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Clinical Specialties - Cancer

Surgical Treatments

surgical treatmentYour treatment plan may involve surgery and your surgeon will explain the approach they plan to take in relation to your specific cancer. Surgery is a medical procedure to examine, remove or repair tissue and can be performed using either an open or minimally invasive approach such as laparoscopy or robotic surgery.

Surgery can be used in the following ways as part of a cancer treatment plan.

Prevent Cancer

Sometimes surgery can be used for preventing or lowering the risk of developing certain types of cancer. The surgery is done before cancer develops by removing tissue that is not yet cancerous but has a high chance of becoming cancerous in the future. This may include changes to cells that identify a precancerous condition or if you have an inherited condition putting you at high risk of developing a certain type of cancer. For example, some women who have a very high risk of developing breast cancer may choose to have one or both breasts removed before cancer develops (called a prophylactic mastectomy).

Diagnose Cancer

Doctors use different types of surgery to diagnose cancer. They can also use surgery to determine the stage a cancer is at or the amount of cancer in the body. This is done by collecting a sample of tissue (biopsy) during surgery, or removing a tumour, and having them examined under a microscope. A pathologist will then examine the tissue or tumour and aim to determine:

  • The exact type of cancer
  • The grade (determined by how different the cancer cells look from other cells) of the cancer
  • If the cancer cells that are seen in any part of the tissue that is removed are also present in the edges of the tissue (called positive surgical margins)
  • If any of the lymph nodes near the tumour have cancer in them

After getting the pathology report, doctors will decide if more treatment is needed and what type of treatments to offer.

Remove cancer

The main goal of surgery is always to completely remove the tumour or cancerous tissue from its location in the body. The earlier that a cancer is identified, the more likely that surgery will be effective. Early detection can catch the cancer while it is still localised and hasn’t spread to other parts of the body.

Surgery may also be used to treat cancer that has spread from where it started (the primary site / tumour) to other parts of the body. The new tumour is called a metastasis, or secondary tumour.

During surgery to remove cancer, the surgeon will also remove a small amount of normal tissue from around the cancer (called the surgical margin). The reason for this is to ensure that no cancer cells are left behind. If cancer cells are not completely removed, they can cause the cancer to come back.

Depending on the type of cancer, the surgeon may also remove lymph nodes close to the tumour. Surgery to remove lymph nodes is called a lymph node dissection. The lymph nodes are examined under a microscope to see if cancer cells are present. If the lymph nodes are not removed and they contain cancer cells, these cells may form new tumours or spread to other parts of the body.

Sometimes it may not be possible to remove all of the cancer because the:

  • The tumour is too big
  • The location of the cancer makes it difficult to remove without damaging nearby organs
  • The cancer is too small to be seen by the surgeon or found by tests
  • A persons' general health makes surgery too dangerous

In some cases when all of the tumour can’t be removed, surgery is still done to remove as much of the cancerous tissue as possible (called debulking). Surgery to reduce the number of cancer cells in the body is called cytoreductive surgery. Cytoreductive surgery may make chemotherapy and radiation therapy more effective.

Whenever possible, surgeons will use less invasive approaches that can be performed through smaller incisions, such as laparoscopic or robotic surgery. They will also try to lessen or prevent side effects, or complications of surgery by carefully repairing any organs or tissue affected by the surgery. This includes sealing off blood vessels and avoiding injury to nearby organs. Find out more information on robotic surgery here.

Relieve symptoms

Palliative surgery is surgery used to relieve symptoms and improve the quality of life. For example, surgery is sometimes used to create a bypass around a blocked or obstructed organ. It can also be used to relieve pain or pressure caused by a tumour. Your surgeon will discuss the risks and benefits of doing surgery, especially when the overall goal is to control symptoms and improve the quality of life rather than cure the disease.

For more information on the palliative care program at the San click here.

Reduce recurrence potential

In addition to removing the cancer, surgeons may also remove other nearby normal structures. These structures can include muscles, nerves and lymph nodes. The surgeon may do this because research shows that removing nearby structures can lower the chance of many types of cancer coming back, or recurring.

Repair affected tissue

Reconstructive surgery may be used to repair tissue that has been affected by cancer or cancer treatments, including surgery to remove a tumour.

Surgeons can use different techniques to repair or rebuild structures in the body. These techniques include skin or tissue flaps and grafts, implants and prostheses.

Support other treatments

Surgery may be used to support other treatments by providing direct access to a blood vessel to simplify administration of drugs or to make other treatments easier.

This access could be through the use of a central venous catheter which simplifies the collection of blood samples or doses of chemotherapy, antibiotics, blood products or intravenous (IV) nutrition. Surgery may also be used to insert a special pump that is used to deliver chemotherapy drugs.

Support body functions

Surgery may also be used to help with body functions including improved breathing and nutrition. A tracheostomy is surgery to make an opening into the trachea (windpipe) through the neck. It is used to place a breathing tube.

People who cannot eat or drink may have a surgical procedure called gastrostomy. This procedure requires surgeons to make an opening into the stomach through the abdominal wall. A tube can then be placed directly into the stomach allowing the healthcare team to provide adequate nutrition and liquids directly into the stomach.

Surgery with other therapies

As part of a cancer treatment plan, surgery may be used along with other cancer treatments, such as chemotherapy and radiation therapy.

Neoadjuvant therapy is treatment given to shrink a tumour before surgery. Chemotherapy, radiation therapy or both may be used as neoadjuvant therapy to shrink a tumour and make it easier to remove with surgery.

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