Surgery plays a vital role in the cancer treatment plan, especially in patients with solid tumors. Surgery is often used to attempt to cure patients whose tumors are localized at the time of the diagnosis. After definite cancer diagnosis, curative surgical operations are conducted to remove or destroy cancerous tissue. Unlike diagnostic surgeries which may remove a small amount of tissue to confirm the existence and the stage of the disease, curative surgeries take a much more radical surgical approach, typically resulting in partial or total removal of the organ of origin.
In a curative procedure, a certain amount of normal tissue as well as cancerous tissue may be removed to obtain adequate margins. The purpose is to minimize the risk of any cancer cells being left behind, which may result in a recurrence of the cancer. For the same purpose, the surgeon may also remove the lymph nodes that are adjacent to the tumor.
Resection of isolated metastases (removal of solitary metastases) may be performed in some cases, especially if there has been a disease-free interval of more than one year after the surgery. Second-look operations are sometimes performed following adjuvant therapies, but they have little effect on the final outcome in the great majority of cancer patients.
Scalpels or other instruments are used in excisional surgeries to eradicate the malignant tumor. Many types of excisional surgeries exist, each named for the particular area of the body in which they are performed. For example, laryngectomy involves removal of a large tumor of the larynx which may include removing part of the tongue or oropharynx. Similarly, parathyroidectomy refers to a surgery to remove parathyroid glands or tumors.
In addition to the more traditional surgical instruments such as scalpels, new technologies are employed in cancer curative surgeries depending on such factors as the patient's age and general health condition, location of tumor, and so on.
Laser surgery uses a powerful beam of light, which can be directed to specific parts of the body, without making a large incision, to destroy cancer cells. Laser also can be used in cancer treatment as well as preventive surgeries. For example, in the digestive system, laser is often used to remove colon polyps, which may later become cancerous. Laser has been used to treat abnormal tissue, carcinoma in situ, and early cancer of the cervix, vagina, and vulva, to name a few. Many woman with breast cancer choose laser as the surgical tool because it is less painful and requires a shorter stay in the hospital.
Laser, as a tumor removal tool, has several advantages over scalpels. It is more precise and takes less operating time. Healing time is often shortened because laser heat seals blood vessels so there is less bleeding, swelling, and scarring involved in the surgical procedure. The downside of laser surgery is its cost and proper training of the cancer surgeons. The equipment can be bulky and technologically complicated compared with the more traditional surgical tools such as scalpels.
Working on a similar biological principle, electrosurgery uses high-frequency electrical currents to cut and destroy cancer cells. In electrosurgery, the high density of the radio-frequency current applied by the active electrosurgical electrode causes a cutting action, which can act like a fine micro-needle, a lancet, a knife, a snare, or even an energized scalpel or scissors.
Another innovative surgical technique to remove cancer is cryosurgery. Liquid nitrogen, or a probe that is very cold, is used to freeze and kill cancer cells. Traditionally, it has been used to treat external tumors, but now the technique is being employed as a treatment for tumors that occur internally.
Similar to laser, cryosurgery, incurs minimal blood loss, little discomfort, and shorter recovery time and shorter hospital stays. While researchers are still studying the effectiveness of cryosurgery as a treatment for other types of cancer, the technique has been used successfully in treating prostate cancer. Just as with the laser techniques, cryosurgery has proven to be effective in preventive surgeries. For example, pre-cancerous skin growths known as actinic keratosis and cervical intraepithelial neoplasia can be treated succesfully with cryosurgery.
According to cancer specialists, the stage of the cancer plays an important role in opting for cryosurgery as a cancer surgical tool. Cryosurgery is most effective for younger patients whose disease is contained entirely within the prostate.
One frequently asked question is: "Can the surgeon cure the cancer after the surgery?" Unfortunately, there is not a definite answer to this question. In many cases, cancer cells can break away from the primary tumor site and spread (metastasize) to other parts of the body by the time of the diagnosis. These patients may not only receive surgery, but may also receive adjuvant treatment such as chemotherapy to destroy the metastases.
The decision of a curative surgery is often made based on such factors as the patient's age and general health condition, location of tumor, stage of tumor, presence or absence of enlarged nodes, and the patient's desire for preservation.
Each of the surgical procedures described above is recorded in the abstract as cancer-directed treatment.