There are many reasons to have surgery. Some operations can relieve or
prevent pain. Others can reduce a symptom of a problem or improve somebody’s
function. Some surgeries are done to find a problem.
The objectives of surgical management of cancer are cure and palliation
care. palliative care is established to convert a lethal disease (like breast
cancer) to a chronic disease. The disease is present but the patient is coping
with it.
- Diagnosis
- Prevention
- Treatment of primary tumor
- Resection of metastasis à improve quality of life and prolong survival
- Management of oncological emergencies
- Surgery for palliation
- Surgery for residual disease Surgery for reconstruction
- Cytoreduction
- Regional chemotherapy
A} Surgery for Diagnosis:
(1)
FNAB (fine needle
aspiration biopsy). They used to be afraid from FNA in the past, because
they thought that cells from the tumor will go along the tract (made by the
needle) and this will worsen the behavior of the tumor and the condition of the
patient. Now the studies proved that there is no harmful impact from using the
FNA. Recently the use of the FNA is becoming more common and feasible, because
of the emerge of guided FNA, using the ultrasound or CT scan.
Disadvantages of FNA:
1- It doesn’t give us
histological diagnosis, it gives only cytological one. So we can’t find
the stage or the grade of the tumor. I can’t find if the tumor is in-situ or
invasive. So we can’t depend on it when there is a need to implement a major
management.
2- It has a false positive
and a false negative results. So if I did FNA in a suspected mass and I found
it negative against my expectations, I consider myself as if I hadn’t done it
at all. IT’S a good positive test but it’s a bad negative test.
(2)
Tru-cut biopsy to capture a high-quality tissue samples with
minimal trauma to the patient. gives histological diagnosis. It must be done
under mammogram, CT scan or computer guidance, has a special needle.
(3)
Incisional biopsy means to make an incision
through a suspicious mass, without removing the whole mass but part of it. Rarely
used except in special circumstances where we must avoid big surgery, and when
tru-cut biopsy is not suggested.
(4)
Excesional biopsy
(Most common procedure done) must be done with safety margin (The best
oncological procedure is done when you don't see the tumor (it remains inside
the safety margin and you don't see it). The distance taken as safety margin
depends on behavior (TYPE) of tumor (more invasive, longer safety
margin) as well as the SITE of tumor (under the eye not like the lower
limb).
B} Surgery for Prevention:
It means that don't allow the tumor to come.
Eg. Female patient has high incidence to develop breast cancer (family
history, BRCA1 BRCA2, age …etc) offering her to do surgery to remove the target
tissue and thus prevent cancer to occur (this approach is not agreed upon
between different surgeons).
C} Surgery for residual disease:
After Neoadjuvent chemotherapy
After radiotherapy
After inadequate surgery
Done after the response found not to be 100% or there was no response.
D} Surgery for Metastatic Disease:
Metastasis, or metastatic disease, is the spread of a cancer or disease
from one organ or part to another not directly connected with it. The new
occurrences of disease thus generated are referred to as metastases.
Most common metastases sites are: lung, brain, liver.
E} SURGERY FOR ONCOLOGIC EMERGENCIES:
Hemorrhage, Abscesses, Perforation eg. gastrointestinal
Perforation of the tract after effective treatment for lymphoma
This article is under development. You are
welcome to contribute to it, valued comments will be added after being reviewed.
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