Class started around 8.15am. We do not have to wake up too early or run to class. In my case, because I was lazy, I took the 7.20am bus every day. I didn’t want to run. I woke up around 5.00 am every morning so I can have my morning coffee in peace. The first part (Lecture) consists of several topics. For instance, “Intro: Cancer epidemiology, genetic background of tumor cell, carcinogenesis, and theory of tumor origin.” Dr. Karel attended to us for the second part (Practical). We were divided into several groups and after a short break, each group was assigned to a different part of the department. There was also a group of Erasmus students from Spain joining our group for Oncology that week.
My group had quite the interesting first day to Oncology as we saw brachytherapy being performed. We wore special cover sheet for radiation protection. It was heavy. The oncologist was teaching us as he was performing the procedure. Brachytherapy is a type of radiation therapy used to treat cancer. It is also known as ‘internal radiotherapy’ because the source of therapeutic radiation is being applied directly inside the patient’s body. The more common form of radiotherapy is the external beam therapy (EBT) where the external source of radiation is directed from outside the patient’s body and targeted at a particular part of the body. There are many cancers treated by EBT such as breast cancer, colorectal cancer, head and neck cancer, lung cancer, prostate cancer and brain tumor.
Meanwhile, in brachytherapy, the oncologist can place a radioactive material directly inside or next to the tumor temporarily or permanently. It allows the oncologist to use a higher total dosage of radiation to treat a smaller area in a shorter time compared to EBT. Brachytherapy is usually used to treat gynecological tumors such as uterine, cervical and endometrial malignancies. It can also be used for other cancers throughout the body. For example, prostate, breast, bronchi and biliary ducts.
Afterwards, we were taken to the outpatient part of the department where another oncologist was waiting for us. She had to do follow-ups on several patients that day. Before a patient came in, she explained the patient’s history and some information regarding the natural history of the particular cancer. There were two patients, a 70-year old woman who came with a suspicion of melanoma and a 70-year old man diagnosed with liposarcoma with retroperitoneal metastasize. In each patient, at least one family member was present with them. The oncologist took her time in explaining every detail to the patient and the family member (s). After each consultation, we would then discussed further about the patient’s diagnosis and treatments.
Finally the final part of the class, which was the seminar. Basically another word for ‘More Lectures’. What you have read so far is basically the structure of a day in the Oncology block, from a medical student studying in Palacky University. How is it like for medical students from other schools, I wonder. Through my experience and observations while being in the Oncology department, I have concluded several things I would like to share with the readers.
Every department in the hospital shares many similarities and still differs from each other in quite a number of aspects. I wonder what makes the Oncology department different. The department feels a bit ‘slow’ relative to the others. But there is still tension here, although a different one, when you compare it to the General Surgery department for example. Mostly are chronic and elderly patients. Some are undergoing curative treatment, some palliative. I felt sad when I saw elderly patients who came without family members. A good support system is very important when managing a cancer patient especially the family caregivers. It can be spouses, children, relatives or friends who help patient with daily activities and health care needs at home.
On the other hand, if we try to look from the physician’s point of view, being in touch with death every day might be one of the worst thing in life. In the book Outliers, author Malcolm Gladwell claims that mastery in any skill can be achieved when one practice in the correct way, for a total of around 10,000 hours. Of course, we can discuss whether this interesting information is a fact or not but I would like to direct your attention back to the physician who deals with death every day. The physician can develop good coping skills that will help him/her in his/her career in the long run, but at the other end of the spectrum, he or she might end up treating the disease, not the patient, forgetting how important human touch is to the patient.
The doctor-patient relationship can be intense because in some ways, cancer patients are needier and they want someone to guide them. Therefore, it is the main responsibility of an oncologist to provide patient education which is usually an extensive and ongoing process. In this way, patient and doctor cooperate to make an informed decision.
Last but not least, to any medical student who wish to specialize in oncology, are you ready for this? It is not an easy task, but our country needs more young physicians who can continue the work of the senior physicians who are in the front line of developing the oncology community in Malaysia. Not for our benefit, but for the patient’s.
Farahliza Grace is a 3rd year medical student studying in the Faculty of Medicine, Palacky University, Czech Republic. Learn more about her and other students at the Young Columnists tab under The Team.