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Oncologic Surgeries
What is Surgical Oncology?
Surgical oncology is a specialty field that focuses on the treatment of different types of tumors with surgery. This type of surgery goes back two hundred years to the first recorded resection of an ovarian tumor way back in 1809. Even back in the 7th century, ancient Egyptians recorded their techniques in removing breast tumors. Currently, a general surgeon will continue their training with a residency in surgical oncology. This is not required though and a surgeon can become a surgical oncologist without the residency. The most common avenue is that a surgeon will be trained in a certain area of the body where they will develop their expertise in the types of cancers at that site. This will also provide experience for the surgeon in prevention, diagnosis, and treatment of those particular cancers. As an example, a thoracic surgeon who is also a surgical oncologist will focus most of their practice on lung cancer while a head and neck surgical oncologist would focus more on cancer is her specialty cancer of the larynx.
How Does Surgery Help?
The oldest form of treatment for cancer is surgery and it can be part of the patient's curative plan. During the consultation, the surgeon will do a full history and exam and then review the diagnostic and staging studies. This will help the surgeon decide if the cancer is removable with surgery and then allow them to plan a surgical approach. With today's improved screen, many patients have found out that they have cancer that is curable at the diagnosis. After the patient has surgery, they will then be provided follow-up care that will include close observation and possibly radiology and lab tests.
The surgical oncologist's goal is to take out the cancer as well as some of the surrounding healthy tissues to make sure the cancer does not return to that area. If it is not possible to remove the whole tumor, a ""debulking"" surgery can be done to take out as much as possible and hopefully relieve some of the pain, obstructions or bleeding. The surgical oncologist will also be involved in more than just the day of surgery. They will also be able to provide expert opinions on biopsies, optimal image guidance, and the likelihood of achieving a clear margin (especially if it is a borderline respectable case) as well as what surgical management will be needed if the disease advances.
Commonly used therapies include chemotherapy and radiation either pre- or post-operatively. It is imperative to make sure that you have a quality surgery as it is not known how well either chemotherapy or radiation will correct or compensate in the event of an inadequate surgery. It may also be necessary to remove the lymph nodes in the tumor's area depending on what type of cancer you have. The status of the lymph node is information that will help decide on your current prognosis and what your future treatment options will be. As an example, if you will have a less favorable prognosis if you have surgery on a small rectal cancer that has nodal involvement that is discovered after the surgery. If there is a disease with node-positive disease, chemotherapy and/or radiation may be recommended. If there is a node-negative disease, then only observation may be recommended after surgery.
The types of cancer surgeries that are possible just depend on where the tumor is located, how far along the cancer is, and how fit the patient is for surgery. This is a continually evolving field and your surgeon will discuss all your surgical options that will work for you and tell you what the risks and benefits of the procedure.
What about Reconstructive Surgery?
After you surgery, it may be necessary to do some reconstructive surgery in the event that it is physically altering or impacting a basic body function. Certain cancers are increasingly seeing new reconstructive techniques to help improve the patient's quality life after surgery. The reconstructive surgery can be done at the same time as the removal of the cancer or sometime after that. Sometimes a surgical oncologist will operate with a plastic surgeon to do the reconstructive surgery together.
Conclusion
Precise details of different surgical techniques are decided by the patient's anatomy, location of the tumor and cancer cell biology. There is no one way to do these surgeries. This area will continue to evolve as experience and evidence continue to influence the field of surgical oncology.