Cancer surgery: Physically removing cancer
The prospect of cancer surgery may make you feel anxious. Help put your mind at ease by learning more about cancer surgery and how and why it’s used.
Cancer surgery — an operation to remove part of your body to diagnose or treat cancer — remains the foundation of cancer treatment.
How is cancer surgery used in treatment?
Common reasons you might undergo cancer surgery include:
Cancer prevention. If you have a high risk of developing cancer in certain tissues or organs, your doctor may recommend removing those tissues or organs before cancer develops.
For example, if you are born with a genetic condition called familial adenomatous polyposis, your doctor may use cancer surgery to remove your colon and rectum because you have a high risk of developing colon cancer.
- Diagnosis. Your doctor may use a form of cancer surgery to remove all or part of a tumor — allowing the tumor to be studied under a microscope — to determine whether the growth is cancerous (malignant) or noncancerous (benign).
- Staging. Cancer surgery helps your doctor define how advanced your cancer is, called its stage. Surgery allows your doctor to evaluate the size of your tumor and determine whether it’s traveled to your lymph nodes. Additional tests might be necessary to gauge your cancer’s stage.
- Primary treatment. For many tumors, cancer surgery is the best chance for a cure, especially if the cancer is localized and hasn’t spread.
- Debulking. When it’s not possible to remove all of a cancerous tumor — for example, because doing so may severely harm an organ — your doctor may remove as much as possible (debulking) in order to make chemotherapy or radiation more effective.
- Relieving symptoms or side effects. Sometimes surgery is used to improve your quality of life rather than to treat the cancer itself — for example, to relieve pain caused by a tumor that’s pressing on a nerve or bone or to remove a tumor that’s blocking your intestine.
Surgery is often combined with other cancer treatments, such as chemotherapy and radiation. Whether you opt to undergo additional cancer treatment depends on your type of cancer, its stage and your overall health status.
How is cancer surgery traditionally performed?
Simple mastectomy and modified radical mastectomy
Simple mastectomy and modified radical mastectomy
A simple mastectomy (left) removes the breast tissue, nipple, areola and skin but not all the lymph nodes. A modified radical mastectomy (right) removes the entire breast — including the breast tissue, skin, areola and nipple — and most of the underarm (axillary) lymph nodes.
A lumpectomy involves removing the cancer and some of the healthy tissue that surrounds it. This illustration shows one possible incision that can be used for this procedure, though your surgeon will determine the approach that’s best for your particular situation. Dissolvable stitches are placed under the skin so that they won’t need to be removed later.
Lung cancer surgery
Lung cancer surgery
Lung cancer surgery can involve removing a portion of the lung or the entire lung. An operation to remove the lung cancer and a small portion of healthy tissue is called a wedge resection. Removing a larger area of the lung is called segmental resection. Surgery to remove one of the lung’s five lobes is called lobectomy. Removing an entire lung is called pneumonectomy.
Traditionally, the primary purpose of cancer surgery is to cure your cancer by removing all of it from your body. The surgeon usually does this by cutting into your body and removing the cancer along with some surrounding healthy tissue to ensure that all of the cancer is removed.
Your surgeon may also remove some lymph nodes in the area to determine whether the cancer has spread. This helps your doctor assess the chance of your being cured, as well as the need for further treatment.
In the case of breast cancer surgery, your doctor may remove the cancer by removing the whole breast (mastectomy) or by removing only the portion of your breast that contains the cancer and some of the surrounding tissue (lumpectomy).
In the case of lung cancer surgery, your doctor may remove part of one lung (lobectomy) or the entire lung (pneumonectomy) in an attempt to ensure that all the cancer has been removed.
In both of these examples, the surgeon may also remove some lymph nodes in the area at the time of the operation to see if the cancer has spread.
What other techniques are used in cancer surgery?
Many other types of surgical methods for treating cancer and precancerous conditions exist, and investigators continue to research new methods. Some common types of cancer surgery include:
- Cryosurgery. During this type of surgery, your doctor uses very cold material, such as liquid nitrogen spray or a cold probe, to freeze and destroy cancer cells or cells that may become cancerous, such as irregular cells in your cervix that could become cervical cancer.
- Electrosurgery. By applying high-frequency electrical currents, your doctor can kill cancer cells, for example, in your mouth or on your skin.
- Laser surgery. Laser surgery, used to treat many types of cancer, uses beams of high-intensity light to shrink or vaporize cancer cells.
- Mohs surgery. Useful for removing cancer from certain sensitive areas of the skin, such as near the eye, and for assessing how deep a cancer goes, this method of surgery involves carefully removing cancer layer by layer with a scalpel. After removing a layer, your doctor evaluates it under a microscope, continuing in this manner until all the abnormal cells have been removed and the surrounding tissue shows no evidence of cancer.
- Laparoscopic surgery. A surgeon uses a laparoscope to see inside your body without making large incisions. Instead, several small incisions are made and a tiny camera and surgical tools are inserted into your body. The surgeon watches a monitor that projects what the camera sees inside your body. The smaller incisions mean faster recovery and a reduced risk of complications. Laparoscopic surgery is used in cancer diagnosis, staging, treatment and symptom relief.
- Robotic surgery. In robotic surgery, the surgeon sits away from the operating table and watches a screen that projects a 3-D image of the area being operated on. The surgeon uses hand controls that tell a robot how to maneuver surgical tools to perform the operation. Robotic surgery helps the surgeon operate in hard-to-reach areas.
Natural orifice surgery. Natural orifice surgery is currently being studied as a way to operate on organs in the abdomen without cutting through the skin. Instead, surgeons pass surgical tools through a natural body opening, such as your mouth, rectum or vagina.
As an example, a surgeon might pass surgical tools down your throat and into your stomach during natural orifice surgery. A small incision is made in the wall of the stomach and surgical tools pass into the abdominal cavity in order to take a sample of liver tissue or remove your gallbladder.
Natural orifice surgery is experimental, and few operations have been performed this way. Doctors hope it can reduce the risk of infection, pain and other complications of surgery.
Cancer surgery continues to evolve. Researchers are investigating other surgical techniques with a goal of less invasive procedures.
What can you expect before and after cancer surgery?
Preparation and healing from cancer surgery varies greatly based on the operation. But in general, you can expect certain similarities, including:
- Preparation. In general, expect to undergo certain tests, such as blood tests, urine tests, X-rays and other imaging tests, in the days preceding your surgery. These tests will help your doctor assess your surgical needs, such as your blood type should you need a transfusion, and identify potential risks, such as infections.
- Anesthesia. If you’re having surgery, you’ll likely need some type of anesthetic — a medication that blocks the perception of pain. Your options for anesthesia will be based on the type of operation.
- Recovery. Depending on your surgery, you may stay in the hospital for a time before going home. Your health care team will give you specific directions for your recovery, such as how to care for any wounds, what foods or activities to avoid, and what medications to take.
What are the risks of cancer surgery?
What side effects you might experience after cancer surgery will depend on your specific surgery. In general, most cancer operations carry a risk of:
- Pain. Pain is a common side effect of most operations. Some cause more pain than others do. Your health care team will tell you how to keep your pain to a minimum and will provide medications to reduce or eliminate the pain.
- Infection. The site of your surgery can become infected. Your health care team will show you how to care for your wound after surgery. Follow this routine closely to avoid infection, which can lengthen your recovery time after surgery. In the rare instance where an infection does occur, your doctor will likely treat this with antibiotics.
Loss of organ function. In order to remove your cancer, the surgeon may need to remove an entire organ. For example, a kidney may need to be removed (nephrectomy) if you have kidney cancer.
For some such operations, the remaining organ can function sufficiently to compensate for the loss, but in other situations you may be left with impairments. For instance, removal of a lung (pneumonectomy) may cause difficulty breathing.
- Bleeding. All operations carry a risk of bleeding. Your surgeon will try to minimize this risk.
Blood clots. While you’re recovering from surgery, you’re at an increased risk of developing a blood clot. Though the risk is small, this complication can be serious.
Blood clots most commonly occur in the legs and may cause some swelling and pain.
A blood clot that breaks off and travels to a lung (pulmonary embolism) is a dangerous and sometimes deadly condition.
Your surgeon will take precautions to prevent blood clots from developing, such as getting you up and out of bed as soon as possible after your operation or prescribing a blood-thinning medication to reduce the risk of a clot.
- Altered bowel and bladder function. Immediately after your surgery, you may experience difficulty having a bowel movement or emptying your bladder. This typically resolves in a few days, depending on your specific operation.
Whatever cancer treatment your doctor recommends, you’re likely to feel some anxiety about your condition and the treatment process. Knowing what to expect can help. Use this information to help you ask informed questions when you meet with your doctor.
Sept. 18, 2020
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