Surgical oncology.

Abstract

There has been a recent reassertion of the surgeon's role in cancer management. Traditionally, surgery has been the major modality of cancer treatment. In settings of clinical trials, surgeons had initially assumed a more passive status, contributing patients while chemotherapists and radiotherapists developed experimental protocols. Currently surgeons are taking an active role in planning and participating in such clinical studies. The American Joint Committee Staging System is being widely adopted, quality control of surgical procedures is improving, and innovative surgical operations are being devised. Surgical oncologists have spearheaded the concepts of multimodal treatment for their colleagues for a variety of cancers, most particularly cancers of the breast, head and neck, esophagus, lung, stomach, colorectum, and testicles, and sarcomas. The interaction of surgical treatment with radiation and chemotherapy is now more carefully planned, both for primary and metastatic tumors, and meaningful data are being derived from patient care. There is emphasis on treatment options, individualization of therapy, and restorative procedures at a variety of cancer sites. Constitutional aspects of cancer, such as nutrition, immune status, and metabolic aberrations, are given more attention, and there is a greater application of advances in cancer biology to the overall clinical care of patients.