have become more precise. As well, pathology
analysis of the tumor has become more efficient
and accurate. The surgeon sends samples of the
tumor and surrounding tissue to the pathology lab-
oratory during the operation for immediate exami-
nation by a pathologist. The pathologist’s initial
report helps the surgeon determine whether there
is a need to remove additional tissue.
In therapeutic surgery the surgeon excises (cuts
out) the tumor with a margin of healthy tissue to
capture stray cancer cells at the tumor’s edges. The
goal of such surgery is to eliminate the cancer so
the person makes a full recovery and remains can-
cer free (with or without adjuvant therapies). For
large tumors that are difficult to remove, the sur-
geon may perform cytoreduction (also called
tumor debulking) to reduce the size and presence
of the cancer as much as possible with the goal of
improving the effectiveness of other treatments
such as chemotherapy or radiation therapy. In
advanced cancer, inoperable tumors may create
obstructions or grow into the space an organ ordi-
narily occupies. The surgeon may perform pallia-
tive surgery to remove enough of the tumor to
relieve pressure on nerves, BLOOD vessels, and
other structures that may be causing pain or inter-
fering with an organ’s function.
Types of Surgery
Until the 1990s the standard practice in therapeu-
tic cancer surgery was to remove substantial tissue
to ensure removal of the cancer, often resulting in
radical surgery such as MASTECTOMY(removal of a
BREASTto treat BREAST CANCER) or bowel resection
(removal of the COLONto treat COLORECTAL CANCER).
Improvements in the understanding of how can-
cer functions in the body in combination with
advances in other treatments for cancer have
shifted the approach in cancer surgery toward
sparing tissue, organs, and limbs to preserve body
structures and functions, relying on a combination
of therapies to treat the cancer. When the stage
and grade of cancer still requires radical surgery,
advances in reconstructive surgery (often per-
formed at the same time as the cancer surgery)
have improved QUALITY OF LIFEafter surgery.
MINIMALLY INVASIVE SURGERYmay be an option
for stage 0 cancers, which are small and narrowly
confined to the site of origin. OPEN SURGERYis gen-
erally the preference for stage 1 and 2 cancers, so
the surgeon is able to remove all of the cancer and
obtain an acceptable margin of healthy tissue. The
length of hospitalization and recovery from the
surgery depends on the operation and the person’s
overall health status. Many people who undergo
surgery as primary treatment for cancer are other-
wise healthy and typically experience a prompt
and uneventful course of recovery.Risks, Side Effects, and
Complications of Surgery to Treat Cancer
Though cancer surgery methods are very
advanced, risks and complications are possible.
Diagnostic imaging procedures provide the sur-
geon with a good understanding of where the
cancer is and how it involves tissues and organs.
However, the surgeon cannot know for certain the
nature and extent of the tumor until the surgery
exposes it for full examination. Though most sur-
geries go exactly as anticipated, unexpected find-
ings can shift the operation in a different
direction. The surgeon typically recognizes the
potential for the unexpected and includes discus-
sion of such possibilities in the informed consent
process. It is important to talk with the surgeon
the anticipated benefits and potential risks of the
planned operation. A second opinion consultation
with another surgeon or with a medical oncologist
for a discussion of nonsurgical treatment options is
often a good idea, particularly when the proposed
surgery is extensive or complex.
See also CANCER TREATMENT OPTIONS AND DECI-
SIONS; MOHS’S SURGERY; QUALITY OF LIFE; PLASTIC SUR-
GERY; SURGERY BENEFIT AND RISK ASSESSMENT.394 Cancer