure why one would choose to go by the designation of a surgical oncologist when he/she would have more extensive training.

[behconsult]

I had a surgical oncologist who did nothing by GI work. I assume you are at a major treatment facility. A surgical oncologist does have additional training. They are also more apt at looking for cancer in other places such as the liver, etc., when they have you open.

[weisssoccermom]

I stand somewhat corrected. Yes, a surgical oncologist can opt to take a 5 hour exam consisting of approximately 200 multiple choice questions to assess the surgeon's knowledge. The surgeon must also have had to have completed a training program in general surgical oncology training - not a specific type of surgery. That isn't, IMO, however, the same as a fellowship in one particular area of concentration such as colon and rectal surgery. Surgeons who are board certified in colon and rectal surgery agree to limit the majority, if not all, of their practice to colon and rectal surgery....whereas a surgical oncologist can practice whatever general surgery he/she wishes.

Ultimately, the choice is up to you....what doctor do you feel comfortable with, whom do you trust, etc. There is no right/wrong answer....it's your body, your journey and your choice.

[SurvivorsSpouse]

Surgical oncologists can be specialists in surgical fields. You can have a colorectal surgeon who is also a surgical oncologist. Surgical oncology fellowships tend to mean that surgical oncologists go rough some of the longest surgical training.

There are definitely trials out there showing patient outcomes are improved by volume per surgeon. In other words, a surgeon who performs more procedures has better outcomes than a general surgeon who might do a proctectomy among other unrelated surgeries. This is especially true with more complex surgeries, which rectal cancers can be. This is precisely why we selected a major GI cancer center for my wife.

Finally diagnosed stage 2A high rectal
No ileo or chemoradiation
3yr NED as of Oct

The first general surgeon in our town said probably chemoradiatio and temp ileo. We got a 2nd opinion from a colorectal surgeon who is also a surgical oncologist at a major cancer center in the SE US. Within 15 min of reviewing the CT disc and speaking with the GI Medical Onc in the cancer center, our surgeon said no chemo and no ileo if everything looked like he thought it would based on the scans.

I cannot stress enough how valuable experience is in treating cancer, that is why we sought out and drove several hours to a high volume major cancer center.

Everyone's decision is personal and needs to wor for them. Good luck making yours, keep your head up and realize there is a lot of room for good outcome here. Fight the fight your way.

[weisssoccermom]

You are correct that you can have a board certified colorectal surgeon who is also a surgical oncologist but most don't go both routes. IMO, if I had to pick.....assuming that a surgical oncologist only had gone through a general surgical oncologist training.....and, from what I could find at the certification board...there is no specialty surgical oncology training....I would NOT pick a surgeon who only had general surgical oncology training no matter how much that surgeon says he/she 'specializes' in one particular type of surgery.

Again, it is your choice and yours alone. Verify credentials....don't assume that because someone says their specialty is one field over the other that it means that they have done anything more than put some words on a piece of paper. Do your research, talk to them, and importantly, make sure that whomever you choose works well with your oncologist. Don't feel pressured into having all of your care at one place....some may like it....others don't. There is no concrete rule that says you must have your care done in one cancer clinic.....many of us have had our chemotherapy closer to home and our surgery somewhere else.

[Chayo]

Thanks for the thoughts, everyone! I'm still in the decision-making process but really would like this thing out of me ASAP!

[sailbd]

Chayo:

Sorry you're dealing with this diagnosis. Simply put, best advice is to go to a large NCI designated medical center. Find out whether you have liver involvement prior to developing any surgical plan for the colon. If you have liver or other distant involvement, see a surgical oncologist to develop a plan that addresses the distant involvement and colon (distant involvement is your enemy and needs to be resected, if possible). If you're treated at a large city NCI designated medical center, your surgeon will be well qualified regardless of designation - but I'd be more particular with the surgeon if you had rectal cancer. Best wishes!

[Chayo]

Thanks! I've requested a consult at MD Anderson - it's 5-6 hours from me (I'm in DFW), but I can get there if they will take me.

[JFrog]

I think you have made an excellent decision. At MDA you will have a different surgeon for each area that is needed. In other words, a colorectal surgeon for the colon, a liver surgeon for the liver, an urological surgeon for any bladder/ureter area etc.. For one of my wife's surgeries there she had 5 different surgical teams involved and actually doing work. The skill of the surgeon has been shown to make a huge difference in the recurrence rate following colorectal cancer surgery. The best way to really know the quality of a surgeon is to ask the OR nurses but other than that you have to base it on their experience. The one study I can recall that measured the outcomes of recurrence showed the surgeons that did the colorectal surgery the most had the best outcomes. Best wishes