Surgical oncologists are cancer specialists who use surgery to diagnose, stage, and remove cancerous tumors. They differ from general surgeons in the depth of their cancer-specific training and their focus on complex or advanced cases, though general surgeons still perform most cancer operations in the U.S., particularly for common tumors of the breast, skin, and lower gastrointestinal tract. A surgical oncologist’s work extends well beyond the operating room, encompassing biopsy procedures, treatment planning, coordination with other cancer specialists, and sometimes palliative interventions designed to relieve symptoms rather than cure disease.
How They Differ From General Surgeons
Any board-certified general surgeon can remove a tumor, and many do. The distinction lies in training depth and case complexity. Surgical oncologists complete a general surgery residency (typically five years) and then an additional two-year fellowship specifically in complex general surgical oncology, accredited by the ACGME. After that, they must pass both a qualifying exam and a certifying exam through the American Board of Surgery, and they have a seven-year window after fellowship to complete the certification process.
This extra training prepares them for cancers that involve multiple organs, require extensive reconstruction, or need advanced techniques like heated chemotherapy delivered directly into the abdominal cavity. When a cancer is straightforward, a general surgeon may handle it. When the diagnosis is uncertain, the tumor is in a difficult location, or the case demands coordination across specialties, a surgical oncologist typically takes the lead.
Diagnosing Cancer Through Biopsies
One of the first things a surgical oncologist may do is obtain a tissue sample to confirm whether a suspicious mass is cancerous. The type of biopsy depends on the tumor’s size, location, and accessibility.
- Fine-needle aspiration: A thin needle draws out fluid and cells from a suspicious area. It’s quick and minimally invasive, often used for lumps near the surface like thyroid or breast nodules.
- Core needle biopsy: A larger needle with a cutting tip removes a small column of tissue, giving pathologists more material to work with than a fine-needle sample.
- Incisional biopsy: A scalpel removes a small portion of a suspicious area, typically when a needle biopsy can’t capture enough tissue or the mass is in a location that requires direct access.
- Excisional biopsy: The entire lump or suspicious area is removed. This serves a dual purpose: it provides a complete tissue sample and, if the margins are clear, may also be the definitive treatment.
Many of these procedures use image guidance, combining CT scans, MRI, or ultrasound with the needle to ensure precise placement, especially for tumors deep inside the body.
Staging and Treatment Planning
Once cancer is confirmed, the surgical oncologist determines its stage, which describes how large the tumor is, whether it has spread to nearby lymph nodes, and whether it has reached distant organs. Staging drives every treatment decision that follows.
At your first visit, a surgical oncologist will typically review your existing test results, explain what they mean, discuss the cancer stage, and lay out treatment options with their benefits and drawbacks. They’ll recommend whether minimally invasive surgery or open surgery makes more sense for your situation, and they’ll outline what you need to do to prepare. This consultation is as much about education and decision-making as it is about scheduling an operation.
Tumor Board Conferences
Cancer treatment rarely falls to one specialist alone. Surgical oncologists participate in tumor board conferences, where a team of physicians from different specialties reviews individual patient cases together. The core team typically includes surgical oncologists, medical oncologists (who manage chemotherapy and drug therapies), radiation oncologists, nurse practitioners, and nurses.
These conferences focus on complex cases where the diagnosis or treatment path isn’t clear-cut. The group discusses tumor characteristics, staging, treatment plans, and whether a patient might benefit from a clinical trial. For patients, this means their surgical oncologist isn’t making decisions in isolation. The recommendation you receive reflects input from multiple experts who have examined your case from different angles.
Types of Cancer Surgery
The core of the job is removing tumors. This ranges from relatively straightforward procedures to operations lasting many hours that involve multiple organ systems.
Surgical oncologists commonly treat cancers of the breast, colon and rectum, stomach, pancreas, liver, thyroid, ovaries, and soft tissues. Some specialize further, focusing on one organ system or cancer type for their entire career.
For certain abdominal cancers, surgical oncologists perform a two-step procedure called HIPEC (hyperthermic intraperitoneal chemotherapy). First, they surgically remove all visible tumors and diseased tissue from the abdomen. Then they insert catheters connected to a perfusion machine, which pumps heated chemotherapy drugs directly into the abdominal cavity for one to two hours. The heat increases the effectiveness of the drugs against any remaining microscopic cancer cells. After draining the chemotherapy, the surgeon rinses the abdomen with a salt solution before closing. This technique is used for cancers that have spread within the abdominal lining, including appendix cancer, colorectal cancer, stomach cancer, mesothelioma, ovarian cancer, and peritoneal cancer.
Robotic and Minimally Invasive Techniques
Many cancer operations that once required large incisions can now be performed through small openings using robotic-assisted surgical systems. The surgeon controls robotic arms from a console, gaining magnified 3D visualization and a range of motion that exceeds what human wrists can do.
Robotic surgery has become a standard approach for prostate cancer and is widely used for colorectal, gynecologic, and thyroid cancers. For thyroid cancer, robotic approaches often result in prompt healing with no visible scarring. For colorectal cancer, the technology is particularly valuable because the anatomy of the pelvis demands precision in tight spaces. Some of the most complex operations, like the Whipple procedure for pancreatic cancer, may actually be safer when performed robotically than through conventional open surgery. The benefits for patients typically include smaller incisions, less blood loss, shorter hospital stays, and faster recovery.
Palliative Surgery
Not every operation a surgical oncologist performs is aimed at curing cancer. Palliative surgery focuses on relieving symptoms and improving quality of life when a cure isn’t possible. A tumor pressing on nerves and causing severe pain can be surgically removed or reduced even if the cancer itself can’t be fully eliminated. Similarly, a tumor blocking the intestines can be bypassed or debulked to restore the ability to eat and digest food.
These procedures don’t change the overall prognosis, but they can dramatically improve how a patient feels day to day. Deciding whether palliative surgery makes sense involves weighing the risks of the operation against the relief it’s likely to provide, and that conversation is a key part of what surgical oncologists do.
Ongoing Responsibilities After Surgery
A surgical oncologist’s involvement doesn’t end when the operation is over. They monitor your recovery, review pathology results from the removed tissue, and use that information to refine the treatment plan. If the pathology reveals cancer at the edges of the removed tissue (positive margins), additional surgery or other treatments may be needed. They also coordinate with medical oncologists and radiation oncologists on whether follow-up chemotherapy or radiation is appropriate.
Long-term surveillance for recurrence is another part of the role. Depending on the cancer type and stage, this can mean periodic imaging, blood tests, or physical exams stretching over years. Surgical oncologists who maintain board certification participate in continuous certification, which includes ongoing medical education and practice improvement requirements, keeping their skills and knowledge current throughout their career.