Cancer surgery FAQ’s
When is surgery used in cancer?
Surgery is used in cancer in different scenarios.
The aim of curative surgery is to remove all the cancer that is seen on tests. This type of surgery enables a cure from the cancer. Curative surgery is done in early stages of cancer and in some instances when the cancer is stage 3. Curative surgery is either done alone or is combined with chemotherapy and/or radiotherapy given after the surgery. These treatments may increase the chances of cure when compared to surgery alone. Where these additional treatments are used depends on the type and stage of cancer at the time of treatment.
Non-Curative surgery (Palliative Surgery)
Here surgery is done with the intention to control symptoms and make the patient better rather than to aim to cure the patient. This type of surgery is done in patients where the cancer is so advanced that it is not possible to remove all of it or the cancer has spread to different parts of the body (stage 4) and hence not curable. Examples of this type of surgery include bypassing a blocked intestine, debulking surgery-to reduce the bulk of cancer to improve symptoms for the patient.
Potentially curative surgery
Some patients who have had curative treatments in the past may have a recurrence of their cancer in one area of the body. Treatment options are discussed and if this recurrence is isolated and operable, a potentially curative surgery is done. The aim is to maximise control of the cancer with the chance of a cure.
This type of surgery is done to help in the diagnosis of the cancer as well as a treatment at the same time. Normally a biopsy is first done before major surgery is undertaken, but in certain circumstances both can be done at the same time.
Here the surgery is done prior to the patient being diagnosed with cancer. This type of surgery is applicable only to patients where there is a very high risk of getting a type of cancer. For example, removal of breasts in a BRCA gene carrier-where risk of breast cancer is high.
This type of surgery is commonly done in cancers of the head and neck region, breast and limb cancers. Usually these surgeries are done along with or after curative cancer surgeries. They are used to restore the function of the organ that has been operated upon or to improve the cosmetic outcome after major surgery.
What are the different methods of surgery used in Cancer?
Surgery is done in different forms to treat cancer
This is the standard form of surgery where a cut is made in the area to be treated and the cancer is removed through that. For example, if the cancer is in the abdomen, a large cut is made in the abdomen for the operation to take place. The advantages of this method are that it is technically easier to do and the only option in some situations. The recovery period is longer compared to other methods.
This is a type of surgery where 3-4 small holes about 1-2cm in size are made and the operation is done through them. A laparoscope is an instrument with a camera and is inserted into one of the holes. The operating surgeon is able to see inside of the body (area of surgery) with this instrument. The operating instruments are inserted through the other holes. The advantage of this technique is that the scar is smaller, and healing is quicker. This technique is not suitable in all cancer surgeries. The disadvantages are that the duration of the operation can be longer than the open method and special training and skills are needed to gain expertise.
This is another form of laparoscopic surgery but with the help of robotic system which controls the instruments. Here, like laparoscopy, small holes are made in the area of surgery. The surgeon sits at a console away from the patient and uses the computer to perform the operation. Any movements made by the surgeon are transferred to the instruments through the robotic system. This method is used to treat some cancers and like laparoscopy can help in quicker recovery of patients. In some types of cancer surgery, side effects may also be less than other forms of surgery. This method though is significantly more expensive than other options.
Less common types of surgery
Less common types of surgery used to treat cancers include
Laser surgery- where lasers are used to burn out cancer cells and used to treat some early stage cancers such as cervix, anus etc.
Cryotherapy-where a probe is inserted into the cancer and the cancer cells are frozen at very cold temperatures
Radiofrequency ablation-where a probe is inserted into the cancer and high energy radio waves are passed which heat the cancer cells and kill them.
It is important to note that these techniques are used for only very limited number of cancers.
What happens after decision is made for surgery?
Once the doctor and the patient have decided for a type of surgery, the patient is made to have a set of blood tests as well as a consultation with the anaesthetic team and other specialists such as physicians or cardiologists to assess and see whether the patient is fit enough to have the operation.
What type of Anaesthesia is used during cancer surgery?
Anaesthesia is use of medications to reduce the discomfort and pain that is associated with surgery. Anaesthesia can be of many types and the common ones are listed below.
Local anaesthesia is where a medicine is injected around the site where the surgery is due to take place. The medicine numbs the area so that the patient does not feel any pain during surgery. The effect of the medicine usually wears off a few minutes to hours after the surgery.
In this type of anaesthesia, medicine is given to numb a larger area than in local anaesthesia. Medications to cause mild sleepiness can also be used along with regional anaesthesia to improve comfort for the patient. This type of anaesthesia is a nerve block or spinal anaesthesia.
This is a type of anaesthesia where the patient is put to sleep with an injection. A tube is inserted into the windpipe to help the patient to breathe. This is the most common type of anaesthesia used for cancer surgery.
What happens following surgery?
After the surgery, the patient stays in hospital for a few days. Drains(tubes) are placed at the site of the operation to help drain any fluid that collects at the surgical site. These are removed after a few days once the fluid stops draining. Once the Patient begins to eat and is feeling better, he/she is discharged home and is seen in the outpatient clinic in about two weeks for removal of sutures or surgical clips which are placed at the time of the operation. The surgeon will also explain to the patient in that visit about the outcome of the surgery and the histology report. This report explains in detail about the cancer and will guide as to whether further treatment is needed.
What are the potential complications of cancer surgery?
Like any surgery, cancer surgery can be associated with side effects and complications. Most of these are specific to the type of surgery that is being done but some common complications associated with surgery include
Infection is an important complication associated with any surgery. Infection can occur at the operated area or in other areas such as lungs or urinary tract. Generally, all precautions are taken prior to, during and after surgery to reduce the risk of infection.
Pain is a common side effect of surgery but can be controlled with good pain killers.
Loss of Blood
Blood is lost during surgery, is usually minimal, but sometimes a blood transfusion is needed during or after surgery.