Surgical oncology is a specialized field of surgery that focuses on the surgical treatment of cancer. It involves the removal of cancerous tumors and surrounding tissues in order to cure or control cancer, prevent its spread, or relieve symptoms. In many cases, surgery is combined with other treatments such as chemotherapy, radiation therapy, or targeted therapy, depending on the type, stage, and location of the cancer.
Surgical oncology plays a key role in the diagnosis, treatment, and management of cancer, and the approach to surgery is tailored to each patient’s specific cancer type and overall health.
- Role of Surgical Oncology in Cancer Treatment
Surgical oncology is typically used in various phases of cancer management, including:
Diagnosis and Staging: Surgery may be used to obtain biopsies of suspicious tissues for diagnosis, or to stage the cancer (determine how far it has spread).
Primary Tumor Removal: The most common use of surgical oncology is to remove the primary tumor, especially when it is localized and has not spread.
Debulking: In cases where the tumor cannot be completely removed, surgery may be performed to reduce the tumor size, making other treatments like chemotherapy or radiation more effective.
Preventive Surgery: Surgery can be performed to remove organs or tissues that are at high risk of developing cancer, in patients with a family history or genetic predisposition (e.g., mastectomy in women with BRCA mutations).
Palliative Surgery: In advanced cancer, surgery may be used to relieve symptoms or prevent complications, such as relieving a blockage or reducing tumor pressure.
- Types of Surgical Procedures in Surgical Oncology
The exact surgical procedure depends on the type, size, location, and stage of the cancer. Surgical oncologists perform a wide range of procedures to treat cancer, which can be categorized as follows:
2.1. Curative Surgery
Curative surgery aims to remove all visible cancerous tissue in an effort to cure the patient. It is most successful when cancer is localized (has not spread).
Excision: Removal of the primary tumor and a margin of healthy tissue around it to ensure all cancerous cells are removed. For example, in early-stage breast cancer, a lumpectomy may be performed, where only the tumor is removed along with some surrounding tissue.
Organ-Specific Surgery: This involves removing specific organs or parts of organs affected by cancer. Examples include:
Mastectomy: Removal of one or both breasts in patients with breast cancer.
Prostatectomy: Removal of the prostate gland in patients with prostate cancer.
Colon resection: Removal of part of the colon affected by colorectal cancer.
Lobectomy: Removal of a lobe of the lung in patients with lung cancer.
2.2. Debulking Surgery
Debulking surgery is used when a tumor cannot be completely removed but can be partially resected to reduce the tumor size. This can help improve the effectiveness of other treatments like chemotherapy or radiation.
Ovarian Cancer: In cases of advanced ovarian cancer, debulking surgery is often performed to remove as much of the tumor as possible to enhance the effectiveness of chemotherapy.
Gastrointestinal Cancer: In some cases of advanced cancer, surgeons may remove part of the stomach, colon, or liver to reduce the tumor burden.
2.3. Palliative Surgery
Palliative surgery is performed to alleviate symptoms of advanced cancer and improve the quality of life, rather than to cure the disease. This may include:
Biliary Bypass: For patients with pancreatic cancer, a biliary bypass may be done to relieve bile duct obstruction.
Stent Placement: Stents may be placed to open blocked ducts (e.g., in the case of colorectal or esophageal cancer).
Bypass Surgery: In advanced cancers that have caused blockages in the gastrointestinal tract or other organs, surgeons may create bypasses to maintain function and relieve pain.
2.4. Preventive Surgery
Preventive surgery is used in high-risk patients to remove tissues or organs before cancer develops. This is often done in individuals with inherited cancer syndromes, such as those with BRCA1 or BRCA2 mutations, which significantly increase the risk of developing breast and ovarian cancer.
Prophylactic Mastectomy: Removal of healthy breast tissue in individuals at high genetic risk for breast cancer.
Oophorectomy: Removal of the ovaries in women at high risk of ovarian cancer, especially in those with a family history or genetic mutations.
Colectomy: In patients with inherited conditions like familial adenomatous polyposis (FAP), where multiple polyps increase the risk of colon cancer, a colectomy (removal of the colon) may be performed to prevent cancer from developing.
2.5. Reconstructive Surgery
Reconstructive surgery is often needed after the removal of cancerous tissues to restore function, appearance, and quality of life. This is commonly seen in cancers that affect the breast, head and neck, or reproductive organs.
Breast Reconstruction: After a mastectomy, breast reconstruction can be done using implants or the patient’s own tissue (flap reconstruction) to rebuild the breast.
Reconstructive Surgery after Head and Neck Cancer: Tumors in the head and neck area (e.g., oral cavity, throat, larynx) may require extensive surgery. Reconstructive procedures can restore speech, swallowing, and appearance.
2.6. Lymph Node Surgery
Lymph node surgery is commonly performed to assess the spread of cancer and help with staging. Lymph nodes are often the first site where cancer spreads.
Sentinel Lymph Node Biopsy: This procedure identifies the first lymph node (sentinel node) where cancer is likely to spread. A small sample is removed to determine if cancer has spread. It is commonly used in breast and melanoma cancers.
Lymphadenectomy: Removal of multiple lymph nodes to check for cancer spread, particularly in cancers like melanoma, head and neck cancers, and gynecological cancers.
- Preoperative and Postoperative Considerations
3.1. Preoperative Considerations
Before surgery, thorough planning and preparation are essential. Key steps in the preoperative phase include:
Diagnostic Tests: Imaging studies (CT, MRI, PET scans) and biopsies may be used to evaluate the tumor and its spread, helping the surgeon plan the most effective approach.
Assessing Patient Health: A comprehensive evaluation of the patient’s overall health and any comorbidities (e.g., heart disease, diabetes) is conducted. Preoperative tests such as blood work, ECG, and chest X-rays may be done.
Informed Consent: The surgeon explains the procedure, potential risks, and benefits to the patient, and the patient must provide informed consent for surgery.
Preoperative Care: This may include stopping certain medications (e.g., blood thinners), fasting before surgery, and preparing the surgical site (e.g., shaving or antiseptic wash).
3.2. Postoperative Considerations
Postoperative care focuses on recovery, minimizing complications, and managing side effects:
Pain Management: After surgery, patients may experience pain, which is managed using medications, including opioids and nonsteroidal anti-inflammatory drugs (NSAIDs). Epidural or nerve blocks may be used in major surgeries.
Infection Prevention: Antibiotics may be prescribed to prevent infections, and sterile techniques are used during and after surgery.
Monitoring for Complications: Postoperative complications, such as bleeding, blood clots, pneumonia, or wound infections, must be carefully monitored. Regular vital sign checks and laboratory tests are essential.
Nutrition: Proper nutrition and hydration are important for wound healing and recovery. Some patients may need feeding tubes or intravenous nutrition.
Physical Therapy: Depending on the type of surgery, physical therapy may be required to regain movement or function, especially after surgeries involving the breast, pelvis, or limbs.
- Advances in Surgical Oncology
Recent advancements in surgical oncology have significantly improved the precision, safety, and effectiveness of cancer surgery. These include:
4.1. Minimally Invasive Surgery (MIS)
Minimally invasive surgery involves small incisions and the use of specialized instruments, such as laparoscopes (tiny cameras) and robotic arms, to perform surgeries with less trauma to the body.
Laparoscopic Surgery: Used for gastrointestinal cancers, where small incisions are made, and a camera is used to guide the removal of tumors. This results in smaller scars and quicker recovery.
Robotic Surgery: Robotic systems like the da Vinci Surgical System allow surgeons to perform highly precise operations with greater control, leading to smaller incisions, reduced blood loss, and faster recovery.
4.2. Intraoperative Imaging
Intraoperative imaging, such as intraoperative ultrasound or MRI, allows surgeons to visualize the tumor and surrounding tissues in real-time during the procedure. This helps ensure the complete removal of the tumor and minimize damage to healthy tissues.
4.3. Enhanced Recovery After Surgery (ERAS) Protocols
ERAS protocols are a set of evidence-based guidelines designed to enhance recovery after surgery by optimizing pain management, minimizing narcotic use, improving nutrition, and accelerating postoperative mobility. These protocols lead to quicker recovery and reduced complications.
- Conclusion
Surgical oncology is a critical component of cancer treatment, offering patients the opportunity to achieve a cure or improve quality of life through tumor removal and symptom management. The techniques and procedures used in surgical oncology have evolved significantly over the years, with minimally invasive surgeries and advanced technologies improving outcomes and reducing recovery times. A skilled surgical oncologist, in collaboration with other cancer specialists, plays a central role in a patient's comprehensive cancer care plan, working toward the best possible outcome for each individual.