Basics of Cancer Surgery with Robert Sticca, MD

Last Updated: April 27, 2017

Dr. Robert Sticca outlines the basic types of surgery used in cancer treatment.

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Understanding Cancer Surgery

Cancer Surgery—Your Personal Experience

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Full text transcript

Cancer.Net®: Doctor-Approved Patient Information from ASCO®

The Basics of Cancer Surgery

Types of Cancer Surgery

Robert Sticca, MD: There are several different categories of cancer surgery.  Initially, in most situations and this depends on the type of tumor, most patients require a biopsy to confirm that it is a malignancy.  So a biopsy can be done in several different ways, either using a needle or some other technique to remove a small piece of the tumor, but it is not – in most cases, it does not remove the entire tumor.

Once the diagnosis of malignancy is confirmed, then we move on to the next stage, which would be surgical removal of the tumor.  And the principles around surgical removal of a tumor are generally – what we generally try to do is remove the tumor and a margin of tissue – a margin of normal tissue around that tumor.

The reason for that is, is that you know, one of the basic properties of cancer is that it has the ability to infiltrate into the surrounding tissue.  So when we remove that surgically, if we just took the tumor out, we would oftentimes miss some of the tumor cells that had infiltrated into the surrounding tissue. 

Other surgical methods that are used for tumor removal are things like a tumor debulking.  This is situation where there's a more widespread tumor.  We know that we can't remove it completely, but we remove as much as possible to make it more amenable to other types of treatments such as chemotherapy and radiation.

A palliative surgery is another type of surgery that we use in cancer.  This is in a situation where we know that we will not be able to remove the complete tumor, but the patient has a lot of symptoms from that tumor.  In that situation, even if – even if we know that the situation is incurable, sometimes surgery is indicated to remove the tumor to improve their quality of life.

Another form of surgery that is used for cancer is reconstructive surgery.  There are many situations where when we remove a tumor, because we have to remove the tumor and some of the surrounding structures that the patients have some functional deficits because of that. 

Another time where we use surgery in the management of cancer is in trying to prevent cancers from occurring.  With our newer techniques, I've been able to diagnose people that are at high risk for cancer by genetic analysis and some other means.  We knew – know in some cases that a patient may have a very high risk of a subsequent cancer. 

We know in several areas, now, breast cancer and colorectal cancer, some prostate cancers, that there can be a very high risk for somebody who has a strong family history or within their family, they have a known genetic mutation.  And in those situations, prophylactic surgery or preventative surgery is often recommended. 

Using Surgery in Determining a Cancer’s Stage

Dr. Sticca: So the staging of cancer is based on several factors and in many cases, these factors have to be determined by a surgical resection.  And again, this varies between the different types of cancer, but in general, most cancers are staged based on the size of the tumor, in some cases, based on the size and how deeply it invades into the organ which it arose in, based on whether or not there are any lymph nodes involved. 

The lymph nodes are the small filters within the fluid system within the body and these are often an area where cancers will spread to initially.  So if the lymph nodes are involved, then that would indicate that the cancer has started to spread.  And lastly, whether or not the cancer has spread to any distant sites such as the liver or the lungs, you know, when a cancer has arisen in a different location. 

So from a surgeon's standpoint, we often try to adequately stage a cancer so that we know – so we know the extent of the tumor – the actual size and whether or not it's spread by removing some of the lymph nodes.  This is especially important in determining further treatments. 

When a patient is considering surgery for cancer, there are several things that they should take into consideration.  Number one is the magnitude of the surgery and then number two is whether or not the surgeon and the institution have any experience in dealing with that type of tumor.

Where to Get More Information

Dr. Sticca: There are some types of cancers that are dealt with on a very wide scale by many surgeons throughout the country and those – in those situations, the patients can get very good care in most locations.

But then there are other tumors that are – require either a much more extensive surgical procedure that is not done in a lot of locations or are very rare tumors that are not dealt with in a lot of different hospitals.  And in that situation, the patient should seriously consider going to a center where there is a little bit more experience in dealing with that type of a tumor.

The American Society for Clinical Oncology or ASCO has a patient Web site called Cancer.Net, which patients can refer to, to get information about specific cancers and also they may be able to use that to gain – to gain access to links to organizations within their local areas that can provide those services.

[Closing and Credits]

Cancer.Net®: Doctor-Approved Patient Information from ASCO®

ASCO's patient education programs are supported by Conquer Cancer Foundation of the American Society of Clinical Oncology. ConquerCancerFoundation.org  

Special Thanks:

Dr. Mary Wilkinson, Dr. Raymund Cuevo, and the staff at Medical Oncology & Hematology Associates of Northern Virginia

Carolyn B. Hendricks, MD, The Cancer for Breast Health

Hasbro Children’s Hospital

Helen F. Graham Cancer Center at Christiana Care Health System

The Adele R. Decof Comprehensive Cancer Center at The Miriam Hospital. The Miriam Hospital is a teaching hospital of The Warren Alpert Medical School of Brown University

Video Footage and photography courtesy of:

St. Jude Children’s Research Hospital Biomedical Communications

Moffitt Cancer Center

University Hospitals Case Medical Center Seidman Cancer Center

The opinions expressed in the video do not necessarily reflect the views of ASCO or the Conquer Cancer Foundation.

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