Surgical Oncology

The division of Surgical Oncology was established in 2003 to promote excellence in cancer surgery across Europe. Cancer surgery is a complex discipline, crossing boundaries of organ specialisation and including breast, colorectal, melanoma, upper GI, hepatopancreatobiliary, thoracic, urology and neurosurgery.  The management of cancer in all disease sites shares a common theme of multidisciplinarity and more than any other type of surgery requires the surgeon to work as part of a complex team. Cancer surgeons must understand the aetiology, molecular biology, diagnostics, medical and radiation oncology, psychology and surgery and aftercare.  

The UEMS Surgical Oncology exam is designed to certify that a surgeon has knowledge across the breadth of cancer surgery with advanced level expertise in their own specialist discipline. The standard of the exam is set at the level of a fully qualified cancer specialist surgeon working to the latest European quality standards and protocols.   The exam is designed to evaluate both a candidate's theoretical and factual knowledge and their ability to apply this knowledge in the surgical and non-surgical elements of modern multidisciplinary cancer care.  The exam is designed to measure a candidate's surgical judgment, clinical reasoning skills and problem-solving ability.   The range of subjects areas covered in the exam are set out in the ESSO Core Curriculum [1] and more recently aligned with the global curriculum for cancer surgery developed jointly between ESSO and the US Society for Surgical Oncology [2]. 

A surgical oncologist is an oncologist who also possesses the expertise to perform operative procedures and interventions. As such, he is expected to possess the required knowledge of the basic principles and tenets of multi-disciplinary cancer management: epidemiology, screening, diagnostic pathology, medical imaging, chemotherapy and radiation therapy, palliative care, interventional radiology and endoscopy. Knowledge of the principles of basic, translational and clinical research are also required.

The surgical oncologist should be technically proficient in the art, science and principles of surgical procedures and there is an inevitable requirement for a degree of experiential learning to acquire practical skills.  The level of technical proficiency is assessed in the first phase of the exam: eligibility assessment.  This establishes whether the candidate has completed their training in surgical oncology, as certified by their national surgical regulatory body. In addition, on review of their signed operative log book, candidates must demonstrate experience of having performing complex cancer surgery both with and without senior supervision.  Once eligibility is confirmed, candidates will be invited to take the written and oral examinations.

These will test the candidate's knowledge of basic and complex surgical procedures for treating malignancies of various organ systems, the principles of clinically relevant anatomy and medical imaging applicable to surgical procedures, the extent of resection for primary lesions and metastatic lesions (including an understanding of how to assess margins and different levels of adequacy such as RO, R1 and R2) and the appropriate extent of lymphadenectomy ranging from nodal sampling, sentinel node biopsy and different levels of lymphadenectomy for various cancers.  Candidates will be expected to display knowledge of the latest research evidence in support of their case management and will be tested on their ability to understand published research in an academic oral exam.

Knowledge of the role of and indications for non-curative debulking surgery as an important part of palliative care is also required.  In addition a range of palliative surgeries and their indications should be understood (palliative bypass surgery, stenting, toilette mastectomy for a fungating locally advanced cancer), as well as the non surgical pallitaive alternatives.  This require close cooperation between the surgical oncologist, medical and radiation oncologists and the palliative and supportive care teams. 

A surgical oncologist should possess a working knowledge across all malignancies involving each specific disease site such as the digestive system, endocrine system, breast, soft tissues, skin, chest and reproductive system.   However, in this era of organ specific surgery and cancer management and with the increasingly complex management algorithms and techniques available candidates may specify up to 2 sub-specialist areas of expertise which will form the focus of the oral examination.   In some cases, candidates who have a very clear practice specialisation within only one area may also now take a UEMS EBSQ examination within this discipline only (see UEMS website for the full range of EBSQ examinations).

It is hoped that the exam will ultimately lead to an increase in the level of expertise of cancer surgery across Europe, not only as a result of the process of leaning required to pass the exam but also by harmonising the standard of care offered to cancer patients across Europe.  Examiners are leaders in the field of cancer surgery drawn from across Europe.

We hope the exam will be a stimulating, challenging and ultimately rewarding experience for all candidates. 

We welcome you to join the UEMS community of medical specialists. 

Lynda Wyld                                     Sergio Sandrucci                   Ibrahim Edhemovic
Chair of the Exam Board              Co-Chair                                 Co-Chair

References

  1. Wyld L, Audisio R, Naredi P, Poston G et al. Core Curriculum for Specialist Training in Surgical Oncology in Europe. European Journal of Surgical Oncology, 2013. 39 (Suppl. 1): p. 1-31.
  2. Are C et al. Global curriculum in surgical oncology. Eur J Surg Oncol, 2016.