Cancer Surgery

• Types of cancer surgery
  • Preventive (prophylactic) surgery
  • Diagnostic surgery
  • Staging surgery
  • Curative surgery
  • Debulking surgery
  • Palliative surgery
  • Supportive surgery
  • Restorative surgery
• How is cancer surgery carried out?

 

• What does cancer surgery involve?
  • Planning
  • Preoperative testing
  • Preparing for cancer surgery
• Risks of cancer surgery
  • Problems during surgery
  • Problems after surgery

Types of cancer surgery

Surgery is done for many reasons. The examples of various types of surgery are as follows:

Preventive (prophylactic) surgery

Preventive (prophylactic) surgery is used to remove tissue that does not contain cancerous cells, but may be precancerous (have the potential to develop into cancer or malignancy). For example, polyps in the colon may be considered precancerous and therefore preventive surgery is used to remove the tissue to prevent transformation to bowel cancer.

Women with a strong family history of breast cancer and have a change (mutation) in a breast cancer gene BRCA1 or BRCA2 are at a higher risk of developing breast cancer. These women may consider prophylactic breast removal to prevent the cancer.

Diagnostic surgery

Diagnostic surgery is used to remove a tissue sample for testing in the laboratory to determine whether the cells are cancerous, thereby confirming the diagnosis of a cancer. The tissue samples also help identify the type of cancer.

Staging surgery

To uncover the extent of cancer, or the spread of the disease in the body, staging surgery may be carried out. An example is laparoscopy (a tube with a camera attached to an end is inserted through a small incision to view the inside of the body).

Curative surgery

Curative surgery is performed to remove cancers from the body. This is particularly useful when the cancerous tumour is confined to a specific part of the body and have not spread/metastasised to other areas.

Curative surgery is the primary treatment in many cancers. It can be preceded by neo-adjuvant radiotherapy or chemotherapy (done before the surgery) or followed by adjuvant therapy (after the surgery). Radiation therapy can also be used during an operation (intraoperative radiation therapy).

Debulking surgery

Debulking surgery removes as much of the cancerous tumour as possible. The remaining portion is then treated with radiation therapy or chemotherapy. This is used in certain situations when removing the entire tumour may cause too much damage to an organ or surrounding areas.

An example where debulking surgery is commonly done is advanced cancer of the ovary.

Palliative surgery

Palliative surgery does not work to cure the cancer, but rather, to help alleviate discomfort and minimise problems arising from the tumour itself or cancer treatment. It is usually used in cancer at advanced stages.

For example, some cancers in the abdomen may grow large enough to block off the bowels, thereby warranting the use of surgery to produce effective relief.

Supportive surgery

Similar to palliative surgery, supportive surgery does not cure the cancer. It is performed to help other cancer treatments work more effectively. Insertion of a catheter to help with chemotherapy is an example of supportive surgery.

Restorative surgery

Restorative surgery is sometimes used as a follow-up to other surgeries to change or restore the patient’s appearance or the function of the related organ/body part.

For instance, breast reconstruction surgery is sometimes performed to restore the physical shape of the affected breast(s). The timing of reconstruction varies from the same time as mastectomy to months or even years later. Immediate breast reconstruction produces less scarring, leading to a more natural cosmetic result.

Restorative surgery is also used to address effects on the appearance of a person’s mouth resulting from curative surgery for oral cancer.

How is cancer surgery carried out?

Cancer surgery aims to remove the tumour with clear margins. Margin means a border of healthy tissue with no cancer cells that are taken away from all around the tumour. The margins may be large or small depending on the type and invasion of the tumour. The specimens taken will be examined under the microscope to ensure that no cancerous cells are present, thereby achieving a clear margin. This is important to minimise the risk of tumour cells being left behind.

Some of the lymph nodes close to the tumour may also be removed during the surgery (called lymph node dissection). Lymph node is a common site where cancer cells spread to. Under the microscope, if cancer cells are seen in the lymph node tissue, there may be ancreased risk of the cancer coming back in the future, and the patient may be recommended to undergo adjuvant therapy (chemotherapy, radiotherapy, hormonal therapy following surgery).

Special surgical techniques that may also be applied during surgery include:

• Electrocoagulation (using high-frequency electrical current)
• Cryosurgery (the use of a liquid nitrogen spray or a very cold probe to freeze and kill abnormal cells)
• Laser therapy

 

What does cancer surgery involve?

Planning

Informed consent (giving written permission to perform a treatment): read the consent form, discuss with the surgeon and make sure you understand the following issues:

1. Your condition in relation to the surgery
2. The goal of the surgery
3. How the surgery is to be done
4. Benefits and risks
5. Side effects to be expected
6. Other options available

 
Preoperative testing

Several tests are needed before the surgery to make sure the body is able to endure surgery and anesthesia. Some of the tests commonly done are:

• Blood group test
• Blood test to evaluate blood counts
• Liver function tests (LFT)
• Kidney function test
• Urinalysis 
• Chest x-ray
• Electrocardiogram (ECG).

It is important to inform the doctor about other diseases that you have (e.g. heart disease, diabetes, high blood pressure and other conditions that may affect the surgery).

 
Preparing for cancer surgery

Fasting from the night before (to empty the digestive tract to avoid vomiting under anaesthesia causing lung aspiration – material entering the lung).

An area of the body may need to be shaved to keep hair from entering the incision site.

Types of anaesthesi
a used may be local, regional or general.

Risks of cancer surgery

Problems during surgery

Problems during surgery may be: 

• Damage to organs and blood vessels;
• Blood loss;
• Adverse reactions to anaesthesia or medication.

Problems after surgery

• Pain – probably the most common type of side effect. There are many ways and medications to deal with pain after surgery.
• Infection of the wound site or digestive tract – this is kept to a minimum by ensuring the wound is clean.
• Pneumonia – performing deep breathing exercises may reduce the risk
• Bleeding – this can either be external (visible bleeding e.g. from the wound) or internal (in organs). Finding the source is important to stop more bleeding if it is serious.
• Blood clots in the deep veins of the legs (deep vein thrombosis) – getting out of bed early to walk around helps prevent this.

References

1. American Cancer Society. Making treatment decisions: Surgery [online]. 2004 [cited 2006 Jan 21]. Available from: URL: http://www.cancer.org/docroot/ETO/content/ETO_1_2X_Surgery.asp
2. Andtbacka RH, Babiera G, Singletary SE, Hunt KK, Meric-Bernstam F, Feig BW et al. Incidence and prevention of venous thromboembolism in patients undergoing breast cancer surgery and treated according to clinical pathways. Ann Surg 2006; 243(1): 96-101.
3. Haagedoorn EML, Oldhoff J, Bender W, Clarke WD, Sleijfer D Th. Essential Oncology for Health Professionals. Assen: Van Gorcum; 1994.
4. MayoClinic.Com. Mastectomy vs Lumpectomy: Breast reconstruction [online]. 2005 [cited 2006 Jan 21]. Available from: URL: http://www.mayoclinic.com/health/mastectomy-lumpectomy/BC99999/PAGE=BC00018
5. Souhami RL et al, editors. Oxford Textbook of Oncology. 2nd ed. Oxford; New York: Oxford University Press; 2002.
6. Souhami, Tobias. Cancer and its management. 4th ed. Oxford Blackwell Scientific Publications; 2003.
7. Stanford Cancer Center. Surgery for Cancer Treatment [online]. 2005 [cited 2006 Jan 21]. Available from: URL: http://cancer.stanfordhospital.com/healthInfo/cancerTreatment/methods/surgery/default