Why are Hematology and Oncology always grouped together? It seems that
every Oncologist (cancer doctor) is also a Hematologist (blood doctor)
and every Hematologist is also an Oncologist. I would think that not
all blood disorders are cancer, or vise versa. Why are Oncology and
Hematology always together?

Hi eddief,

     Hematology-Oncology(Heme/Onc) usually refers to the department
that sees patients with blood and platelet disorders and cancers that
are treated with a non-surgical therapy, such as bone marrow
transplant, stem cell transplant, pheresis, or chemotherapy. (Think
?liquid? therapy when differentiating heme/onc from oncology) Types of
cancer typically seen in a heme/onc department would be leukemias,
lymphomas, Hodgkins, non-Hodgkins, multiple myelomas and immunological
disorders. So, an oncologist is not a hematologist, or vice versa. But
a hematologist oncologist is a hematologist that specializes in the
diseases mentioned above. A hematologist oncologist would not treat
operable cancers such as prostate cancer.

Oncology usually refers a department that sees cancers that require
surgical treatment such as ovarian cancers, throat and digestive
system cancers, thyroid cancer, etc. Patients would be seen by an
oncologist or a surgeon with experience in cancer surgery. Some
doctors have received special training, or have experience with a
certain kind of medicine, and may see and treat patients themselves
without referring them to a specialist.


Because disorders and diseases seen in heme/onc often overlap, it is
more effective to have hematologists working closely with oncologists.
Many patients see both ?heme? and ?onc? doctors during the course of
their therapy.  A breast cancer patient, for example, may be treated
with a bone marrow transplant or stem cell transplant, and her
oncologist would work in conjunction with the hematologist. Another
benefit to doctors and patients is the heme/onc clinic is equipped
with special microscopes and often have their own lab, which enables
the doctors and medical technologists to make rapid diagnosis, or
monitor patients quickly and efficiently. Hematologists and
oncologists are well trained specialists that have the skills to
identify cells under the microscope that general practice doctors
often don?t posses.

You are correct in stating that not all blood disorders are cancer.
Most anemias, such as iron deficiency anemia, infectious agents,
anemias caused by red cell defects and hemoglobinopathies, etc. are
certainly not cancerous, but are treated by hematologists. Again,
hematologists study ALL forms of blood disorders, cancerous and
non-cancerous, but they are not oncologists, and would not treat colon
cancer.

Large  hospitals often have a routine hematology lab, where blood is
tested  on most in-patients. The CBC (Complete Blood Count) is the
most well known hematology test, and is run on most in-patients at
some time during their stay. If a blood disorder, lymphoma or leukemia
is found, or suspected, the patient?s doctor will refer them to a
hematologist, if they feel it is necessary. From there, the
hematologist orders specialized tests run on highly sophisticated
equipment by specialized medical technologists, and usually run in the
?Special Hematology? lab, or the Heme/Onc lab, within the heme/onc
department.

To further complicate matters, there are many doctors who have
multiple specialties. There are no hard and fast rules in this area!

If this is not the information you were seeking, please do not rate
the answer until you are satisfied. Simply request an Answer
Clarification, and I will clarify things for you as soon as possible.

Sincerely, Crabcakes

Search Terms
Personal experience working in a Heme/Onc laboratory

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Request for Answer Clarification by eddief-ga on 15 Apr 2005 01:01 PDT

It seems that I can't find "just" a hematologist that isn't an
oncologist also. I don't want you to find one, but is this just
because, as you say, the diseases and treatments overlap? It seems
that every hematologist is also an oncologist (at least in their
titles). Thanks for your clarification.
Eddie F

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Clarification of Answer by crabcakes-ga on 15 Apr 2005 09:25 PDT

Hi again eddief,

  If you could elaborate a bit more... are you seeking a hematologist?
May I ask why? And yes, there ARE doctors who are "just"
hematologists. However, hematologists also treat forms of cancer, such
as leukemias.

  Could you let me know why you need a hematologist, and are you
opposed to seeing a doctor (hematologist) that also treats blood
dyscrasias? The more I know about what you are after, the better I can
answer your question.

  Sincerely, Crabcakes

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Request for Answer Clarification by eddief-ga on 15 Apr 2005 11:33 PDT

It's for my dad. He was just diagnosed with myelodisplastic syndrome
(MDS or basically low platelets) and is seeing a
hematologist/oncologist. He asked me why every hematologist is also an
oncologist. I looked around for the answer unsuccessfully and then
asked you. So basically I'm looking for something I can tell my dad
that won't be too scary.
Thanks for all of your extra help.
Eddie F

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Clarification of Answer by crabcakes-ga on 15 Apr 2005 12:07 PDT

Hi eddief,

   Thank you for the nice tip. I'm sorry to hear about your dad. Not
to alarm you or your dad, but his seeing a heme/onc is actually a good
idea, as some forms of MDS can become more serious.

http://www.emedicine.com/med/topic2695.htm

http://www.nci.nih.gov/cancerinfo/pdq/treatment/myelodysplastic/patient/

http://www.merck.com/mrkshared/mmanual/section11/chapter138/138d.jsp

Not a good analogy, but think of a hematologist as a Mercedes Benz
mechanic, and the oncologist as a BMW mechanic. Each are specialized
mechanics. Suppose you took your car to a mechanic who was specialized
as a Mercedes Benz AND a BMW mechanic. This MB/BMW mechanic knows both
vehicles well and you woud probably have no qualms about having your
BMW serviced by this mechanic.

I wish your dad the best!
Sincerely, Crabcakes

Well said with excellent content. Clarification was also appreciated. Thank You.

There is a very simple answer to this question which was missed.  The
reason that just about every hematologist is an oncologist (and vice
versa) is that under the current training system, doctors who want to
do one also train in the other.

To wit:

After 4 years of undergrad, 4 years of medical school, and 3 years of
internal medicine residency, a doctor has the option to subspecialize
by taking a fellowship in a particular discipline --- usually on the
order of another 3 years.  The subspecialities in internal medicine
include (to name but a few) cardiology (matters relating to the
heart), gastroenterology (matters relating to the gut), endocrinology
(matters relating to hormones), and hematology/oncology (matters
relating to blood diseases as well as solid tumors).

Now just because you do a heme/onc fellowship does not mean you have
to see all kinds of patients.  If your particular area of interest is
breast cancer, for example, you could attempt to sub-subspecialize in
that, so to speak.  It might be difficult to get enough patients to
make ends meet, of course, which is why most people in this position
have a broader practice.

Hematology is difficult to focus on, for this very reason.  There are
simple not enough patients who require the services of a hematologist
(in most areas) for a physician to avoid the solid tumors.  Thus if
your interest is hematology, chances are that you will also see
patients with, say, lung, breast, colon, and prostate cancer (which
are the most common tumors in the US).

Someone who specializes purely in blood disorders (or even in
particular types of blood disorders) is likely to be someone who has
been around for a long time, is well-known in the field, and gets
enough referrals of difficult or refractory cases from other doctors
to be able to do just that.

As to the question as to WHY hematology and oncology are grouped
together, I can only speculate that hematologists deal with both
cancer and non-cancer blood diseases, and that it seems semi-natural
for that to be associated with solid tumors as well.

An addendum:

To correct what I see of as misinformation in the original answer:
oncology is  a multidisciplinary field where internists, radiation
oncologists, and surgeons of various stripes (general, chest,
gynecologic, and ENT, for example) all work together.  A heme/onc
department will often see and treat patients who have received or will
receive non-liquid forms of therapy, such as surgery or radiation. 
The idea that oncology is a field distinct from
hematologists/oncologists and that it involves only non-chemical type
therapies is simply not true.

For example: the oncology service on which I am working right now
includes patients who have had surgery and are receiving adjuvant
chemotherapy; patients who have received neo-adjuvant chemotherapy (or
radiotherapy, or radiochemotherapy) first, followed by surgery;
patients who have only had chemotherapy; patients who have only had
surgery; patients who have failed one modality and are being treated
with another; and so on.

The distinction between "liquid" and "non-liquid" therapies simply
does not differentiate between hematologic and oncologic diseases:
some patients with solid tumors have chemotherapy, some have
radiotherapy, some have surgery, and some have a combination. 
Likewise, patients with blood cancers, such as lymphomas and
leukemias, can have any or all of these therapies as well.

Thank you linezoid, for adding some great information to my answer.
However, I supplied no "misinformation"! I clearly stated that
oncologists perform surgery and the professions do overlap and work
together. The answer was explained in lay terms to make it easy for
all to understand. Your explanation was very well done, but  mine is
not "misinformation"

Regards, Crabcakes

Hi again.

Strictly speaking, I don't want to get into a big argument about this
as it's relatively unimportant.  I must say, though, that oncologists
are doctors who have done a residency in internal medicine and a
fellowship in hematology/oncology.  They do not perform surgery.  They
give chemotherapy and coordinate with other doctors who perform
surgery (general surgeons, thoracic surgeons, gynecologic surgeons,
ear-nose-and-throat surgeons, plastic surgeons, and various
subspecialities and sub-subspecialities within these fields, to name
but a few), and with doctors who provide radiotherapy (radiation
oncologists, who belong to another subspecialty of internal medicine).

Cheers.