Treatments

Surgical oncology

A surgical oncologist treats cancer by removing diseased tissue and often nearby lymph nodes, the parts of your immune system that act as filters, where cancer may spread.

Surgery for Seattle Cancer Care Alliance (SCCA) patients takes place at University of Washington Medical Center or Seattle Children’s, where surgeons use leading-edge techniques and state-of-the-art equipment to perform traditional, minimally invasive, and robot-assisted procedures. Our surgeons work with skilled teams that include anesthesiologists, nurses, and technologists to provide safe and effective surgeries with exceptional post-surgical follow-up care.

Surgery is the oldest form of cancer treatment. It is often used in conjunction with medical oncology treatments — including chemotherapy, hormone therapy, and immunotherapy — and radiation oncology treatments for many disease and cancer types.

Surgery can be used to help diagnose and determine the stage of a cancer. It can even prevent cancer from occurring in a person who’s at particular risk — for example, when doctors remove colon polyps that might become cancerous. Reconstructive surgery restores form or function after cancer treatment. Surgery is also used to relieve symptoms associated with disease; this is called palliative surgery.

Surgery types

Surgical oncology is the branch of surgery that specializes in treating cancer. It takes years of training to become a surgeon and hours of operative time to become an expert in the field. UW Medicine surgeons, who perform surgery for SCCA patients, are all experts, and many specialize in specific cancer operations. Below are descriptions of the most common types of surgery that our surgeons perform for cancer.

Preventive surgery

Also called prophylactic surgery, preventive surgery is intended to keep cancer from occurring. For example, many colorectal cancers are prevented when doctors (gastroenterologists or colorectal surgeons) remove precancerous polyps during screening colonoscopies. Prophylactic colectomy (colon removal) for familial adenomatous polyposis (FAP) is another example. FAP is an inherited condition in which hundreds to thousands of colon polyps form over time; they will become cancerous if not treated. Women with inherited mutations in the BRCA1 or BRCA2 gene who are at high risk for breast and ovarian cancer may decide to have preventive surgery. These women may have a double mastectomy (breast removal), salpingo-oophorectomy (ovary and fallopian-tube removal), or both to decrease their risk of developing cancer.

Diagnostic surgery

Diagnostic surgery is a method of obtaining a tissue sample (biopsy) to help doctors detect or confirm the presence of cancer. Surgical biopsy techniques include incisional biopsy, in which a small area is cut out, and excisional biopsy, in which an entire mass is removed. Incisional and excisional biopsies can be done using minimally invasive surgical techniques or during traditional open surgery. Doctors can also take biopsies during endoscopic procedures or using a needle to withdraw cells.

Staging surgery

Surgical staging is the process of confirming during surgery how much cancer is present and where it is in the body, including whether and how far it has spread. Often staging is done during surgery that is already happening to remove a tumor. Sometimes surgeons perform a separate staging surgery first to look inside the body and take samples of tissue for testing. For example, for someone with pancreatic cancer the surgeon may start with laparoscopic surgery to investigate the stage of the tumor and see whether a larger operation to remove the tumor is likely to be effective. If it is, the surgeon will proceed. But if the tumor is too widespread to be removed, the surgeon will only take a sample for biopsy. This way patients avoid a much more intensive surgery that requires a long hospital stay and recovery time but that won’t improve the outlook for their disease.

Treatment or curative surgery

Nearly 60 percent of people with cancer have surgery to remove their cancer. For cancers that form a solid mass (as opposed to cancers of the blood or lymph, which are throughout the body), surgery is typically essential to curing the disease, and for some cancers it may be the only treatment that’s needed. If cancer has spread beyond its original site, then surgery cannot cure it but may still be helpful for treating the effects or symptoms of the disease. There are many surgical techniques used to remove or destroy cancer. Some patients have a surgical procedure designed to help deliver another treatment. For example, most patients who need chemotherapy get a central venous access device (port and catheter). A small surgical procedure is used to implant this device, typically just below the collarbone. Medicine is injected or infused into the port, which lies under the skin, and then the medicine flows through the catheter (tube) into a nearby vein. This avoids the need for repeated needle sticks to veins in the arms. When treatment is over, the port and catheter are removed in another minor procedure. Another example is a device called an intraperitoneal catheter, used to deliver chemotherapy directly into the abdominal cavity of a woman with ovarian or uterine cancer. It’s placed during a larger operation to remove the cancer.

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC)

This treatment is for people with peritoneal carcinomatosis, or cancer that has spread to the abdominal lining (peritoneum). It combines two parts in one operation: 

•    A surgery to remove all the cancer that surgeons can see
•    Chemotherapy, in liquid form, that is warmed and then put into the abdomen to kill any cancer cells left behind after surgery 

The cancer may have started in the appendix, stomach, colon, rectum, ovaries or fallopian tubes. CRS-HIPEC is also used for mesothelioma of the abdomen and some rare sarcomas that can spread to the peritoneum. This treatment may be able to control advanced disease while also giving you good quality of life.

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Reconstructive surgery

Reconstructive surgery recreates and restores parts of the body after cancer treatment. Common reconstructive surgeries include breast reconstruction for women who have had a lumpectomy or mastectomy for breast cancer and facial reconstruction for people who have had surgery for head or neck cancer. In some instances, a person with sarcoma may receive a metallic implant or a bone transplant after having cancerous bone removed. If cancer in the pelvic cavity requires radical surgical removal of organs, like the rectum, bladder, or vagina, a plastic surgeon may do surgery to close the area afterward by creating a flap. Reconstruction may also involve microvascular surgery, in which the surgeon uses a microscope to see and sew together tiny blood vessels.

Palliative surgery

As the name suggests, palliative surgery is intended to improve quality of life by easing pain and other complications caused by advanced cancer. Palliative surgery does not treat or cure cancer but may provide relief in certain situations. For example, if a tumor is causing pain by pressing on nerves or if it’s blocking the intestine and other treatments aren’t adequate, surgery might be an option. Surgeons, as well as other members of the health care team, help patients consider their treatment goals and weigh the relative benefits and risks of palliative surgery.

Surgical techniques

UW Medicine surgeons are nationally and internationally respected doctors who offer exceptional surgical and follow-up care to patients and their families. They are on the leading edge, using the newest techniques and advancing cancer care by improving diagnosis and treatment. Our surgeons also conduct research to increase medical knowledge and improve treatment results for all patients.

Surgical techniques used to remove cancer include:

  • Minimally invasive surgery, such as laparoscopic surgery, done through small incisions in the abdomen, and endoscopic surgery, done through a natural body opening
  • Robot-assisted surgery, in which the surgeon uses a robotic device such as the da Vinci Surgical System to perform very precise, complex motions
  • Open surgery, in which the surgeon makes a large incision to access the tumor

In the sections below, we also discuss other ablative techniques (methods of removing or destroying tissue) used in cancer care, including:

  • Laser surgery, which vaporizes cells
  • Radiofrequency ablation, which uses heat to kill cells
  • Irreversible electroporation, which uses electrical current to make holes in cells

Minimally invasive surgery

Minimally invasive surgical techniques result in less pain, less scarring, less blood loss (and decreased need for blood transfusions), shorter hospital stays, and faster recoveries for many patients compared to open techniques. UW Medicine surgeons are among the country’s leading experts in minimally invasive surgery, including for common cancers, like colon cancer, as well as rare cancers, like intradural spinal cord tumors. Here are several examples of minimally invasive surgical techniques that UW Medicine surgeons use.

Laparoscopic surgery

Laparoscopic surgery is performed through several small incisions in the abdomen. Through one incision, the surgeon inflates the abdomen with carbon dioxide gas so there’s room inside to see and operate. Then the surgeon uses the other small incisions to insert a laparoscope—a thin, lighted tube with a tiny video camera—and other surgical tools into the abdominal space. The entire surgery is done through these small incisions. When the same technique is used to perform surgery on the chest, it’s called thoracoscopic surgery.

Video-assisted thoracic surgery (VATS)

Video-assisted thoracic surgery (VATS) is a minimally invasive technique for patients who might otherwise need open-chest surgery (thoracotomy) to remove lung tissue. In a thoracotomy, the surgeon makes a long incision. Then, in order to reach the lungs, the surgeon must cut or spread the ribs. This method, while sometimes necessary, is more traumatic to the body. Recovery can be painful and take many weeks. VATS is done through a series of small incisions. People who undergo VATS tend to spend less time in the hospital, need less pain medication, have less scarring, and recover faster than those who have a thoracotomy. 

Endoscopic surgery

Endoscopic surgery is similar to laparoscopic or thoracoscopic surgery, but the scope is inserted through one of the body’s natural openings, such as the mouth, nose, or anus, rather than through incisions. This technique can be used to remove certain tumors in the throat, larynx, esophagus, colon, bladder, brain, and other areas.

Open surgery

Open surgery is the traditional form of cancer surgery, where the surgeon makes one long incision to see inside a patient and perform the necessary procedures to diagnose, stage, or treat cancer. UW Medicine surgeons are all experts in open surgical techniques, and many specialize in specific cancer operations as well.

Examples of open surgeries are laparotomy, open surgery of the abdomen, and thoracotomy, open surgery of the chest. Maxillofacial surgeries may be open surgeries as well.

For many complex procedures, an open approach is preferred or warranted over a minimally invasive approach. Knowing when to perform an open or minimally invasive procedure is important, and this is part of the expertise offered by UW Medicine surgeons. Your surgeon will carefully consider all the options and recommend the approach that’s most appropriate for you.
 
Sometimes it’s not possible to use a minimally invasive approach. For example, small incisions may not provide adequate access if patients have adhesions from past surgeries or because of the size or location of a tumor. In these cases, a large incision is needed. 

Other ablative techniques

In cancer treatment, doctors may use other ablative techniques (methods of removing or destroying tissue) along with or instead of surgery done with a scalpel.

Laser surgery

A laser can be used to cut through tissue or vaporize (burn) cancers, destroying the cells. A carbon dioxide laser produces a beam of infrared light, which can ablate tumors or cells that have undergone precancerous changes. SCCA gynecologic oncologists use this minimally invasive technique to treat certain cancers of the female reproductive system. UW Medicine head and neck surgeons use it to ablate precancerous lesions and early cancers in the mouth and throat and to remove certain cancers in the larynx, providing better voice and swallowing outcomes and quicker recovery than open surgery.

Radiofrequency ablation (RFA)

Radiofrequency ablation (RFA) uses heat to kill cells. It’s particularly useful against cancers that are difficult to remove surgically. Most often, this treatment is used for liver tumors and some lung tumors. A needle-like probe is inserted into the tumor. An ultrasound, computed tomography (CT) scan, or magnetic resonance imaging (MRI) is used to guide the probe to the right place. Then an electrical current is sent through the probe, creating heat around the end of it and destroying the cancer cells. The probe can be passed through the skin into the tumor (percutaneous RFA, done by an interventional radiologist), or it can be inserted into a tumor during open, laparoscopic, or thoracoscopic surgery (by the surgeon).

Irreversible electroporation (NanoKnife)

Irreversible electroporation (IRE) is a new tumor ablation technique that uses electrical currents to open the membrane around a cancer cell, destroying the cell without harming the surrounding tissue. IRE provides a way to treat liver tumors that are close to other vital organs and structures and that cannot be removed surgically or be destroyed safely using RFA. Needle-like NanoKnife probes are inserted into the tumor. An ultrasound, CT scan, or MRI is used to guide the probes to the right place. Then micropulses of electrical current are sent through the probes, causing the cell membranes to open, leading to the cells’ death. The probes can be passed through the skin, or they can be inserted into a tumor during surgery.

Argon beam coagulation

An argon beam coagulator is a device that uses electrical current passed through a stream of argon gas to destroy tissue. At SCCA, physicians use this device to treat ovarian cancer and to stop blood loss during surgery.

Robot-assisted surgery

SCCA, in partnership with University of Washington Medical Center (UWMC), is home to one of the most comprehensive and technologically advanced robot-assisted surgery programs in the Puget Sound region. UWMC brought robot-assisted surgery to this region and is the leading regional center where other surgeons come to train. Our surgeons have performed minimally invasive robot-assisted surgical procedures—which result in less pain and blood loss, reduced infection rates, shorter hospital stays, and faster recovery times than traditional open surgeries — for more than a decade.

Specialized robotic equipment

Surgeons at UWMC use the da Vinci Surgical System for robot-assisted surgeries. With the da Vinci robot, the surgeon sits at a console near the patient and uses joysticks and foot pedals to control three robotic arms. One robotic arm holds a camera, while two others hold surgical instruments. This system gives the surgeon a true three-dimensional view; allows the surgeon to perform very precise, complex motions; and helps prevent surgeon fatigue. UWMC has two da Vinci robots, each with dual consoles, which allow two surgeons to operate together.

Examples of robot-assisted surgery

Minimally invasive robot-assisted surgery can be used to treat a wide range of cancers, including bladder, colorectal, endometrial, kidney, liver, lung, ovarian, pancreatic, penile, prostate, throat, thyroid, and tongue cancers. Here are examples of robot-assisted procedures our surgeons perform for cancer:

Robot-assisted hysterectomy for endometrial or uterine cancer

Through tiny, one- to two-centimeter incisions, UW Medicine surgeons can use the da Vinci system to remove the uterus with great precision and control, minimizing a patient’s pain as well as the risks associated with large incisions, such as increased infection risk and longer recovery time.

Robot-assisted partial and radical nephrectomies for renal cell carcinoma

With the da Vinci robot, UW Medicine surgeons can remove part or all of a kidney through small incisions, depending on where the cancer is and how much of the organ needs to be removed. The robot supports more precise operations with the added patient benefits of having a shorter hospital stay, losing less blood, and recovering more quickly.

Robot-assisted surgery for liver, bile duct and pancreatic cancer

UW Medicine surgeons have led the way with robot-assisted surgery, performing the first robot-assisted hepatectomy (liver removal) and robot-assisted bile duct operations in the Pacific Northwest as well as the state’s first robot-assisted Whipple procedure for pancreatic cancer.

Robot-assisted prostatectomy for prostate cancer

Surgeons use laparoscopic prostatectomy to remove prostate glands through several small incisions. UW Medicine surgeons have years of experience performing this operation using the da Vinci Surgical System

Transoral endoscopic robot-assisted surgery for throat cancer

For people with certain throat cancers, transoral endoscopic surgery is a much less invasive treatment than open surgery. With the help of a surgical camera and microscope that are passed through the mouth, the surgeon can use the robot to direct surgical tools to the tumor location, avoiding the need for disfiguring surgery and tracheotomy. This approach may also minimize or eliminate the need for chemotherapy and radiation and the side effects that may come with those treatments.

Transaxillary robot-assisted hemithyroidectomy for thyroid cancer

In this procedure, surgeons use the da Vinci robot to remove half of the thyroid by creating an incision in the underarm (axilla) area. The scar is hidden in the underarm rather than visible on the neck, and with good care an underarm incision will heal faster than a neck incision.