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Usually, surgery
is recommended for the following purposes. |
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Prophylactic
surgery is performed to remove a growth that is not presently
malignant, but is likely to become malignant if left untreated. This
is done in precancerous conditions such as polyps in the colon. Sometimes
preventive surgery is used to remove an organ when people have an
inherited condition that makes development of a cancer likely. Women
with a very strong family history of breast cancer and/or genetic
testing results that show a mutation of breast cancer susceptibility
genes (BRCA1 or
BRCA2) may consider
prophylactic mastectomy (breast removal). |
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Diagnostic
surgery is used to obtain a tissue sample for laboratory testing,
called biopsy
to confirm a diagnosis and identify the specific cancer. There are
several surgical techniques used to obtain a sample. The type of technique
used is determined by the type, size, location and growth characteristics
of the suspected tumor. |
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Staging
surgery determines the extent of disease. Examples of two surgical
procedures used for staging cancers of organs in the abdomen are laparoscopy
and laparotomy (see surgical techniques). |
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Curative surgery
is the removal of a localised tumor when there is hope of taking out
all the cancerous tissue. Curative surgery is called primary treatment
of the cancer.It also involves removing a rim of normal tissue along
with the diseased part, in order to provide a greater margin of safety
for prevention of recurrence. |
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Palliative
surgery is performed to alleviate the suffering and complications
of advanced disease and is not to cure cancer.
It is an effort to correct a problem that is causing discomfort or
disability. For example, some cancers may metastasize
to the spine. As they continue to grow, they may press on the spinal
cord or nearby nerves causing paralysis or severe pain. If the metastatic
cancer does not respond to radiation or chemotherapy, palliative surgery
can relieve these symptoms and improve the patient's quality of life.
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Supportive
surgery is used to help with other types of treatment. For example,
vascular access devices such as a port are placed under the skin to
help with chemotherapy treatments. |
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Restorative
(or reconstructive) surgery is used to restore a person's appearance
or the function of an organ or body part. Examples includes breast
reconstruction after mastectomy or use of bone grafts or prosthetic
(metal or plastic) bone or joint replacements after surgical treatment
of a bone cancer. |
Diagnostic
Surgical techniques
A procedure to remove all or part of a tumor for diagnostic tests
is called a biopsy.
Some types of biopsies involve operations to remove an entire organ
and can be done only by experienced surgeons. Other types of biopsies
are minimally invasive and may remove tumor samples through a thin
needle or an endoscope (a flexible lighted tube).
These biopsies are sometimes done by surgeons, but can also be done
by other doctors such as radiologists, oncologists, pulmonologists,
pathologists or gastroenterologists.
Fine needle aspiration
cytology(FNAC): FNAC uses a very thin needle and an ordinary syringe
to withdraw a small number of tissue cells from the tumor mass. The
doctor can aim the needle while feeling a suspicious tumor or area
near the surface of the body. If the tumor is deep inside the body,
the needle can be guided while it is viewed by a sonograph or CT scan.
The main advantage of FNAC is that it does not require a surgical
incision (cutting through the skin). The disadvantage is that in some
cases this needle cannot remove enough tissue for a definite diagnosis.
Excisional or incisional biopsy: A surgeon cuts
through the skin to remove the entire tumor (excisional biopsy) or
a small part of a large tumor (incisional biopsy). This often can
be done with local anesthesia or regional anesthesia (numbing medication).
If the tumor is inside the chest or abdomen, general anesthesia is
used.
Endoscopy:
This test uses a very flexible tube with a viewing lens or a video
camera, and a light on the end. If a video camera is used, it is connected
to a televison set, allowing the doctor to clearly see any masses
in the area. The endoscope can be passed through natural body openings
to view suspicous areas in the gastrointestinal tract, genitourinary
tract and the respiratory tract. The advantages of endoscopy are the
opportunity to directly view the cancer which removes some of the
doubt about the mass, and the ability to take a biopsy (tissue sample)
through the endoscope to determine whether cancer is present and if
so, its type.
Laparoscopy: This procedure is similar to endoscopy
but is used to examine the contents of the abdomen and remove tissue
samples. The tube is passed through a tiny incision in the abdomen
(A similar procedure to view the inside of the chest is called thoracoscopy).
In common parlance, this is often referred to as 'key-hole
surgery'.
Laparotomy: A laparotomy is a surgical technique
that involves an incision into the abdomen, usually a midline incision
from upper to lower abdomen. This may be done when there is uncertainty
about a suspicious area that cannot be diagnosed by less intrusive
tests. During the laparotomy, a biopsy of a suspicious area can be
done and an assessment can be made about the location, size and involvement
of surrounding areas. This technique involves general anesthesia (A
similar operation involving the chest is called thoracotomy).
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