केएमसी कैंसर संस्थान

Surgical oncology is a specialized field of surgery that focuses on the surgical treatment of cancer. The primary goal of surgical oncology is to remove tumors and surrounding tissues in order to eradicate cancer. Surgery may be used in combination with other treatments like chemotherapy, radiation therapy, and immunotherapy to improve patient outcomes. Surgical oncologists are trained to remove cancerous tissue while minimizing damage to healthy surrounding tissues.

Key Roles of Surgical Oncology:

Surgical oncologists are experts in treating different types of cancer through surgery. They work closely with other cancer specialists like medical oncologists, radiation oncologists, and pathologists to create a comprehensive treatment plan for each patient. Their main roles include:

1. Diagnosis and Staging: Surgical oncologists often perform biopsies (removal of tissue samples) to diagnose cancer. They may also play a role in determining the cancer’s stage by examining tumor size, spread, and involvement of surrounding tissues.
2. Treatment of Localized Tumors: Surgery is often the primary treatment for tumors that are confined to one area of the body. The goal is to remove the tumor completely with clear margins, meaning that no cancer cells are left behind.
3. Tumor Removal: Surgery may be performed to remove the primary tumor, as well as any affected lymph nodes or surrounding tissue to ensure complete removal of cancer cells. This can help prevent cancer recurrence.
4. Reconstruction and Supportive Care: In some cases, surgical oncologists perform reconstructive surgeries after tumor removal, especially in cases where significant tissue loss occurs (e.g., in breast cancer or head/neck cancer). They may also provide surgical options for symptom relief or to manage complications caused by cancer.

Types of Surgical Oncology Procedures:

1. Diagnostic and Biopsy Procedures:
   • Needle Biopsy: A thin needle is used to extract a small tissue sample from the tumor for examination under a microscope.
   • Incisional Biopsy: Involves removing part of a tumor for analysis when a needle biopsy is not possible.
   • Excisional Biopsy: The entire tumor or suspicious area is removed for diagnostic purposes. This is often done when a tumor is easily accessible.
2. Tumor Resection (Resection Surgery):
   • Wide Local Excision: The tumor is removed along with some healthy tissue around it to ensure clear margins, especially in solid tumors like breast, colon, and skin cancers.
   • Lobectomy or Organ Resection: In some cancers, entire organs or parts of organs may be removed, such as a lung lobectomy for lung cancer, or a partial hepatectomy for liver cancer.
   • Total Organ Removal: In cases of advanced cancer or when the organ is severely damaged, the entire organ may be removed, such as a total mastectomy (removal of the entire breast in breast cancer) or prostatectomy (removal of the prostate in prostate cancer).
3. Lymph Node Removal (Lymphadenectomy):
   • If cancer has spread to nearby lymph nodes, the surgeon may remove them to prevent further spread and to assist with staging cancer. This procedure is commonly performed in cancers like breast cancer, melanoma, and head/neck cancers.
4. Reconstructive Surgery:
   • After removing tumors, particularly in cases of breast cancer or head and neck cancers, reconstructive surgery may be performed to restore appearance and function.
   • For example, breast reconstruction after mastectomy, or reconstruction of the mouth, jaw, or throat after removal of tumors in the head and neck region.
5. Minimally Invasive Surgery:
   • Laparoscopy and robotic surgery are less invasive alternatives to traditional surgery. These techniques use smaller incisions and specialized instruments (often controlled by a robotic system) to remove tumors with reduced recovery times and fewer complications.
   • Keyhole surgery allows for faster healing and less pain post-surgery, which is beneficial for patients who require more delicate procedures, such as in abdominal or pelvic cancers.
6. Palliative Surgery:
   • Sometimes surgery is used not to cure cancer, but to alleviate symptoms and improve quality of life. For instance, a surgeon may remove or bypass blockages caused by tumors in the gastrointestinal tract or urinary tract.
   • Procedures like stent placements, colostomy, or gastric bypass are common palliative surgeries to help manage symptoms of advanced cancer.
7. CyberKnife or Stereotactic Surgery:
   • While not strictly a traditional surgical technique, stereotactic surgery or CyberKnife surgery (a non-invasive procedure that delivers targeted radiation) is an option for patients with tumors that are difficult to reach with conventional surgery. These techniques allow for precise targeting of tumors in areas like the brain, lungs, or spine.

Indications for Surgical Oncology:

Surgical oncology may be recommended in several situations, such as:

1. Curative Surgery: The tumor is localized and can be completely removed, which may cure the patient (e.g., early-stage breast cancer or colon cancer).
2. Adjuvant Surgery: Surgery is used alongside other treatments like chemotherapy or radiation to improve overall outcomes. This is often the case when cancer has spread to surrounding tissues, or after chemotherapy/radiation to remove remaining cancer cells.
3. Preventive Surgery: In some cases, surgery is performed to remove tissue that may develop into cancer in the future. For example, women with a high genetic risk of breast cancer (due to mutations in BRCA1 or BRCA2) may opt for a preventive mastectomy.
4. Palliative Surgery: In advanced cancer, surgery may be used to alleviate symptoms or reduce complications (e.g., blocking of the intestines or bile ducts).

Risks and Side Effects of Surgical Oncology:

Like any major surgery, cancer surgery carries risks such as:

• Infection: Due to the incisions or removal of tissue.
• Bleeding: Surgery can result in blood loss, which may require a transfusion.
• Organ damage: In some cases, surgery may damage surrounding healthy tissues or organs.
• Post-surgical pain and swelling: Pain management is a critical part of recovery.
• Recovery time: Depending on the procedure, recovery can take weeks to months.

Recovery and Follow-Up Care:

Recovery after surgery varies depending on the type of surgery, the patient’s overall health, and the extent of the cancer. After the procedure, patients may need:

1. Hospitalization: Some surgeries require an overnight stay in the hospital, while others may be outpatient procedures.
2. Pain Management: Managing post-surgical pain is important, and this may include medication and physical therapy.
3. Follow-Up Appointments: Regular follow-up visits are essential to monitor recovery, check for complications, and assess for any recurrence of cancer.
4. Physical Therapy or Rehabilitation: If extensive surgery was performed (especially for breast cancer, head/neck cancer, or gastrointestinal cancers), rehabilitation may be necessary to restore function or appearance.

Advances in Surgical Oncology:

1. Robotic Surgery: Robotic systems allow for greater precision and smaller incisions, resulting in quicker recovery times and less pain for patients.
2. Enhanced Recovery After Surgery (ERAS) Protocols: These are evidence-based strategies designed to minimize complications and improve recovery times by optimizing nutrition, pain management, and mobility after surgery.
3. Neoadjuvant Therapy (Pre-Surgical Treatment): Chemotherapy or radiation therapy may be used before surgery to shrink tumors, making them easier to remove and improving the chances of a successful outcome.

Conclusion:

Surgical oncology plays a crucial role in the treatment of cancer, offering the potential for curative treatment, symptom relief, or better overall outcomes when combined with other cancer therapies. Surgical oncologists are highly specialized in performing delicate and complex operations to treat cancer, with advancements in technology continually improving outcomes and recovery times for patients.