Cancer surgery

When surgery is used

The location and extent of the tumour defines whether a cancer is able to be treated by surgery. Superficial, small, encapsulated tumours are the type most easily removed by surgery.

Approximately 90 per cent of cancer patients have some type of surgery for diagnosis, initial treatment, or management of complications.

More recently surgery has expanded to include prevention, diagnosis and staging, reconstruction, support and palliation.

Prevention through surgery

Some people have a higher risk of developing cancer due to a family history of certain cancers or from specific conditions. In some cases, prophylactic surgery - surgical removal of non-vital benign tissue, or an organ that is responsible for predisposing the person to higher risk - can possibly prevent occurrence of cancer.

Diagnosis through surgery

Surgical procedures are often used for the precise diagnosis of cancer and for defining the stage of the disease. This is often done by performing a biopsy. There are various types of biopsies. These include:

• Incisional - when a piece of tissue is removed
• Needle biopsy - when cells are removed using a needle
• Excisional - for small tumours when the whole tumour is removed
• Sentinel node biopsy – is a new way of detecting whether cancer has spread to the lymph nodes. A small amount of radioactive material and a dye is injected near the cancer and shows up the first – or ‘sentinel' – node to receive lymph fluid from the cancer. If this sentinel node is clear it usually means that the other nodes are clear too

A laparotomy, when the abdomen is opened and the organs examined, or laparoscopy (keyhole surgery), where the organs in the abdomen are examined by inserting a tube with a camera at the end through the tummy wall, may also be done to diagnose cancer and its extent.

Surgical treatments for cancer

Primary treatment involves removal of a malignant tumour. This is used for tumours which can be entirely removed.

Palliative surgery is performed to control the cancer, reduce symptoms and improve quality of life for those whose cancer is not able to be entirely removed.

Reconstructive surgery

Surgery for cancer often results in some kind of disfigurement or mutilation, which can cause major depression and social isolation. Reconstructive surgery's purpose is to improve function or cosmetic appearance or both and quality of life.

When carrying out surgery, surgeons may use various techniques:

• Electrocauterization surgery – the process of destroying tissue using an electric current delivered through a probe. This technique is particularly useful in treating bladder cancer.
• Cryosurgery – the use of extreme cold temperatures to destroy cancer cells, and is often done several times. This technique is used on both external and internal tumours.
• Laser - a beam of light with special properties is used to cut through tissue and coagulate blood vessels. This is often used on head and neck cancers.
• Photodynamic therapy - where lasers are used to activate light sensitive drugs which are injected and absorbed by cancers. The light causes the drug to become poisonous to the cancer cells and destroys them without damaging surrounding healthy tissue.
• Radiofrequency ablation therapy - uses a special needle which is directed into the tumour under CT scan guidance. A radiofrequency current is passed via the needle to heat and destroys the cancer tissue whilst stopping any bleeding.
• Video assisted thoracoscopy is undertaken through a one inch incision, aided by a miniature camera inserted through another small incision.
• Gamma knife is a highly advanced instrument which is used to treat brain tumours and arteriovenous malformations. It makes no incision, but very precisely aims concentrated beams of radiation on the tumour, without damaging the healthy tissue.

Recovery from surgery will depend on the type performed.

In general, patients having surgery will have access to specialist nurses as well as their surgeons. These nurses are available to the patients and their families and can give support and advice on all aspects of treatment and rehabilitation.

Watch and wait

Sometimes standard treatment is to 'watch and wait'. This means no treatment is given unless the cancer starts to develop or cause symptoms.

As each cancer is different, it's hard to be specific, but as a general rule you‘ll be monitored on a regular basis and should discuss with your doctor how often this will be. Some patients find it hard to live with cancer and not be given any treatment. Ask your doctor to explain the reasons for not giving you any treatment at this time and make sure that you understand their reasons for taking this approach.