Cancer surgery may be performed on the tumor either for diagnosis as in excision biopsy, or it is performed as part of the cancer cure.
Surgical treatment for cancer usually involves surgical removal of the whole organ. Examples include:
- Removal of the whole lung in lung cancer
- Mastectomy (removal of the breast) in breast cancer
- Prostatectomy (removal of the prostate) in cancer of the prostate
To treat cancer, surgery involves removal of the tumor, some tissue around the tumor (called clear margin), and possibly the neighboring lymph nodes into which cancer may have spread. Surgery is decided upon after the investigations have revealed all the necessary data about the tumor to the cancer surgeon.
This radical surgery is necessary so that nothing is left to chance of leaving any malignant tissue behind. A single cancer cell left behind can give rise to a recurrence of cancer.
The tumor that is removed is then sent to pathology for examination. The report of the pathology will help the doctor to determine the stage of cancer, type of cancer, and subsequently the adjuvant therapy of radiation and/or chemotherapy. This is important to obtain a good prognosis.
The surgery sometimes has to be abandoned if the cancer surgeon finds that cancer has spread or metastasized. Surgical management of cancer, therefore, becomes applicable in a patient in whom cancer has not spread.
A doctor who treats cancer with surgery is called a surgical oncologist. This (surgery) is the oldest type of cancer treatment and still offers high success rates for many kinds of cancers even today.
Surgery works by removing the entire cancerous tumor or lesion from the body so that no cancer cells remain in the body. When indicated, surgery offers the best chance of cure and getting rid of the disease completely, especially if there is no metastasis.
When is surgery indicated in cancer patients?
The cancer surgeon may order surgery on a patient for the following reasons:
- For the purpose of diagnosing cancer (excision biopsy)
- To surgically remove the whole tumor
- Exploratory surgery is done to locate the cancer
- To find out if cancer has spread (metastasis)
- To repair the damage caused by the disease and restore the body’s appearance or function
- To give relief from cancer symptoms to the patient. Under certain circumstances, the surgeon performs surgery to give symptomatic relief to the patient. Examples of such cases are obstruction of the bowels and spinal cord compression.
What are the different types of surgeries used in cancer treatment?
There are several types of surgeries used to treat cancer and the cancer surgeon chooses the type depending on the indication. Sometimes, he combines surgery with other forms of therapies.
Most cancer patients undergo some form of surgery at some point during the course of the disease. Sometimes, it is done to cure the disease, sometimes to relieve the symptoms and offer relief to the patient.
There are different types of surgeries for cancer and some of us may need to undergo more than one type. Your surgeon will decide the type of surgery and how many procedures you may need to undergo and his decision depends on the following factors:
- The type of cancer you have
- The grade of cancer, which tells how advanced your cancer is
- The planned protocol of your treatment
- Whether you will need reconstructive surgery later
Since surgery treats only that part of your body where cancer has developed, it is not a choice of treatment for blood cancers like leukemia or any other cancer that has metastasized.
Very often, after undergoing surgery, your doctor will also put you on some other form of cancer therapy.
The following are the different types of surgeries used in cancer treatment:
Curative surgery primarily involves the removal of the malignant tumor from the body. Curative surgery becomes the choice of treatment when the cancerous growth is localized to a specific part or organ of the body and the cancer cells have not spread anywhere else.
In curative surgery, the surgeon removes all cancerous tissue to achieve a cure. This may involve the removal of part or whole of the cancerous organ along with some part of healthy tissue around it. The nearby draining lymph nodes may also be removed.
Your oncologist may also order chemotherapy or radiation therapy before surgery to shrink the tumor or after surgery to kill any cancer cells that may have remained.
Preventive cancer surgery
Preventive surgery also referred to as prophylactic surgery, involves the removal of tissue that does not contain cancer cells, but has the strong possibility of becoming malignant in the future.
For example, polyps in the colon may be considered precancerous tissue and preventive surgery may be performed to remove them.
Preventive surgery is sometimes chosen in people who harbor risk factors for developing cancer. For example, the surgeon may recommend the removal of the ovaries of a woman to avoid the risk of ovarian cancer if the person has a very strong family history of it.
Diagnostic surgery involves surgically removing all or part of a suspected tumor. This can be tissue cells or fluid and examining this material under a microscope. Microscopic examination of the biopsied material is the definitive way in which cancer is positively diagnosed. It also helps to identify the type of cancer and possibly the stage of the disease.
The purpose of surgical staging is to determine the extent of the spread of cancer (the stge) in the body. Laparoscopy is one example of staging surgery. A fiber-optic tube with a lens or camera is inserted through a small incision in the skin to view the inside part of the body and remove a tissue sample for a histopathology examination.
Debulking surgery, also called tumor debulking, involves the removal of as much possible of the tumor as possible. This is especially indicated when removing an entire tumor may cause damage to an organ or the body.
This is done for a better prognosis with chemotherapy or radiation and to allow these therapies to kill all the cancer cells that are present.
This surgery also helps to give symptomatic relief to the patient and improve his quality of life increase his life span.
Palliative surgery is used in the treatment of advanced cancers. This surgical intervention is basically not for cure but to reduce the patient’s symptoms and improve his quality of life. The cancer surgeon may also consider palliative surgery to counter any discomfort cancer treatment may have caused.
It does not, however, have any impact on increasing the patient’s survival rate.
Supportive surgery, like palliative surgery, does not work towards cancer cure but facilitates for the other cancer treatments to be more effective
An example of supportive surgery would be the insertion of a chemo port that is centrally placed under the skin near a large vein in the upper chest to facilitate chemotherapy.
Another example would be the insertion of a feeding tube into your stomach to facilitate delivery of medication and nutrition if the cancer lesion makes it difficult for you to take things through your mouth.
Restorative surgery is indicated when curative or other cancer surgeries have caused disfigurement to the patient’s body part. It is always done when other surgeries have been completed and the patient’s appearance has been considerably damaged.
For example, surgery done to cure oral cancer can considerably alter the shape and appearance of a person’s mouth and face. Similarly, women who have undergone mastectomy may need reconstruction surgery to restore the physical shape of the removed breast for cosmetic reasons.
What different techniques are used in cancer surgery?
Besides the different types of surgeries used in the treatment of cancer, there are various techniques followed to perform these surgeries. Some of the common techniques include:
Cryosurgery involves the use of extremely cold substances such as compressed liquid nitrogen or argon gas to freeze and kill cancer cells and abnormal tissue.
It is a localized treatment directed towards the affected part of the body. For example,
- It is used to treat skin growths called actinic keratoses that can turn cancerous.
- It is used to destroy the abnormal cells that develop in the cervix of the uterus and which can turn into cervical cancer. This condition is known as cervical intraepithelial neoplasia or cervical precancer.
In Electrosurgery, the oncologist surgeon applies high-frequency electrical currents through a metal instrument or needle to kill cancer cells. For example, it can be used to kill cancer cells in the mouth or on the skin.
Laser surgery uses high-intensity special light beams instead of incision and dissecting instruments, such as scalpels, to perform surgical procedures. Laser beams shrink and vaporize the tumor cells and decrease their spread. Besides, they help to excise tumors and prevent blood loss by sealing small blood vessels.
The doctor performs Mohs surgery in his office under local anesthesia. This surgery was perfected by Dr. Fredrick E. Mohs and involves removal of the affected part of the tissue layer by layer with a small scalpel, preparing its slide for microscopic examination, the study of the slide under the microscope, and reconstruction of the excised tissue. Since the removal of the affected tissue is microscopically controlled, healthy tissue is spared.
Mohs surgery is useful for removing cancer from sensitive areas of the skin, such as near the eye. Since it is excised layer by layer, it helps to assess how deep the cancer is.
After removing a layer, your doctor evaluates it under a microscope, continuing in this manner until all the abnormal cells have been removed and the surrounding tissue shows no evidence of cancer.
Mohs surgery is the most effective technique for treating many basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs). The cure rate for basal cell carcinoma is almost 97% while for squamous cell carcinoma, it is less.
A surgeon makes several small incisions in the skin and inserts a laparoscope with a tiny camera into your body. He views the inside of the body on a monitor. Smaller incisions mean the patient recovers faster and the risk of complications is reduced.
Laparoscopic surgery helps
- The doctor to directly visualize the affected lesion
- In diagnosis when noninvasive methods do not help in the diagnosis
- In collecting samples for biopsy
- In staging the cancer
- In treatment and giving symptomatic relief to the patient
Robotic surgery, or robot-assisted surgery, is an advanced form of minimally invasive surgery with very small skin incisions where surgeons use a robot to assist them in certain surgeries.
Robotics has revolutionized the way surgery is now conducted in many complex cancer surgical procedures for the treatment of many cancers, including prostate, stomach, pancreas, liver, colon, head and neck, and gynecologic cancers. However, not all cancer patients are the right candidates for this procedure.
In this surgery, the surgeon sits away from the operation table at a console with his eyes on the screen that offers a high-definition 3-D image of the area that is being operated upon.
He uses hand controls that control the robot to maneuver the miniaturized surgical instruments and perform the surgery with extreme precision. Robotic surgery helps in performing surgeries in hard-to-reach areas.
Other advantages of robotic surgery include less blood loss, less pain after the procedure, a shorter hospital stay, less scarring, and the ability to recover and return to normal, daily activities much quicker.
What are the risks and potential side effects of surgery for cancer treatment?
The risk of complications exists in any surgery. In spite of the giant advances, science and technology have made, the risk of potential side effects exists. But, surgery continues to be carried out in cancer treatment because the benefits outweigh the risks.
Complications during surgery can include:
- Damage to other organs in the body
- Damage to nearby tissues
- Blood loss
- Adverse reactions to medication
Post-operative complications can include:
- Pain or discomfort at the site of surgery
- Other illnesses, such as pneumonia
- Blood loss or clots
- Slow recovery of other body functions
Possible long-term effects include:
Possible long-term effects depend on the type of surgery performed and the site where it is performed.
- Surgery on or around the reproductive organs can have an adverse effect on you being able to father or mother a child.
- Patients who undergo colorectal cancer surgery may need an opening in the belly to be made to which the end of the colon is attached. This is called a colostomy.
- Men who have had a radical prostatectomy (removal of the prostate) are at risk of losing control over their urine (urinary incontinence) or becoming unable to get or keep an erection (erectile dysfunction).
Cancer surgery continues to develop and go forward. Research is always investigating more and more surgical techniques with the aim of being less invasive and causing fewer complications.