Surgical oncology is a procedure involving the removal of cancerous tissues. After the surgery, oncologists are able to diagnose and identify stage of each cancer. They can also make a suitable plan for cancer patients to relieve their symptoms or mitigate the risks of cancer. Surgical oncology is one of the subspecialties of surgery and a part of comprehensive cancer treatment along with other specialties.
Patients who suffer from breast cancer, endocrine tumors, melanoma, sarcoma, gastric cancer, hepato-pancreato-biliary cancer, colorectal cancer, gynecological cancer, and ENT cancer can benefit from the surgery. With a precise diagnosis of the cancer stage, oncologists and medical team are able to provide a promising and reasonable expected results to patients.
Different cancers, different approaches
Each type of cancers can be treated using a combination of different treatment methods. Doctors may use either radiation or chemotherapy when detecting a clear granular cancer before removing cancerous cells while considering the stage of the cancer.
Colorectal cancer is the most common type of cancer that is suitable for surgery. Each type of surgery is used in different cancer stages and its location. Polypectomy is used for stage 0 cancer cases to remove the polyp, a projecting growth of tissue from a surface in the body. For large polyp, Endoscopic mucosal resection (EMR) and Endoscopic submucosal resection (ESR) is more appropriate. EMR or ESR is an advanced surgery and can help some patients from undergoing traditional surgery.
Proctectomy, Colectomy and Pelvic exenteration are applicable for advanced stage of colorectal cancer cases, including removing some parts of the organ and lymph nodes as well as both healthy tissues and affected tissues.
There are two types of breast oncological surgery known as lumpectomy and mastectomy. Respectively, the first procedure removes the tumor and some part of the normal tissues while the latter removes the entire affected breast. Physician assessment and diagnosis are required for each breast cancer case.
Lesion from large cervical cancer mass and small precancerous mass can be managed with different types of surgery. Small mass procedure includes Cryosurgery, which destroys precancerous tissue, LEEP or loop electrosurgical excision procedure, Cone, Hysterectomy and Bilateral salpingo-oophorectomy. LEEP is a thin wire charged with electrical current to remove the tissues. Cone is the procedure of removing the cancerous tissues in women who plan to have a baby in the future. The operation that removes the uterus and the cervix is Hysterectomy, not removing the vagina and lymph nodes. Last but not least, Bilateral salpingo-oophorectomy is a process that removes ovaries and fallopian tubes at the same time.
For large cervical cancer lesions, surgeons estimate 4-5 cm width to indicate the surgery. There are two major surgeries, including Trachelectomy and Radical hysterectomy. Trachelectomy is the removal of cervix and the surrounding tissues, suitable for women who have larger cancer that could be around up to 2 cm and have plan for future pregnancy. Radical hysterectomy is the excision of cervix, uterus, some parts of the vagina and nearby lymph nodes. The surgery could be done by a scar less method through the vagina or open abdominal procedure.
Early stage lung cancer patients may be advised to undergo surgery. The most common lung cancer surgeries are the followings;
Pneumonectomy is to remove the entire lung for patients who have healthy lungs. Sleeve lobectomy includes the lobe where the tumor is located. It also removes the connecting bronchus and reconnects to the remaining lobes. For standard surgery, lobectomy is common among cancer patients and includes the removal of the affected lung lobes. The last two procedures are recommended for patients who have poor lung capacity and are unable to tolerate the aforementioned surgeries. To surgically remove a part of the lobe where cancer is located, approximately less than 2 cm tumor size, surgeon usually prefers Segmentectomy or segmental resection. The last procedure is called Wedge resection, comprising the excision of a wedge-shape piece of the tumor and the surrounding tissues. Wedge-resection is also useful for biopsy.
Surgical advancements in oncology
Surgical procedures and interventions are common for treating identifiable malignant mass. Surgeons usually perform the operation on specific type of cancer. Colon cancer, for example, is an indication. With the advancements of technologies, there are several protocols and approaches, in order to achieve better treatment outcomes and lesser post-operative complications.
HIPEC,or Hyperthermic intraperitoneal chemotherapy surgery is comprised of two-steps procedure. Removal of cancerous cells is followed by an application of heated chemotherapy drugs inside patient’s abdomen to eliminate microscopic cancer cells. This technique was first introduced in 1980 and designed to treat cancers that spread beyond organ which can’t be treated by traditional chemotherapy. By directly circulating chemotherapy drugs at 42 degree Celsius in the abdomen, patients receive higher doses of treatment and lesser toxicity.
Ovarian cancers, as well as colorectal and appendix cancers, can be treated by HIPEC and mesothelioma. Recently, MD Anderson Cancer Center found that stomach cancers can be cured using HIPEC. Patients who respond well to standard chemotherapy seem to be suitable for HIPEC. However, they have to consult physician prior to making any decision.
Minimally invasive surgical techniques have played a vital role in helping surgeons to remove cancerous tissues and surrounding tissues while having minimum effects on the healthy cells. The technique can be used in different types of cancer, such as colorectal and liver cancers. Various benefits of MIS are that patients have less pain, less scarring, fewer complications and faster recovery time.
Robotic surgery is also becoming well-known and being adopted in MIS for cancer. According to the research, there were several types of cancer that are feasible to be treated. Hepatobiliary, gastric, pharyngeal and base of tongue cancers are among them. Skilled doctors can perform surgeries with high accuracy with the help of robotic equipment which aims to achieve better functional outcomes and recovery in post-operative cancer patients.