Cancer Operations - Oncological Surgery

Surgery is the oldest known treatment for cancer.

Surgeons in ancient times, when pathology, anatomy and modern surgical techniques were unknown, attempted to remove tumors through catheterization (cauterization) or with a knife, but these interventions mostly failed to achieve the desired success.

With major advances in science and technology, today early-stage or locally advanced cancers are mainly treated with invasive / radical surgery. Surgery is also frequently used in some stage 4. (metastatic, advanced) cancers to reduce tumor burden or relieve sudden tumor-related complaints such as pain, intestinal obstruction and nerve compression. Cancer operations are usually performed by oncological surgeons with advanced expertise in surgery for the particular cancer.

Note: Surgery is the main treatment for early-stage solid (organ) cancers!

Invasive surgery is the conventional method of cancer treatment, reaching cancerous tissue through a skin incision. However, minimally invasive treatments, some performed by interventional radiologists, play an increasing role in cancer care. Minimally invasive procedures use small openings causing less harm to the patient instead of large incisions.

Examples of minimally invasive oncological surgery include:

• laparoscopic surgery (keyhole surgery), 
• robotic surgery (keyhole surgery with DaVinci and similar robots),
• natural orifice surgery (through the mouth, rectum and vagina),
• single-incision laparoscopy (SILS). The following minimally invasive methods are performed by interventional radiologists: 
• cryoablation (destruction by freezing), 
• radiofrequency ablation (destruction by burning), 
• nanoknife (electroporation).

What Types of Cancer Surgery Are There?

Whether a cancer patient is suitable for surgery depends on:

• The type of cancer
• The cancer's location (anatomical site) and stage
• The patient's general health

Surgery is not the first option for every cancer. It is a local (regional) treatment. If your cancer has spread, or if the tumor is small but your cancer has systemic characteristics (such as breast cancer), surgery may not be the best treatment for you. In hematological cancers (such as leukemia and lymphoma ), systemic treatments such as chemotherapy take priority. In this situation, chemotherapy, targeted treatment, immunotherapy or hormone treatment affecting your whole body may be better. Radiotherapy can also be used to shrink tumors and control symptoms and complaints.

Surgery is one of the main cancer treatments and may be the only treatment you need. In a cancer operation, your surgeon removes the tumor intact, along with some surrounding normal tissue (called clear surgical margins or negative surgical margins ). The lymph nodes closest to the cancer are also usually removed to detect cancer cells that may have spread.

Various cancer operations are performed for different purposes. The main types are;

• Curative cancer operations: These are conventional cancer operations, removing the tumor with some surrounding normal tissue.
• Preventive (prophylactic) cancer operations: Used in hereditary cancers. For example, BRCA mutation carriers having their breasts and ovaries removed before cancer develops. The best-known example is Angelina Jolie.
• Diagnostic cancer operations: For sampling abdominal lymph nodes in lymphoma
• Cancer operations for staging: In ovarian cancer, direct examination during surgery and sampling the peritoneum provide information about cancer stage.
• Cancer operations to reduce tumor volume (debulking): Most often associated with ovarian cancer treatment, this method is also used in certain stage 4. breast cancers and cancers with immunogenic characteristics, such as kidney cancer.
• Cancer operations providing temporary relief (palliative): For tumor-related obstructions (intestinal blockages) that can occur in bowel cancers
• Supportive cancer operations and procedures: Venous port placement. Instead of repeatedly establishing intravenous access during cancer treatment, central venous access is placed in a major chest vein. This access also allows blood sampling for tests. Temporary or permanent stomach tube (gastrostomy tube – G-tube) placement when food cannot be taken orally.
• Cancer operations to restore tissue integrity (reconstructive): Frequently used in head and neck cancers and breast cancer.
• Minimally invasive cancer surgeries: Such as laparoscopic surgery, robotic surgery and natural orifice surgery

The clearest difference between cancer operations and other operations is complete removal of tumor tissue with lymph nodes and all affected neighboring organs, touching or puncturing the tumor as little as possible to prevent recurrence, and always obtaining surrounding healthy tissue, particularly in curative cancer operations. This requires the surgeon to have command of all surrounding tissues and the ability to correct problems arising in any tissue in the operative area.

Does Choosing an Experienced Center for Cancer Surgery Make a Difference?

Many scientific studies have shown that cancer treatments at centers with a high patient volume (number) are more successful. Analyses have even demonstrated significantly longer average survival among patients treated at these centers.

Patients should choose a surgeon with whom they feel most comfortable and who is known to be experienced in this field. It is important to work with an oncology team that approaches you positively, inspires confidence and answers questions clearly, thereby preparing you psychologically for surgery as well as possible. 

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What Are the Causes of Cancer, Briefly?