How is surgery used in cancer treatment?
What are the different types of surgery used in cancer treatment?
What is informed consent?
What are the risks and potential side effects of surgery for cancer treatment?
Can other types of surgery help treat cancer?
Types of anesthesia
About your anesthesiologist
Surgery, the oldest form of cancer treatment, is used in several ways to help cancer patients. It provides the best chance to stop many types of cancer and also plays a part in diagnosing, staging and supporting cancer treatment.
Having surgery is different for every patient — depending on the type of surgery, the type of cancer and the patient’s health. For some people, surgery is a major medical procedure with life-changing side effects. For others, surgery is quick and has few side effects.
Several types of surgery are helpful to people with cancer. Some surgeries are used in combination with other types of treatment. The following is a list of surgeries with a brief explanation of their goals:
- Curative surgery – removes the cancerous tumor or growth from the body. Surgeons use curative surgery when the cancerous tumor is localized to a specific area of the body. This type of treatment is often considered the primary treatment; however, other types of cancer treatments, such as radiation, may be used before or after the surgery.
- Preventive surgery – is used to remove tissue that does not contain cancerous cells, but may develop into a malignant tumor. For example, polyps in the colon may be considered precancerous tissue and preventative surgery may be performed to remove them.
- Diagnostic surgery – helps to determine whether cells are cancerous. Diagnostic surgery is used to remove a tissue sample for testing and evaluation (in a laboratory by a pathologist). The tissue samples help to confirm a diagnosis, identify the type of cancer or determine the stage of the cancer.
- Staging surgery – works to uncover the extent of cancer or the extent of the disease in the body. Laparoscopy (a viewing tube with a lens or camera is inserted through a small incision to examine the inside of the body and to remove tissue samples) is an example of a surgical staging procedure.
- Debulking surgery – removes a portion, though not all, of a cancerous tumor. It is used in certain situations when removing an entire tumor may cause damage to an organ or the body. Other types of cancer treatment, such as chemotherapy and radiation, may be used after debulking surgery is performed.
- Palliative surgery – is used to treat cancer at advanced stages. It does not work to cure cancer, but to relieve discomfort or to correct other problems cancer or cancer treatment may have created.
- Supportive surgery – is similar to palliative surgery because it does not work to cure cancer. Instead, it helps other cancer treatments work effectively. An example of supportive surgery is the insertion of a catheter to help with chemotherapy.
- Restorative surgery – is sometimes used as a follow-up to curative or other surgeries to change or restore a person’s appearance or the function of a body part. For example, women with breast cancer sometimes need breast reconstruction surgery to restore the physical shape of the affected breast(s). Curative surgery for oral cancer can cause a change in the shape and appearance of a person’s mouth. Restorative surgery may be performed to address these effects.
Informed concent is a crucial part of understanding your cancer care and is when you give your cancer care team written permission to perform a treatment. It is your chance to state that you know why and how the treatment is being performed, how it may help you, what the risks and possible side effects are, and which other treatment options may help you. Before you give this permission, make sure to ask your oncologist any questions you have.
Risk is a part of any surgery. Though science and medical technology have made surgery a safe and reliable treatment option, there is always the risk of potential problems and side effects. In many cases, however, the positive effects of surgery outweigh the risks. The more you know about surgery for cancer, the more informed your choices will be. Be sure to discuss the following potential complications with your cancer care team prior to undergoing treatment:
- Problems during surgery may include:
- Damage to organs in the body
- Blood loss
- Adverse reactions to medication
- Problems after surgery may include:
- Pain or discomfort (a common problem following surgery that can often be relieved with medication and with the help of your cancer care team)
- Other illnesses, such as pneumonia
- Blood loss or clots
There are several specialized surgeries used during cancer treatment. The following is a list of some of these surgical treatments:
- Cryosurgery – this surgery technique uses extremely cold temperatures to kill cancer cells. Cryosurgery is used most often with skin cancer and cervical cancer. Depending on whether the tumor is inside or outside the body, liquid nitrogen is placed on the skin or in an instrument called a cryoprobe (which is inserted into the body so that it touches the tumor). Cryosurgery is being evaluated as a surgical treatment for several types of cancers.
- Laser surgery – this technique uses beams of light energy instead of instruments to remove very small cancers (without damaging surrounding tissue), to shrink or destroy tumors or to activate drugs to kill cancer cells. Laser surgery is a very precise procedure that can be used to treat areas of the body that are difficult to reach including the skin, cervix, rectum and larynx.
- Electrosurgery – skin cancer and oral cancer are sometimes treated with electrosurgery. This technique uses electrical current to kill cancer cells.
- Microscopically controlled surgery – this surgery is useful when cancer affects delicate parts of the body, such as the eye. Layers of skin are removed and examined microscopically until cancerous cells cannot be detected.
- Radiofrequency ablation - this procedure uses radio waves to heat and destroy abnormal cells. The radio waves travel through electrodes (small devices that carry electricity).
During surgery, you will be given some form of anesthesia — a medication administered for the relief of pain and sensation during surgery. The type and dosage of anesthesia is administered by the anesthesiologist. When a patient faces surgery, he or she will meet with the anesthesiologist before the procedure. The anesthesiologist will review the patient’s medical condition and history to plan the appropriate anesthetic for surgery.
There are various forms of anesthesia. The type of anesthesia you will receive will depend on the type of surgery and your medical condition. Usually, an anesthesiologist will administer a sedative in addition to the anesthetic. The different types of anesthesia are as follows:
- Local anesthesia – local anesthesia is medication given to temporarily stop the sensation of pain in a particular area of the body. A patient remains conscious during a local anesthetic. For minor surgery, a local anesthetic can be administered via injection to the site. However, when a large area needs to be numbed, or if a local anesthetic injection will not penetrate deep enough, physicians may resort to regional anesthetics.
- Regional anesthesia– regional anesthesia means numbing only the portion of the body that will be operated on. Usually an injection of local anesthetic is given in the area of nerves that provide feeling to that part of the body. There are several forms of regional anesthetics, two of which are described below:
- Spinal anesthetic – often used for lower abdominal, pelvic, rectal or lower extremity surgery. This type of anesthetic involves injecting a single dose of the anesthetic agent directly into the spinal cord in the lower back, causing numbness in the lower body.
- Epidural anesthetic – this anesthetic is similar to a spinal anesthetic and also is commonly used for surgery of the lower limbs and during labor and childbirth. This type of anesthesia involves continually infusing drugs through a thin catheter that has been placed into the space that surrounds the spinal cord in the lower back, causing numbness in the lower body.
- General anesthesia – general anesthesia causes a patient to be unconscious during surgery. The medicine is either inhaled through a breathing mask or tube, or administered through an intravenous line — a thin plastic tube inserted into a vein (usually in the patient’s forearm). A breathing tube may be inserted into the windpipe to maintain proper breathing during surgery. Once the surgery is complete, the anesthesiologist ceases the anesthetic and the patient wakes up in the recovery room.
Anesthesiologists are the physicians trained to administer and manage anesthesia given during a surgical procedure. They also are responsible for managing and treating changes in your critical life functions — breathing, heart rate and blood pressure — as they are affected by the surgery being performed. Further, they immediately diagnose and treat any medical problems that might arise during and immediately after surgery.
Prior to surgery, the anesthesiologist will evaluate the patient’s medical condition and formulate an anesthetic plan that takes that patient’s physical condition into account. It is vital that the anesthesiologist knows as much about your medical history, lifestyle and medications as possible. Some particularly important information he or she needs to know includes the following:
- Reactions to previous anesthetics – if you have ever had a bad reaction to an anesthetic drug, you need to be able to describe exactly what the reaction was and what your specific symptoms were. Give the anesthesiologist as much detail as possible, such as whether you felt nauseated following surgery.
- Current herbal supplements – it has recently been learned that certain herbal products, commonly taken by millions of Americans, can cause changes in heart rate and blood pressure, and may increase bleeding in some patients. The popular herbs gingko biloba (an herb used for many conditions associated with aging, including poor circulation and memory loss), garlic (an herb often used for cardiovascular conditions and to help prevent colds, flu and other infectious diseases), ginger and ginseng (used as a general tonic to increase overall body tone; considered helpful in elevating energy levels and resistance to stress) may lead to excess blood loss by preventing blood clots from forming. In addition, St. John’s wort (a popular herb used for mild to moderate depression) and kava kava (another popular herb used for depression and to elevate mood) may prolong the sedative effect of the anesthetic. The American Society of Anesthesiologists advises patients planning to have surgery to stop taking all herbal supplements at least two to three weeks prior to surgery to rid the body of these substances.
- Any known allergies – discussing any known allergies with the anesthesiologist is very important, as some anesthetic drugs trigger cross-allergies, particularly in persons who have allergies to eggs and soy products. Allergies to both foods and drugs should be identified.
- Recent and/or current prescribed and over-the-counter medications – it also is important to let your surgeon and anesthesiologist know about both prescribed and over-the-counter medications you are taking, or have recently taken. Certain prescribed medications, such as coumadin, a blood thinner, must be discontinued for some time prior to surgery. In addition, as many people take a daily aspirin to prevent heart attack or dietary supplements for other health reasons, physicians need to be aware of these habits, as they can prolong bleeding and interfere with muscle relaxants used by anesthesiologists.
- Cigarette smoking and drinking – cigarette smoking and alcohol can affect your body just as strongly (and sometimes more strongly) than many prescribed medications you may be taking. Because of the way cigarettes and alcohol affect the lungs, heart, liver and blood, these substances can change the way an anesthetic drug works during surgery. It is important to let your surgeon and anesthesiologist know about your previous, recent and current consumption of these substances prior to surgery.
Undergoing surgery can be a good motivator to quitting smoking. Most hospitals are smoke-free and physicians, nurses and other health professionals will be there to give you support. In addition, you will heal and recover faster, especially in the incision area, or if your operation involves any bones. Quitting smoking also reduces your risk of heart disease and cancer.
- Use of street drugs (such as marijuana, cocaine, amphetamines, etc.) – patients are often reluctant to discuss matters of illegal drug consumption, but you should remember that all conversations between you and your surgeon and anesthesiologist are confidential. It is crucial that he or she know about your previous, recent and current consumption of these substances. It is important to keep in mind that the only interest your physician has in this information is learning enough about your physical condition to provide you with the safest anesthesia possible.