oncology is a specialized
area of oncology that engages
surgeons in the cure and management
Cancer has become a medical specialty warranting
its own surgical area because of advances
in the biology, pathophysiology, diagnostics,
and staging of malignant tumors. Surgeons
have traditionally treated cancer patients
with resection and radical surgeries of
tumors, and left the management of the cancer
and the patient to other specialists. Advances
in the early diagnosis of cancer, the staging
of tumors, microscopic analyses of cells,
and increased understanding of cancer biology
have broadened the range of nonsurgical
cancer treatments. These treatments include
systematic chemotherapy, hormonal therapy,
and radiotherapy as alternatives or adjunctive
therapy for patients with cancer.
all cancer tumors are manageable by surgery,
nor does the removal of some tumors or metastases
necessarily lead to a cure or longer life.
The oncological surgeon looks for the relationship
between tumor excision and the risk presented
by the primary tumor. He or she is knowledgeable
about patient management with more conservative
procedures than the traditional excision
to the American Association of Cancer Registries,
the most commonly diagnosed cancers for
males in the United States during 1995–1999,
with total of over 1.7 million cases for
all races, were:
non-Hodgkin's lymphoma 4.2%
White males make up more than 1.4 million
of the total prostate cancer cases, with
African Americans and Hispanic Americans
accounting for 160,356 and 75,237 cases
respectively. Each of the latter groups
had higher stomach cancer incidence in the
top five list, replacing non-Hodgkin's lymphoma.
For women, the total cases for all races
was over 1.6 million, and white women made
up more than 1.4 million of this number.
There were 140,888 female African American
cases and 76,810 Hispanic American female
cancers for all groups were:
colon & rectum–12.2%
corpus & uterus–5.9%
African American women had higher rates
of cervical cancer, replacing ovarian cancer
in the top five list.
oncology is guided by principles that govern
the routine procedures related to the cancer
patient's cure, palliative care, and quality
of life. Surgical oncology performs its
most efficacious work by local tumor excision,
regional lymph node removal, the handling
of cancer recurrence (local or widespread),
and in rare cases, with surgical resection
of metastases from the primary tumor. Each
of these areas plays a different role in
Local excision has been the hallmark of
surgical oncology. Excision refers to the
removal of the cancer and its effects. Resection
of a tumor in the colon can end the effects
of obstruction, for instance, or removal
of a breast carcinoma can stop the cancer.
Resection of a primary tumor also stops
the tumor from spreading throughout the
body. The cancer's spread into other body
systems, however, usually occurs before
a local removal, giving resection little
bearing upon cells that have already escaped
the primary tumor. Advances in oncology
through pathophysiology, staging, and biopsy
offer a new diagnostic role to the surgeon
using excision. These advances provide simple
diagnostic information about size, grade,
and extent of the tumor, as well as more
sophisticated evaluations of the cancer's
biochemical and hormonal features.
lymph node removal
node involvement provides surgical oncologists
with major diagnostic information. The sentinel
node biopsy is superior to any biological
test in terms of prediction of cancer mortality
rates. Nodal biopsy offers very precise
information about the extent and type of
invasive effects of the primary tumor. The
removal of nodes, however, may present pain
and other morbid conditions for the patient.
and regional recurrence
Radical procedures in surgical oncology
for local and regional occurrences of a
primary tumor provide crucial information
on the spread of cancer and prognostic outcomes.
However, they do not contribute substantially
to the outcome of the cancer. According
to most surgical oncology literature, the
ability to remove a local recurrence must
be balanced by the patient's goals related
to aesthetic and pain control concerns.
Historically, more radical procedures have
not improved the chances for survival.
for distant metastases
In general, a cancer tumor that spreads
further from its primary site is less likely
to be controlled by surgery. According to
research, except for a few instances where
a metastasis is confined, surgical removal
of a distant metastasis is not warranted.
Since the rapidity of discovering a distant
metastasis has little bearing upon cancer
survival, the usefulness of surgery is not
time-dependent. In the case of liver metastasis,
for example, a cure is related to the pathophysiology
of the original cancer and level of cancer
antigen in the liver rather than the size
or time of discovery. While surgery of metastatic
cancer may not increase life, there may
be indications for it such as pain relief,
obstruction removal, control of bleeding,
and resolution of infection.
Surgery removes cancer cells and surrounding
tissues. It is often combined with radiation
therapy and chemotherapy. It is important
for the patient to meet with the surgical
oncologist to talk about the procedure and
begin preparations for surgery. Oncological
surgery may be performed to biopsy a suspicious
site for malignant cells or tumor. It is
also used for tumor removal from such organs
as the tongue, throat, lung, stomach, intestines,
colon, bladder, ovary, and prostate. Tumors
of limbs, ligaments, and tendons may also
be treated with surgery. In many cases,
the biopsy and surgery to remove the cancer
cells or tissues are done at the same time
as the biopsy.
impact of a surgical procedure depends upon
the diagnosis and the area of the body that
is to be treated by surgery. Many cancer
surgeries involve major organs and require
open abdominal surgery, which is the most
extensive type of surgical procedure. This
surgery requires medical tests and work-ups
to judge the health of the patient prior
to surgery, and to make decisions about
adjunctive procedures like radiation or
chemotherapy. Preparation for cancer surgery
requires psychological readiness for a hospital
stay, postoperative pain, sometimes slow
recovery, and anticipation of complications
from tumor excision or resection. It also
may require consultation with stomal therapists
if a section of the urinary tract or bowel
is to be removed and replaced with an outside
reservoir or conduit called an ostomy.
After surgery, the type and duration of
side effects and the elements of recovery
depend on where in the body the surgery
was performed and the patient's general
health. Some surgeries may alter basic functions
in the urinary or gastrointestinal systems.
Recovering full use of function takes time
and patience. Surgeries that remove such
conduits as the colon, intestines, or urinary
tract require appliances for urine and fecal
waste and the help of a stomal therapist.
Breast or prostate surgeries yield concerns
about cosmetic appearance and intimate activities.
For most cancer surgeries, basic functions
like tasting, eating, drinking, breathing,
moving, urinating, defecating, or neurological
ability may be changed in the short-term.
Resources to attend to deficits in daily
activities need to be set up before surgery.
The type of risks that cancer surgery presents
depends almost entirely upon the part of
the body being biopsied or excised. Risks
of surgery can be great when major organs
are involved, such as the gastrointestinal
system or the brain. These risks are usually
discussed explicitly when surgerical decisions
Most cancers are staged; that is, they are
described by their likelihood of being contained,
spreading at the original site, or recurring
or invading other bodily systems. The prognosis
after surgery depends upon the stage of
the disease, and the pathology results on
the type of cancer cell involved. General
results of cancer surgery depend in large
part on norms of success based upon the
study of groups of patients with the same
diagnosis. The results are often stated
in percentages of the chance of cancer recurrence
or its spread after surgery. After five
disease-free years, patients are usually
considered cured. This is because the recurrence
rates decline drastically after five years.
The benchmark is based upon the percentage
of people known to reach the fifth year
after surgery with no recurrence or spread
of the primary tumor.
and mortality rates
and mortality of oncological surgery are
high if there is organ involvement or extensive
excision of major parts of the body. Because
there is an ongoing disease process and
many patients may be very ill at the time
of surgery, the complications of surgery
may be quite complex. Each procedure is
understood by the surgeon for its likely
complications or risks, and these are discussed
during the initial surgical consultations.
are comprehensive surgical procedures for
many cancers, and complications may be extensive
due to the use of general anesthetic and
the opening of body cavities. Open surgery
has general risks associated with it that
are not related to the type of procedure.
These risks include possibility of blood
clots and cardiac events.
is an extensive body of literature about
the complication and morbidity rates of
surgery performed by high-volume treatment
centers. Data show that in general, large
volumes of surgery affect the quality outcomes
of surgery, with smaller hospitals having
lower rates of procedural success and higher
operative and postoperative complications
than larger facilities. It is not known
whether the surgeon's experience or the
advantages of institutional resources in
operative or postoperative care contributes
to these statistics.
Alternatives to cancer surgery exist for
almost every cancer now treated in the United
States. Research has been very successful
for some—but not all—cancers.
There are many alternatives to surgery,
and chemotherapy and radiation after surgery.
Most organizations dealing with cancer patients
suggest alternative treatments. Physicians
and surgeons expect to be asked about alternatives
to surgery, and are usually quite knowledgeable
about their use as cancer treatments or
as adjuncts to surgery.
to "Oncology Treatment"