Surgical Oncology

Among the standard oncology modalities, surgical oncology is singular in that it lacks a separate board certification or even an added qualification mecha­ nism. 'Card-carrying' surgical oncologists are certified by the American Board of Surgery, as are all other general surgeons. What distinguishes the surgical oncologist is a set of cognitive skills rather than a specific armamentarium of surgical techniques. This different conceptual framework is derived from ex­ tensive additional training that leads to an in-depth understanding of the natural history and biologic behavior of the various solid tumor systems. Equipped with this perspective, the surgical oncologist is particularly well positioned to integrate the various available therapeutic modalities into a coherent care program for the solid tumor patient. As a central theme, the chapters of this book demonstrate that increasingly sophisticated diagnostic and staging approaches are helping to move chemo­ therapy and radiotherapy into the preoperative neoadjuvant setting. This fundamental alteration is based on the awareness that even early-stage solid tumor disease is frequently systemic at the time of presentation, at least on a subclinical level. And although the primary tumor may be controllable by surgery with radiotherapy, the uncontrolled (and initially clinically unappar­ ent) distant disease ultimately determines patient survival. The other perspec­ tive driving the neoadjuvant approach is an emerging awareness that for most solid tumor systems, neoadjuvant treatment responses can facilitate less muti­ lating surgery with comparable levels of local disease control.