Surgery

Surgery is the oldest form of cancer treatment and is still the main treatment for many types of cancer. It can be used to diagnose, treat, or even help prevent cancer in some cases. Most people with cancer will have to go through some type of surgery. Surgery is most often used to treat solid tumours. Surgery may be the only therapy required or part of a combined approach to cancer treatment. There are many different surgical techniques and procedures used in cancer diagnosis and treatment.

Types of Surgery

Preventive (prophylactic) surgery

Preventive surgery is done to remove body tissue that is likely to become cancer, even though there are no signs of cancer at the time of the surgery. For example, pre-cancerous polyps may be removed from the colon.

Sometimes preventive surgery is used to remove an entire organ when a person has an inherited condition that puts them at a much higher risk for having cancer some day. For example, some women with a strong family history of breast cancer are found to have a change (mutation) in the DNA of a breast cancer gene (BRCA1 or BRCA2). Because their risk of getting breast cancer is high, these women may want to consider prophylactic mastectomy. This means the breasts are removed before cancer is found.

Preventive mastectomy (also called prophylactic or risk-reducing mastectomy ) is the surgical removal of one or both breasts in an effort to prevent or reduce the risk of breast cancer . Preventive mastectomy involves one of two basic procedures: total mastectomy and subcutaneous mastectomy. In a total mastectomy, the doctor removes the entire breast and nipple. In a subcutaneous mastectomy, the doctor removes the breast tissue but leaves the nipple intact. Doctors most often recommend a total mastectomy because it removes more tissue than a subcutaneous mastectomy. A total mastectomy provides the greatest protection against cancer developing in any remaining breast tissue.

Diagnostic surgery (biopsy)

This type of surgery is used to take out a piece of tissue or tumour to find out if cancer is present or what type of cancer it is. The diagnosis of cancer is made by looking at the cells under a microscope. There are many ways to get a sample of cells from an area that looks like it may be cancer. Biopsies are used to diagnose a cancer and to determine the extent of disease during the staging process.
Tissue or cell samples can be taken from almost any part of the body. The type of biopsy used depends on the area of the body to be biopsied and the type of cancer suspected.

It’s Surgery to diagnose and stage cancer

Type of Biopsy

Fine needle aspiration biopsy

Fine needle aspiration (FNA) uses a very thin needle attached to a syringe to pull out small bits of tissue. If the tumor can’t be felt near the surface of the body, the needle can be guided into the tumor by looking at it using an imaging test, like an ultrasound or CT scan.
The main advantage of FNA is that there is no need to cut through the skin, so there is no surgical incision. A drawback is that in some cases the needle can’t take out enough tissue for an exact diagnosis. A more invasive type of biopsy (one that involves larger needles or a cut in the skin) may then be needed.

Core needle biopsy

This type of biopsy uses a larger needle to take out a core of tissue. A core biopsy sample can be removed with a needle if the tumor can be felt at the surface. Core biopsies can also be guided by imaging tests if the tumor is too deep to be felt.
The advantage of core biopsy is that it usually collects enough tissue to find out whether the tumor is cancer.

Excisional or incisional biopsy

For these biopsies a surgeon cuts through the skin to remove the entire tumor (excisional biopsy) or a small part of the tumor (incisional biopsy). They can often be done with local or regional anesthesia. This means numbing drugs are used just in the area where the biopsy will be done. If the tumor is inside the chest or belly (abdomen), drugs that put you into a deep sleep and keep you from feeling pain (general anesthesia) may be needed.

Endoscopy

This procedure uses a long, thin, flexible tube with a viewing lens or a video camera and a fiber optic light on the end. If a video camera is used, it’s connected to a TV screen. This allows the doctor to clearly see any tumors in the area. Endoscopes can be passed through natural body openings to look at areas of concern in places such as those listed below. Any of these procedures can be called an endoscopy but the more specific name is given as well:

Pharynx (throat) – pharyngoscopy
Larynx (voice box) – laryngoscopy
Esophagus (swallowing tube) – esophagoscopy
Stomach – gastroscopy
Small intestine – duodenoscopy
Colon (large intestine) – colonoscopy
Sigmoid colon (lower part of colon) – sigmoidoscopy
Bladder – cystoscopy
Respiratory tract (windpipe, smaller breathing tubes, and lungs) – bronchoscopy

Some of the advantages of endoscopy are:

The doctor can look right at the tumor and get a good idea of where it is and how big it is.
A sample of tissue can be taken through the scope to find out if the tumor is cancer.
An open surgical cut (incision) and drugs to put you in a deep sleep (general anesthesia) are usually not needed.

Local numbing medicines are needed before some types of endoscopy. Medicines may also be given to make you relax or go into a light sleep.

Ultrasonography

Ultrasound devices can be attached to the end of some endoscopes. This allows doctors to make pictures of the layers of the swallowing tube (esophagus), main breathing tubes (trachea and bronchi), and parts of the bowel (large intestine) by using sound waves. Nearby lymph nodes can be seen, too. Using the ultrasound pictures to guide it, a needle can be put through the endoscope and cells can be taken from tissues that do not look normal.

Laparoscopy, thoracoscopy, or mediastinoscopy

Laparoscopy is much like endoscopy, but a small cut (incision) is made in the skin of the belly (abdomen). A thin tube called a laparoscope is then put through the cut and into the belly to look for areas that may be cancer. If any are seen, they can be biopsied using a needle that is put in through the laparoscope.

General anesthesia is most often used for laparoscopy (you are given drugs to out you into a deep sleep while it is done).
When this type of procedure is done to look inside the chest it may be called a thoracoscopy or mediastinoscopy General anesthesia is also used for this procedure. The scope is put in the body through a small cut next to or above the top of the breastbone, or a small cut between the ribs. Biopsies are taken through the scope.

Open surgical exploration (laparotomy or thoracotomy)

A laparotomy may be needed when easier, less invasive explorations do not give enough information about an area of concern in the belly (abdomen). In this procedure, a surgeon makes a cut (incision), usually from the bottom of the breastbone (sternum) down to the lower part of the belly to look directly at the area in question. The location and size of the tumor and the nearby areas can be seen, and biopsies can be taken. This is a major surgical procedure, so the patient is given medicines to cause a deep sleep and prevent pain (general anesthesia).

An operation much like this can be done to open and look inside the chest. This is called a thoracotomy

Staging surgery

Staging surgery is done to find out how much cancer there is and how far it has spread. The physical exam and the results of lab and imaging tests are used to figure out the clinical stage of the cancer. But the surgical stage (also called the pathologic stage) is usually a more exact measure of how far the cancer has spread.

Curative surgery

Curative surgery is done when cancer is found in only one area, and it’s likely that all of the cancer can be removed. In this case, curative surgery can be the main treatment. It may be used alone or along with chemotherapy or radiation therapy, which can be given before or after the operation. Sometimes radiation therapy is actually used during an operation. (This is called intraoperative radiation therapy.)

Debulking (cytoreductive) surgery

Debulking surgery is done to remove some, but not all, of the cancer. It is done when removing all of the cancerous tumor would cause too much damage to an organ or nearby tissues. In these cases, the doctor may take out as much of the tumor as possible and then try to treat what’s left with radiation or chemotherapy. Debulking surgery is commonly used for advanced cancer of the ovary and some lymphomas.

Palliative surgery

This type of surgery is used to treat problems caused by advanced cancer. It is not done to cure the cancer. Palliative surgery can also be used to correct a problem that’s causing discomfort or disability. For example, some cancers in the belly (abdomen) may grow large enough to block off (obstruct) the intestine. If this happens, surgery can be used to remove the blockage. Palliative surgery may also be used to treat pain when the pain is hard to control by other means.

Supportive surgery

Supportive surgery is done to help with other types of treatment. For example, a vascular access device such as a Port-A-Cath® or Infusaport® can be surgically placed into a large vein. The port can then be used to give treatments and draw blood, instead of putting needles in the arms.

Restorative (reconstructive) surgery

This type of surgery is used to improve the way a person looks after major cancer surgery, or to restore the function of an organ or body part after surgery. Examples include breast reconstruction after mastectomy or the use of tissue flaps, bone grafts, or prosthetic (metal or plastic) materials after surgery for head and neck cancers. For more information on these types of reconstructive surgeries,

Surgical techniques

cryosurgery:

Uses extremely cold temperatures to freeze and destroy tumor cells

Electro surgery: high-frequency electrical current is used to destroy cancer cells

radiofrequency ablation (RFA), a new procedure in which a special needle-thin probe heats and destroys abnormal tissues. the probe is inserted into a tumor. very thin prongs are extended into the tumor. the prongs deliver a high-frequency electrical current and heat to the tumor tissue. the position of the probe and the treatment is monitored with an ultrasound or CT scan

Endoscopic hollow, tube-like instrument with a lighted (fiber optic) end allows the doctor to look inside organs and take tissue samples

Laparoscopic surgery: a long, flexible tube is placed through small incisions into the body
used to view structures or organs inside the body or remove tissue

Laser surgery: a laser beam destroys tumor cells

Microscopically controlled surgery or Mohs surgery: used to remove cancerous tissue in layers which are examined under a microscope

Stereo tactic surgery: a procedure that precisely locates deep tumors using 3 coordinates obtained with the help of a CT scan or MRI
used so biopsies can accurately be taken, the tumor removed, or radiation precisely given (stereo tactic radio surgery)

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