Nearly all patients with cancer will have some kind of surgery. Surgery may be used to perform a biopsy in order to obtain a specimen for determining an accurate diagnosis, provide local treatment of the cancer, and obtain other information to help determine whether additional treatment is necessary. Surgical techniques continue to improve, and surgeries are now less invasive and often performed on an outpatient basis.
In order to diagnose a cancer, a physician will typically perform a biopsy of a suspicious area, lump or mass suspected of being cancer. A biopsy can be performed on an outpatient basis. During a biopsy, part or all of the suspected cancer is removed and cells contained in the sample are sent to a pathology laboratory to determine whether cancer is present. Other information obtained from the biopsy sample can play an important role in treatment decisions. If the biopsy indicates that cancer is present, additional tests to determine the stage of cancer will be performed. Surgery may be performed as part of the staging evaluation and/or as part of treatment after the patient and doctor determine the overall treatment plan.
The successful treatment of cancer often requires the involvement and coordination of several different treatment approaches. This is referred to as multi-modality treatment and may consist of surgery, radiation therapy, chemotherapy and/or hormonal therapy. It is important to understand that surgery is a local treatment and is only capable of treating the cancer cells removed during surgery. By the time a cancer is diagnosed, many patients will already have experienced spread of cancer cells through the blood and lymph system to other locations in the body. These cancer cells are referred to as micrometastases and currently available tests cannot always detect micrometastases. Information obtained during surgery and from other tests determines the likelihood of the cancer having spread and whether additional treatment with chemotherapy, radiation, or hormonal therapy is necessary.
The following sections may answer additional questions that you have about undergoing surgery.
The following terms may be useful:
- Biopsy is the removal of a piece of tissue from an organ or other part of the body for microscopic examination to confirm or establish a diagnosis, estimate prognosis, or follow the course of a disease.
- Curative surgery is the removal of the entire tumor. Even after curative surgery, you may still be given chemotherapy or radiation to kill micro-metastases. Micro-metastases are cancer cells that may still be in the body but cannot be detected by current technology.
- Cryosurgery involves the use of liquid nitrogen or a very cold probe to freeze cancer cells.
- Debulking surgery is when the entire cancer cannot be removed without serious damage to the body so the surgeon takes out only that portion of the tumor that can be removed safely. The rest of the tumor may be killed with radiation therapy or chemotherapy.
- Electrosurgery uses an electrical current to destroy cancer cells.
- Laser surgery is surgery in which a beam of light is used instead of a scalpel.
- Mohs surgery is the removal of skin cancer by shaving off one layer at a time. The dermatologist (skin doctor) looks at each layer under a microscope. When the layers look normal (no cancer) the surgeon stops removing skin.
- Prophylactic surgery is surgery used to prevent cancer when there is a good chance that a particular body tissue will become cancerous in the future.
- Palliative surgery is a type of surgery that does not treat the underlying disease but is done to control symptoms of cancer, such as pain.
- Restorative or reconstructive surgery is commonly called plastic surgery. This type of surgery restores the function and appearance of an area after a previous surgery.
- Staging surgery is surgery used to determine the extent of the cancer, or how large it is and how much it has spread throughout the body. This is very important, as it will determine the course of treatment.
- Will I need to have surgery?
- What is the operation (procedure) that is recommended?
- What is the surgeon’s experience with this procedure?
- What is the reason that this procedure is necessary at this time?
- What are the options if this procedure is not done?
- Are there alternatives to surgery?
- What is the goal of surgery?
- What should I know about the risks of surgery?
- Should I get a second opinion?
- Where should I get surgery?
- What are the specific risks of anesthesia?
- What is the recovery process after this procedure?
- Should I have surgery before or after chemotherapy?
Although most patients will have a biopsy performed, however, not all cancers require surgical treatment. Some cancers are best treated with radiation therapy or chemotherapy. In some instances, the cancer may be too big or difficult to remove with surgery. Your healthcare team will work with you to determine whether surgery is part of your overall treatment plan. If surgery is necessary, you will undergo a number of tests to determine whether you are an appropriate candidate for surgery.
Ask your surgeon for a simplified explanation of the type of operation, technique used, and why it should be performed. (Pictures and drawings tell patients and family a great deal.)
Ask the surgeon about his experience with this procedure, its outcome, and the hospital or setting in which the operation will be performed.
Is the procedure being done to relieve pain, diagnose a condition, correct deformity, for cosmetic reasons, or what exact purposes?
What are the non-surgical or medical treatments available? What will/might happen if the operation is not done at this time? If the operation is not done at this time, can it be done later? What are the advantages and disadvantages?
Surgery may be the only treatment available or one of several choices or part of an overall treatment strategy that includes other treatments, such as radiation or chemotherapy. Ask your doctor how the recommended surgical treatment compares to other non-surgical treatment options and why surgery is best for you.
What exactly are the expected or possible benefits of doing the procedure? Is the goal of surgery to cure the cancer, prolong life, or relieve symptoms and improve quality of life?
Surgery does involve risks and side effects, depending on the type of surgery you have, and the expertise and experience of the surgeon and hospital. Generally, the more invasive or complicated the surgery, the greater the risk of side effects. Additionally, research has indicated that hospitals and surgeons that perform more surgeries like yours have better outcomes. Before you have your surgery, you may want to get a second opinion from another surgeon and inquire as to the track record of his/her hospital.
It is very common and appropriate to seek out a second opinion. This will not be a problem with the first surgeon who will recognize this as commonplace. If you choose to have surgery, the surgeon will tell you about all of the risks, side effects and benefits associated with your specific surgical procedure. Second opinions can reassure anxious patients (and family members) to make the whole process easier for all involved.
Several prior publications have indicated that outcomes of patients undergoing surgery may be significantly improved if they are treated in a hospital that has performed a large volume of such procedures. These results are presumed to be due to a more skilled and dedicated healthcare team that has experience with high-risk situations, as well as the attendance of skilled surgeons in such hospitals. However, the role of an individual surgeon in terms of surgical volume and patient outcome has been less well-defined in medical literature.
Patients undergoing complex surgical procedures have a significantly reduced risk of operative mortality if their surgeon has performed a large volume of the specific procedure compared to patients whose surgeon has performed a low volume of the procedure. Patients who are to undergo a complex surgical procedure should speak with their surgeon about their particular risks or ask their physician to refer them to a surgeon who performs a large number of the surgical procedure in which they are to undergo for treatment of their disease.
What are the risks of the type of anesthesia to be used? What are the possibilities for anesthesia methods (local, regional, general, etc.)?
Procedures each vary in terms of wound recovery and rehabilitation programs. It is very important for patients to know the long-term program ahead of time for the best planning.
Chemotherapy that is administered before surgery is referred to as neoadjuvant therapy and chemotherapy that is administered after surgery is referred to as adjuvant therapy. Patients should ask their doctor if the treatment of their disease typically involves neoadjuvant or adjuvant chemotherapy.