What is Radiation Oncology?
Radiation oncology is a subspecialty practice focused on the use of therapeutic radiological sources to treat cancer in both adults and children. Radiation oncologists treat a wide variety of cancers, including those arising from practically any area of the body. Radiation is often delivered as the primary form of treatment as a curative modality for tumors of the prostate, lung, brain, and gastrointestinal and gynecologic tracts. The use of radiation pioneered the concept of “organ preservation” for tumors of the head and neck, allowing patients to avoid disfiguring surgery and preserve function while optimizing cure. Additionally, radiation can also be delivered to help improve quality of life for patients seeking palliation.
Most radiation treatments are delivered from a high-energy x-ray source termed a linear accelerator which can be programmed and configured to produce an external beam, although radiation oncologists also do procedures where they implant radioactive elements directly into the body. Training is 4 years long and follows a 1-year internship – most residents do their internships in internal medicine or surgery. For more about the specialty, click this link on “A Day in the Life".
Medical Student FAQs
What do radiation oncologists do?
Radiation oncologists utilize ionizing radiation for the treatment of cancer. The field focuses on prescribing and planning the appropriate therapy based on the patient diagnosis, ensuring that the treatment is properly administered each day, managing any complications of care, working with medical and surgical oncology colleagues in an interdisciplinary setting, and following the patient after treatment to manage late side effects and monitor the status of disease. Most of the work is done in the outpatient setting, although some procedural-based radiation oncologists spend time in the operating room and even admit patients to the hospital. Given that some patients with cancer are diagnosed unfortunately in the emergency room, radiation oncologists are also consulted to help devise a treatment plan in this setting. Much of the work involves counseling and educating patients on their cancer diagnosis and providing support through their care journey.
Who do I work with?
Radiation oncology is by its nature a very team-based and multi-disciplinary specialty. Radiation oncologists work with other ancillary staff that also includes physicists, dosimetrists, radiation therapists, and nurses. In most academic centers, they also work as part of a multi-disciplinary cancer team that includes medical oncologists, surgical oncologists, radiologists, and pathologists. Although the work is generally outpatient-based, the sheer nature of caring for cancer patients can lead to long, intense days. This is another reason why having a strong supportive team is so important.
What are some other things I should know about the day to day?
The specialty is highly academic with a focus on physics, molecular biology, immunology, and evidence-based clinical medicine. Technological advances in engineering, imaging, and computer processing power have also resulted in dramatic improvements in the way in which radiation can be practically delivered. In recent years, artificial intelligence, robotics, and machine learning have assumed importance in the design of increasingly sophisticated treatments. Radiation oncologists divide their time between seeing patients (inpatients and outpatients), participating in tumor boards and multidisciplinary clinics, reviewing imaging with radiology, performing procedures (such as radioactive implants), and using computer algorithms to devise treatment plans. Knowledge of anatomy is crucial for radiation oncologists, as everything done is dependent on being able to reliably identify and target a tumor in three-dimensional (or often, four-dimensional, with the added component of time, space). Careful history taking and physical examinations are very important in this field and help provide information valuable to treatment planning. In the academic setting, radiation oncologists often dedicate a significant portion of their time to research (clinical or basic science). Many are involved in the design of clinical trials with the goal of improving care for patients.
Do medical emergencies exist in radiation oncology?
Medical emergencies are rare. However, scenarios that require the urgent administration of radiation do exist. These include spinal cord compression from paralysis is imminent due to growth of cancer into the central nervous system; superior vena cava (SVC) syndrome, where a tumor is blocking the flow of blood into the thorax leading to compression of critical structures including nerves, soft tissue, and vasculature; and hemoptysis and airway obstruction from tumors infiltrating the respiratory tract. Some scenarios involving brain metastasis can also be considered emergencies depending on the clinical presentation and symptoms.
What if I don’t have a strong physics or engineering background?
No problem! Many of us were in similar shoes. The physics in radiation oncology is different than the theoretical physics from one’s undergraduate days or from studying for the MCAT. Radiation physics is much more practical and taught from the standpoint of patient treatment. While the learning curve can be steep, nearly all residents who apply themselves eventually master the material-- even those lacking strong physics or engineering backgrounds. It is our goal not to train the next Albert Einstein or Stephen Hawking. Rather, we recognize that residency is about training folks to become competent radiation oncologists who understand medical physics to thoughtfully administer radiation to help patients.
Are there research opportunities at UCI?
Absolutely. As part of Orange County’s only NCI-designated cancer center and one of only a select few nationwide, UCI Radiation Oncology prides itself on its commitment to scientific discovery. All our faculty are engaged in active investigations and would be thrilled to hear from you. Feel free to browse our faculty biographies and reach out to any one of us!
What about after residency?
Residency graduates have a plethora of options. Some go on to work in academic (university-affiliated) medical centers; others choose to work with community-based hospitals; or private practice groups that either own their own free-standing facilities or staff local hospitals.
What is job satisfaction like for radiation oncologists?
Radiation oncologists have reported consistently high rates of job satisfaction for decades. This is likely due to the combination of the gratifying work of caring for people with serious illnesses; the privilege of being able to establish lifelong relationships with patients; the opportunity to engage in meaningful cancer research of all kinds; and the evidence-based, cerebral nature of the field. Working as part of a dynamic multi-disciplinary care team and being able to live on the cusp of leading technological advances are also positives. The predictable work hours and lack of inpatient (overnight) call contribute to a lifestyle where it is more than possible to balance work and personal interests.
This sounds great as a career, but I am unsure. What should I do?