Early nuts and bolts about oncology

Hi DR Ryan here, medical oncologist, PROFESSOR, RETIRED COLONEL AND CANCER SURVIVOR and this is when tumor is the rumor and cancer is the answer.
This is largely FROM A BOOK OF THE SAME NAME AS WELL AS ITS WEB SITE www.whentumoristherumorandcanceristheanswer.com WHICH are both  THERAPEUTIC
The goal is not to sell books as much as it is to get out the authentic words about cancer as 2 million people and more, as we age, will have it and 80% of us knew know or will know someone with it .
In terms of family and friends that is more than 20 million people and that too is growing. Visit the web site. The book is available on Amazon as well as the web site but again this is a NON PROFIT endeavor which is all paid for by me so I could control the content and stay away from untruths and sensationalisms which editors often in this field want
THIS is the real deal and take from it what you need when you need it .
After this, our 9th time of meeting. Next week we will do a summary of all we have said. In this section I will try to answer questions as we go along as possible
        In this section, I present an overview of the structure of the field of oncology and some critical terms and aspects all patients will encounter. Also as I said since this is a short section I encourage questions on both it and anything regarding cancer and I’ll do my best to answer them as long as a good answer is not too lengthy. This sets the stage by being less in depth than an individual might find in some textbooks for professionals on the matter and covers some material that will appear again in different format later on.
You will also see the tone change just a bit when we get to the direct and dry science. The material is going to be in-depth, for many of you of interest and for others not so and be a bit dry but it is ok and a necessary part of  the big picture and needs to be covered.
We will later. not in this section, discuss some chemotherapy agents somewhat. Nonetheless, I urge you take a good look at it all, even if you only understand it notionally. The reason is this; cancer is damn frightening and profoundly complex. The more you understand, even notionally, of the tools we use to describe it and classify it and its treatments as well as its origin, the more you can control the experience. The more you comprehend its ‘mindset’ physiologically on a cellular level and the tools we have to image it and eradicate it, the more you can engage in outside reading that is focused and appropriate. Facts are your fodder and fuel to go from a leap of faith in your treatment to informed conviction, and I suspect the material is not so dry as to not be worth a run though.
The more you understand putting all the pieces together the more peace you will have. If only it serves as reference for loved ones or perhaps not at all, you still have the comfort of knowing it is there for you to understand more. It is not essential that you know all of this but the more you master the more you will master the anxiety that seeks to direct you rather than you be in the director’s chair.
Thus, the book can serve readily as a reference taking you wherever you need to go to learn more about the journey you are on or are about to undertake. Take advantage of that structure and peruse the table of contents selecting easily what you need and jump right in.
In this section, you will have enough to be familiar with the road and major signposts starting from your first rumor of tumor until you actually begin therapy because cancer was the answer.


Overview of Specialty


Let us first look at what is required to become a medical oncologist.



Training requirements:




University (BS or BA)      4 years

Medical school (MD)      4 years*

Internship                1 year

Internal medicine residency      2 years

Oncology fellowship            or  2 years

Hematology fellowship   or     2 years

Hematology/Oncology            3 years (combined)


*Osteopathy degree is also acceptable in place of MD


The above is needed to sit for the exam for board certification in Hematology or Oncology (separate boards).

Training falls under the auspices of the American Board of Internal Medicine. You must be board certified in Internal Medicine and complete the training of the above fellowships to be eligible to sit for oncology or hematology written exams. Essentially all those completing the fellowships sit for the Medical Oncology exam and about 50% sit for the hematology board. My advice is never be treated by a non-board certified (in medical oncology or only hematology) physicians with few exceptions.( leukemia and lymphoma are often treated expertly by both. The board pass rate is 58-65% with board certification only good for 10 years, as you must re-pass a new exam. As mentioned, many do not sit for the hematology board and remain “board eligible” until first request to sit for the exam, then eligibility is good for six years. This system is under review.


Specific and related fields


Medical oncology involves the management of most cancers in adults and is one of the younger Internal Medicine sub-specialties. The need for a “cancer specialist” did not arise until early 1970’s with the advent of sophisticated chemotherapy regimens. This required specific training for delivery of drugs and follow-up of unique, life-threatening side effects as well as much more in depth understanding of the natural history of a disease promulgating the need for a “quarterback” for cancer care. Patients are usually referred to us after the diagnosis. There is significant overlap with hematological cancers of the blood system such as leukemia and lymphoma as mentioned above. Our role has largely evolved to being deeply involved behind the scenes when the diagnosis is suspected but not made.

Pediatric oncology involves cancers of children and young adults (up to 18 years old). The above training is similar with a pediatric residency instead of internal medicine.

Gynecologic oncology treats ovarian, cervical, and uterine cancers. An obstetrics and gynecology residency, followed by a 2-year fellowship is required with formalized board certification.

Urology involves the primary surgical approach, but not the chemotherapy, if any, of bladder, kidney, and prostate cancer. There is some significant degree of chemotherapy treatment by the urologist directly into the bladder for the more superficial bladder cancers. There is some extent of treatment of recurrent or even preoperative and immediately postoperative hormonal manipulation of prostate cancer being increasingly done by this field. Training is four years after a one-year surgical internship.

Otolaryngology, also known as (ENT) involves primarily surgery only on cancers of the head and neck. There is a 4-year residency after internship.

Surgical oncology largely concentrates on breast, colon, melanoma, and other solid tumors: some have training sufficient to credential them to give chemotherapy. This entails a 5-year residency followed by 1-2 year fellowship.

Neurosurgeons deal largely with the removal and or biopsy of tumors of the brain or spinal cord tumors. This entails a 7-year residency.

Thoracic surgery concentrates on early stage lung cancers and occasional open biopsies of the lining of the heart or other chest structures. This entails a five-year residency followed by fellowship.

Orthopedic surgery deals with the primary surgery of bone cancers or metastases, surgical removal and stabilization of bones (rods/ pins) weakened by cancers.

Radiation Oncology entails a 1-year general internship. After a 3-4 year residency, they give radiation to different types of cancer as primary treatment such as brain tumors, lung cancers, some lymphomas (cancer of lymphocytes) or treatment after surgery (breast after removal of breast cancer) or treatment along with chemotherapy (synergism)-head and neck, rectal, anal, and lung, or treatment of local painful boney areas of tumor spread.

The Scope Of The Problem


Perhaps not obvious to some and certainly not meant to be clever, age is the greatest single factor worldwide for developing malignancy. Think of it. Assaults of whatever nature from the outside are constant (to varying degrees) and continuous. Our own aging argues for how our major mechanisms to fend off the various external causes of cancer are not what they used to be in our youth. Think of sun caused skin changes and cancers.

Cancer may one day replace heart disease as the No. 1 cause of death worldwide with a growing burden in poor countries thanks to more cigarette smoking and other factors. Globally, over 13 million people are diagnosed with some form of cancer yearly with 8 million deaths. This represents a global cancer burden doubling in the last 30 years of the 20th century, with doubling again between 2000 and 2020 and nearly tripling by 2030. By 2030, over 25 million people a year may be diagnosed with cancer, with two thirds dying from it.

In men, lung cancer is the most common form in terms of new cases and deaths, while breast cancer is the most common type among women in new cases and deaths. More men than women get cancer and die from it with cancer currently accounting for about one in eight deaths worldwide.

Trends that will contribute to rising cancer cases and deaths include the aging of populations in many countries, as cancer is more common in the elderly and cigarette smoking rates are increasing in poor countries.  Some countries have made progress in cutting cigarette smoking, which causes most cases of lung cancer as well as many other illnesses. In the United States, the most recent figures show that for the first time since records have been kept, less than 20 percent of adults were smokers in 2007. However, cigarette companies are finding new customers in developing countries. About 40 percent of the world’s smokers live in just two nations — China and India.

Decades ago, cancer was considered largely a problem of westernized, rich, industrialized countries. However, much of the global burden now rests in poor and medium-income countries. Many of these countries have limited health budgets and high rates of communicable diseases, while cancer treatment facilities are out of reach for many and life-saving treatments are less available.

At the same time, progress against cancer is occurring in such places as the United States and Europe. For example, health authorities in the United States report that cancer diagnosis rates are now dropping for the first time in both men and women and previous declines in cancer death rates are accelerating. They attributed the progress to factors such as regular screening for breast and colorectal cancer, declining smoking rates and improved treatments.

Let’s look a little more specifically at the numbers in the United States. Cancer is about 25% of all deaths and appears on track to replace cardiovascular disease as number one. One cancer alone, lung, is 30 % of all deaths. Prostate is second in men responsible for 25% of deaths. Prostate is also the most commonly occurring cancer in men with breast cancer just ahead of lung cancer, in women.

Cancer is uncommon in adolescents and children (with only about 150 cases per million in the U.S.), with leukemia the most common. If we put all ages and both sexes together the odds of getting cancer are about 460 per 100,000. This is not rare

Cancer in the first year of life has an incidence of about 230 per million in the U.S. with the most common cancer being nueroblastoma.

In the U.K. cancer is in the lead over cardiovascular disease yet it appears much lower in third world countries most likely owing to much higher deaths from infectious diseases such as malaria and TB and accidents.

Nonetheless, cancer remains a major public health problem worldwide with skin, lung, prostate, and breast, lung, colorectal and urinary bladder representing the majority of types



THIS HAS BEEN the first of a series on the nuts and bolts on oncology kept intentionally short to encourage questions. Next week , our 9th week together, will be a summary of all we have covered so this is the first  week on the nuts and bolts of oncology and intentionally kept more mellow


Any more questions?????


This has ben DR kevin Ryanmd mba facp and hematologist oncologist here, medical oncologist PROFESSOR AND RETIRED COLONEL AND CANCER SURVIVOR and this is when tumor is the rumor and cancer is the answer. Modeled after my book of the same name available on thE web site OF THE SAME NAME you can find it on the web site and a lot more, interviews, films excerpts on the site and it is also available on Amazon   IN ALL FORMATS I AM Signing off radio www.w4cs.com the cancer support radio program REMIND YOU THE PROGRAM IS ARCHIVED HERE AND THE iheart RADIO AS WELL AS THE WWW.W4CS BLOG AND MYBLOG ACCESSED EASILY FROM THE WEB SITE