Surgery for Cancer

What is cancer surgery?

As we all know, cancer leads to formation of large, rapidly growing tumours which can obstruct function, impinge on healthy tissues, and also spread to distant cells through metastasis. Cancer surgery is a mode of treatment, diagnosis, and palliative care for cancerous growths. The specialists who perform these procedures are called surgical oncologists.

Types of cancer surgery

Depending on the key function of the surgery, there are many types of surgeries:

• Curative Surgery: the main aim of surgery is to remove the tumour from the individual’s body. This is done in initial stages for well-defined tumours which haven’t spread to other organs. Surgery may be accompanied by chemotherapy or radiation therapy.
• Preventive Surgery: tumours or growths which have a tendency to turn cancerous are removed surgically as a preventive measure. For example, if a polyp which is not cancerous, appears pre-cancerous, it is removed surgically.
• Diagnostic Surgery: to confirm the occurrence of cancer, the oncologist needs to see the cellular changes in the tumour. Study and observation of a small part of the tissues for diagnosis is called biopsy. Biopsy can be of two types:
  1. Incision biopsy: a small portion of the tumour or suspected mass is excised and viewed under a microscope.
  2. Excision biopsy: the tumour is too big and the entire mass needs to be removed from which a small portion is examined under microscope.
• Staging: Treatment of a cancer, widely depends on the stage of the cancer. Staging is done in order to figure out the size and extent of the spread of tumour. The oncologist may even take a sample of the associated lymph nodes to see if the cancer has spread. The samples are then biopsied.
• Debulking Surgery: In some cases, the spread of tumour may be so extensive that removal of the entire mass may cause more harm than good. In such cases, the surgeon removes a portion of the tumour. Other treatment modes like chemotherapy and radiation therapy may be used along with this.
• Palliative Cancer Surgery: This is a type of surgery in which the procedure does not cure the patient of cancer but reduces the discomfort and pain associated with it. It is usually done in widespread cancers which may be impinging in vital organs or the cancer which may cause bleeding.
• Reconstructive Cancer Surgery: once the primary surgery is done, the part of the patient may need surgical reconstruction to restore function, structure and aesthetics. One of the most common examples of reconstructive surgery is breast reconstructive surgery after mastectomy.
• Supportive surgery: these surgeries are again not curative but make the primary curative surgery easier. For example catheter insertion for chemotherapy.
• Apart from conventional surgical means, there are various recent developments to improve the success rate of the surgical procedure. Some of these are:
• Cryosurgery: it is a type of surgical procedure which involves subjecting the cancer cells to extremely cold temperatures leading to freezing off of the cells. This procedure may be performed on the external surface or on the internal surface using a cryoprobe.
• Laser surgery: LASER stands for light amplification by stimulated emission of radiation. Here, light energy is used to destroy cancer cells instead of mechanical surgery. It is a very precise technique which focuses on minute parts of the tumour like rectum, cervix, larynx, and skin.
• Electrosurgery: electrical energy is used to destroy the cancer cells. It is mainly used in skin cancers and oral cancers.

Prostate Cancer Surgery:

Prostate cancer surgery has two main types of approaches- radical surgery and laparoscopic surgery.

Radical prostatectomy: It is a traditional approach to prostatectomy where the complete gland is removed. There are two approaches to this procedure:

• Radical retropubic prostatectomy: the initial incision is at the lower abdomen, up to the pubic bone. The surgeon may also sample some of the associated lymph nodes to check for the spread. If the spread of cancer has approached the lymph nodes, the surgeon will not proceed with the surgery as it may cause more harm than help.
• Radical perineal approach: In this type of approach, the surgeon makes an incision from the skin between the anus and scrotum. This method is not used as commonly as it leads to erectile dysfunctions and does not allow access to the lymph nodes. These surgeries are relatively shorter and less painful.
• Transurethral resection of the prostate (TURP): this is a palliative surgery to relieve symptoms. The surgeon uses an instrument called resectoscope and removes the inner part of the prostate gland.

Laparoscopic prostatectomy: Laparoscopy is a surgical approach which uses small incisions and long instruments. It is minimally invasive and leaves less scar tissue. The surgeon may use long instruments directly or through a control panel to control the instruments.

• Laparoscopic radical prostatectomy(LRP): the surgeon inserts long instruments which can reach the prostate through small incisions. One of the instruments will have a camera at the end. This allows the doctor to see the path as he/she navigates through the body. This procedure has lower bleeding and shorter hospital stay. It may even be less painful than the traditional methods.
• Robot-assisted laparoscopic radical prostatectomy: instead of manually manoeuvring the instruments, the surgeon controls the instruments from a control panel and robotic arms perform the surgery. This provides more dexterity and precision to the doctor.

SIDE EFFECTS OF SURGERY:

• Urinary incontinence: the patient is unable to control passage of urine and may have a dribble or leakage of urine. There are various levels: stress incontinence, overflow incontinence, urge incontinence, continuous incontinence.
• Erectile dysfunction: the penile erection in humans is controlled by two bundles of nerves. The surgeons usually try to avoid damaging these nerves or at least on bundle of nerves is left undisturbed (nerve-sparing surgery). if one bundle is damaged, the patient may not have spontaneous erections. It both are damaged; the patient may not have erections at all. This again depends on the surgeon and the age of the patient. Medications may be taken to aid return of function (sildenafil, alprostadil).
• Changes in orgasm: patient may report a “dry” orgasm or reduced occurrence of orgasms. Rarely, the patient may also have painful orgasms.
• Loss of fertility: the vas deferens, the duct which carries the sperms from the testicles to the urethra is ligated (cut). So, the sperms are produced but are not released. Patients who want to father a child may have to go for alternatives like sperm banking prior to the surgery.
• Lymphedema: this may occur due to removal of many of the lymph nodes. The lymph fluid may accumulate in the patient’s limbs and genitals.
• Inguinal hernia: a prostatectomy increases the chances of developing an inguinal hernia.

Thyroid Cancer Surgery:

Depending on the extensiveness of the tumour, there are various types of surgical procedures.

• Lobectomy: it is a surgical procedure where the entire thyroid need not be removed. The surgeon makes an incision on the neck and resects the affected lobe, usually along with the isthmus. This surgery is performed in cases where the cancer does not show signs of spreading to other parts or also used as a diagnostic measure if FNAC is not clear. The main advantage of this type of surgery is that the patient may not need to take thyroid hormone supplements after surgery.
• Total Thyroidectomy: this procedure involves complete removal of the thyroid gland. The procedure is similar to that of lobectomies. Sometimes, the surgeon may leave a small portion of the thyroid gland back. This is called near-total thyroidectomy. If some of the gland is left behind, it is called sub-total thyroidectomy. Once the surgery is performed, the patient will be put on thyroid supplement pills (levothyroxine) for his/her entire life. Recurrence can be detected with radioiodine scans and thyroglobulin blood tests.
• Lymph node removal: if the lymph nodes are affected, the associated lymph nodes are also removed. This is done by a procedure called modified radicular neck dissection or central compartment neck dissection.

SIDE EFFECTS OF THYROID CANCER SURGERY:

• Hoarseness of voice (may be temporary or permanent)
• Parathyroid glands removed/damaged: this leads to low blood calcium levels, which causes muscle spasms, numbness and tingling sensations.
• Hematomas (large blood clots)