Surgery

Surgery despite being one of the oldest forms of cancer treatment remains one of the most effective.

Curative surgery in general is performed for early stage tumours ie. stage 1 and 2 but sometimes for stage 3 and 4 in combination with other oncology treatments such as chemotherapy, radiotherapy, targeted therapy and immunotherapy.  When a person undergoes surgery for cancer, they undergo an operation in which the tumour and a rim of surrounding normal tissue is removed from the body. If the surgeon is not able to remove a good margin of normal surrounding tissue, then the surgery is unlikely to be curative. It is better for that patient to have some treatment before surgery (neoadjuvant treatment) to shrink the tumour before attempting an operation.

Not all cancers are suited for surgery. Some cancers for example nasopharyngeal cancers and  extensive cervical cancers are usually treated with radiotherapy and chemotherapy upfront and cancers like lymphomas and leukaemias are treated with systemic therapy upfront. These types of tumours are generally very successfully treated without the need for surgery.

Apart from cure, surgery can be used to help diagnose/biopsy the cancer and remove parts of the tumour that are causing symptoms such as pain or swelling to offer palliative relief.

Surgery Types

Surgery can be used for different purposes.

• Diagnostic surgery is the process where a surgeon removes part of a tumour in order to biopsy it. The biopsy is then examined by a pathologist who determines if it is cancerous or benign and if cancerous, what the origin of the cancer is.
• Staging surgery is used to investigate whether or not the tumour has spread beyond the primary. An example would be laparoscopic surgery to examine the abdomen before embarking on stomach or oesophageal surgery 
• Curative surgery is the removal of a tumour and a rim of surrounding normal tissue.
• Debulking is the process where a surgeon removes as much of a tumour as possible without damaging the rest of the body. This is typically used in conjunction with other treatments such as chemotherapy.
• Palliative surgery is used to relive the side effects that may be caused by a tumour. This can include pain relieve if a tumour is pressing on a nerve, for example, to stop bleeding when cancers are in or near areas that are susceptible to bleeding or where bleeding is a side effect of a treatment. Surgery can also be used to insert a feeding tube into a patient in order to keep them sustained when treatment makes it difficult to eat, and to prevent broken bones that are caused by treatments through the insertion of a metal rod into certain parts of the patient’s body.
• Reconstructive surgery is used following the removal of a tumour to restore either the function or appearance of the patient’s body. This surgery can be conducted either at the time of the original surgery, or at a later date, depending on the individual situation.
• Prophylactic (or preventative) surgery is undergone when a person is at risk of developing cancer in order to prevent it. For example, women with a genetic predisposition for breast cancer such as BRCA mutation may choose to have a mastectomy to prevent themselves developing the cancer. 

Minimally Invasive Surgery

The majority of the surgeries mentioned above involve a surgeon making large incisions to the body in order to achieve their goal, however this is not the only method of surgery. Minimally invasive surgery is the use of small incisions made by surgeons. This type of surgery often has less recovery time and less instances of pain following surgery.

Some minimally invasive surgeries and procedures are:

• Laparoscopic surgery: Where a surgeon makes a small cut in the skin using a small lighted tube with a camera. Laparoscopic surgery takes place in the abdomen and is sometimes done with the aid of a robot controlled by a doctor. Both mediastinoscopy and thoracoscopy are similar types of surgery to a laparoscopic surgery, however they are conducted within the chest.
• Laser surgery: The removal of cancer through the use of a narrow beam of high-intensity light. 
• Mohs micrographic surgery: Conducted by a dermatologist, skin cancer is shaved off one later at a time until all cells within a layer of skin look healthy.