General Cancer Information

Surgery

Is the oldest cancer treatment; removing tumors and sometimes curing patients of cancer. Surgeries vary in complexity from simple removal of a skin tumor to a exten- sive abdominal surgeries for pancreas cancer. Fortunately, surgical techniques have greatly improved over the past several decades, and surgery is much safer than it was in the past.

For instance, in the massive operation for cancer of the pancreas, (called a "Whipple" procedure,) the death rate from surgery has decreased from 40% to less than 10%. Exacting neurosurgical techniques use "stereotactic guidance" (imaging a brain tumor in 3 dim- entions) to minimize the amount of normal brain tissue injured when removing a brain tumor. These stereotactic techniques are now being used to sample breast tumors, to ensure accuracy and minimize scarring. Newly designed staplers allow the bowel to be reconnected in colon and rectal cancers, preserving continence and avoiding a colostomy bag (which drains stool through the abdomen). Microsurgical procedures can be performed using lasers and laparoscopic techniques, whereby a small visualization tube can be inserted toward the tumor and a surgery done without actually opening up the patient. These newer techniques are aided by advances in care after surgery, including less infection risk, new antibiotics to prevent or fight infection, better pain control and quicker return to normal activities.

While these advances in surgery are indisputable, its role in treating cancers will always be limited. This is because surgery can only treat a local tumor; it can't cure a patient who's disease is already widespread. Surgery is a essential component in diagnosing (i.e. doing a biopsy) and treating many cancers, since the bulk of the tumor can be removed, and getting "local control" of the cancer (in it's area or origin) is essential for cure. The surgeon tries to get "clear margins" ( meaning no cancer cells left behind or es- caping into the area surrounding the tumor), or additional treatments will be necessary to cure the patient. Our current strategy often involves combining it with radiation therapy, chemotherapy, hormonal, and immune-boosting treatments to increase effectiveness. This allows killing of cancer cells that have escaped from the tumor, and may allow for a less debilitating and disfiguring surgery, getting equal survival results. For instance, patients who had muscle tumors of the limbs used to get routine amputation and be handicapped; now a combination of pre-operative radiation therapy, chemotherapy and a more limited surgery can usually save these limbs with good function!