Surgery is used in almost every type of cancer as a cancer treatment. It can be used in a variety of situations:
- Removing the Tumor
- Removing other Tumors
- Relieving Symptoms
- Ports and Catheters
One of the most common uses of cancer surgery is to establish a diagnosis. This is often referred to as a biopsy. A cancer may first present as a mass that either can be felt or can be seen on a scan. A sample of the mass is needed to determine whether it is cancerous (malignant) or non-cancerous (benign). The sample is then sent to a pathology department to be examined by a pathologist. The pathologist identifies the contents of the sample and sends his/her findings to the doctor on a pathology report. Depending on the individual situation, there are several ways to sample the tissue.
A needle biopsy is when a needle is inserted into the mass to get a sample. This can be done when the mass can be felt or it can be done with x-rays to assist a surgeon or radiologist in guiding the needle to the correct location.
An excisional biopsy is an open surgical procedure whereby the mass is removed in its entirety. In some cases, such as breast cancer, the excisional biopsy may be the definitive lumpectomy, provided the surgical margins (edges) are free and clear of cancer cells. In other cases, such as lymphomas, the excisional biopsy serves only as a diagnosis and additional chemotherapy will, in many cases, be recommended.
Remove the tumor
Another very common use for surgery is to remove the tumor. Most often, when cancer is first diagnosed, a determination will be made as to whether it is operable. That is, whether or not it can be removed by cancer surgeons. Tumors that can be removed are localized. The cancer cannot have spread outside the area of the original tumor. The tumor must not be attached to critical blood vessels, nerves or other organs where surgical intervention may cause more harm than help. In most cases, the tumor cannot be in more than one location. If a tumor meets these criteria, then surgery is performed by a cancer surgeon with "cure" as a goal. In many cases, the adjacent lymph nodes will be removed along with the primary tumor. Involvement of lymph nodes may or may not affect surgery and/or surgery's goal. However, lymph node involvement will usually indicate the need for additional treatment.
Two exceptions are kidney cancer and ovarian cancer. In kidney cancer, nephrectomy (removing the kidney) in patients with metastatic disease is accepted practice. In ovarian cancer, surgery is done by cancer surgeons regardless of the apparent extent of disease. The tumor is debulked. That is, as much of the cancer as can be removed is removed. Tissue samples are taken from specific sections of the abdomen and sent for analysis. The pathology results will determine the true extent of the disease and will assist in determining further treatment.
Surgery is not done as a primary treatment for leukemia, multiple myeloma, and most lymphomas (Hodgkin's and non-Hodgkin's diseases).
All tissue removed in surgery will be sent to the pathology department for complete analysis. The final report may take from 3 days to 1 week to process. In complicated cases, final pathology results may take longer. If the tumor has been removed in its entirety, the surgical margins (edges of the tumor) on all dimensions must be free and clear of any cancer cells.
Remove other tumors
In some special situations, surgery may be done to remove tumors at times other than the initial diagnosis. The situations are as follows:
Some large tumors may be treated with radiation and/or chemotherapy prior to surgery. This may be done to shrink the tumor to make surgical removal easier or to reduce potential complications from surgery. This form of treatment may be done in rectal cancer, head and neck cancer, some forms of breast cancer, and experimentally in some cancers of the lung and esophagus. This form of treatment is designed for very specific situations and does not apply to all diagnoses.
Sometimes a tumor can return in its original location. Surgery may be done to remove the returning tumor if it is technically possible.
Some cancers, such as sarcomas and melanoma might be best managed surgically, if possible. In cases where there are a limited number of metastases in locations that are surgically accessible, surgical removal of metastatic tumor may be appropriate
Surgery may also be done in an effort to relieve symptoms. For example, if a tumor is blocking the colon, it may be removed to allow the bowels to function. Of course, surgery should be considered only when the benefit to the patient is expected to be greater than the risk of the procedure.
Reconstructive surgery may be offered to restore appearance and/or function. This type of surgery is most common in cancers of the head and neck, some sarcomas, and breast cancer.
Ports and catheters
Some cancer treatments require that a port or catheter be placed to provide consistent and reliable venous access. A port or catheter can be placed in a brief outpatient surgical procedure. These devices are usually removed once therapy is completed.
In rare cases, surgery may be done in an attempt to prevent a cancer from developing. This usually occurs when a hereditary condition, that may predispose a person to the development of cancer, is present. Some examples are Familial Adenomatous Polyposis (FAP) where by the colon may be removed to prevent colon cancer from developing and people with the BRCA2 gene who may elect to have bilateral mastectomies to prevent the development of breast cancer.