Surgery

Surgery is known the oldest type of cancer therapy and remains an effective treatment for many types of cancer today.

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Why Surgery?

To diagnose cancer

To remove all or some of a cancer or tumour

To locate the cancer

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

Types of conventional surgery

Diagnostic

For most types of cancer, a biopsy is the only way to make a definitive diagnosis. During a surgical biopsy, the surgeon makes a cut called an incision in the skin. Then, he or she will remove the suspicious tissue.

There are 2 main types of surgical biopsies:

  • An incisional biopsy is the removal of a piece of the suspicious area for examination.
  • An excisional biopsy is the removal of the entire suspicious area, such as an unusual mole or a lump.

After a biopsy, a pathologist uses a microscope to examine the tissue removed. The pathologist will interpret laboratory tests and evaluate cells, tissues, and organs to diagnose disease.

Staging

Staging surgery is performed to find out the size of the tumour and if or where it has spread. During this surgery, the doctor often removes some lymph nodes near the cancer to find out if it has spread.

The health care team uses the results from this surgery along with the results of other tests to guide the treatment options. These tests can also help predict a patient’s prognosis, which is the chance of recovery.

Tumour removal

Surgery is most commonly used to remove the tumour and some of the surrounding healthy tissue. The tissue surrounding the tumour is called the margin. Tumour removal may be the only treatment, or it may be combined with:

  • Chemotherapy
  • Radiation therapy
  • Other treatments, which may be given before or after surgery

With conventional surgery, the surgeon makes large incisions through skin, muscle, and sometimes bone. In some situations, surgeons can use surgical techniques that are less invasive. These less-invasive techniques may speed recovery and reduce pain afterwards.

Convention Surgeries

Debulking

Sometimes, the surgeon cannot remove the entire tumour as removing it might cause too much damage to the body. In this situation, the surgery procedure is used to remove most of the tumour. Other treatments, such as radiation therapy or chemotherapy, may be used to shrink the remaining cancer. These treatments may also be given before surgery to help shrink the tumour so it can be removed.

Palliation

Palliative surgery is used to relieve side effects caused by a tumour. It plays an important role in improving 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 tumour causes the following complications:
  • Pressure on a nerve or the spinal cord
  • Blockage of the bowel or intestines
  • Pressure or blockage elsewhere in the body.
  • To stop bleeding. Certain cancers are more likely to cause bleeding, including:
    • Cancers in areas with a high concentration of blood vessels, such as the uterus,
    • Cancers in organs that are fragile and can easily bleed when food and waste products pass through, such as the oesophagus, 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 involves tying blood vessels using surgical thread.

Reconstruction

Reconstructive or plastic surgery may be an option to restore the body's appearance or function. The surgery can be done at the same time during the removal of the tumour. It also can be done later after the patient recovers or received additional treatment.

Prevention

Some surgery is performed to reduce the risk of developing cancer. For example, doctors often recommend 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 to the BRCA1 and BRCA2 breast and ovarian cancer genes may decide to have a mastectomy or oophorectomy to lower the risk of developing breast or ovarian cancer. A mastectomy is the removal of a breast, whereas an oophorectomy is the removal of the ovaries.

Minimally invasive surgery

Conventional surgery often requires large incisions. In some situations, a surgeon can use one or more small incisions. These surgeries typically result in shorter recovery times and less pain after the procedure.

Below are some examples of minimally invasive procedures and surgeries:

Laparoscopic surgery

The doctor performs surgery through small incisions in the skin using a thin, lighted tube with a camera. The term laparoscopy refers to a minimally invasive surgery of the abdomen. The terms, mediastinoscopy and thoracoscopy are used when the same type of procedure is performed in the chest. Laparoscopic surgery may also be done with robotic assistance for some surgeries. During this type of surgery, the surgeon directs robotic instruments to perform the surgery. This surgical procedure may be used for the kidneys, a man’s prostate, or a woman’s uterus or ovaries.

Robotic Assisted Surgery

A highly advanced method in the latest of MIS, to perform surgery using the da Vinci Surgical System which allows surgeon to perform surgery through a few small incision with unsurpassed clarity of 3D vision and wrist designed instruments which can bend and rotate far greater than a human hand. Movement of the surgeon is scaled and translated into fine movement of the instruments which gives surgeons unprecedented control in the surgery. The robotic technology enables a routine complex surgery to be done in a minimally invasive way with benefits of less blood loss, fewer complications, shorter hospital stays, smaller incisions for minimal scarring, and faster recovery.

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

The dermatologist shaves 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.

Endoscopy

The doctor inserts a thin, flexible tube with a light and camera at the tip, into the body. It may be inserted into the mouth, rectum, or vagina to examine internal organs. During an endoscopic procedure, it is possible to remove samples of potentially abnormal tissue for further examination.