Surgery


 

What is Surgery?
Surgery, the oldest form of treatment for cancer, produced great discomfort and risk to the patient before the discovery of anesthesia and antisepsis(sterilisation of instruments to prevent infection). But today, surgery offers the greatest chance of cure for many types of cancer.

Surgery

Above 60 per cent people with cancer have to undergo some type of surgery or operation.

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Why is Surgery used?
Usually, surgery is recommended for the following purposes.

  • 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).
  • 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.
  • 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).
  • 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.
  • 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.
  • 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.
  • 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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What is Laser Surgery?
The term laser stands for Light Amplification by Stimulated Emission of Radiation. Laser light is a highly focused and powerful beam of light energy that is used in medicine for very precise surgical work, such as repairing a damaged retina in the eye, cutting through tissue (replacing a scalpel), or vaporizing a cancer of the cervix. It is also very useful in cancer of voice box, small cancers in the mouth, or on the skin. Surgery can be less complicated with laser . For example, with fiber optics, light can be directed to many parts of the body without making a large incision and without damaging surrounding normal tissues.

Cryosurgery
Cryosurgery involves the use of a liquid nitrogen spray or a very cold probe to freeze and kill abnormal cells. This technique is sometimes used to treat precancerous conditions such as those affecting the cervix. Cryosurgery is also being tried as a treatment of some cancers like prostate cancers. Usually cryosurgery involves little or no pain.

Written Informed Consent Informed consent is the written permission to have surgery or any other procedure by the patient, based on the understanding of the procedure that the doctor recommends like how it is to be done, what are the side effects and benefits. Although the specifics of the form may vary, the form usually attests to the fact that the doctor has explained your condition to you, in a language understood by you, in terms understood by you as to how the surgery will benefit you, what are the risks, and what other options are available to you. Your signature means that you have received this information and that you are willing to have the surgery or procedure.

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Does Surgery cause a cancer to spread?
In nearly all situations, the answer is definitely not. But there are some important exceptions and doctors who are experienced in taking biopsies of cancers and treating them with surgery are very careful to avoid these situations.

The chances of a needle biopsy causing a cancer to spread is extremely low. In the past, larger needles were used for biopsies and the chance of spread was more significant. Most types of cancers can be safely sampled by an incisional biopsy, but there are a few exceptions. For these types of cancer, doctors may recommend removing the entire tumor if it is likely to be cancerous. In other cases a needle biopsy can be safely used and, if that indicates the tumor is a cancer, surgery to remove it will follow. Some types of cancers have the potential to spread into the surgical wound when an incisional biopsy is done. So surgeons doing such a biopsy will be certain that the skin surrounding the biopsy site is in a location that can later be completed removed as part of the follow up operation to remove the entire cancer.

One common myth about cancer is that a cancer will spread if it is exposed to air during surgery. Cancer does not spread because it has been exposed to air. Some people may believe in this myth because they often feel worse after the operation than they did before. It is normal to feel this way when beginning to recover from any surgery. If you delay or refuse surgery because of this myth, then you may be cheating yourself. The best chance of a cure from most types of cancer is to remove all cancer cells as early as possible after diagnosis. Sometimes chemotherapy or radiation therapy alone will provide a cure. But often surgery is needed and can be the first and most important treatment choice a patient has.

There is some animal research to suggest that removing a primary (main or first) cancer might cause small metastases elsewhere in the body to begin growing. Although this may occur in some cases, this concern is less important than problems that arise when the primary cancer is not removed. As long as the primary cancer is present, its cells may continue to spread to other parts of the body. Also chemotherapy and radiation therapy are usually more effective after most of the cancer has been removed by surgery. And, removal of the primary tumor is often needed to prevent potentially life threatening complications caused by continued growth of the mass.

Patients with any concerns about surgery and cancer spread are encouraged to discuss this issue with their surgeon and other members of their cancer care team.

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What questions should I ask my doctor?
Before undergoing surgery, you will want to find out all you can about the benefits, risks and side effects of the operation. Answers to the following questions will help you feel comfortable about your decision.

  • Why am I having this operation?
  • What are the chances of its success?
  • Is there any other way to treat this cancer?
  • Exactly what will you be doing - and removing - in this operation? Why?
  • How long will the surgery take?
  • What can I expect after the operation? Will I be in a great deal of pain?
  • Will I have drains or catheters?
  • How long will I be in the hospital after the surgery?
  • How will my body be affected by the surgery?
  • How long will it take for me to recover?
  • Will any of the effects be permanent?
  • Other than my cancer, am I healthy enough to tolerate the stress of the surgery and the anesthesia?
  • What are the potential risks and the side effects of this operation?
  • What is the risk of death or disability as a result of this surgery?
  • What will happen if I choose not to have the operation?
  • What are the chances that the surgery will cure my cancer?

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Should I get a second opinion?
One of the ways to find out that a suggested operation is the best for you may be to get the opinion of at least two surgeons before you agree to an operation. Your doctor should not mind your doing this.

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