Oncosurgery or surgical oncology is the branch of surgery applied to oncology; it focuses on the surgical management of tumors, especially cancerous tumors. A surgical oncologist is a surgeon who has special training in treating cancer. Surgical oncology is one of the many short appointments under Surgery for us - medical students - and its a two week posting. We - a group of 15 students - were posted for this appointment, under a prominent surgical oncologist, during the last two weeks (of September) in the National Cancer Institute (NCI), the leading hospital under the Ministry of Health dedicated to the diagnosis and follow-up treatment of cancer patients, in Maharagama.
The NCI offers both the diagnostic facilities necessary for the identification of all types of cancer, and specialised care in surgery, chemotherapy and radiotherapy. A team of expert Consultants manage the hospital services alongside medical doctors, nurses, pharmacists, medical physicists, laboratory technicians and minor workers. Anyone can access the services, free off charge. In addition to delivering quality care services the NCI is the major training centre for medical undergraduates and postgraduates of the Postgraduate Institute of Medicine (PGIM).
We couldn't have asked for a better consultant. He had twenty years of experience as examiner in final year MBBS exams in various universities - and he was still invited to as examiner. Thus he knew all the ins and outs of how our short cases and long cases are examined. He stressed the point that as house/medical officers we would come across patients in the Ward and the Clinic setting, as well as the emergency section. How are our competencies in these settings evaluated? Our long case examinations evaluates our competency in the Ward setting - where we have to do a holistic history taking and examination to reach a probable diagnosis with differential diagnosis and a plan of management. Our short case examinations evaluates our competency in the Clinic setting - where we may come across new patients or follow up patients for a shorter period of time. As for our knowledge and skills in Emergency Medicine, which cannot obviously be resurrected for examination purposes - this would be covered in our written exams and MCQs.
I've never come across a more cheerful, witty, talkative consultant as this one. He was a blatant contradiction to the gloomy sad place this was. I thought at first this was a coping mechanism but then realized otherwise. Here was a man with perfect confidence in his job - who loved doing his job (surgery was like to him like playing a first person shooter game was to me) and who achieved immense satisfaction in doing his job - which literally saves countless lives. Why should he be other than cheerful and happy and optimistic? His emotional and rational intelligence was off the charts and he knew exactly what we were thinking at all times - and made succinct witty remarks now and then. He had two sons who were rebellious medical students too and so he knew exactly what we were like. He signed and gave back his thank you saying he didn't like to be reminded of .... well he sure had some strangeness in him.
The consultant and his senior registrars and others - wasted no opportunity to teach us things. These guys loved showing off their knowledge and skills - but it was the attitudes to their work that was really exceptional. They had/have to go through a minimum of fifteen years of formal medical education, training and experience and there simply was no end to the stuff we could learn from them. Two weeks was never going to be enough. Wednesdays and Fridays were surgery days. Tuesdays and Thursdays were clinic days and the rest of the time this group of doctors were at the wards. Each of us were allocated patients for history taking and follow up. In the clinic sessions we helped with the examinations and learnt a low through observation and classes. In the surgery sessions - each of us got an opportunity to assist.
More than half of his male ward (which was just one of the many wards) were of patients with oropharyngeal cancers - mirroring the national statistics. Heavy smoking, heavy alcohol consumption and betal leaf chewing have been associated with the high rates of these cancers. if you have a friend who you badly need to stop with these habits, just take a walk across this ward. The mirroring with national statistics was also true with breast cancer and the female ward. Unfortunately breast cancer cannot be prevented simply by healthier lifestyle and the cessation of addictive behaviors. But there are stuff you could do to prevent dying from it. Other cancers seen were osteosarcomas, thyroid cancers, colorectal etc etc There were many patients in pain and on strong opiod analgesics. Some were clearly on the last stages of their life with multiple complications.
During the clinic sessions, we got the opportunity to practice our history taking and examination skills yet again. Lump, breast, thyroid examinations were practiced over and over again. Sri Lankan patients in the free healthcare system are really helpful and willing to be used for such purposes fortunately. It was a privilege to be posted in a tertiary care center. During surgery days, we got the opportunity to assist surgeries. There were many many masectomies done as well as removal of osteosarcomas, liposarcomas, thyroid lobes etc etc the surgeons made it all look so very easy.
Over 100 types of cancers affect humans. Tobacco use is the cause of about 22% of cancer deaths. Another 10% are due to obesity, poor diet, lack of physical activity or excessive drinking of alcohol. Many cancers can be prevented by not smoking, maintaining a healthy weight, not drinking too much alcohol, eating plenty of vegetables, fruits and whole grains, vaccination against certain infectious diseases, not eating too much processed and red meat and avoiding too much sunlight exposure. If you have any questions or want to know more (about anything) feel free to ask in the comments below.
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