One of the most common questions my patients ask is, “Doctor, do I need to meet a surgical oncologist only if surgery is already planned?”
The answer is no.
Over the years, one of the most common misconceptions I have encountered is that meeting a surgical oncologist automatically means surgery is inevitable. In reality, many of my consultations involve helping patients that surgery may not be the first – or even the best – treatment option.
A surgical oncologist is involved much before the actual operation. My role often begins when a patient has a suspicious lump, an abnormal scan, a biopsy report showing cancer, or a recommendation for surgery that the family does not fully understand.
Cancer surgery is not simply about removing a tumor. It is about understanding the cancer, confirming the diagnosis, assessing the stage, deciding whether surgery is required, choosing the right timing, selecting the safest approach, preserving function wherever possible, and planning recovery.
In many cancers, the most important decision is not just “Can we remove it?” The more important question is, “Is surgery the right treatment at this stage, and is this the right time to do it?”
A surgical oncologist is a surgeon who has specialized training and experience in the surgical management of cancer. The work is different from routine surgery because cancer behaves differently from other diseases.
A surgical oncologist must understand:
Cancer staging is the process of understanding how much cancer is present in the body, including tumor size and whether it has spread. Staging directly influences treatment planning.
In simple words, a surgical oncologist is not just an operating surgeon. A surgical oncologist is part of the decision-making team that helps decide whether surgery is required, what kind of surgery is appropriate, and how surgery fits into the complete cancer treatment plan.
A surgical oncologist helps patients through several stages of cancer care.
This may include:
The American Cancer Society explains that cancer surgery may be used to diagnose, treat, stage, or sometimes prevent cancer, depending on the situation.
In my clinical experience, patients often think surgery is a single event. But in cancer care, surgery is part of a larger pathway. The quality of planning before surgery and the decisions made after surgery are just as important as the operation itself.
Cancer treatment usually involves more than one specialist. Each doctor has a different role.
| Specialist | Main Role |
|---|---|
| Surgical Oncologist | Plans and performs cancer surgery; helps decide whether and when surgery is needed |
| Medical Oncologist | Treats cancer with chemotherapy, immunotherapy, targeted therapy, and other medicines |
| Radiation Oncologist | Treats cancer using radiation therapy |
| Radiologist | Interprets scans such as CT, MRI, PET-CT, mammography, and ultrasound |
| Pathologist | Confirms the diagnosis by examining biopsy or surgical tissue |
| Nuclear Medicine Specialist | Helps with PET scans and selected nuclear medicine procedures |
A medical oncologist treats cancer using medicines that travel through the body. A radiation oncologist treats cancer using focused radiation. A surgical oncologist treats cancer through surgery and helps decide where surgery fits in the treatment sequence.
Most good cancer care is multidisciplinary. This means the surgical oncologist works with medical oncologists, radiation oncologists, radiologists, pathologists, anesthetists, dietitians, physiotherapists, stoma therapists, and other specialists when required.
In Bengaluru, our multidisciplinary discussions are especially important for complex cancers such as rectal cancer, esophageal cancer, pancreatic cancer, ovarian cancer, lung cancer, stomach cancer, liver tumors, and recurrent cancers.
You should consider meeting a surgical oncologist if:
Many patients come to me after already receiving one treatment recommendation. Some are anxious because they have been advised major surgery. Some are confused because one doctor has suggested chemotherapy first, while another has suggested surgery.
What I typically advise my patients is this: before any major cancer treatment, first understand the diagnosis, stage, goal of treatment, and sequence of care. Once these are clear, decisions become less frightening and more logical.
The work of a surgical oncologist often starts before surgery is even confirmed.
A surgical oncologist reviews the patient’s symptoms, examination findings, imaging reports, biopsy report, tumor markers where relevant, and overall medical condition.
Cancer treatment cannot be planned from one report alone. A scan may show the extent of disease. A biopsy may confirm the cancer type. Clinical examination may reveal whether the tumor is fixed, mobile, ulcerated, bleeding, or affecting nearby structures.
A biopsy is often needed to confirm cancer. Biopsies may be done with a needle, through an endoscope, or during surgery, depending on the case.
But biopsy planning is very important. In certain cancers, the biopsy route and technique can affect future surgery.
For example:
I often explain to patients that biopsy is not just “taking a small piece.” It is the first step in cancer treatment planning.
Staging helps answer four important questions:
The stage determines whether surgery should be done first or whether chemotherapy, radiation, or another treatment should come before surgery.
For example, some colon cancers may be treated with surgery first. Many rectal cancers may need chemotherapy or radiation before surgery. Some breast cancers may need chemotherapy first to shrink the tumor. Some esophageal cancers may need chemoradiation before surgery. Some advanced cancers may need systemic treatment instead of immediate surgery.
Not every cancer patient needs surgery. Not every cancer patient needs surgery first.
This is an important point.
A surgical oncologist also helps decide when surgery is not the right first step. Sometimes operating too early can reduce the effectiveness of treatment. Sometimes chemotherapy or radiation can make later surgery safer or more effective. Sometimes major surgery may not help if the cancer has spread widely.
A responsible surgical opinion should explain both when surgery is useful and when surgery should be delayed or avoided.
Surgical oncologists primarily treat solid tumors. These are cancers that form a mass or tumor in an organ or tissue. Surgery remains the primary and most effective curative treatment for localized solid-organ cancers (Lancet Oncology Commission). About 80% of all cancer patients (the majority of whom have solid tumors) will require some form of surgical intervention.
In my practice, this includes cancers such as:
Some cancers are treated mainly with surgery, while others require medicines or radiation as an important part of treatment. The exact plan depends on cancer type, stage, tumor biology, and patient fitness.
The goal of cancer surgery is not simply to remove a visible lump. The goal is safe cancer removal with proper margins, correct lymph node assessment, and preservation of important structures wherever possible.
During surgery, a surgical oncologist may:
A good cancer operation is not only about what is removed. It is also about what is preserved.
For example, in rectal cancer, preserving bowel, urinary, and sexual function may be important. In breast cancer, the plan may involve breast conservation or reconstruction where suitable. In oral cancer, speech, swallowing, and appearance matter. In soft tissue tumors, limb preservation may be possible in selected patients.
Patients often ask me, “Doctor, is robotic surgery better than open surgery?”
The honest answer is: not always.
Robotic surgery, laparoscopic surgery, and thoracoscopic surgery are minimally invasive techniques. They may help selected patients recover faster, with smaller incisions, less pain, and shorter hospital stay. But they are not automatically better for every cancer.
Open cancer surgery remains very important in many complex cancers, large tumors, recurrent cancers, advanced cancers, and cases where wider access gives safer cancer clearance.
| Approach | When It May Be Useful | Important Point |
| Robotic surgery | Selected pelvic, abdominal, thoracic, and complex minimally invasive procedures | Useful only when cancer safety is not compromised |
| Laparoscopic surgery | Selected abdominal cancers such as some colorectal and stomach cancers | Smaller incisions may support recovery in suitable patients |
| Thoracoscopic surgery | Selected chest procedures | Depends on tumor location and stage |
| Open surgery | Large, complex, advanced, recurrent, or technically demanding cancers | Still essential in many cancer operations |
In surgical oncology, the best surgery is not the one with the smallest incision. The best surgery is the one that removes the cancer safely while protecting the patient’s recovery and quality of life.
Before undergoing cancer surgery, ask your doctor these questions:
In my clinical experience, patients feel more confident when they understand why surgery is being advised, not just what surgery is being advised.
Fact: A surgical oncologist helps with diagnosis, biopsy planning, staging, treatment sequencing, surgery, recovery, and follow-up.
Fact: Some cancers need chemotherapy, radiation, or other treatments before surgery.
Fact: Robotic surgery is useful in selected cases, but open surgery remains essential for many complex cancers.
Fact: Some patients may need chemotherapy, radiation, targeted therapy, immunotherapy, or structured follow-up after surgery.
Fact: The right surgery depends on cancer biology, stage, margins, lymph nodes, patient safety, and long-term quality of life.
Not every symptom means cancer, but some symptoms should not be ignored.
Please seek medical attention if you have:
Early evaluation does not mean you will need surgery. It simply helps establish the diagnosis and prevents unnecessary delay.
For me, the question in cancer surgery is not only whether a tumor can be removed. The more important question is whether surgery is the right treatment, at the right time, in the right sequence, and with the right goal.
In my practice, I explain to patients that good cancer surgery is not just technical surgery. It is decision-making, planning, teamwork, recovery support, and long-term follow-up.
Every cancer behaves differently. A colon cancer is different from a rectal cancer. A stomach cancer is different from a pancreatic cancer. A breast cancer is different from an ovarian cancer. Even within the same cancer type, two patients may need different treatment plans because their stage, fitness, tumor biology, family circumstances, and recovery needs are different.
That is why experience, multidisciplinary thinking, and patient-centered planning matter in surgical oncology.
A surgical oncologist does much more than perform cancer surgery.
The role includes diagnosis review, biopsy planning, staging, treatment sequencing, surgical decision-making, cancer surgery, recovery planning, final histopathology review, coordination of further treatment, and long-term follow-up.
Cancer surgery should always be planned with a clear understanding of the cancer type, stage, patient fitness, treatment goals, and expected recovery.
If you or your loved one has been diagnosed with cancer, advised a biopsy, or asked to undergo cancer surgery, meeting an experienced surgical oncologist can help you understand whether surgery is needed, when it should be done, what approach is suitable, and how it fits into the complete cancer care pathway.
A surgical oncologist diagnoses, stages, plans, and performs surgery for solid tumors. The role also includes biopsy planning, deciding whether surgery is needed, coordinating with other cancer specialists, and supporting recovery after surgery.
A surgical oncologist is a cancer surgeon with specialized training in cancer surgery and treatment planning. The specialist understands cancer biology, staging, margins, lymph nodes, reconstruction, recovery, and multidisciplinary cancer care.
You should see a surgical oncologist if you have been diagnosed with cancer, advised a biopsy, recommended surgery, need a second opinion, or want to understand whether surgery is required.
Surgical oncologists primarily treat solid tumors, including gastrointestinal, breast, gynecological, thoracic, head and neck, urologic, endocrine, soft tissue, bone, and advanced abdominal cancers.
No. Some cancers need surgery, while others may be treated with chemotherapy, radiation, immunotherapy, targeted therapy, or surveillance. The decision depends on cancer type, stage, tumor biology, and patient condition.
No. Some cancers need chemotherapy or radiation before surgery. A surgical oncologist helps decide the correct treatment sequence.
Robotic surgery may be helpful in selected patients, but it is not always better. Open surgery remains important in many complex cancers. Cancer safety is more important than incision size.
Yes. A second opinion can help confirm diagnosis, stage, treatment sequence, surgical options, risks, recovery expectations, and whether surgery is the right next step.
Written by: Dr. Suraj Manjunath
Senior Consultant Surgical Oncologist, Bangalore
MBBS, MS, MCh – Surgical Oncology
25+ years of experience in surgical oncology
12,000+ cancer surgeries performed
20,000+ patients treated
Former Professor and HOD, Surgical Oncology
This article has been written and medically reviewed under the guidance of Dr. Suraj Manjunath, Senior Surgical Oncologist in Bangalore. Dr. Suraj Manjunath has over 25 years of experience in the surgical treatment of cancers involving the gastrointestinal tract, breast, gynecological organs, head and neck region, thoracic organs, urologic system, endocrine glands, soft tissue, and bone.
He has extensive experience in open cancer surgery, robotic cancer surgery, laparoscopic cancer surgery, thoracoscopic cancer surgery, cytoreductive surgery, and HIPEC. His clinical focus is on safe cancer clearance, individualized surgical planning, complication prevention, and structured recovery after major cancer operations.
The content is intended for patient education and should not replace a personalized consultation with a qualified surgical oncologist.
Medically reviewed by: Dr. Suraj Manjunath
Senior Consultant Surgical Oncologist, Bangalore
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