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Updated August 18, 2015.

Chemotherapy.  Surgery.  Radiation.  Immunotherapy.  Stem cell transplant.  So many types of treatment for so many types of malignancies.  Still, the majority of cancer patients receive some combination of surgery, chemotherapy, and/or radiation.  Thus for cancer patients and their loved ones, the selection of the physicians with to partner in battling their malignancy has direct and significant implications on their outcome and future.

But what many people don’t appreciate is that among cancer physicians, the search for a cancer surgeon who is the “right fit” represents a unique challenge.

With no disrespect intended to my non-surgeon colleagues, the most important factor on the success of chemotherapy and/or radiation therapy is the selection of the chemo drugs or radiation approach, respectively, and the dosage and administration of both.  A competent chemo physician (oncologist) can frequently and routinely consult shared guidelines and publications to select and fine-tune a “best” chemotherapeutic approach to a patient’s specific cancer.  Likewise, a radiation oncologist can repeatedly review the current medical literature to determine the radiation approach most likely to benefit a given patient.  This is not to imply that chemotherapy and radiation treatments are simply “cook book,” as the personal knowledge and professional experience of the physician does play an important role in successful cancer treatment.

Rather, it is to emphasize that prior to and even during chemo and radiation therapy, the treating physician has access to the same information on treatment used in the world’s best cancer institutions.  The oncologist and radiation oncologist can consult journals, colleagues, and other information sources at any time.  Thus, unless you are considering enrolling in an investigational clinical trial or you harbor an extremely rare or advanced malignancy, the selection of your oncologist and radiation oncologist is fairly straight forward.

The success of the surgical procedure aimed at removing your cancer, however, is vastly more dependent directly on the experience, knowledge, and technical skills of the individual surgeon who is performing the operation.  Even with adequate preparation, what we surgeons find during operations routinely requires a rapid change in our initial plan, modifications which occur in real time while our patients are asleep and the operation is already underway and which have meaningful implications for our patients’ cancer journey.  Trust me as a surgeon who has operated on hundreds and hundreds of cancer patients when I say that much of what impacts a patient’s likelihood of a successful cancer operation is entirely dependent on the individual human being who is performing the procedure.

Thus the selection of your cancer surgeon is critical in providing you the best chance in achieving your health goals.  So here’s a quick guide matching common types of cancer with specific types of surgeons (my book, Own Your Cancer, goes into greater detail on physician selection):

• Lung Cancer:  today, there are few general surgeons who have adequate training and experience to perform lung cancer operations (they tend to be in their sixties), as such procedures are now routinely performed by surgical specialists.  Thus, if you meet an older general surgeon with significant lung cancer experience, fine.  But most lung cancer patients should find a thoracic (chest) or cardiothoracic (heart and chest) surgeon (they have completed a surgical fellowship after finishing their general surgery training).
• Breast Cancer:  given how common this malignancy is, breast cancer surgery today is still routinely performed (and performed well) by general surgeons.  Just be sure to confirm the general surgeon’s experience (do they operate for breast cancer three times a week, or three times a year?).  Many plastic surgeons (who have first completed general surgery training) are also experienced in breast cancer surgery (plus any necessary breast reconstruction), as are surgical oncologists (who complete a fellowship after general surgical training)
• Colon & Rectal Cancer:  it is critical to understand that while many general surgeons are experienced in appropriately removing early-stage colon cancers, surgery for rectal cancers should be performed by a colorectal surgeon or surgical oncologist (both have additional fellowship training following general surgical training), as these are much more challenging operations, and many physicians believe (myself include) and some studies suggest that these surgical specialists’ additional training and experience may directly and favorably impact patient outcomes.  In addition, colorectal surgeons and surgical oncologists should be seriously considered by patients harboring more advanced colon cancers.
• Prostate Cancer:  while many prostate cancer patients ultimately are treated non-surgically, it is important to first be evaluated by a urologist.
• Skin Cancer:  the vast majority of skin cancers are curable and can be treated by a dermatologist, plastic surgeon, or general surgeon.  Melanomas are much more dangerous, and while all three types of physician can treat these aggressive malignancies, you must find one with significant experience specifically in the treatment of melanomas.
• Cervical Cancer:  many general gynecologists are experienced in the surgical treatment of simple cervical cancers.  However, if your gynecologist is not experienced in this area, or if your cervical cancer is more advanced, you should seek out a gynecologic oncologist (who have additional training in the treatment of gynecological cancers).
• Pancreatic of Liver Cancer:  some general surgeons truly have significant experience in the challenging operations required to treat cancers of the pancreas or liver.  That said, most patients should find a hepatobiliary surgeon (try contacting an academic/university medical center nearest you) or surgical oncologist, as both types of surgeon have advanced training focusing on these challenging organs and procedures.