Surgical treatment

Surgical treatment of cancer involves the removal of the tumor mass by surgery. It is the only type of treatment for malignant diseases that is not performed by oncologists, but primarily by surgeons. Many patients with cancer are treated surgically. In general, surgery is most often used for patients with localized disease (solid tumors located in one place), while it is rarely used for widespread disease. However, surgery is not necessarily the best choice for patients with localized disease, and it is always a good idea to consult an oncologist. Also, in the case of surgery, additional oncological treatment is often required after it. In order to prevent pain during the procedure, anesthesia is used, which can be local (causing loss of sensation in a small part of the body being operated on), regional (loss of sensation in one region, for example the right hand) and general (the patient is put to sleep and is unconscious during the operation, used when major procedures are required).

In addition to traditional surgery, there are also newer methods that do not involve cutting tissue with a scalpel. Cryotherapy uses liquid nitrogen or argon to freeze tissue, and can be used for early-stage skin tumors, retinoblastoma, and precancerous lesions of the cervix. Lasers use high-energy light beams that can cut tissue, and also allow for great precision and can be used on small areas. According to their characteristics, they can be used for basal cell carcinoma of the skin, precancerous changes, and cervical, vaginal, and esophageal cancers. Unlike cryotherapy, hyperthermia exposes a small area of ​​the body to high temperatures instead of freezing. This can destroy tumor cells or make them more sensitive to radiotherapy or chemotherapy. One of its special forms is radiofrequency ablation, which generates heat using high-energy radio waves, and is now routinely used, for example, in patients with liver metastases. Photodynamic therapy uses drugs that respond to a specific light stimulus. When the tumor is illuminated with such light, the drug becomes active or destroys surrounding tumor cells. This type of treatment is most often used for skin tumors.​

Figure 1. Illustration of a laparoscopically guided operation (minimally invasive surgery). The advantage over a standard open procedure is less tissue trauma and faster patient recovery.

Standard surgical procedures can also be performed in several ways. In open surgery, the surgeon makes one large incision on the surface of the body (for example, in the middle of the abdomen for abdominal surgery). In minimally invasive surgery (laparoscopy), several smaller incisions are made, and a laparoscope (a long tube with a camera) is inserted through one of them. The surgeon therefore does not have a direct view of the surgical field, but rather views it on a screen, and through the other incisions he inserts the necessary tools to perform the procedure. Minimally invasive surgery requires a shorter recovery time for the patient due to the smaller incisions.

The main purpose of surgery is to completely remove tumor tissue, but the goal can also be debulking (removing part of the tumor to reduce damage to surrounding organs or enhance the effect of other types of treatment) or reducing symptoms (tumors that cause pain or pressure). Surgical treatment also carries certain risks, and some of the more common consequences are postoperative pain, infection, bleeding, and reactions to anesthesia. Surgery can also change the way the body uses food (especially in cases of surgery on the intestines, stomach, and the rest of the digestive tract), and some patients need to correct their pre-operative diet due to weakness or malnutrition. In any case, scientific research results show that proper nutritional therapy helps to improve the success of the surgery, reduce complications, and recover faster from the surgery. For more information on this and other aspects of nutrition, contact our nutritionist. The tissue removed during the surgery is sent to a pathologist during the procedure, who will check the presence of tumor cells under a microscope and determine their characteristics. The pathologist can also provide information on whether the tumor was completely removed.

Additional interesting facts

Does surgery make sense in metastatic disease? As a rule, such an approach is not recommended. Why? In most cases, when the disease is widespread, surgery is technically not possible to completely remove the entire tumor mass in the body, and removing only one or a few changes (while others remain) will not help in the treatment or prolong life. In addition, such procedures carry their own risks, just like any other surgery, and they also lead to the need for recovery from the procedure, making it impossible to use other forms of treatment. However, in certain situations, surgical treatment is also recommended in the metastatic disease phase. For example, in metastatic kidney cancer, most patients are recommended to remove the primary tumor in the kidney despite the presence of metastases, while in patients with neuroendocrine tumors, removal of large tumor masses can be performed, which can positively affect the patient's quality of life. There are other examples where this option can be used. For more detailed instructions, contact our team.

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