|How Is Surgery Used For Cancer?
Surgery is one of the oldest forms of cancer treatments. It is usually elective which means that it does not have to be performed immediately. As well as curing cancer, it also plays a role in cancer diagnosis and staging (how far the cancer has progressed). Other types of surgeries include prophylactic surgery for cancer prevention; debulking (cytoreductive) surgery; curative, palliative and reconstruction surgery. Invasive surgery is where the surgeon has to cut into the body tissue. Today, due to progress in new surgical techniques some operations involve less cutting which means they are less invasive. Surgery is still considered the best treatment for cancer, particularly cancer in the early stages. Most cancer patients will undergo some type of surgery or surgical procedure (a ‘procedure’ is considered a minor surgery). This includes women with:
• Uterus cancer
• Cervical cancer
• Vagina cancer
• Fallopian tube cancer
• Vulva cancer
What Surgeries Are Performed?
A surgical procedure, most diagnostic surgery is undertaken by biopsy. This is where a piece of tissue from the suspected cancerous area is taken and sent to a lab for testing. A cancer diagnosis can then be given by looking at the cells under a microscope. This is important for determining treatment plans (or if you want to participate in cancer clinical trials). There are different ways to take cell samples, or perform biopsies. For example, with a fine needle aspiration (FNA) biopsy, a very thin needle attached to a syringe is inserted into the tumor and a piece of tissue is snipped. If the tumor is deep the doctor will use an ultrasound scan or CT scan to guide the needle. Alternatively a core needle biopsy may be performed; as the needle is larger it can take out more of a tissue sample. Other options include excisional biopsy where the entire tumor is removed or incisional biopsy, where part of the tumor is cut away. On the other hand, endoscopy and laparoscopy (which use a thin lighted tube with a camera on the end) are generally more explorative. If less invasive measures do not work, a surgeon may need to perform open surgical exploration (thoracotomy or laparotomy). Carried out under general anesthesia the whole chest and stomach may be opened up so that the surgeon can look directly into the area in question.
Preventive Surgery (Prophylactic)
This surgery involves removing body tissue which is likely to become cancerous, even though no cancer signs exist at the time of surgery. This is more commonly performed in women with a strong family history of breast cancer and where genetic testing for breast cancer have identified them as carriers of the BRCA1 or BRCA2 mutation genes. As their risk is considerably higher than the average woman, they may consider a prophylactic mastectomy where both breasts are removed before cancer has a chance to develop. Another common instance is prophylactic surgery to remove pre-cancerous polyps from the colon.
Interesting: Read about the thermography screening debate.
This is carried out to determine how far the cancer has spread. A physical examination of the patient and lab tests will determine the clinical stage of the disease. Usually however doctors will also want to know the pathological stage (also called surgical staging) of the disease. Sometimes for example when they examine the person internally they discover that the clinical staging may be different to the pathological stage (it may be more extensive than they thought). The most common procedures for staging surgery are laparotomy and laparoscopy.
This is only performed where cancer is restricted to one area and all of the cancer can be removed. It may be in fact the only treatment the patient requires. In some instances radiation therapy or chemo (see Chemotherapy Guide) will be used before or after the operation. Occasionally radiation therapy is used during the operation and this is known as intraoperative radiation therapy. Examples of curative surgery include lumpectomy and mastectomy.
Debulking Surgery (Cytoreductive)
This is carried out to remove part, but not all, of the cancerous tissue. It is usually performed where cutting out all of the tissue could harm nearby organs, so doctors think it is safer to remove as much of the tumor as possible and deal with the rest by chemo or radiation. It is commonly used for advanced ovary cancer and some lymphomas (cancer of the lymphatic cells of the lymphatic system).
This is not performed to cure cancer but rather treat problems associated with it in the advanced stages of the disease. For example a patient with advanced stomach cancer may find that the tumor grows large enough to block and cause severe pain of the abdomen. Surgery will be performed to remove the blockage.
Reconstruction Surgery (Restorative/Reconstructive)
This is performed to improve the way a person looks or to restore function to a part of the body after cancer surgery. The most common example is breast reconstruction surgery after a mastectomy. See our breast cancer guide for an overview.
What Questions Should I Ask My Doctor?
If your surgeon has recommended a procedure or operation, you may want to ask some of the following questions:
• Why do you think I need this operation and what are my chances of success?
• Is there any alternative?
• How many operations like this have you performed?
• What is your success rate?
• Are you certified by the American Board of Surgery?
• What will you actually do during the operation?
• What will you take out?
• How long with the operation take and will I need blood transfusions?
• How long will I need to stay in hospital after?
• What is the normal recovery speed?
• Will I look or feel any different after?
• What are the chances it will cure my cancer?
• What are my options if it does not?
• What would happen if I chose not to have surgery?
• What timeframe do I have to consider my options?
• Would you object if I get a second opinion?
• What is the best treatment for cancer?
Any serious treatment recommendation is worth getting a second opinion on. Your doctor should not mind and you may find that your insurance company insists on it. You should not have to get all the tests done again; you can bring the results of those you already have with you.
Check our fighting foods: Cancer diet foods.
How Do I Prepare For Surgery?
Before the operation you will be told about all aspects of the surgery, including how it will be performed, what the risks are, possible side effects and what other options you have (if any). The patient will need to sign a consent form giving the doctor permission to proceed.
In most instances tests are performed in the days before the operation, particularly if a major operation is planned. These tests are performed to test your reaction to drugs which will be used during surgery. They may also help doctors better understand your condition. Most commonly, a blood test will be carried out to measure your blood count which will help assess the risk of infection and bleeding. A urinalysis will check for kidney infections. A chest X-ray and EKG will check the lungs and heart. A CT scan can check the size and any changes in the tumor.
Depending on the type of surgery being performed, there may be different requirements. If a general anesthesia is going to be given a laxative or enema to empty the bowels may be prescribed. You will also be told not to eat or drink for several hours before the operation. This is to avoid vomiting while unconscious which can cause serious lung problems.
You may need to have a shower and use a special bacteria killing soap.
What Happens During Surgery?
On the morning of surgery the woman is taken to the pre-surgery area and the preparations begin. An IV line will be inserted into the arm or hand which makes it possible to administer blood, liquids or medications if necessary. She will be given the anesthetic by a specially trained nurse and may also be given a sedative to help her relax. Sometimes a 'conscious sedation' may be given before a general anesthetic (and even before procedures which do not require a general anesthetic). This means she will forget the procedure itself, but will still be conscious and can follow directions. In the operating theatre the woman will be scrubbed and covered so that only the point where the incision is to go will show. If she is scheduled for a regional anesthetic (to numb the lower region) she will be told to curl up on the table. A tube is inserted into a space in the backbone and she will be numbed from that point down. If she has received a general anesthetic by IV, this will not last very long. A large tube will be put down her throat which will deliver a mixture of gases and oxygen to keep her deeply unconscious. Once the surgery is completed, she will be moved to the post anesthesia recovery room where she will gradually wake or (or regain the use of her lower body if a regional was applied). If she is scheduled to stay in hospital she will be wheeled to her bed on a gurney. If she is to go home, she will receive written instructions on aftercare and medications.
What Are The Possible Complications?
Complications during major surgeries are not common but include:
Bleeding during the operation. This may result in blood transfusions.
Damage to blood vessels or internal organs.
Reaction to anesthetic or other medications used. This is why vital signs are tracked (heart rate, blood pressure and breath rate).
Failure of other organs which may have been weak before surgery.
Pain is a minor but common problem associated with cancer surgery recovery but it can usually be dealt with by Tylenol or aspirin. If pain is particularly severe stronger drugs such as codeine and morphine may be prescribed.
Infections at the point of surgical incision are a potential problem. This is why keeping the wound clean is important. If an infection occurs it can be treated by antibiotics.
Less Common Problems
Blood Clots in the legs which can break and head for the lungs. This is why most patients are encouraged to get out of bed and walk as soon as possible.
Pneumonia may occur in people with weakened lungs, such as smokers. Doing some deep breathing exercises after surgery reduces this risk.
Internal bleeding can occur if a blood vessel was not properly sealed off. This may require another surgery to correct.
Does Exposure To Air Cause Cancer To Spread?
No, this is a myth. The idea is that cancer will spread if it is exposed to air during surgery. The reason some people thought this, is because they felt worse after surgery. Most people will feel bad after surgery, particularly a major surgical procedure, so it is quite normal. It does not mean that the cancer has spread. Occasionally a surgeon may find more cancer than they expected from X-rays when they open a person up. This is does not mean the exposure to air cause the spread of the disease, the cancer was already there, it was just missed.