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MCh Surgical Oncology Training Program

Dr. Sandeep Kumar,FRCS, PhD
King George's Medical College, Lucknow University

A 2-year training program for MCh surgical oncology is suggested

Objectives :

Knowledge, skills and clinical experience:

1. Comprehensive management of cancer arising in the abdomen, breast, head and neck and limbs. The trainee should be able to perform usual operations for complex / recurrent neoplasms and various palliative operations.

2. A broad knowledge of other treatment modalities (Radiotherapy, Chemo-endocrine Therapy and supportive measure used in cancer patients) and fundamentals of tumour immunology and biology.

3. Able to provide life support, resuscitation, operation on vascular access, central venous catheterisation for chemotherapy etc.

Cancer Research :

Ability to design and conduct prospective clinical trials, field trials, collect epidemiological data, conduct/ supervise laboratory studies with some working knowledge of molecular biological techniques.

Cancer Education :

Ability to train students and physician in cancer management and to conduct cancer related public education programmes. Ability to use common computer pro-grams for word processing, data analysis and management, graphic and medline searches.

Institutional Leader-ship in MCh Surgical Oncology :

Skills in developing a tumour registry, psychological rehabilitation for cancer patients and their families; ability to organise meetings and discussions on cancer patient care.
Dr. Sandeep Kumar,FRCS, PhD King George's Medical College, Lucknow University

A 2-year training program for MCh surgical oncology is suggested

Objectives :

Knowledge, skills and clinical experience:

1. Comprehensive manage-ment of cancer arising in the abdomen, breast, head and neck and limbs. The trainee should be able to perform usual operations for complex / recurrent neoplasms and various palliative operations.

2. A broad knowledge of other treatment modalities (Radiotherapy, Chemo-endocrine Therapy and supportive measure used in cancer patients) and fundamentals of tumour immunology and biology.

3. Able to provide life support, resuscitation, operation on vascular access, central venous catheterisation for chemotherapy etc.

Cancer Research :

Ability to design and conduct prospective clinical trials, field trials, collect epidemiological data, conduct/ supervise laboratory studies with some working knowledge of molecular biological techniques.

Cancer Education :

Ability to train students and physician in cancer management and to conduct cancer related public education programmes. Ability to use common computer programs for word processing, data analysis and management, graphic and medline searches.

Institutional Leader-ship in MCh Surgical Oncology :

Skills in developing a tumour registry, psycho-logical rehabilitation for cancer patients and their families; ability to organise meetings and discussions on cancer patient care.

PROGRAM REQUIREMENT FOR MCh SURGICAL ONCOLOGY

(A) General Comments :
MCh Surgical Oncolgy fel-lowship should encompass a minimum of two years following completion of general surgical residency. Atleast 18 months should be devoted to clinical training and the rest of the time (six months) should be used by rotation on non surgical oncology services which may include an epidemiological unit, cancer registry and a protein biochemistry or molecular biological laboratory also. There should be adequate interaction with companion surgical specialities (thoracic, gynaecology, urology, orthopaedics, paediatrics, neuro and reconstructive) in overall management of cancer patients.

(B) Advanced MCh Surgical Oncology Training (18 months) :
The minimum number of operative cases (as surgeon or first assistant) performed is listed below as per anatomic regions:

1. Head and Neck : 20 operative cases
a) Oral cavity tumours.
b) Resections of tumours of base of tongue, pharynx, larynx, maxilla and base of skull.
c) Radical neck dissection-partial, modified or complete.
d) Major resections for melanoma, salivary gland tumours, squamous/basal cell carcinomas, thyroid and soft tissue tumours.

2. Trunk and Extremities :
a) Major resections for melanomas
b) Soft tissue/bone tumours
c) Radical lyrnph node dissections (inguinal, iliac, axillary)
d} Major amputations (hemipelvectomy, fore-quarter amputation)
e) Isolated limb perfusion for chemotherapy

3. Breast:
a} Mastectomies.
b) Conservation treatment of wide excision.
c) Operation on benign breast disease.
d) Localisation techniques.

4. Abdominal Cavity:
a) Gastro Intestinal operations.
b) Liver, biliary ducts and pancreas.
c) Retroperitoneal.
d) Pelvic surgery (including recurrent/met astatic disease.

All categories should be represented. A total of 80 cases in categories 2,3,4 of which not less than 10 cases should be in any category. In addition the trainee should have involvement in management of patients treated by medical oncologist including :
1. Staging for lymphomas.
2. Resections for distant metastatic disease.
3. Insertion of indwelling access devices for chemotherapy.
He should be proficient in endoscopy involving aero-digestive tract.
The trainee should make a continuous log of type and number of surgical procedures in which he partici-pated. (Format as required by American Board of Surgery is suggested)

(C) Non-Surgical Oncologic Training (6 months):
1. Radiation Oncology:
Cobalt therapy, brachy therapy, computerised planning etc. (1 month).
2. Surgical Pathology : FNAC. recognition of epithelial and common connective tissue tumours, tissue handling, section cutting, dissection of lymph node from specimens, immumo-cytochemistry etc. (1 month)
3. Systemic Therapy : Common treatment protocols for solid tumours, crisis management, use of blood products and management of leucopenia and granulocytopenia (1 month)
4. Clinical Epidemiology: Methodology of clinical trials including knowledge of biostatics, design of clinical research protocols, and establishing computerised databases (1 month)
5. Supportive and Rehabilitation Care :
The trainee must be experienced in providing supportive care to cancer patients. This includes total parenteral and enteral alimentation, surgical emergency care, rehabilitating services in various settings, including reconstructive surgery and rehabilitation after extremely sarcoma surgery, masterctomy and major head and neck surgery, pain relief and triage (1 month)
6. Molecular Biology : Radioimmunoassay lab,protein biochemistry lab, DNA lab etc. (1 month) (D) Research Training : Each trainee should participate in an investigative project. Clinical and basic research should be included in training and the trainee should be familiar with statistical methods. A short dissertation which may be a case series analysis, small clinical trial, epidemiological data, philosophical or theoretical approach to surgical oncology problem, epidemiological or ecological, laboratory study may also be submitted and completed during the six months rotation In the non surgical departments.
The above was submitted to the Medical Council of India by the Secretary Dr. Sandeep kumar in Dec. 1998.