Watch the Cancer.Net Video: Basics of Cancer Surgery with Robert Sticca, MD, adapted from this content.
Cancer surgery removes the tumor and nearby tissue during an operation. A doctor who treats cancer with surgery is called a surgical oncologist. Surgery is the oldest type of cancer treatment. And it is still an effective treatment for many types of cancer today.
There are many reasons to have surgery:
To diagnose cancer
To remove all or some of a cancer
To find out where the cancer is located
To find out if the cancer has spread or is affecting the functions of other organs in the body
To restore the body's appearance or function
To relieve side effects
You may have surgery in a doctor's office, clinic, surgery center, or hospital. Where you have surgery depends on the type of surgery and how much time you need to heal from it. Inpatient surgery means that you need to stay in the hospital overnight or longer to recover after the surgery. Outpatient surgery means that you do not need to stay overnight in the hospital before or after surgery.
Types of surgery
Diagnostic. For most types of cancer, a biopsy is the main way to diagnose cancer. During a surgical biopsy, the surgeon makes a cut, called an incision, into the skin. Then, he or she removes some or all of the suspicious tissue.
There are 2 main types of surgical biopsies:
An incisional biopsy removes a piece of the suspicious area to study.
An excisional biopsy removes the whole suspicious area, such as a mole or a lump.
After a biopsy, a pathologist examines the tissue that was removed under a microscope. A pathologist is a doctor who interprets lab tests. He or she also evaluates cells, tissues, and organs to look for disease. The pathologist then gives a pathology report to the oncologist. Next, the oncologist looks at the report and diagnoses the tumor.
Staging. Staging surgery is used to find out the size of the tumor and if or where the cancer has spread. The doctor often also removes some lymph nodes near the cancer to find out if it has spread. Lymph nodes are tiny, bean-shaped organs that help fight infection.
Your health care team uses the results from this surgery and other tests to guide the treatment options. These tests can also help predict a person’s prognosis, which is the chance of recovery. The cancer's stage may also be included on the pathology report.
Tumor removal, also called curative or primary surgery. Surgery is most commonly used to remove the tumor and some of the nearby healthy tissue. The tissue around the tumor is called the margin.
With conventional surgery, the surgeon makes large incisions through skin, muscle, and sometimes bone. Sometimes, he or she can use surgical techniques that are less invasive. These techniques may speed recovery and reduce pain after surgery. Learn more about types of minimally invasive surgery below.
Debulking. Sometimes, the surgeon cannot remove the entire tumor. Or removing it might cause too much damage to the body. In these cases, surgery is used to remove as much of the tumor as possible. Other treatments, such as radiation therapy or chemotherapy, may also be used to shrink the rest of the cancer. These treatments may also be given before surgery to help shrink the tumor so it can be removed.
Palliation. Palliative surgery relieves side effects caused by a tumor. It greatly improves the quality of life for patients with advanced cancer or widespread disease. For example, surgery may be used to:
Relieve pain or restore physical function when a tumor causes the following problems:
Pressure on a nerve or the spinal cord
Blockage of the bowel or intestines
Pressure or blockage elsewhere in the body
Stop bleeding. Certain cancers are more likely to cause bleeding:
Cancers in areas with a large amount of blood vessels, such as the uterus
Cancers in organs that are delicate and can easily bleed when food and waste products pass through, such as the esophagus, stomach, and bowel.
Bleeding may also be a side effect of some drugs used to treat cancer. When surgery is needed to stop bleeding, a common technique is suture ligation. This surgery ties blood vessels using surgical thread.
Insert a feeding tube that delivers drugs if the cancer or treatment has made it hard to eat. A feeding tube is inserted directly into the stomach or intestine through the abdominal wall. A tube may also be inserted into a vein to deliver pain medication or chemotherapy.
Prevent broken bones. Bones weakened by cancer or cancer treatment can break easily and often heal slowly. Doctors may insert a metal rod to help prevent the breaking of weak bones and relieve pain during healing.
Reconstruction. After the main surgery to remove a tumor, people may choose to have another surgery to restore the body's appearance or function. This is called reconstructive or plastic surgery. Reconstructive surgery may be done at the same time as surgery to remove the tumor. Or it may be done after a person has healed or received more treatment. Examples of reconstructive surgery include breast reconstruction after a mastectomy and surgery to restore a person’s appearance and function after head and neck surgery.
Prevention. Surgery is also done to reduce the risk of getting cancer. For example, doctors often suggest the removal of precancerous polyps in the colon to prevent colon cancer. In addition, women with a strong family history of breast or ovarian cancers or known mutations in the BRCA1 and BRCA2 breast and ovarian cancer genes may decide to have a mastectomy or oophorectomy. A mastectomy is the removal of a breast. An oophorectomy is the removal of the ovaries. Having these surgeries lowers the risk of developing breast or ovarian cancer.
Learn more about common types of surgery for specific types of cancer.
Types of minimally invasive surgery
As mentioned above, the surgeon often makes large incisions in the body during surgery. But in some cases, a surgeon can use one or more smaller cuts. These surgeries typically speed up recovery times and have less pain after surgery.
Below are some examples of minimally invasive procedures and surgeries:
Laparoscopic surgery. The doctor makes small cuts in the skin using a thin, lighted tube with a camera. The term laparoscopy refers to a minimally invasive surgery of the abdomen. Mediastinoscopy and thoracoscopy is the same type of surgery but it is done in the chest. Laparoscopic surgery may also be done with the help of a robot. During this type of surgery, the surgeon directs robotic instruments to do the surgery. This surgical procedure may be used for the kidneys, prostate, uterus, or ovaries.
Laser surgery. The doctor uses a narrow beam of high-intensity light to remove cancerous tissue.
Cryosurgery. The doctor uses liquid nitrogen to freeze and kill abnormal cells.
Mohs micrographic surgery, also called microscopically controlled surgery. A dermatologist uses this type of surgery to shave off skin cancer. He or she does this a layer at a time until all cells in a layer look like normal cells when viewed under a microscope.
Endoscopy. The doctor inserts a thin, flexible tube with a light and camera on the tip into the body. This device is called an endoscope. It may be inserted into the mouth, rectum, or vagina to examine the internal organs. During this procedure, the doctor might remove samples of suspicious tissue to examine further. Learn more about types of endoscopy.