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COURSE AND SYLLABUS OF DM
MEDICAL ONCOLOGY IN AIIMS
INTRODUCTION
The practice of oncology is in a period of significant change. There is an expansion of new information
regarding the molecular and cellular biology, immunology and Biochemistry
of cancer and a steady
increase in our ability to more effectively diagnose and treat human malignancies. ‘Medical Oncology’
as a specialty has assumed immense importance. Institute Rotary Cancer Hospital, All India Institute of
Medical Science is one of the few centers in India that provides the prestigious postgraduate super
specialty course-DM
Medical Oncology. It is important that the candidates interested in pursuing their
career in medical oncology, besides a good clinical acumen, possess a sound understanding of the
related basic sciences. They should be able to comprehend the essentials of molecular biology, genetics,
signal transduction and immunology and translate the knowledge into clinical practice.
GOAL OF THE PROGRAM
To ensure adequate supply of medical oncology experts who assume leadership role in their fields.
AIMS OF THE PROGRAM
To produce a medical oncologist who:
1. Is capable of providing an excellent patient care
2. Possesses adequate knowledge base (both basic and applied) to effectively interact with medical
colleagues in a wide range of disciplines.
3. Is a good researcher
4. Is a competent teacher
OBJECTIVES AND GUIDELINES TO THE CONDUCT OF
PROGRAM
It is a 3-year course that imparts intense training to DM
candidates into the field of medical oncology
and related subjects with adequate exposure to clinical and laboratory based activities.
MEDICAL ONCOLOGY — D M
Department of Medical Oncology, Institute Rotary Cancer Hospital,
All India Institute of Medical Sciences, New Delhi
54 Syllabus D M / M Ch — AIIMS
CLINICAL TRAINING
The objectives of the clinical training are:
1. To develop clinical judgment and technical skills in diagnosis and the total management of patients
with neoplastic diseases, with various modalities of treatment individually or in combination
2. To make the student expert in handling all kinds of medical emergencies arising either due to
cancer spread or problems related to therapy. The latter include: a) infections secondary to severe
neutropenia, leading to respiratory distress/failure, renal insufficiency, hepatic insufficiency, and
neurological disturbance, b) hemorrhagic complications, c) electrolyte disturbance, d) other
toxicities.
3. To impart full knowledge concerning cancer chemotherapy, hormone therapy, biologics, gene
therapy, immune therapy; their mechanism of action, side effects, mode of administration, interrelation
with other drugs and their therapeutic effects.
4. To make the candidate familiar with all the modern diagnosis aids including ultrasound, CT scan,
NMR, MRI, PET scans, mammography, endoscopy, and radinuclide scans.
5. To make the candidate conversant with the indications and application of blood component therapy,
newer antibiotics, newer antifungal and antiviral agents and other supportive measures.
6. To make the candidate fully conversant with and trained in various aspects of high dose
chemotherapy and stem cell transplantation (both allogeneic and autologous) including schedule
of treatment, indication for the use of growth factors, GVHD prophylaxis and management of
various complications including acute and chronic GVHD.
7. To provide an insight into clinical trials (design, data collection, analysis and interpretation of
related statistics), cancer epidemiology, preventive and community oncology.
8. To make the candidate understand the psychology of his patients, which is often disturbed with
the knowledge that he or she has a cancer. The candidate will be made to learn to understand and
tackle these psychological issues with compassion and gentle behaviour.
9. To teach the candidate about effective communication skills and how to impart bad news to the
patients.
10. To make them expert in managing the terminally ill patients. They would be given knowledge
regarding pain management and other palliative care measures.
GUIDELINES
The candidate works in the department of medical oncology as following
INDOORS POSTING
This may vary from 8 to 12 months
The candidate is allotted certain beds and he is required to work up patients admitted on those beds.
He plans out a diagnostic work up and treatment plan, discusses it with the concerned consultants,
presents it on the grand rounds and assumes complete responsibility of the patients during their hospital
Course and Curriculum of D M Medical Oncology 55
stay. He should work in harmony with the ward nurses.
OUT PATIENT DEPARTMENT (OPD) POSTING
Duration is 16 months. The candidate is posted to chemotherapy evaluation clinics and various
specialty clinics including breast cancer, gastrointestinal, urology, lymphoma-leukemia, pain evaluation,
bone and soft tissue, pediatric tumors, head and neck, Gynecology
oncology, pulmonary oncology.
The candidates posted to these clinics work under the supervision of consultants. They are expected
to see new as well as follow-up patients so as to plan out the management and assess the therapeutic
responses of a particular patient.
DAY CARE AND OPD PROCEDURES (MINOR OT) POSTING
Duration is 4 months. During this posting a candidate is expected to learn skills
In introducing per cutaneous subclavian, internal jugular, and femoral vein catheters
Familiarity with different venous access devices likes Hickman catheter, subcutaneous port etc.
Institution of chemotherapy and supervision of side effects
Procedures like bone marrow biopsy, liver biopsy, trucut biopsy, lumbar puncture, intrathecal
chemotherapy and aspiration of fluids.
BMT UNIT POSTING
Duration is 2 months. The candidate works under the supervision of concerned consultants and assumes
responsibility of managing the patients undergoing high dose chemotherapy.
ELECTIVE POSTING
It is for 6 weeks. The candidate selects the area of his or her interest, it may be training within the
institute or at other specialized centers within or out side India. The candidate is required to seek
acceptance from the concerned departments/centers where he wishes to work and also permission
from the Chief IRCH.
ANCILLARY POSTING
It will be for 3 months as follows:
Surgical oncology (3 weeks)
Radiation oncology (3 weeks)
Laboratory (4 weeks)
Rotation to blood bank and nuclear medicine department (1 week each)
Radiodiagnosis (2 weeks)
LABORATORY TRAINING
The candidate, apart from understanding the value of laboratory tests in a given malignancy must
possess the basic knowledge of interpreting the laboratory data and correlating it with clinical data. For
this purpose, candidate is posted in various laboratories through laboratory posting or dissertation topic.
56 Syllabus D M / M Ch — AIIMS
The candidate are posted to various laboratories, some o which are attached to medical oncology
itself, such as cytogenetics laboratory, in-vitro tissue culture laboratory. In addition, candidate is
posted in immunology, Microbiology
, HLA and Pathology
laboratory.
These postings enable the candidate to understand histopathology, immunopathology,
histochemsitry, cytopathology, genetics of tumors, their functional properties and modes of spread
etc. He is also made familiar with the various types of stem cell mobilization, harvesting, and
cryopreservation techniques.
The candidate is required to learn the basic techniques of tissue culture, cytogenetics, staining
and study of peripheral/bone marrow smears, operation of blood cell counter and cell separator
machine.
RESEARCH TRAINING
The candidate is introduced to the field of research in medical oncology; both at clinical and laboratory
level.
DISSERTATION
The candidate is required to work on 2 projects clinical and laboratory based. The research proposals
are to be submitted within 6 months of joining the course and completed report 6 months before the final
exam. Every 6 months the candidate should present the progress report on the thesis work.
The candidate can either design a prospective study or do retrospective analysis related to his thesis
work. The candidate should see to it that the study is published in a national or international journal.
Besides the dissertation work, the candidate is encouraged to work on and publish case series and
case reports in peer reviewed journals and send papers for presentation to national and international
conferences. He is also be encouraged to design new clinical as well as laboratory based protocols, to
write research proposals for granting of funds and to establish new laboratory techniques.
TRAINING ORIENTED TOWARDS MAKING THE CANDIDATE AN
EXPERT TEACHER
Academic schedule
Integrated teaching program to expose the candidate to various fields of oncology are provided by
regular clinico-pathologic conferences, seminars, case discussion sessions, and radiology conferences.
Following academic activities are planned through out the year except during summer and winter vacations.
The candidate will be encouraged to actively participate in these meetings, carefully listen to the topics,
ask questions, critically analyze and give his/her comments and suggestions.
Monday: Teaching program, 8-30 to 9-30AM. Faculty from IRCH and from other departments at
AIIMS
discusses topics related to basic and clinical oncology, Biostatistics
, making an effective
presentation etc.
Tumor Board, 4-30 to 5-30 PM. By rotation senior resident working with each of the faculty
members brings some interesting/difficult case/es for discussion. After taking into consideration view
points of various members, a consensus is reached as to the best treatment plan for the patient.
Course and Curriculum of D M Medical Oncology 57
Tuesday: Radioconference, 8-30 to 9-30 AM. The radiographs, CT/MRI/bone scans and GI
series of patients seen in the OPD and wards are discussed with the radiologist. If present, serial films
are discussed. This helps in diagnosis, staging, prognosis and response evaluation. It is preferable that
the senior resident reads the films and then asks for the expert opinion.
Oncopath Conference, 12 noon to 1 PM. The senior residents provide the clinical history of the
cases and the histopathology slides are discussed with the expert pathologists.
Wednesday: Journal club/mortality meeting, 8-30 to 9-30 AM. Alternatively journal club and
mortality meeting are planned. In the journal club, the senior resident reviews relevant studies published
in the latest journals, presents them and critically analyze the design of the study, the results, drawbacks
and feasibility of carrying out the study in our set up. In the morality meeting, the treatment course and
probable cause of death of the patients expired recently in the IRCH ward is discussed. The senior
resident also discusses a related topic in detail.
Thursday: Seminar, 8-30 to 9-30 AM. Candidate presents a given topic and discusses it. He
should be able to review the topic critically and make independent observations.
Friday: 8-30 to 9-30 AM. During this session, the candidates present their research proposals and
update on their projects. Also case discussions are held, whereby the candidate presents the case
history, examination and management plan of the patient.
CONDITIONS FOR CERTIFICATION
The candidate will be guided and judged as regards his/her abilities to provide competent care to his
patients through various means like ward rounds, discussions held in OPD/clinics and weekly academic
activities. Internal assessment through internal examination held in March and September every year will
be done and this record will be made available at the time of final examination.
EXAMINATION
The examination will be conducted in there parts.
1. Theory paper
Paper I
Basic science in oncology: Radiation physics, Tumor biology, Biochemistry
, Biometry, Immunology
and Pharmacology
.
Paper II
General oncology, Tumor Pathology
, Staging, Diagnosis, Radiology, Nuclear medicine.
Paper III
Medical Oncology including chemotherapy, epidemiology, rehabilitation, terminal care, clinical trials
and prevention.
2. Clinical and practical
Long case 1
58 Syllabus D M / M Ch — AIIMS
Short cases 4
Spotters 4
3. Viva-voce
Grand viva, histopathology, hematology slides, CT scans and X rays.
BOARD OF EXAMINATION
Two internal and two external examiners
Assessment of Candidate
1. Assessment of the three parts of the examination shall be done jointly by the members of the
respective board of examiners.
2. Assessment of theory papers will be done individually by each examiner. The average of marks
will be taken into consideration
3. A candidate will be declared to have qualified for the DM
degree in medical oncology if the
candidate has satisfied the members of the respective boards of examiners individually and collectively
that he/she had an adequate knowledge in all aspects of the three parts of examination. The
candidate is required to score at least 50% of marks in theory separately and 50% of marks in
clinical and viva-voce examination taken together.
4. A candidate whose thesis/research work has not been approved or who is unsuccessful in any
part of the examination will be followed up as per institute rules.
5. The examination is conducted generally twice a year in the months of May and December.
SYLLABUS
Paper I (Basic Science in Oncology)
1. Cell cycle
2. Pathology
, Invasion & Metassssstasis
3. Etiology of Cancer
a. Viral
b. Chemotherapy
c. Physical
d. Hormonal
4. Epidemiology of Cancer
5. Principles of Cancer Management – Surgical Oncology, Radiation Therapy, Chemotherapy, Biologic
therapy
6. Pharmacology
of Cancer Chemotherapy
7. Clinical trials in cancer
Course and Curriculum of D M Medical Oncology 59
8. Cancer prevention Tobacco related cancer, Diet & Risk reduction Chemopreventive Agents, Hormones
9. Caner Screening
10. Imaging Techniques of Cancer Diagnosis & Management
11. Specialized techniques of Cancer Diagnosis and Management
12. Vascular Access and Specialised Technique of drug delivery
Paper – II Clinical Oncology (Medical)
1. Cancer of Head and Neck
2. Cancer of Lung and Mediastinun
3. Cancer of Gastro Intestinal Track
4. Cancer of Genito Urinary System
5. Cancer of the Breast
6. Cancer of Endocrine System
7. Sarcomas of Soft Tissues & Bone
8. Benign & Malignant Mesotheliomas
9. Cancer of skin
10. Malignant Melanoma
11. Neoplasms of CNS
12. Cancers of childhood
13. Lymphomas
14. Leukemias and other Haematological Malignancies
15. Paraneoplastic Synddromes
16. Cancers of unknown primary site
17. A.I.D.S – related malignancies
18. Oncological Emergencies
19. Treatmetn of Metastatic Cancers
20. Gynaecological Cancers
21. High Dose Chemotherapy & Transplantation
Paper – III (Recent Advances in Oncology)
1. Essentials of Molecular Biology
2. Molecular Biology of Cancer: Onccogenes Cytogenetics
3. Bone Marrow dysfunction in cancer patient
4. Infections in cancer Patients and neutropenic patients
5. Adverse effects of treatment
6. Supportive Care and Quality of Life
60 Syllabus D M / M Ch — AIIMS
7. Rehabilitation of Cancer Patient
8. Newer approaches in caner treatment
9. Newer drugs in cancer treatment
Periodicals Recommended
Book Editor
1. Caner Principles and Practice of Oncology Vincent T. Devita
2. Principles and Practice of Pediatric Oncology Philip A. Pizzo
3. Decision Making in Oncology Bengamin Djubegovic
4. Current Medical Diagnosis and Treatment Lange Medical Book International edition
5. The Basic Science of Oncology IanF. Tannock
6. Cancer Treatment Charles M Haskel
7. Cancer Chemotherapy Chabner
8. Principles of Internal Medicine Harrison
9. Text Book fo Pediatrics Nelson
10. Text Book of Oncology Abelloff and Armitage
Journals
1. Cancer Treatment Review
2. Journals of Pediatric Hematology/Oncology
3. Current Opinion in Oncology
4. The Indian Journal of Cancer
5. The Seminars in Oncology
6. Haematology/Oncology Clinics of North America
7. Medical and Pediatric Clinic of North America
8. Cancer
9. Current Problems in cancer
10. Journal of Clinical Oncology
11. Lancet
12. NEJM (New England Journal of Medicine)
13. Blood
14. British Journal of Hematology
15. Bone Marrow Transplantation
16. Seminars in Hematology
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