Specialist Q&A: What Can an Oncologist Do for You?

Elson: There are a few different types of oncology. There's medical oncology, which is more chemotherapy, and that's a subspecialty of internal medicine. They would go to medical school and then complete a residency in internal medicine, which is usually three years. Then they'd do a fellowship in oncology, which is usually another three years.

What I did was radiation oncology. That would be medical school, then one year of a general residency that they call an internship. Most people do internal medicine, which is what I did. After that, it's four years of radiation oncology residency, and then there's a different specialty called surgical oncology. That involves medical school and then going to surgical residency, which is usually five years. A surgical oncology fellowship is usually two or three years. So it depends on what kind of oncology.

For radiation oncology, we work with all the different types of oncologists, but basically, if there's anybody who's a patient with cancer—usually it's cancer, although there are some noncancerous things we deal with, too—if there's anything appropriate for them to have radiation, then we set that up for them. Typically, it involves having a consult where we have a meeting to go over all the information, and then if it looks appropriate to do radiation, we do special planning procedures, like mapping procedures, when we do the treatments. The treatments are usually given over a couple weeks, and most of the time, it's daily treatments like a daily X-ray.

We monitor people's progress during the process and help if they're having problems with anything. After they're done, we follow up and usually do some lab testing and image testing periodically for monitoring. Usually, the medical oncologist is mostly in charge of the treatment plan, so we work with them to help out with whatever is needed.

It's a very interesting field. It's very data and technology driven. On the radiation side, it involves a lot of advanced imaging like MRI [magnetic resonance imaging], PET [positron emission tomography] and CT [computed tomography] scans. The technology for the treatment delivery has really improved over the last 20 years to where it's a lot more accurate, so you're able to pinpoint things and do types of treatment that weren't even possible 20 years ago.

They used to pretty much only use chemo for whatever types of cancers they might be dealing with. Nowadays, they've discovered—because of genetic sequencing—there are a lot of gene mutations linked to a special drug they could use. It might be a pill or something easier than chemo; immunotherapy is a big thing. There are drugs that can boost your immune system to help fight cancer.

They're entering more of a personalized medicine scheme, where somebody might have a tumor and a while back they might have just given chemo. Now they send them back for special testing, and they might find a different drug, a pill or immunotherapy, and use that instead, so there are less side effects from the treatment.

For adult oncology, the most common cancer types are going to be lung [cancers], for both men and women. Colon and rectal cancers are very common. For women, specifically, breast cancer is one of the most common cancers. For men, prostate cancer is one of the most common. We also see things like head and neck cancers.

Less common are rare types like lymphomas and subtypes of lung cancers, like mesothelium.

Usually, oncologists like to have as much information or data as possible. If somebody has had any X-rays or CT scans or MRIs or any testing or labs or biopsies, all that information is very helpful. Sometimes it can be hard to get if it's not all within the same system. If somebody went to one hospital to do one thing and the other to do the other thing, then it's helpful to try to collect all the information and give it to the oncologist ahead of time for review.

Another thing that's probably a good idea for anybody is to try to bring a relative or a friend or someone who can also listen to the whole thing, because it can be a lot of information and it can be a little bit overwhelming. We always encourage people to bring a family member or relative or somebody who can come along and listen in so they can try to remember some of the information and ask questions.

Usually, a more primary-level doctor will find a problem. Somebody might have a primary care doctor who does testing and they find something that might look as if it could be cancer. It depends on the circumstance. Usually, they end up with some sort of procedure where there's a biopsy of some sort, so like getting a needle-based sample of an abnormality. If that turns out to be cancerous, they usually refer them to an oncologist.

Sometimes the oncologist has to figure out if it's cancer or not on their own. Most of the time when they meet with somebody, they already have established the diagnosis of cancer, likely through a biopsy.

Usually, people have an initial visit with an oncologist. It's fairly lengthy. It's like a consult. You get a lot of information. If there's more testing that needs to be done, they probably have another couple of visits over the next few weeks or so.

During treatment, like if someone is doing chemo, they'll have a visit with at least a nurse or somebody in their office every week or so. They're often checking labs. After treatment is over, people end up going once every couple of months for a checkup. If someone had treatment and it's been five years and their cancer is gone, they might just go for a visit twice a year or something like that. As time goes on, if things are going well, it spreads out more.

Most chemo is given in cycles: The average would be a chemo treatment every three or four weeks. The actual chemo usually takes a couple of hours. On average, it's about four to six cycles, so about three to five months is a common timeline. For radiation, we usually do the treatment every weekday for a couple of weeks.

Because gene sequencing is becoming much cheaper and easier to do, in the future, it's quite possible that everybody will just have their entire genetic sequence and have their own sequence library. And they can find genes that might predispose people to certain cancers, like prevention basically. If you knew you were predisposed to certain kinds of cancer, you could do screening for that at an earlier age.

I think prevention is probably going to be one of the things that will be a lot better in the future. Right now, we just have age-based screening recommendations for different cancers.