Watch the Cancer.Net Video: Basics of Cancer Surgery with Robert Sticca, MD, adapted from this content.
This is the first article in a three-part series, and it provides an overview of the basics of surgery. Other articles in this series address what to expect when undergoing surgery and side effects of the treatment.
Surgery (the removal of cancerous tissue from the body) is the oldest type of cancer therapy, and it remains an effective treatment for many types of cancer today. The goal of surgery varies. It can be used to diagnose cancer; determine where it is located, whether it has spread, and whether it is affecting the functions of other organs in the body; remove all or some of the cancerous tissue; restore the body's appearance or function; or relieve side effects.
A doctor who specializes in treating cancer using surgery is called a surgical oncologist. Some types of surgery can be performed in a doctor's office, clinic, or surgery center. This is called outpatient surgery. For other types of surgery, patients are admitted to the hospital for a period of time. This is called inpatient surgery.
Types of conventional surgery
Diagnostic. For most cancers, a biopsy is needed to make an accurate diagnosis. A surgical biopsy involves a surgeon making an incision in the skin and removing some or all of the suspicious tissue. There are two main categories of surgical biopsies. An incisional biopsy removes a piece of the suspicious area for examination. An excisional biopsy removes the entire lump. Learn more about types of biopsies and what to expect during the procedure.
After a biopsy, a pathologist (a doctor who specializes in interpreting laboratory tests and evaluates cells, tissues, and organs to diagnose disease) examines the tissue with a microscope and provides a pathology report to the surgeon or oncologist, who then makes the diagnosis.
Staging. Staging surgery determines the size of the tumor and whether it has spread to lymph nodes and other organs in the area. Together with the physical examination, biopsy, and results of laboratory and imaging tests, it allows the doctor to accurately determine the extent of disease, which can then be used to determine the best treatment options.
Tumor removal (also called curative or primary surgery). The most common type of cancer surgery is to remove the tumor and surrounding tissue (called a margin). Tumor removal may be the sole treatment, or it may be combined with chemotherapy or radiation therapy, which can be given before or after surgery. In some cases, doctors can use surgical techniques that are less invasive, which can speed your recovery. Learn more about types of minimally invasive surgery below.
Debulking. When the complete removal of a tumor is not possible or might cause excessive damage to the body, surgery can be used to remove as much of the tumor as possible. Other treatments, such as radiation therapy or chemotherapy, are then used to address the remaining cancer.
Palliation. Palliative surgery is used to relieve side effects caused by a tumor. It plays an important role in extending survival or improving quality of life for patients with advanced cancer or widespread disease. Examples include:
- Surgery to relieve pain. If a tumor presses on a nerve or the spinal cord, blocks the bowel (intestine), or creates pressure or blockage elsewhere in the body, surgery can help relieve pain or restore physical function.
- Surgery to stop bleeding. Certain cancers are more likely to cause bleeding because they occur in areas (such as the uterus) with a high concentration of blood vessels or organs (such as the esophagus, stomach, and bowel) in which the tumors are very fragile and can easily bleed due to the passage of food and waste products. In addition, bleeding can be a side effect of some drugs that are used to treat cancer. When surgery is needed to stop bleeding, a common technique is suture ligation, which involves tying off blood vessels using surgical thread.
- Surgery to insert a feeding tube or tubes for delivering medications. If the cancer or cancer treatment has made it difficult for the patient to eat, a feeding tube may be inserted directly into the stomach or intestine through the abdominal wall. Or a tube may be inserted into a vein to deliver pain medication or chemotherapy.
- Surgery to prevent broken bones. Bones weakened by cancer or cancer treatment can break easily and tend to heal slowly. A metal rod can help prevent fractures of weak bones and relieve pain during healing. Learn more about bone health during cancer treatment.
Reconstruction. After primary cancer surgery, additional surgery is sometimes an option to restore the body's appearance or function. Examples of reconstructive (plastic) surgery include breast reconstruction after a mastectomy and surgery to replace normal tissue and nerves that were removed in the head and neck area.
Prevention. Some surgeries are performed to reduce the risk of developing cancer. For instance, the removal of precancerous polyps in the colon is recommended to prevent colon cancer. In addition, women with a strong family history of breast and/or ovarian cancers and those who carry mutations (changes) in the BRCA1 and BRCA2 breast/ovarian cancer genes may decide to have a prophylactic (preventive) mastectomy (removal of the breast) and/or oophorectomy (removal of the ovaries) to reduce their risk of future cancer.
Learn more about types of surgery that are commonly used for specific cancer types.
Types of minimally invasive surgery
Conventional surgery requires larger incisions (cuts) through skin, muscle, and sometimes bone, which can make recovery slow and painful. However, in some cases, minimally invasive surgery may be an option. Such procedures are performed through one or more small incisions and generally have shorter recovery times and less postoperative pain. Below are some examples of minimally invasive procedures and surgeries:
Endoscopy. This is a general name for a procedure in which a doctor inserts a small tube with a light and camera on the end into an opening of the body (such as the mouth, rectum, or vagina) to examine the internal organs. During an endoscopic procedure, it is possible to remove samples of potentially abnormal tissue for further examination. Learn more about endoscopic techniques.
Laparoscopic surgery. With this type of surgery, the surgeon makes small incisions in the skin to insert a lighted tube with a camera. A laparoscopy refers to a minimally invasive surgery of the abdomen. Mediastinoscopy and thoracoscopy are terms used when the same type of procedure is performed in the chest.
Laser surgery. A narrow beam of high-intensity light is used to remove cancerous tissue.
Cryosurgery. Liquid nitrogen is used to freeze and kill abnormal cells.
Mohs micrographic surgery. Also called microscopically controlled surgery, Mohs micrographic surgery involves shaving off a skin cancer one layer at a time until all cells in a layer appear to be normal cells when viewed under a microscope.