Malignancy load on general surgeons: the need to change the general surgical training curriculum.
OBJECTIVE
With the advent of newer diagnostic modalities more and more cancer patients are being diagnosed each year. The rising detection rate and greater public awareness have immensely increased the load on already overburdened and increasingly fewer surgical oncology units. As a result a large number of these cases are being dealt with by general surgeons.


METHODS
We have used a retrospective case count from a single surgical unit, based at the University Hospital, Varanasi, and data from the Hospital Based Cancer Registry (HBCR), Regional Cancer Centre (RCC), Trivandrum, from 1990 to 1994, to define the malignancy load on general surgical units and to define the number and sites of malignancies commonly encountered by general surgeons.


RESULTS
A total of 28,136 patients were registered at the RCC, the commonest malignancy being oral cavity (16.35%), followed by lung (12.7%) and breast (23.8%) among men and women, respectively. On the other hand, in the 2123 patients with malignancy who were treated at the Medical College (MCH) in Trivandrum, the commonest sites encountered were stomach (11.68%), thyroid (10.31%) and colorectal (9.5%). This was quite similar to the frequencies observed at Varanasi, where colorectal cancer constituted 10.26% and stomach 6.98%. Only 13.6% of the patients reporting to RCC were treated by surgery alone or in combination, while this figure was 48. 1% for MCH. Similarly 2056 (7.3%) patients presenting to RCC had completed treatment prior to being referred to RCC; almost all of these patients were treated by surgery at referral institutions by general surgeons.


CONCLUSIONS
The results clearly indicate an increased demand on the surgical oncology units, or alternatively an urgent need to redefine the postgraduate curriculum for the better training of general surgeons in understanding malignant disease, especially in the developing countries. We recommend a minimum of 6 months training in surgical oncology for each general surgery postgraduate.
Pandey
M
M
Division of Surgical Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India.
Varghese
C
C
Mathew
A
A
Nair
M K
MK
Gautam
A
A
Shukla
V K
VK
D002173:Cancer Care Facilities / Q000706:statistics & numerical data; D003479:Curriculum / Q000592:standards*; D004503:Education, Medical, Graduate / Q000592:standards*; D005260:Female; D013502:General Surgery / Q000706:statistics & numerical data; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007194:India; D008297:Male; D008485:Medical Audit; D009369:Neoplasms / Q000601:surgery*; D012042:Registries