Multidisciplinary Treatment of the Cancer Patient
Core concepts
Modern oncology is delivered by a multidisciplinary team (MDT): surgery, medical oncology, radiation oncology, pathology, radiology, nursing, and allied health. Candidates must understand when each modality is curative vs palliative, and how they combine: neoadjuvant (before surgery), adjuvant (after), concurrent chemoradiation, and definitive non-surgical treatment.
Know the principles: staging drives intent; performance status and comorbidity determine fitness; patient preference and goals of care are integral. Recognize that treatment decisions balance oncologic benefit against toxicity and quality of life.
Traps in questions
- Assuming adjuvant therapy benefits all patients-it is stage- and risk-dependent.
- Confusing neoadjuvant (downstage before surgery) with adjuvant (eradicate micrometastases after).
- Overlooking that elderly or frail patients may be best served by de-escalated or palliative approaches.
- Forgetting supportive care (antiemetics, growth factors, palliative radiotherapy) is part of multidisciplinary management, not an afterthought.
Worked example / rule of thumb
A patient with locally advanced rectal cancer: the MDT typically sequences neoadjuvant chemoradiation → restaging → surgery → adjuvant chemotherapy, with the exact order depending on stage and response. Rule of thumb: ask "what is the goal-cure or palliation?" first; every subsequent modality choice follows from that.
Also understand tumor board documentation and the value of second opinions for rare or borderline-resectable disease.