Surgery is the first step for some solid cancers. It is often needed for biopsy to make a diagnosis. Surgery may also be part of the treatment plan. It may be part of a cure or done to help relieve symptoms from large tumors.
- How do surgery and other procedures work?
- What are surgery and other procedures used for?
- What are the types of surgery and other procedures?
- What adverse effects can occur with surgery and invasive procedures?
- Which cancers are surgery and other procedures used to treat?
The goal of surgery is to remove as much of the cancer as possible. Healthy nearby tissue will also be preserved as much as possible.
Surgery is not always an option. The type of cancer and the location and size of the tumor will play a role in the decision. The doctor will also consider how fast the tumor may grow and if it has spread to other areas of the body. Finally, your overall health will be taken into account. You and your team will make decisions based on your health preferences quality of life.
Preventive or Prophylactic Surgery
Some people may have a higher risk of cancer than others. It may be because of certain genes or growth of precancerous cells. Procedures may be done to remove at risk tissue. Examples include:
- Cryosurgery to remove precancerous cells on the cervix
- Hysterectomy—for someone with family history and genetic markers for gynecologic cancer
A sample of tissue is removed. It will be carefully examined under a microscope. It will show if cancer is present and what type of cancer it is. Current tests can also show the genetic make up of the cancer and other factors that will help to create a treatment plan.
Staging surgery is used to label how advanced the cancer is. A number of test results are used to determine staging. Surgery can help in staging because the doctor will be able to see how far the cancer has spread.
If the entire tumor can be removed it is considered a cure. It may be done with surgery alone or in combination with other treatment. Chemotherapy may be used after surgery to attack any cancer cells that are left. Radiation therapy may he used before surgery to shrink the tumor or after to kill any remaining cancer.
Debulking or Cytoreductive Surgery
It may not be possible to remove the entire tumor. A debulking surgery will remove as much of the tumor as possible. This will not be a cure but it may make radiation or chemotherapy more effective.
Surgery may not be useful against the cancer itself. This type of surgery will help to manage problems caused by advanced cancer. It may help to manage pain or problems such as blockages or bleeding.
Supportive or Combination Surgery
Some surgery is used to support other types of treatment. For example, a catheter may be placed into a vein to help deliver chemo.
Restorative or Reconstructive Surgery
Cancer and treatment can change how the body looks and works. Surgery may be needed after treatment is done. Individual goals will vary. Breast reconstruction after mastectomy is one example.
There are a number of biopsy procedures. Some will require surgery others can be done in the doctor's office. A biopsy often removes just a sample of the tissue. Sometimes, the entire tumor is removed during the biopsy.
The following are some of the more common tissue biopsy procedures.
The doctor cuts through the skin to remove a small part of a larger tumor. This is usually done with anesthesia to numb the area. General anesthesia may be needed if the tumor is in the chest or belly. It will keep you asleep.
The doctor cuts through your skin to remove the entire tumor. This is usually done with local or regional anesthesia. General anesthesia may be needed if your tumor is in the chest or belly.
Fine Needle Biopsy
Needle Core Biopsy
Similar to a fine needle biopsy, but the needle is slightly larger. The doctor will be able to remove a larger sample of tissue.
A scope can be passed down the throat. A camera at the end of the scope will let the doctor see areas of abnormal tissue. It can help to show the size and location of tumors. A biopsy may also be done with the scope. Medicine may be given to make you sleepy and more relaxed.
An endoscope can be used to view inner surfaces of:
- Small intestine
- Rectum and colon
- Respiratory tract
Small cuts are made in the belly near the bellybutton. A scope with a camera or tools is inserted through the cuts. A gas is passed into the belly to open the area up. The scope will show organs in your belly such as intestines, stomach, gallbladder, and organs of the pelvis. Tools can be passed through the scope to perform surgery such as biopsy.
Because the incisions are very small, there is less pain associated with the procedure. Recovery is also often faster than an open surgery. A local or general anesthetic may be used.
Similar procedures that are used for the chest cavity include:
A high-frequency electrical current is delivered\ by needles, blades, or electrodes. They can be used to destroy cancer cells. It can be done in a doctor's office. This procedure is used for some cancers of the skin, mouth, anus, and rectum.
Extremely cold temperatures are used to freeze and kill abnormal cells. Carbon dioxide, Freon, and nitrous oxide are most often used. A very cold probe may also be used. This procedure can be done in a doctor's office.
Cryosurgery is used to treat surface lesions. This includes skin cancer and gynecologic cancers or precancers.
A powerful beam of light energy can kill cancer tissue. It can be used for precise surgical work, like repairing the retina of an eye. Lasers are used to remove tumors in difficult-to reach areas. It can also be used for cancer in areas with a lot of blood vessels.
- Photocoagulation—tissues are super-heated, which destroys the tissue. It can prevent blood loss if the area has many blood vessels.
- Photoablation—vaporizes the tissue.
- Laser surgery—may be used for cancers of the cervix, larynx, liver, rectum, and skin.
A procedure used with skin cancer. Suspect tissue is shaved off layer by layer. Each layer is examined after it is removed. The procedure ends when there is no cancer in the removed tissue.
Less invasive options are ideal. Smaller cuts often mean less pain and faster recovery. However, it is not always an option. Open surgery may be needed. A larger cut will be made over the area. It will let the doctor view the area and remove tissue. General anesthesia will be used.
Careful methods have reduced the dangers of surgery. However, there are some risks involved.
Complications may be due to the surgery itself, the anesthesia, or cancer. The more complicated the surgery, the greater the risk.
Complications can include any of the following:
- Bleeding —This may require blood transfusions from donors. Blood may be collected before surgery so that you can use your own blood.
- Damage to internal organs or blood vessels
- Reactions to anesthesia or other medications —Vital signs will be watched during surgery to watch for any signs of a reaction.
- Problems with other organs, such as the heart or kidneys —These are also very rare, but can be life threatening. More common in people with previous problems with these organs.
Complications after surgery may include:
- Pain —Some pain is normal, but it should not interfere with your recovery. There are a number of treatment options. Communication with care team with help to best manage pain.
- Infection at the incision site —You and your care team can take steps to reduce the risk of infection but some may still happen. Antibiotics are usually given to treat these infections.
The following adverse effects are less common, but can be more serious:
- Pneumonia —Smoking, lung problems, or previous surgery increase the risk of pneumonia. Deep breathing exercises and getting out of bed as soon as possible after surgery can help.
- Other infections within the body —Some procedures carry more risk of infection than others. Antibiotics may be given before surgery to prevent infection.
- Bleeding —Can occur if a blood vessel was not sealed off or a wound reopens.
- Blood clots —Can form in the deep veins of the legs after surgery. Long periods of bed rest can increase the risk. Blood clots can break off and travels to your lung and cause a more serious problem. The care team will encourage people to get out of bed and walk as soon as possible.
- Slow recovery of normal body functions —For example slow intestines can lead to constipation.
A guide to cancer surgery. American Cancer Society website. Available at: https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/surgery.html. Updated April 2016. Accessed December 29, 2018.
Modalities of cancer therapy. Merck Manual Professional Version website. Available at: http://www.merckmanuals.com/professional/hematology-and-oncology/principles-of-cancer-therapy/modalities-of-cancer-therapy. Updated July 2018. Accessed December 29, 2018.
Surgery. National Cancer Institute website. Available at: https://www.cancer.gov/about-cancer/treatment/types/surgery. Updated April 29, 2015. Accessed December 27, 2016.
Last reviewed December 2018 by Mohei Abouzied, MD Last Updated: 12/31/2018