Treatments

Surgical oncology

At Fred Hutchinson Cancer Center, patients receive surgical oncology care from leading doctors who specialize in surgeries to remove tumors and cancerous tissue. Your Fred Hutch surgical oncologist knows the most advanced surgical options for treating your disease and will design a personalized treatment plan to fit your needs.

Oncologist A physician who has special training in diagnosing and treating cancer. Some oncologists specialize in a particular type of cancer treatment, such as treating cancer with radiation. A physician who has special training in diagnosing and treating cancer. Some oncologists specialize in a particular type of cancer treatment. For example, a radiation oncologist specializes in treating cancer with radiation. Treatment plan A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A treatment plan may also include information about how much the treatment is likely to cost and about regular follow-up care after treatment ends.

Request an Appointment

About Surgical Oncology

Surgical oncology is an area of medicine that focuses on diagnosing and treating cancer using surgery. It can help diagnose cancer and find out how advanced a cancer is (the stage). Surgery can also be used to treat cancer by removing diseased tissue as well as any lymph nodes that may be nearby. Lymph nodes are parts of the immune system that work like filters, and cancer can spread to them.

Sometimes, surgery can be used to prevent cancer — for example, when a doctor removes polyps (growths) from the colon that could become cancerous. Doctors use surgery to restore the form or function of body tissues and parts that were affected by cancer treatment, too.

In addition, surgery can help relieve symptoms associated with cancer and give patients a better quality of life, such as a procedure to help reduce pain. This is called palliative surgery.

Surgery is often used along with other types of cancer treatments, such as chemotherapy, hormone therapy, immunotherapy and radiation treatments.

Leaders in Surgical Oncology

Our surgeons are nationally and internationally recognized. These doctors not only treat cancer in Fred Hutch patients, they are leaders who are helping to advance cancer care for all.

Fred Hutch, in partnership with UW Medicine, is home to one of the most comprehensive and technologically advanced robot-assisted surgery programs in the Puget Sound region. UW Medicine brought robot-assisted surgery to the area, and it is the leading regional center where surgeons come to train and learn from our doctors.
Fred Hutch surgeons did the first robot-assisted hepatectomy (liver removal) and robot-assisted bile duct operations in the Pacific Northwest. Our surgeons were also the first in Washington state to do the Whipple procedure for pancreatic cancer using a robot-assisted device.
Knowing when to do an open or minimally invasive procedure is important, and this is part of the expertise offered by Fred Hutch surgeons. Our surgeons are among the country’s leading experts in minimally invasive surgery for common cancers, like colon cancer, as well as rare cancers, like intradural spinal cord tumors.
Our surgeons are also experts in open surgical techniques, and many of them specialize in specific cancer operations as well.

Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It may be given alone or with other treatments. Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, infusion or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy or biologic therapy. Hormone therapy Hormones can cause some cancers to grow. To slow or stop growth, synthetic hormones or other drugs can be used to block the body’s natural hormones, or surgery is used to remove a hormone-producing gland. Treatment that adds, blocks or removes hormones. For certain conditions (such as diabetes or menopause), hormones are given to adjust low hormone levels. Hormones can also cause certain cancers (such as prostate and breast cancer) to grow. To slow or stop the growth of cancer, synthetic hormones or other drugs can be used to block the body’s natural hormones, or surgery is used to remove the gland that makes a certain hormone. Also called endocrine therapy, hormonal therapy and hormone treatment. Immunotherapy A type of therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection and other diseases. A therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection and other diseases. Some immunotherapies only target certain cells of the immune system. Others affect the immune system in a general way. Types of immunotherapy include cytokines, vaccines, bacillus Calmette-Guerin (BCG) and some monoclonal antibodies. Stage The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer and whether the cancer has spread from the original site to other parts of the body. Symptom A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. Some examples of symptoms are headache, fatigue, nausea and pain.

Types of Surgery

We offer the full range of surgeries available to treat cancer. These surgeries are done at UW Medical Center – Montlake or Seattle Children’s, using leading-edge techniques and state-of-the-art equipment. Below are descriptions of the most common types of surgery that our surgeons do.

Treatment or curative surgery

CRS-HIPEC

Reconstructive surgery

Palliative surgery

Preventive surgery (also called prophylactic surgery) is used to stop cancer from developing. For example, doctors can remove precancerous polyps during a screening colonoscopy, which can help prevent colorectal cancer.

Another example of preventive surgery is colon removal (prophylactic colectomy) for familial adenomatous polyposis (FAP). FAP is an inherited condition where hundreds or thousands of colon polyps form over time. These polyps will become cancerous if they are not treated.

People with inherited mutations in the BRCA1 or BRCA2 gene (changes in their DNA that run in their family) may decide to have preventive surgery to reduce their risk of developing cancer. One procedure is a double mastectomy (removal of both breasts) and ovary and fallopian-tube removal (salpingo-oophorectomy).

Colonoscopy An examination of the inside of the colon using a colonoscope, which is inserted into the rectum. A colonoscope is a thin, tube-like instrument with a light and a lens for viewing. An examination of the inside of the colon using a colonoscope, which is inserted into the rectum. A colonoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue to be checked under a microscope for signs of disease. Gene The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. Precancerous A condition that may (or is likely to) become cancer. Also called premalignant. Screening Checking for disease when there are no symptoms. Because screening may find diseases at an early stage, there may be a better chance of curing the disease Checking for disease when there are no symptoms. Because screening may find diseases at an early stage, there may be a better chance of curing the disease. Examples of cancer screening tests are the mammogram (for breast cancer), colonoscopy (for colon cancer) and Pap and HPV tests (for cervical cancer). Screening can also include a genetic test to check for a person’s risk of developing an inherited disease.

Diagnostic surgery is used to take a tissue sample (biopsy) so it can be tested for cancer. One type of diagnostic surgery is called incisional biopsy, where a small area of tissue is removed. Another type is called excisional biopsy, when 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 by using a needle to take cells for testing.

Biopsy The removal of a sample of tissue or fluid that is examined to see whether cancer is present. This may be done with a large needle or through surgical removal of tissue or fluids. Biopsy The removal of a sample of tissue or fluid that is examined to see whether cancer is present. This may be done with a large needle or through surgical removal of tissue or fluids.

Staging surgery is used to confirm how much cancer is in the body and where it is, including if the cancer has spread and how far.

Often, staging is done during a surgery to remove a tumor. Other times, a surgeon will do a staging surgery on its own, so they can look inside the body and take samples of tissue for testing before another surgery or treatment begins. For example, if a patient has pancreatic cancer, the surgeon may use laparoscopic staging surgery to look at the tumor, find out its stage and see if a separate surgery is needed to remove it. If possible, the surgeon will remove the tumor. But if the tumor is too widespread to be removed, the surgeon will only take a biopsy (tissue sample).

Biopsy The removal of a sample of tissue or fluid that is examined to see whether cancer is present. This may be done with a large needle or through surgical removal of tissue or fluids. Stage The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer and whether the cancer has spread from the original site to other parts of the body. Staging Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from where it first formed to other parts of the body. Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from where it first formed to other parts of the body. It is important to know the stage of the disease in order to plan the best treatment.

More than half of people with cancer have surgery as treatment to remove their cancer. In some cases, it is the only treatment that is needed. However, some cancers, like those that affect the blood or lymph, cannot be treated with surgery because the cancer is widespread in the body.

There are many surgical techniques that can be used as treatment or to help cure cancer. Some patients have a surgical procedure that helps deliver another type of treatment. For example, most patients who have chemotherapy need a central venous access device (port and catheter). A small surgical procedure is used to put this device in their body, and when treatment is over, another minor procedure is used to remove it.

Another example is a surgical technique called an intraperitoneal catheter, which is used to deliver chemotherapy directly into the abdominal cavity of a person with ovarian or uterine cancer. It is placed in the patient’s body during a surgery to remove the cancer.

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) surgery is for people who have a type of cancer that has spread to the abdominal lining (peritoneal carcinomatosis). The cancer may have started in the appendix, stomach, colon, rectum, ovaries or fallopian tubes.

There are two stages to this surgery:

Surgically remove all the cancer that can be seen.
Put liquid chemotherapy medicines into the abdomen to destroy any cancer cells that may be left.

CRS-HIPEC is also used for mesothelioma of the abdomen and some rare sarcomas that can spread to the abdominal lining (peritoneum).

Learn More

Reconstructive surgery recreates and restores parts of the body that have been affected by cancer or cancer treatment. One common procedure is breast reconstruction for patients who have had a lumpectomy or mastectomy. Other common procedures are facial reconstruction for people who have had surgery for head or neck cancer.

Sometimes, a person with sarcoma may have reconstructive surgery to put in a metallic implant. Other patients might have a bone transplant after having cancerous bone removed, which is also a type of reconstructive surgery. If a patient has cancer in the pelvic cavity and one or more of their organs need to be removed (like the rectum, bladder or vagina), a plastic surgeon may do surgery to reconstruct the area.

Another type of reconstructive surgery is called microvascular surgery. This is when a surgeon uses a microscope to see and sew together tiny blood vessels.

Even if surgery cannot cure a cancer, it can sometimes still be helpful for treating the effects of cancer. This is called palliative surgery. Palliative surgery can help improve a patient’s quality of life by helping to reduce their pain and improve other issues caused by advanced cancer. For example, if a tumor is pressing on nerves and causing pain, and other treatments are not available, palliative surgery might be an option.

Surgical Techniques

Fred Hutch surgeons use the full range of surgical techniques to remove cancer, and they have access to state-of-the-art medical technology for their surgeries.

Minimally Invasive Surgery

Minimally invasive surgery, such as laparoscopic surgery, is done through small incisions (cuts) in the abdomen. Endoscopic surgery is another type of minimally invasive surgery, done through a natural body opening, such as the mouth, nose or anus.

Minimally invasive surgical techniques result in less pain, less scarring, less blood loss (and need for blood transfusions), shorter hospital stays and faster recoveries for many patients compared to traditional open surgeries.

Laparoscopic surgery A surgery done with the aid of a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue to be checked under a microscope for signs of disease. Surgery done with the aid of a laparoscope. A laparoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue to be checked under a microscope for signs of disease.

Laparoscopic surgery

Laparoscopic surgery (laparoscopy) is done through several small incisions (cuts) in the abdomen. Through one incision, the surgeon inflates the abdomen with carbon dioxide gas, which creates space in the body to see and operate. Then, the surgeon uses other small incisions to put a laparoscope — a thin, lighted tube with a tiny video camera — and other surgical tools into the abdominal space. When this same technique is used for surgery on the chest, it is called thoracoscopic surgery.

Endoscopic surgery

Endoscopic surgery (endoscopy) is similar to laparoscopic or thoracoscopic surgery, because very tiny surgical tools and scopes are used. However, the difference is that the scope goes in through one of the body’s natural openings, such as the mouth, nose or anus, not through incisions (cuts). Endoscopy can be used to remove some types of tumors in the throat, larynx, esophagus, colon, bladder, brain and other areas.

Endoscopy A procedure that uses an endoscope to examine the inside of the body. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. A procedure that uses an endoscope to examine the inside of the body. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue to be checked under a microscope for signs of disease.

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. VATS is done using a small video camera called a thoracoscope, which is put into the chest cavity through a series of small incisions (cuts).

Thoracic Having to do with the chest.

Open Surgery

Open surgery is the traditional form of cancer surgery. During open surgery, a surgeon makes one larger incision (cut) to access a tumor and diagnose, stage or treat cancer.

Fred Hutch doctors always consider minimally invasive treatment options for their patients. However, in some complex cases, open surgery is a better choice. Other times, it is simply not possible to use a minimally invasive approach. For example, sometimes the size or location of a tumor makes it impossible to remove with a minimally invasive procedure.

Examples of open surgeries are laparotomy, which is an abdominal surgery, and thoracotomy, which is an open surgery of the chest. Maxillofacial surgeries (surgeries of the face, jaw or mouth) are sometimes done as open surgeries as well.

Ablative Techniques

Instead of surgery that uses a scalpel to cut body tissue to access a tumor, doctors may use other ways to remove or destroy cancerous tissue. These are called ablative techniques. Fred Hutch surgeons are highly experienced in the full range of these procedures.

Stage The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer and whether the cancer has spread from the original site to other parts of the body.

Laser surgery

Laser surgery is a minimally invasive technique where a laser is used to cut through tissue or vaporize (burn) cancers, destroying the cells. A carbon dioxide laser makes a beam of infrared light, which can ablate tumors or cells that have gone through precancerous changes.

Fred Hutch gynecologic oncologists use laser surgery to treat some female reproductive system cancers. Our head and neck surgeons also use it to ablate precancerous lesions and early cancers in the mouth and throat and to remove certain cancers in the larynx. Using laser surgery in this way is often better than traditional surgery and results in better outcomes for a patient’s swallowing and voice.

Precancerous A condition that may (or is likely to) become cancer. Also called premalignant.

Radiofrequency ablation (RFA)

Radiofrequency ablation (RFA) is when heat is used to kill cancer cells. It is especially useful in treating cancers that are difficult to remove with surgery.

To do RFA, a surgeon puts a needle-like probe into the tumor. An ultrasound, computed tomography (CT) scan or magnetic resonance imaging (MRI) is used to guide the probe to the right place. Next, an electrical current is sent through the probe, creating heat around the end of the probe to destroy the cancer cells. The probe can be passed through the skin into the tumor (called percutaneous RFA, which is done by an interventional radiologist), or it can be put into a tumor by a surgeon during open, laparoscopic or thoracoscopic surgery. Often, RFA is used to treat liver tumors and some lung tumors.

Computed tomography A procedure that uses a computer linked to an X-ray machine to make a series of detailed pictures of areas inside the body. The pictures are used to create three-dimensional (3-D) views of tissues and organs. A procedure that uses a computer linked to an X-ray machine to make a series of detailed pictures of areas inside the body. The pictures are taken from different angles and are used to create three-dimensional (3-D) views of tissues and organs. A dye may be injected into a vein or swallowed to help the tissues and organs show up more clearly. This scan may be used to help diagnose disease, plan treatment or find out how well treatment is working. Imaging In medicine, a process that makes pictures of areas inside the body. Imaging uses methods such as X-rays (high-energy radiation), ultrasound (high-energy sound waves) and radio waves. Radiologist A physician who has special training in creating and interpreting pictures of areas inside the body. The pictures are made with X-rays, sound waves or other types of energy. Ultrasound A procedure that uses high-energy sound waves to look at tissues and organs inside the body. The sound waves make echoes that form pictures of the tissues and organs on a computer screen. A procedure that uses high-energy sound waves to look at tissues and organs inside the body. The sound waves make echoes that form pictures of the tissues and organs on a computer screen (sonogram). Ultrasound may be used to help diagnose diseases, such as cancer. It may also be used during pregnancy to check the fetus (unborn baby) and during medical procedures, such as biopsies. Also called ultrasonography. Ablation Treatment to remove or destroy all or part of a cancer; also used to remove or stop organ function. Besides surgery and drugs, other types of ablation include extreme heat, freezing and chemicals.

Treatment that removes or destroys all or part of a cancer; can also be used to remove or stop the function of an organ. For example, removing the ovaries or testicles or taking medicines that cause them to stop making their hormones would be called ablation. Besides surgery and drug treatment, other ways of ablating body tissues and tumors include extreme heat, freezing and chemicals.

Irreversible electroporation (NanoKnife)

Irreversible electroporation (IRE) uses electrical currents to open the membrane around a cancer cell and destroy it without harming the surrounding healthy tissue.

During the procedure, needle-like NanoKnife® probes are put into the tumor. A computed tomography (CT) scan or magnetic resonance imaging (MRI) is used to guide the probe to the right place. Then, micropulses of electricity are sent through the probes, causing the cell membranes to open and be destroyed. The probes can be passed through the skin, or they can be put into a tumor during surgery.

IRE is often used to treat liver tumors that are close to other vital organs and structures that cannot be removed surgically or safely destroyed using radiofrequency ablation (RFA).

Argon beam coagulation

Gynecologic oncologists use an argon beam coagulator to treat ovarian cancer. This device uses electrical current passed through a stream of argon gas to help with cytoreductive surgery (CRS), which is used to reduce the size of the tumor. It is used as an adjunct therapy to achieve the goal of CRS, which is to destroy all visible disease.

Adjunct therapy Another treatment used together with the primary treatment. Its purpose is to assist the primary treatment.

Robot-assisted Surgery

For robot-assisted surgeries, our surgeons use the da Vinci Surgical System. With this system, the surgeon sits at a computer console near the patient and uses the attached devices to control three robotic arms. One robotic arm holds a camera, and the others hold surgical tools. This system gives the surgeon a 3D view of the treatment area, allowing them to do very precise, complex motions.

Robot-assisted surgery can be used to treat a wide range of cancers, such as bladder, colorectal, endometrial, kidney, liver, lung, ovarian, pancreatic, penile, prostate, throat, thyroid and tongue cancers.

Fred Hutch doctors also have access to a dual-console da Vinci robot, which allows two surgeons to do complex robot-assisted surgeries at the same time.

Hysterectomy

Through tiny incisions (cuts), our surgeons do robot-assisted hysterectomies for patients with endometrial or uterine cancer. Using this system, they are able to remove the uterus with great precision and control.

Nephrectomies for renal cell carcinoma

A surgeon can remove part or all of a kidney through small incisions (cuts) and using robotic technology, depending on where the cancer is and how much needs to be removed.

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

Liver, bile duct and pancreatic cancer surgeries are complex and can also be treated using robotic technology. The 3D visualization and the improved precision and control of the robot allow these complex surgeries to be done as minimally invasive procedures.

Prostatectomy for prostate cancer

Surgeons at Fred Hutch can use laparoscopic prostatectomy to remove prostate glands using tiny surgical tools and several small incisions (cuts). This procedure has mostly replaced traditional open prostatectomy, when a surgeon operates through a single larger incision to remove the prostate and the lymphatic tissues, which can contain cancer.

Transoral endoscopic surgery for throat cancer

Using a tiny surgical camera and microscope that are passed through the mouth, our surgeons can treat throat cancers, avoiding the need for other surgeries or tracheotomy. This approach may also minimize or eliminate the need for chemotherapy and radiation as additional treatments.

Transaxillary hemithyroidectomy for thyroid cancer

In this procedure, half of the thyroid is removed through an incision (cut) in the underarm (axilla) area, instead of the neck. This procedure is sometimes preferred because the scar is hidden in the underarm and, with proper care, the incision can heal faster than a neck incision. Surgeons are able to see a very detailed view of the treatment area with this approach.

Post-Surgical, Follow-up Care

Your care team will continue to care for you after your cancer surgery, which will help you recover as quickly as possible. We work together to help prevent infection, minimize your pain and avoid complications.

Supportive care services

Along with treating your cancer, Fred Hutch provides a range of services to support you and your caregiver before, during and after treatment. This is part of how we take care of you — not just your disease.

From registered dietitians to chaplains, we have experts who specialize in caring for people with cancer. We understand this may be one of the most intense and challenging experiences you and your family ever go through. We are here to provide the care you need.

Learn More

Nutrition

Our registered dietitians have special training on nutrition for cancer prevention, treatment and survivorship. They work together with the rest of your care team.

Go to Page

Nutrition

Palliative care

Our palliative care team is here to support the best possible quality of life for you, no matter what stage your disease is.

Go to Page

Palliative care

Physical therapy

Our physical therapists can help with concerns related to weakness, balance, scar tissue, lymphedema, range of motion and rehabilitation equipment.

Go to Page

Physical therapy