Cancer Surgery

What is Cancer Surgery?

Cancer surgery, also known as surgical oncology, is a medical specialty focused on the surgical management of cancer. It involves the removal of cancerous tissue, which can be a tumour or malignant cells, from the body. The main goal of cancer surgery is to eliminate the cancer, prevent its spread to other parts of the body, and potentially cure the patient.

Who is Suitable for Cancer Surgery?

The suitability for surgery varies from case to case and depends on various factors. Here are some considerations:

Stage of Cancer: Cancer surgery is most effective when cancer is in its early stages or localised. Patients with stage 0, I, II, and some stage III cancers are often suitable candidates for curative surgery.
Overall Health: A patient's general health plays a significant role in determining suitability for surgery. Individuals with underlying medical conditions that may increase the risks of surgery may need careful assessment and optimisation before undergoing the procedure.
Tumour Location and Size: The location and size of the tumour matter. Some tumours may be inoperable if located in critical areas or have grown too large.
Extent of Spread: Surgery alone may not be curative for patients with advanced cancer that has spread to multiple organs. Surgery may be combined with other treatments like chemotherapy or radiation therapy.
Patient Preferences: It's essential to consider the patient's preferences and goals when determining the suitability for surgery. Some patients may prefer more conservative treatments or prioritise quality of life over curative measures.
Multidisciplinary Approach: In many cases, cancer treatment involves a multidisciplinary approach. A team of specialists, including surgeons, oncologists, radiologists, and pathologists, collaborate to determine the most appropriate treatment plan for each patient.
Advanced Techniques: Advances in surgical techniques, such as minimally invasive surgery and robotic-assisted surgery, have expanded the options for many patients, reducing recovery times and complications.

Benefits of Cancer Surgery

Cancer surgery offers numerous benefits in the management and treatment of cancer, including:

Curative Potential: Surgery can be curative, especially for cancers that are localised or in their early stages. By removing the cancerous tissue, surgery aims to eliminate the cancer and offer the chance of a cure.
Local Tumour Control: Surgery provides excellent control over the local tumour. It can effectively remove the tumour, preventing it from growing or causing further damage to nearby tissues and organs.
Quick Resolution: In some cases, surgery can rapidly resolve symptoms. For example, it relieves pain or discomfort caused by a tumour obstruction or bleeding.
Tissue Diagnosis: Surgery often involves the removal of a tissue sample (biopsy), which is crucial for diagnosing cancer and determining its type and stage. This information guides further treatment decisions.
Staging: Surgery is essential for staging cancer accurately. Staging helps determine the extent of the disease and influences treatment planning. It informs whether additional treatments like chemotherapy or radiation therapy are needed.
Palliation: In advanced cases where a cure is impossible, surgery can palliate symptoms. For instance, you are removing part of a tumour to improve breathing or swallowing.

Types of Cancer Surgery

There are several types of cancer surgery, each designed to address specific aspects of cancer management:

Curative Surgery: This type of surgery aims to remove the cancer completely. Examples include lumpectomies and mastectomies for breast cancer or colectomies for colon cancer.
Debulking Surgery: Debulking surgery reduces its size when a tumour cannot be entirely removed. This can relieve symptoms and make other treatments more effective.
Palliative Surgery: Palliative surgery alleviates symptoms and improves a patient's quality of life, even though it may not cure the cancer. Examples include procedures to relieve obstruction or pain.
Prophylactic Surgery: In individuals at high risk of developing certain cancers due to genetic mutations, prophylactic surgery may be recommended to remove at-risk tissues or organs—for example, prophylactic mastectomy in cases of BRCA gene mutations.
Reconstructive Surgery: After removing cancerous tissue, reconstructive surgery may be performed to restore the appearance and function of affected areas. This is common in breast reconstruction following mastectomy.
Lymph Node Dissection: In many cancer surgeries, nearby lymph nodes are examined and sometimes removed to determine if the cancer has spread.
Minimally Invasive Surgery: Techniques like laparoscopy and robotic-assisted surgery allow smaller incisions and shorter recovery times. They are commonly used for various cancer surgeries, including prostatectomies and hysterectomies.

Alternative Options for Cancer Surgery

While surgery is a crucial tool in cancer treatment, there are alternative or complementary approaches depending on the type and stage of cancer. Some alternatives include:

Chemotherapy: Chemotherapy uses drugs to target and kill cancer cells. It can be used as a standalone treatment or in combination with surgery, especially for cancers with a high risk of spreading.
Radiation Therapy: Radiation therapy uses high-energy beams to target and destroy cancer cells. It is often used with surgery or as a primary treatment for certain cancers.
Immunotherapy: Immunotherapy harnesses the body's immune system to fight cancer cells. It has shown remarkable results in various types of cancer.
Targeted Therapy: Targeted therapies specifically target the genetic or molecular abnormalities driving cancer growth. They are often used when surgery is not an option.
Hormone Therapy: Hormone therapy is used for hormone-sensitive cancers, such as breast or prostate cancer, to block or lower hormone levels that fuel cancer growth.
Precision Medicine: Precision medicine involves tailoring treatment based on the individual's unique genetic and molecular profile, optimising therapy effectiveness.
Watchful Waiting or Active Surveillance: In some cases, particularly with slow-growing cancers or elderly patients with other health concerns, a healthcare team may recommend close monitoring rather than immediate surgery or aggressive treatments.

Preparation Before Cancer Surgery

Consultation and Planning: Before the surgery, you will have a detailed consultation with your oncologist. They will review your medical history, perform a physical examination, and discuss the surgical procedure, its purpose, and potential risks and benefits.
Preoperative Evaluation: Your medical team will conduct various tests, such as blood work, imaging scans, and cardiac evaluations, to ensure that you are in the best possible condition for surgery.
Medication Review: Inform your healthcare team about all the medications, supplements, and herbal remedies you are taking. Some medications may need to be adjusted or temporarily stopped before surgery.
Fasting: Typically, you will be asked not to eat or drink anything for a specified period before surgery. This is essential to prevent complications during anaesthesia.
Lifestyle Adjustments: If you smoke, your surgeon may recommend quitting before surgery, as smoking can impede healing. Maintaining a healthy diet and staying physically active can also improve surgical outcomes.
Support System: Arrange for a support system to assist you during your recovery. You may need help with daily activities for a period after surgery.
Questions and Consent: Don't hesitate to ask questions and clarify doubts with your surgical team. You will be asked to provide informed consent before the procedure.

Cancer Surgery Procedure

Anaesthesia: You will be given anaesthesia to ensure you are comfortable and pain-free during the surgery. The type of anaesthesia (general, regional, or local) will depend on the nature of the surgery.
Incision: The surgeon will make an incision at the predetermined site to access the cancerous tissue. The size and location of the incision depend on the type and location of the cancer.
Tumour Removal: The primary goal of surgery is to remove the cancerous tissue. This may involve removing a tumour, part of an organ, or an entire organ, depending on the extent of the disease.
Lymph Node Evaluation: If necessary, nearby lymph nodes may be removed and examined to determine if the cancer has spread.
Minimally Invasive Techniques: In some cases, minimally invasive techniques like laparoscopy or robotic-assisted surgery may be used. These involve smaller incisions and specialised instruments for greater precision.
Reconstruction: In cases where tissue or organs are removed, reconstructive surgery may be performed immediately or in a separate procedure to restore form and function.
Monitoring: Throughout the surgery, your vital signs, such as heart rate, blood pressure, and oxygen levels, will be closely monitored by the surgical team.

What to Expect After Cancer Surgery?

After surgery, you will be taken to a recovery room, where medical staff will closely monitor your vital signs as you wake up from anaesthesia.

The length of your hospital stay varies depending on the type of surgery and your recovery progress. Some surgeries require a brief stay, while others require extended hospitalisation.

Cancer Surgery Recovery Plan

A well-structured recovery plan can help optimise your healing and improve your overall well-being.

Pain Management: Your healthcare team will provide strategies to ensure comfort. Medications, both over-the-counter and prescription, may be prescribed to control pain.
Wound Care: Proper wound care is crucial to prevent infection. Follow your surgeon's instructions for cleaning and dressing the incision site.
Diet and Nutrition: Nutrition plays a vital role in healing. Follow any dietary recommendations provided by your healthcare team. You should start with a clear liquid diet and gradually progress to solid foods.
Physical Activity: Early mobility is essential to prevent complications like blood clots. Start with gentle movements and gradually increase your activity level as directed by your healthcare team.
Medications: Take prescribed medications as directed, including pain relievers, antibiotics, and medications to prevent blood clots, if necessary.
Follow-Up Appointments: Attend all scheduled follow-up appointments with your surgical oncologist and other healthcare team members. These appointments are essential for monitoring your recovery, discussing pathology results, and planning adjuvant treatments.
Emotional Support: Coping with cancer surgery's emotional and psychological aspects is crucial. Seek support from friends, family, support groups, or mental health professionals if needed.
Resuming Normal Activities: Gradually resume normal activities as your healthcare team advises. It's essential to strike a balance between activity and rest to support your recovery.
Adjuvant Treatments: Depending on your cancer type and stage, you may require additional treatments such as chemotherapy, radiation therapy, or immunotherapy. Your healthcare team will discuss these options with you.

Cancer Surgery Prognosis

The prognosis after cancer surgery varies widely based on several factors, including:

Cancer Type: The specific type of cancer and its aggressiveness influence prognosis.
Cancer Stage: The stage at which cancer is diagnosed is a critical determinant of prognosis. Early-stage cancers generally have a better prognosis than advanced-stage cancers.
Surgical Success: The extent to which the surgeon removed cancerous tissue and whether any cancer cells remain after surgery.
Pathology Results: Examination of the surgical specimen by pathologists can provide additional information about the cancer, such as its grade and genetic characteristics, which may impact prognosis.
Overall Health: Your overall health and any underlying medical conditions can affect your ability to recover from surgery and respond to other treatments.
Adjuvant Treatments: If additional treatments like chemotherapy or radiation therapy are required, their success and tolerability can influence prognosis.

Cancer Surgery Risks

While cancer surgery is generally safe and effective, it does come with potential risks and complications, which can vary depending on the type and extent of the surgery. Some common risks include: