Cancer Surgery

Cancer Surgery

Surgery is the oldest form of cancer treatment. About 60% of
cancer patients will undergo surgery, either by itself or in
combination with other therapies. When possible, surgery still
offers the best chance for curative treatment outcome in many
cancers. Surgery physically removes a cancer tumor localized
to one part of the body. In some situations, chemotherapy and/or
radiation therapy may be offered before surgery to soften tumors
or reduce their size to facilitate surgery and reduce the risk of
cancer recurrence afterwards. In some cases, newer minimally
invasive surgical techniques allow much less discomfort, less
damage to normal organs, and markedly faster recovery while
preserving the effectiveness of cancer surgery.

At the Cancer Center of Frederick, we work closely together with all the finest surgeons in Frederick as well as even more specialized academic surgeons at University-affiliated hospitals and larger comprehensive cancer centers to offer you the highest quality and most technologically advanced surgical care available.

Seven Types of Cancer Surgery [click on type of surgery below for more details]

Curative Surgery

Curative surgery simply involves removal of a cancerous tumor. It works best on localized cancers that haven't yet spread to other parts of the body, and is often followed by radiation therapy or chemotherapy to make sure all cancerous cells have been removed.

Preventive Surgery

Preventive surgery is used to keep cancer from occurring. Many colon cancers can be prevented by removing precancerous polyps before they become malignant. A woman at very high risk for breast cancer may decide to have her breasts removed rather than worry about getting breast cancer later in life.

Diagnostic Surgery

Diagnostic surgery (biopsy): In this procedure, the surgeon removes some or all of a tumor for examination to determine if the growth is cancerous. A biopsy can be done in several ways:

Fine Needle Aspiration (FNA): a needle is inserted into the tumor and material is drawn out for inspection under a microscope.
Incisional or excisional biopsy: the patient is put under local or regional anesthesia, which numbs the area, and a small incision is made in the skin. The surgeon either removes a piece of a large tumor (incisional), or the entire mass (excisional), for further examination. If the tumor is in the chest or abdomen, general anesthesia is used.

Staging Surgery

Staging surgery is used to determine the extent of a cancer. This procedure can sometimes be done without an incision by using tiny cameras (scopes) attached to a flexible tube, which are inserted into natural body openings. An endoscope is used in hollow body cavities and organs such as the lungs, intestinal tract and urinary tract. Besides allowing surgeons to view the suspicious area, these devices can take a tissue sample. A laparascope is used to view the abdominal cavity. Laparotomy involves a small incision in the abdominal cavity, done under general anesthesia. Laparotomies are used when the suspicious area cannot be examined by less invasive procedures.

Supportive Surgery

Supportive surgery is used to help with other cancer treatments. For example, some chemotherapy devices require a port (connecting device) to be inserted under the skin.

Reconstructive Surgery

Reconstructive surgery returns the body to normal or near-normal appearance or function following cancer treatment. The most common restorative surgery is reconstruction of a breast after a mastectomy. Facial reconstruction and testicular implants are also examples of reconstructive surgery.

Palliative Surgery

Palliative surgery is only used to ease pain, disability or other complications that come with advanced cancer. Palliative surgery may improve quality of life, but is not a cure or anti-cancer treatment.

Minimally Invasive Surgery

Minimally invasive surgery takes advantage of advances in computer imaging and robotics to provide effective surgical cancer treatment with a much smaller impact on the patient. Using tiny, tube like cameras that look inside the body, miniaturized instruments and imaging machines that provide real-time views in the operating room, minimally invasive surgeries result in much smaller incisions and decreased recovery time. Advantages of minimally invasive surgery include:

• Less blood loss
• Decreased need for blood transfusions
• Shorter hospital stays
• Decreased pain and need for postoperative pain medications
• Earlier resumption of regular diet
• Quicker recovery and return to normal activities
• Less scarring and improved cosmetic appearance

Robotic Surgery

Robotic surgery systems consist of one or more robotic arms, precisely controlled by surgeons seated at a console, which enlarges 3-D views of the surgery site. The arms are tipped with an endoscope for viewing the treatment area, or surgical instruments that can fit into an incision less than an inch long. The instrument handles that control the robotic arms have the added benefit of reducing surgeon fatigue during long or complicated surgeries and eliminating "hand tremor."

For some cancer cases, the Da Vinci® robotic surgery system can be employed manipulating four robotic arms like the one pictured right. Although the robotic arms are doing the actual surgery, they still require direct input from the surgeon and cannot be merely programmed to operate without human intervention. Candidates for robotic-assisted surgery include patients undergoing prostatectomy, hysterectomy, thoracic procedures and some general surgeries.

Video Assisted Thoracoscopic Surgery (VATS)

VATS can be used to aid in the diagnosis of lung and esophageal cancers. Using a limited number of tiny incisions, small diameter video-thoracoscopes can allow examination of the entire thoracic cavity (see diagram at right). Biopsies of the lining of the chest cavity (pleura), lung nodules, mediastinal masses and pleural fluid can easily be obtained for diagnosis. In certain instances, definitive therapy can be performed at the same time, such as pleurodesis for pleural effusions. VATS is the technique of choice for the diagnosis of malignant mesothelioma. The procedure usually requires an overnight stay in hospital.