The role of a radiation oncologist in the cancer care continuum

By Ariel E Pollock, MD, Radiation Oncologist

“So you’re a radiologist?”

Not quite….I’m a radiation oncologist. I treat cancer, or other tumors and some benign

conditions, with radiation.

Once a patient is diagnosed with cancer or once there is suspicion that they may have cancer, they are going to be scheduled with a multitude of new doctors for new scans and tests. Every cancer is different, and the workup for every cancer patient will include different components. But at the end of the day, a patient’s cancer will be assigned a stage (I to IV), and they will probably meet with three main doctors: a medical oncologist, a surgeon, and a radiation oncologist.

What is the difference, and why do patients need to meet with all of these different doctors?

The medical oncologist

A medical oncologist is often the first doctor that a patient gets sent to when they’re diagnosed with cancer, but that is not always and does not always need to be the case. Medical oncologists have four years of internal medicine training followed by three years of combined hematology and oncology training. They treat cancer patients with systemic therapy - drugs that are administered via a peripheral IV or a port, or even orally - that target the whole body. These drugs include chemotherapy, targeted therapy, and immunotherapy. Sometimes systemic therapy is recommended with other therapies (such as radiation or surgery), and sometimes it is recommended as monotherapy.

The surgeon

A surgeon is a bit easier to explain. There are different surgical specialties, however. There are neurosurgeons, otolaryngologists (head and neck surgeons or ENTs), thoracic surgeons, breast surgeons, general surgeons, surgical oncologists, gynecologic oncologists, and urologists…all who operate on patients with cancer.

The radiation oncologist

Finally, we get to my specialty…radiation oncology. This one is a little less understood. We have one year of either medical (or sometimes surgical training) followed by four years of oncology-specific training. We don’t have radiology-specific training; however, we learn a lot about radiology on the job during our residency and definitely learn enough to do our jobs very well. We treat patients with radiation. Just as systemic therapy may be recommended by itself or in conjunction with additional therapies, radiation is sometimes recommended with systemic therapy or surgery as well and is sometimes recommended alone.

All these specialists work together to coordinate your treatment

These recommendations all depend on the cancer type and cancer stage. We work very closely with medical oncologists, surgeons, and other specialists (pulmonologists, gastroenterologists, etc) to come up with a treatment plan. We then also work with very specialized people within our own department/office to treat patients with radiation. We work with physicists, medical dosimetrists (they design radiation plans), and radiation therapists (they physically treat the patients on the machines). At the end of the day however, the radiation oncologist is the oncologist overseeing your entire treatment and plan and determining what to treat, when to treat it, and how much to treat. We use extremely advanced technologies and understand radiation physics and cancer biology in order to optimize cancer treatment. We oversee your medical care during radiation and manage any side effects during and after treatment. We then also follow you once treatment is done for your cancer surveillance.

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