Surgery for cancer
An OPERATION to remove a cancerous tumor. Surgery is the first line of treatment for cancer that a surgeon can readily reach without endangering the person, and when there is a single defined tumor. Multiple tumors may also be appropriate for surgery, depending on the type of cancer, the location of the tumors, and how clearly contained the tumors are. Surgery is typically the primary therapy for treating cancer, with adjuvant (accompanying or follow-up) treatment with RADIATION THERAPY, CHEMOTHERAPY, IMMUNOTHERAPY, or HORMONE THERAPY for a comprehensive approach. A person might undergo chemotherapy or radiation therapy before surgery to shrink the tumor, and also may undergo such treatment after surgery to eradicate any remaining cancer cells.
How Surgery Works to Treat Cancer
Surgery may be therapeutic (attempt to remove the cancer) or palliative (remove enough of the tumor to relieve PAIN or other symptoms). As oncologic surgeons have learned more about how cancer grows and spreads in the body, surgery methods have become more precise. As well, pathology analysis of the tumor has become more efficient and accurate. The surgeon sends samples of the tumor and surrounding tissue to the pathology laboratory during the operation for immediate examination by a pathologist. The pathologist’s initial report helps the surgeon determine whether there is a need to remove additional tissue.
In therapeutic surgery the surgeon excises (cuts out) the tumor with a margin of healthy tissue to capture stray cancer cells at the tumor’s edges. The goal of such surgery is to eliminate the cancer so the person makes a full recovery and remains cancer free (with or without adjuvant therapies). For large tumors that are difficult to remove, the surgeon may perform cytoreduction (also called tumor debulking) to reduce the size and presence of the cancer as much as possible with the goal of improving the effectiveness of other treatments such as chemotherapy or radiation therapy. In advanced cancer, inoperable tumors may create obstructions or grow into the space an organ ordinarily occupies. The surgeon may perform palliative surgery to remove enough of the tumor to relieve pressure on nerves, BLOOD vessels, and other structures that may be causing pain or interfering with an organ’s function.
Types of Surgery for cancer
Until the 1990s the standard practice in therapeutic cancer surgery was to remove substantial tissue to ensure removal of the cancer, often resulting in radical surgery such as MASTECTOMY (removal of a BREAST to treat BREAST CANCER) or bowel resection (removal of the COLON to treat COLORECTAL CANCER). Improvements in the understanding of how cancer functions in the body in combination with advances in other treatments for cancer have shifted the approach in cancer surgery toward sparing tissue, organs, and limbs to preserve body structures and functions, relying on a combination of therapies to treat the cancer. When the stage and grade of cancer still requires radical surgery, advances in reconstructive surgery (often performed at the same time as the cancer surgery) have improved QUALITY OF LIFE after surgery.
MINIMALLY INVASIVE SURGERY may be an option for stage 0 cancers, which are small and narrowly confined to the site of origin. OPEN SURGERY is generally the preference for stage 1 and 2 cancers, so the surgeon is able to remove all of the cancer and obtain an acceptable margin of healthy tissue. The length of hospitalization and recovery from the surgery depends on the operation and the person’s overall health status. Many people who undergo surgery as primary treatment for cancer are otherwise healthy and typically experience a prompt and uneventful course of recovery.
Risks, Side Effects, and Complications of Surgery to Treat Cancer
Though cancer surgery methods are very advanced, risks and complications are possible. Diagnostic imaging procedures provide the surgeon with a good understanding of where the cancer is and how it involves tissues and organs. However, the surgeon cannot know for certain the nature and extent of the tumor until the surgery exposes it for full examination. Though most surgeries go exactly as anticipated, unexpected findings can shift the operation in a different direction. The surgeon typically recognizes the potential for the unexpected and includes discussion of such possibilities in the informed consent process. It is important to talk with the surgeon the anticipated benefits and potential risks of the planned operation. A second opinion consultation with another surgeon or with a medical oncologist for a discussion of nonsurgical treatment options is often a good idea, particularly when the proposed surgery is extensive or complex.
See also CANCER TREATMENT OPTIONS AND DECISIONS; MOHS’S SURGERY; QUALITY OF LIFE; PLASTIC SURGERY; SURGERY BENEFIT AND RISK ASSESSMENT.
