Cancer patients will increasingly receive more than one modality of treatment delivered by cancer physicians from different medical specialties (e.g., internal medicine and surgery). Increasingly, those physicians providing cancer care will also be specialists, or even subspecialists, who confine their practice to a narrow scope of malignancies, such as breast cancer and gastrointestinal cancer, because it is challenging to keep up with the application of novel information in this expanding field, which is growing exponentially.

There is a substantial reorganization of cancer care delivery taking place around the globe that is focused around the multidisciplinary care of patients by physicians, united more around a specific disease management approach, such as breast cancer, than by their boarded medical specialty, such as surgical or  medical oncology.^2–4 Therefore, contemporary cancer care is becoming a team approach! Besides physicians, other stakeholders of the multidisciplinary team have also become valuable assets to this concept and include patient navigators, nurse practitioners, social workers, survivorship personnel, clinic coordinators, clinical trial nurses, hospital chaplains, and community outreach representatives.

Although surgical treatment is the centerpiece of our specialty, what differentiates surgical oncology from other areas in surgery is the oncology experience and expertise needed in dealing with all aspects of cancer management in a multidisciplinary fashion. The salient feature of differentiation is that surgical oncology is both a technical and cognitive specialty involving a chronic disease process.^4–7

It has been estimated by the World Health Organization that by 2030 surgical diseases will contribute significantly to the burden of global health. The treatment of cancer at its best involves a multimodality approach for local control with surgery and radiation as well as systemic control with a variety of oral and intravenous medications. Likewise, patient characteristics as well as awareness, physician preferences, hospital type, and country^8,9 impact the care administered for a particular cancer.^3,10,11

So what is the role of the surgeon in this evolving environment of cancer care delivery? How much do surgeons need to specialize, or limit the scope of their practice to keep up with a rapidly advancing field? How can practicing surgeons incorporate new devices, diagnostics, and drugs into their surgical practice? How do we need to train and certify the next generation of surgeons who will be a future partner in providing multidisciplinary cancer care? Does specialization make a difference in the outcomes of our care? These and other fundamental issues will need to be addressed by both surgical and oncology leadership around the world.

Over the past 40 years in the United States, the surgical specialization, known as “surgical oncology,” has grown to be an essential part of cancer care delivery, both in academic medical centers and in the majority of cancer centers as well as hospitals within the local community. In many institutions, the role of the surgical management for most types of cancer is expanding, and surgical oncologists are at the forefront of multidisciplinary and protocol-driven programs to improve the outcome of the surgical patient with cancer. Through the years, the primary professional organization that has led this effort has been the Society of Surgical Oncology (SSO)and the European Society of Surgical Oncology (ESSO). For membership purposes, the SSO defines a surgical oncologist as “…a physician with a major professional interest and commitment to oncology.” The mission of the SSO is to improve patient care by advancing the science and practice of surgical oncology.

At a broad level, one can define the roles and responsibilities of a surgical oncologist as one who (1) functions as an excellent surgeon who can safely manage cancer patients through complex operations and have the judgment to know what operations to select, (2) knows how to integrate surgical treatment as part of a multidisciplinary team, including the type and timing of surgery after preoperative systemic therapies and/or radiation therapies, (3) participates as an oncologist in the long-term disease-management of cancer patients, (4) conducts clinical research and/or translational research, and (5) develops as well as supervises clinical trials. Thus, the surgical oncologist is a dual specialist—both a surgeon and an oncologist—who can incorporate the advances in oncology management into his or her surgical practice, which in many, if not most cancer patients involves frequent use of preoperative and postoperative chemotherapy, biological therapy, and radiation therapy in various combinations and sequences.^1,5,7

In 2011, an important event occurred in the United States that has implications on the practice of oncology worldwide. After many years of deliberation, the American Board of Surgery and the American Council on Graduate Medical Education formally approved surgical oncology as a boarded subspecialty of general surgery (technically it is termed “Complex General Surgical Oncology”).^12–15  Graduates of surgical oncology training programs will take both a written and oral examination.¹⁵ There is a critical need to standardize the curriculum objectives and content for training as well as certification of surgical oncologists worldwide, which at present is very heterogeneous.^16–18

Recently, the Society of Surgical Oncology (SSO) and the European Society of Surgical Oncology (ESSO) have copublished two essential articles about the training of surgical oncologists and the disparities of training at a global level.^19–22 The initial paper analyzed the variations in training paradigms for surgical oncologists across the world and determined:

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  Significant variations in the training paradigms globally associated with geographic location and economic standing.

  
  
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  The total surgical training length is extensive, varying between 8 and more than 17 years, depending on the country.

  
  
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  Several countries do not have the capability to offer surgical oncology fellowship training programs, and there is wide variability in the location of foreign countries that physicians travel to in order to obtain required training.

  
  
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  Although some countries do not offer surgical oncology fellowships, they still mandate specialized training in surgical oncology.

  
  
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  No structured pathways to integrate the knowledge acquired abroad into the native health and medical systems.

These variations can have a detrimental effect on the global surgical oncology workforce. The majority of cancers at some stage will require the expertise of an adequately trained surgical oncologist. The availability of a curriculum that prescribes a set of uniform minimum of surgical oncology training standards can initiate the process of addressing these global inconsistencies. The two leading global surgical oncology societies of the world (The SSO and ESSO) have jointly developed such a curriculum consisting of a minimum set of training domains and requirements that can be adapted for different regions of the world.^21,22 Thus, surgical oncologists must be versed to comprehend the indications, risks, and benefits of systemic therapy (chemotherapy, targeted therapy, immunotherapy) and radiation therapy in the best combination and sequence of a multidisciplinary care plan for a surgical patient with cancer. Their training should also equip the surgeon to be a clinical investigator participating in clinical trials and contributing to evidence-based medical care. This curriculum published by both societies could serve as the platform to not only streamline training but also educate the surgeons to be competent in all facets of oncology.