What is Surgical Oncology?
Surgical Oncology is a discipline of medicine committed to treating cancer tumours through the means of surgery. Cancer treatment methods include chemotherapy, radiation therapy, surgery, hormone therapy, bone marrow transplant, immunotherapy, targeted drug therapy and more.
Traditionally, surgery has been the first line of treatment for cancer. It’s only in the last century that other treatment avenues like chemotherapy and radiotherapy came into being. Surgical oncology deals with the use of surgical techniques to treat all forms of cancer.
Cancer surgery may not necessarily be the only treatment available for cancer but is generally considered for most forms of cancer. An oncologist would have to consider surgery along with other treatments like chemotherapy and radiotherapy.
Surgical oncology involves the following functions:
- Diagnosis of cancer and determining its stage by taking a biopsy or other methods.
- Surgically removing the tumor or a part of it.
- Surgically remove the tumor along with other affected body parts.
- Reconstruct parts that are affected due to the surgical treatment.
A surgical oncologist plays a vital role in providing multidisciplinary cancer care. They are trained to manage both simple and complex cases of primary and secondary cancer. Surgical oncologists have immense knowledge of cancer biology, imaging technologies, radiation therapy and chemical and biological therapy.
Our Surgical oncologists work along with an experienced and dedicated team of nurses, anesthesiologists,/a> and other technologists to offer the best, safest and most effective cancer care treatment.
Experienced team of surgical oncologists at Narayana Health's group of hospitals ensure surgical removal of the tumour at the site of occurrence. The patients are explained on the process involved in surgery and the recuperation time. Nutritionists and rehab specialists support the patient during the process of recovery. Reconstructive surgeons work on the restoration of the appearance of the body based on the condition of the patient.
The department comprises of numerous speciality sections:
- Sarcoma surgery
Sarcoma is an uncommon cancer type that is mostly found in the bones, muscles, cartilage, nerves, tendons and blood vessels of your arms and legs. They grow in connective tissue cells that support other tissues in the human body. Sarcoma surgery is performed to remove the tumour out of the body.
- Paediatric surgery
Surgery in children can be more complicated than that in adults. We offer the best pediatric surgical services and comprehensive care to our patients. The highly experienced and dedicated team of paediatric surgeons manage and treat the health of children including neonates.
- Melanoma surgery
Melanoma affects the melanocytes cells in your skin and is one of the most serious types of cancers. Exposure to UV radiation is considered to be one of the leading causes of melanoma. If melanoma spreads beyond the skin, surgery is suggested to remove the affected lymph nodes.
- Hepato-pancreato- biliary (HPB) surgery
Hepato-pancreato- biliary cancers are the cancers that affect the pancreas, liver, gallbladder and the bile ducts. A surgery procedure is performed to remove the malignant cells from the body. The treatment is combined with other cancer treatment options like internal radiation therapy or regional chemotherapy.
HIPEC is an alternative method for providing chemotherapy. In this particular method, chemotherapy is offered directly into the abdomen. For gastric cancers, this is one of the most effective and recommended treatment options.
- Endocrine surgery
Apart from radiation therapy, endocrine cancer treatment also includes surgery to remove the cancerous tumour. Those diagnosed with endocrine cancers are also offered hormonal therapy to balance hormone levels.
- Colorectal surgery
Colorectal surgery is a discipline of medicine that manages conditions of the rectum, anus and colon. Surgery is performed to remove cancer and tissues from the wall of the rectum.
- Acute care general and palliative surgical oncology
These sections provide diagnosis, suitable treatment and surgical services to cancer patients to improve survival, shorten recovery times and minimize treatment-related side effects.
The treatment option can be surgery alone or surgery along with other treatment options. Surgery is performed to remove the formed tumour. In some cases, surgery isn’t helpful like in leukaemia (blood cancer), there is no mass to be removed.
Surgery in cancer treatment is mostly used
- To perform a diagnostic procedure to ascertain the stage of cancer
- Remove the tumour or cancer
- Remove a part of the tumour
- Palliative surgery is performed to ease the symptoms of cancer
- Reconstructive or restorative surgery to change the condition of the body post-surgery.
Surgical Oncology – types of surgeries
In surgical oncology, there are different procedures carried out that depend on the objective of treatment. The types of surgeries carried out depending on the treatment goals are:
Tumors and masses can be formed in the body. In most cases, these may be benign or harmless. Doctors would like to avoid risks and may want to test the masses before deciding. As a result, a sample of the mass needs to be collected and sent for testing to determine if it is cancerous or not. This procedure is referred to as diagnostic surgery. It may involve cutting out a small area of the tissue (incisional biopsy) or removing an entire mass (excisional biopsy). A biopsy may be done without an incision by inserting a fine needle to withdraw the tissue.
This is also known as prophylactic surgery and the goal is to prevent cancer. It’s possible that polyps or precancerous tissues are detected during diagnosis. While these are not cancerous tumors, a surgical oncologist may decide to remove these tissues as a preventive measure. Related treatments include mastectomy where the breast is removed in high-risk cases to prevent breast cancer. Similarly, in those who are at risk of developing ovarian cancer, the ovary and fallopian tubes may be surgically removed as a preventive measure.
This is a surgical procedure done by a surgical oncologist to determine the stage of cancer. Treatment for cancer depends on how much cancer cells have spread. A staging surgery may be done to open up the affected parts and find out the extent of cancer. This may be done using laparoscopy where small incisions are done and a laparoscope inserted to investigate the cancer. This is generally not a very invasive form of surgery.
This is the actual treatment done by a surgical oncologist. Once the presence of cancer is confirmed and the stage decided, a surgery is done to remove cancer cells and other affected body tissues. Surgery involves removing cancer cells and lymph nodes that are affected. Sometimes a part of an organ or the entire organ may have to be removed as a part of treatment. Surgery can be used along with chemotherapy, where a port and catheter is surgically inserted to allow medicines to be delivered to the blood.
When surgery is carried out, a part of an organ may be removed. It would be required to reconstruct the body to restore body parts, this is known as reconstructive surgery. For instance, when surgery for head and neck cancer is done, facial reconstruction is needed to reconstruct the face, which otherwise is affected because of removal of tissues. Microvascular surgery is generally used to stitch together small blood vessels to reconstruct body parts.
When cancer is at an advanced stage, curing it may not be possible. However, quality of life needs to be improved through various means. Palliative surgery provides relief from the symptoms of cancer. If a tumor is pressing on a nerve and causing pain, then the tumor is removed to provide relief from symptoms, even though the surgery may not treat the cancer.
Surgical oncology techniques
There are different surgical techniques that are used in the treatment of cancer. All these surgical oncology techniques are classified under the following heads:
- Open or invasive surgeries: where a large incision is made to carry out the surgery.
- Minimally invasive surgeries: where small incisions are made. Examples are robotic surgery and laparoscopic surgery.
- Ablative surgeries: where ablative methods are used to destroy the cancer cells in conjunction with surgery.
The various techniques used include:
- Open surgery: This is a technique, where a large incision has to be made on the affected body part so that the surgeon can reach the cancerous cells and remove it.
- Laparoscopy surgery: In this technique, the surgeon uses small incisions and inserts a laparoscope, a device that has a camera. This allows the surgery to be done precisely without resorting to an open surgery. It ensures quicker healing for the patient. It is sometimes referred to as endoscopic surgery or keyhole surgery. It can be used for diagnosis, staging, and treatment.
- Robotic surgery: This is the result of application of technology in medicine. For high-risk surgeries, a robot can be used, which is controlled by the doctor using a monitor. This is helpful to reach out to parts of the body that is difficult for the surgeon and where a steady hand is needed.
- Cryosurgery: In this technique, freezing is used to destroy cancer cells. Here the surgeon inserts a cold probe or a spray that uses liquid nitrogen on cancer cells. This can be used for preventive, as well as, treatment surgery.
- Electrosurgery: This is a technique that uses electric currents to kill cancer cells. An electrode is inserted and is used to deliver electric current precisely to the cancer cells without affecting healthy cells. The current would kill the cells thus destroying the tumor.
- Natural orifice surgery: This is a form of surgery where there are no incisions made, instead the natural body orifice like the mouth and rectum is used to insert a tube that has surgical tools. A camera is present to guide the surgeon to carry out the surgery to remove cancer cells.
- Nano Knife: This is an ablative technique of surgery. A needle-like proof known as the nano knife is used in this procedure. It is inserted into the tumor and electric current is used to open up the membranes of the cells. This results in the death of the cells and the tumor can be destroyed. The nano knife can be inserted through the skin or through any other surgical technique.
- Laser surgery: Here, laser beams are used to ablate cancer cells. The beams can vaporize the cells thus destroying them. It is also used to destroy pre-cancerous cells.
Surgical oncology and the patient
Surgical oncologists need to ensure that the patient is prepared for surgery and understand the recovery procedure. The oncologist would spend time before and after the surgery to ensure the process is done in a way to ensure patient comfort. Some of the key aspects here are:
- The surgical oncologist counsels the patient to make him/her understand about the procedure that is carried out, benefits, and risks.
- The decision on the required amount of anesthesia is made and this is informed to the patient.
- The patient is advised on things to be done before the surgery. Certain medications like blood thinner may need to be stopped before surgery. Also, arrangements for blood may need to be made.
- Once the surgery is complete, the patient is discharged only after the surgical oncologist determines the patient is ready to go home. Instructions for care at home are given and follow-up visits done to monitor recovery.
Surgical Oncology FAQs
General surgery does not handle specialized cases involving cancer. A surgical oncologist is trained on surgical procedures and techniques to treat cancer.
The effectiveness of cancer treatment depends on the cancer stage. When detected early, surgery ensures that cancer cells and all affected tissues are removed. This can ensure cancer is completely treated. In advanced stages, cancer would have spread to other parts making treatment all the more difficult.
Surgery is generally the first line of treatment for any form of cancer, especially in the early stages. It can be used to treat most types of cancers, including breast cancer, colorectal cancer, pancreatic cancer, liver cancer, cancer of the head and neck, lung cancer, ovarian cancer, etc.
Yes, anesthesia is needed to carry out surgeries. General anesthesia can be used to make the patient unconscious, while the surgery is carried out. Many minor surgeries can be done using local anesthesia with sedation to keep the patient comfortable. The type of surgery and the patient’s overall health is considered while deciding on the use of anesthesia. A surgical oncologist would work along with an anesthetist during the surgery.
Surgery in cancer care is needed to
- Diagnose and stage a cancer
- Remove the cancer or tumour
- Remove a part of the tumour. Sometimes, removing all the tumour or cancer can’t be safely done. So, surgeons perform debulking surgery and remove parts of the tumour without harming other parts of the body.
- Alleviate the symptoms caused by cancer. This is also known as palliative surgery
- Change the condition of the body after surgery. This is called restorative or reconstructive surgery.
In some patients, surgery is the only treatment option. However, surgery is done along with other treatments in many patients, such as chemotherapy, targeted or immune therapies, radiation therapy and hormone therapy.
Surgery can be neoadjuvant and adjuvant. Neoadjuvant means that the surgery is performed after other treatment, while, adjuvant means that the surgery is done before the other treatments.
All surgeries come with some form of risks, which can be the following
- Delayed wound healing
Surgical oncology specializes in the following:
- Breast cancer
- Endocrine tumours
- Gastric cancer
- Pancreas, liver, bile duct and gallbladder surgery
- Upper gastrointestinal and stomach surgery
- Neuroendocrine tumours
Usually, surgery requires incisions to made through skin, muscles or bones. Sometimes, these cuts can be painful and take some time to recover. To keep the patient from feeling the pain during surgery, anaesthesia is given. It can be one of the following
- Local anaesthesia, that causes loss of feeling in a small area of the body
- Regional anaesthesia, that causes loss of feeling in a part of the body, such as an arm or a leg
- General anaesthesia, that causes loss of feeling or complete loss of awareness Certain surgeries can be performed without making cuts or incisions in the body, which include
- Cryosurgery: The cancer cells are subjected to extreme cold produced by liquid nitrogen or argon gas. It may be used to treat skin cancer in its early stages, retinoblastoma, and precancerous growth on the skin and cervix.
- Lasers: Powerful beams of light are focused on cancerous areas to shrink or destroy them. Laser treatments are usually used to treat tumours on the surface of the body or the inside lining of internal organs.
- Hyperthermia: A form of treatment that uses high heat to damage and kill cancer cells. It may also be used to make these cells more sensitive to radiation and certain chemotherapy drugs.
- Photodynamic surgery: This treatment uses drugs that react to a certain type of light. The tumour is then exposed to the light which activates the drugs and kills nearby cancer cells.