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 Seattle Cancer Care Alliance (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.
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 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.
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.
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.
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.