Malignancy load on general surgeons: the need to change the general surgical training curriculum

Aims: With the advent of newer diagnostic modalities more and more cancer p atients are being diagnosed each year. The rising detection rate and greate r public awareness have immensely increased the load on already overburdene d and increasingly fewer surgical oncology units. As a result a large numbe r of these cases are being dealt with by general surgeons. Methods: We have used a retrospective case count from a single surgical uni t, based at the University Hospital, Varanasi, and data from the Hospital B ased 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 gene ral surgeons. Results: A total of 28,136 patients were registered at the RCC, the commone st malignancy being oral cavity (16.35%), followed by lung (12.7%) and brea st (23.8%) among men and women, respectively. On the other hand, in the 212 3 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, when 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 20 56 (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 r eferral institutions by general surgeons. Conclusions: The results clearly indicate an increased demand on the surgic al oncology units, or alternatively an urgent need to redefine the postgrad uate curriculum for the better training of general surgeons in understandin g malignant disease, especially in the developing countries. We recommend a minimum of 6 months training in surgical oncology for each general surgery postgraduate.