Surgery for cancer: removal of tumors in Oncology
Treatment of malignant tumors remains a difficult task and remains a cornerstone of modern Oncology. The development of science and the emergence of new methods of dealing with cancer allow you to achieve full recovery of many patients, but remains unchanged the main principle of treatment is maximal resection of tumour tissue. The role of surgery for cancer cannot be overemphasized, because the only way to get rid of as from the tumor itself and the negative impact that it has on the affected organ. If the disease is discovered in advanced stage, the surgical intervention if you are not able to extend the life of the patient, then at least to improve his health and get rid of painful manifestations of cancer, poisons the existence of the patient in the last months and weeks of life.
The removal of various formations on the human body is not new in medicine, surgery was performed thousands of years ago, and attempts to treat cancer were made before our era. In Ancient Egypt tried to surgically remove tumors of the breast, but the lack of knowledge about the nature of tumor growth, opportunities are anesthesia, antibiotic therapy, low level antiseptic measures did not allow to achieve positive results, so the outcome was pretty sad.
Last century became a kind of turning point, which allowed us to revise views on surgery in Oncology. Improvement of the approaches and re-evaluation of existing standards was given the opportunity to make surgical treatment not only more effective but also rational, when to replace the radical and often mutilating interventions came more gentle methods that enable and extend the life of the patient, and to maintain its quality at an acceptable level.
For many tumors surgical removal was and remains the «gold standard» of treatment, and most of us struggle with a malignant tumor is certainly associated with need for surgery. Significantly improve the efficiency of surgical treatment has allowed chemotherapy and radiation, conducted both before and after the removal of the cancer, but to completely replace operation is nothing even in the twenty-first century.
Today surgery in Oncology is not limited to removal of tumors, it also performs a diagnostic role, it can accurately determine the stage of the cancer, and when carrying out operations to remove whole organs, reconstructive surgery is becoming one of the most important stages and treatment, and subsequent rehabilitation. If the patient’s condition is such that to produce radical treatment is impossible, as there are severe concomitant diseases, preventing the intervention, or time was lost, and the tumor actively spread through the body, to the aid of palliative surgery to ease the condition and help avoid other complications from the tumor.
Approaches in cancer surgery
Used in Oncology chemotherapy and radiation therapy have a lot in common, most of the patients particular type of cancer, and the differences in each patient consist merely in the list of drugs, their dosage, intensity and method of exposure. Speaking of surgery, it is impossible to name any particular treatment regimen used for all patients with this type of cancer.
The choice of access, type of transaction, its volume, the need for reconstruction of the authority, the number of stages of treatment, etc. are almost always individual, especially in the common forms of cancer. Of course, certain standards still exist in the surgical treatment, but there can be no two identical tumors, it does not happen and just exactly the same operations.
Essential to an effective surgical intervention for cancer pathology is the observance of the principles ablastic and antiblastic that should be played regardless of the cancer type, form, growth stage, condition of the patient.
Ablestik involves total removal of the tumor within healthy tissue, so no cancer cells remained in the growth zone of the tumor. Adherence to this principle is possible under the so-called cancer in situ does not extend beyond the cell layer, which gave rise to the cancer in the first and second stage of the disease in the absence of metastasis. The third and fourth stages of the tumor, exclude the possibility of elastichnost intervention, since cancer cells have already begun their spread throughout the body.
Antiblastic consists of certain measures preventing the further spread of the tumor after surgery. Since the removal of the cancer may be accompanied by injury of the tissues of the tumor, and the risk of detachment of the already poorly connected malignant cells with a hit them in jars quite large. Compliance with certain technical features in the process of removing the tumors allows the surgeon to remove the tumor as accurately as possible, thereby decreasing the likelihood of recurrence and metastasis to a minimum.
The special features of surgery for malignant tumors include:
- Careful isolation of the wound from tumor tissue, early ligation of vessels, especially veins, preventing the spread of cancer cells and metastasis.
- Linen, gloves, instruments at each phase of the operation.
- The advantage of using electrocautery, laser, cryotherapy.
- Lavage of the area of intervention substances with cytotoxic effects.
The types of surgeries in Oncology
Depending on the stage of the tumor, its localization, presence of complications, comorbidities oncologist surgeon prefers a particular type of operation.
Upon detection of potentially dangerous neoplasms that have a high risk of malignancy, used a so-called preventive surgery. For example, removal of colon polyps helps prevent the growth of cancer in the future, and the patient is under constant observation.
The development of cytogenetic techniques allowed us to determine the genetic mutations characteristic of certain tumors. Especially clearly this relationship is observed for breast cancer, when in one family, it is possible to observe the recurrence of the disease in women from generation to generation. Upon detection of the corresponding mutation can resort to to remove the breast before the start of tumor growth. Such examples already exist and known to many: the actress angelina Jolie had surgery a mastectomy to avoid cancer in the future, because she had discovered the mutant gene.
Diagnostic operations are carried out to clarify the stage of the disease, malignant neoplasms, the nature of the lesion and the surrounding tissue. Such interventions need to be accompanied by taking a piece of tumor for histological examination (biopsy). If you remove all neoplasia, achieved two goals – and diagnosis, and treatment. Diagnostic operations also include a laparoscopy (examination of the abdominal cavity), laparotomy (opening the abdominal cavity for examination), thoracoscopy (examination of the chest cavity).
In recent years, with the development of high-precision non-invasive diagnostic methods that do not require surgical procedures, diagnostic operations to determine the stage of the cancer process has considerably decreased, although a decade ago it was a common practice in some types of tumors.
Cytoreductive surgery aim to maximally remove the tumor tissue and require subsequent chemotherapy or radiation. For example, cancer of the ovaries, often accompanied by the spread of the tumor into nearby organs and the peritoneum, it is not always possible to remove completely, no matter how radical was not operation.
Palliative interventions are conducted not with the aim of complete tumor removal and to alleviate the suffering of the patient or to deal with complications. Palliative care is often the lot of patients with advanced forms of cancer, when the tumor cannot be removed completely or radical intervention is associated with high risks. An example of such operations can be considered a restoration of bowel continuity with inoperable cancer, to stop bleeding from the tumour, as well as removal of isolated distant metastases. Another effect of palliative surgery will be reducing tumor intoxication and a General improvement in the patient’s condition, which will hold additional courses of chemotherapy or radiation.
Reconstructive surgery is used to restore the function or appearance of your body. If in the case of tumors of the intestine or urinary system it is important to give the patient a chance to recover in the usual way by recreating bladder section of the colon, after removal of the chest, operations on the face of one important aspect is the cosmetic effect. Plastic surgery enables you to restore the appearance of the body giving the patient the possibility of a comfortable existence in the family, among relatives, and beyond. The use of modern techniques and synthetic materials for plastic reconstruction of parts of the body largely determine the success of reconstructive surgery.
Depending on the scale of the tumor, the surgeon may resort to resection (partial removal of the organ), amputation (removal of Department of the authority) or hysterectomy (total removal of the organ). In case of small neoplasms, carcinoma in situ is a preference for resection or amputation. An important role plays the possibility of resection for the lesions of the organs that produce hormones. For example, when thyroid cancer is such a gentle technique in the case of small tumors without metastasis gives us a chance at least partially to preserve organ function and to avoid serious complications. Extensive neoplastic lesions leave no choice and require total removal of the body together with the tumor.
As a feature of malignant tumors that distinguish it from other pathological processes, is metastasis, the surgical treatment of cancer decided to remove the lymph nodes, the detection of cancer cells. Germination of neighboring organs or tissues requires the broadening of operations to eliminate all visible foci of tumor growth.
From General to specific
Having described the General features and approaches to surgical treatment of cancer, let’s consider the peculiarities of operations at specific types of cancer. As mentioned above, the doctor always has an individual approach to the choice of the method of tumor removal, which depends on type of cancer and the body in which it was formed.
Breast cancer is related to one of the most common in women worldwide, therefore, not only treatment but also rehabilitation and life care many. The first description of the radical operation was done more than a hundred years ago, when physician William Halsted conducted a mastectomy for cancer. Operation Halstead was very traumatic, as it required the removal of the gland and fatty tissue, both breast muscles and lymph nodes. This amount of interference maimed patients, leading not only to serious cosmetic defect, but also to deformation of the chest wall, which inevitably has an effect on the function of thoracic cavity organs and psychological state of women.
Throughout the twentieth century, approaches to surgery for breast cancer has improved, and experience has shown that the effect at a more benign techniques are not worse, but a higher quality of life and the rehabilitation process is successful.
Today modified versions of operations of Halstead (with preservation of the pectoral muscles) are produced at 3-4 stages of the tumor with massive involvement of lymph nodes, but she had a radical mastectomy only when the germination of the neoplasia of the pectoralis major muscle.
The advantage of breast conserving surgery is the removal of only part of the body that provides a good cosmetic effect, but a condition of their holding will be early diagnosis.
In non-invasive forms of breast cancer, when metastases are absent, too, removes the sector or quadrant of the body. The sense of preserving the axillary lymph nodes is to vain not to disrupt lymph flow from the arm, to avoid severe swelling, pain, movement disorders, always related lymphadenectomy.
When invasive cancer no choice, because the lymph nodes are often involved in the pathological process and should be removed necessarily.
For small tumors in I-II stages of the disease is one of the best operations is considered a lumpectomy – removal of tumor with surrounding tissue, but retaining the remainder of the body. Lymph nodes are retrieved through a separate small incision in the armpit. The operation is atraumatic and elegant, has good aesthetic effect and the number of recurrences or the probability of progression is not higher than with more extensive procedures.
The necessity of removing the entire gland, but no adipose tissue and lymph nodes, can occur in non-invasive carcinomas and hereditary form of the disease (prophylactic mastectomy).
Great importance has the appearance of the breast after surgical treatment, so the role of plastic surgery, allowing to restore the shape of the body by its own tissues, and with the help of artificial materials. Options such oncoplastic interventions, a great multitude, and peculiarities of their implementation are dictated by the characteristics of the tumor, shape of the breast, tissue properties, and even the preference of the surgeon in choosing a particular tactic.
When choosing a specific method of surgical treatment it is important to carefully examine the patient, assess the risks and to choose the operation that will meet all the criteria of cancer and to avoid recurrence or disease progression.
Along with breast cancer in women, prostate cancer in men also not give up their positions, and the issues of surgery in this case is still relevant. The «gold standard» for cancer of this localization is total removal of the prostate – radical prostatectomy, anything better and more efficiently it is not, and the difference lies in the access to and application of techniques allowing you to save your nerves and erectile function. One of the options considered laparoscopic prostatectomy, in which the organ is removed through a small incision, but it is possible only in the early stages of the tumor.
Equipped with modern equipment of foreign clinics and Russian major cancer hospitals that offer prostate removal with the help of robotisation system Da Vinci that enables intervention with even smaller incisions than laparoscopy. To conduct such an operation requires a very high qualification, experience and professionalism of the surgeon, assistants and the equipment is concentrated in larger cancer centers.
Radical prostatectomy is used even in the case of very small carcinomas, and removal of part of the prostate is shown only when surgical intervention is palliative, allowing urination to restore the disturbed massive growth of the tumor tissue to stop bleeding or to reduce pain.
Cancer of the gastrointestinal tract
Tumors of the gastrointestinal tract almost always require radical and even expanded operations, as actively metastasize already in the early stages. So, stomach cancer gives the defeat of the regional lymph nodes are already in the penetration of submucosal layer, with the size of the tumor can be quite small. Only when the carcinoma is limited to mucosa, allowed endoscopic resection with preservation of lymph nodes, in other cases, carry out the removal part (resection) or all of the stomach with lymph node dissection, number of lymph nodes no less than 27. In severe stages apply palliative surgery to restore patency of the stomach, relieving pain, etc.
For bowel cancer surgery is determined by the location of the tumor. If the affected transverse colon, can be performed resection of the intestine, and in the case of tumor growth in the left or right half of the colon, hepatic or splenic angles surgeons resort to removing half of it (hemicolectomy).
Often interventions of this kind are made in several stages, where the intermediate is a colostomy – a temporary hole in the abdominal wall for elimination of feces. This period is very difficult psychologically for the patient requires care of the colostomy and dieting. Further can be carried out reconstructive surgery, aimed at restoring the natural passage of the contents to the anus.
A very difficult task remains the treatment of colorectal cancer, often requiring removal of the whole body, without subsequent plastic surgeries there is not enough.
Uterine tumors almost always involve surgical treatment, but approaches can be different depending on the stage of the cancer and the age of the woman. Cervical cancer is often diagnosed in young patients, so the issue of preservation of childbearing and hormonal functions is quite acute. Most often in malignant tumors of this localization have resorted to complete removal of the uterus, ovaries, lymph nodes and tissue of the pelvis. In this volume of interference about the possibility of having children can be forgotten, and the symptoms of premature menopause are quite heavy and poorly amenable to correction. In this regard, young women in the early stages of the tumor and try to preserve the ovaries, and when non-invasive or micro-invasive cancer allowed the deletion of the fragment of the cervix (conization), but in this case, you need to remember about the possibility of relapse.
In many foreign clinics practicing organ surgery, a radical trachelectomy, when it only removes the cervix and surrounding tissue. Such interventions are complex and require very highly qualified surgeon and no special skills, but the result is the preservation of fertility.
Neoplasms of the endometrium (mucosa) often leave no choice and require complete removal of the uterus and appendages, lymph nodes, tissue of the pelvis. Only in cases of early forms of the disease, when the tumor does not extend beyond the mucous membrane, possible sparing techniques to save the body.
Cancer of paired organs
Surgical treatment of malignant tumours of paired organs (kidney cancer, lung) provides a great opportunity to apply radical methods, but on the other hand, if the second body is also not healthy, then difficulties may arise.
The kidney removal for cancer in the early stages of the disease gives 90% positive results. If the tumor is small, we can resort to the removal of part of an organ (resection), which is especially important for patients with one kidney or other diseases of the urinary system.
Prognosis after the removal of the kidney can be called favorable for maintaining normal function of the other kidney, which will have to take on the full process of urine formation.
The removal of the entire lung cancer is performed in severe cases. Operations on the respiratory system difficult and traumatic, and the consequences of the removal of lung cancer can be a disability and loss of ability to work. However, it should be noted that the degradation depends not only on the fact of removing the whole body, because the second light is able to assume its function as the patient’s age, presence of comorbidity and stage of cancer. It is no secret that lung cancer affects mostly older people, so the presence of coronary heart disease, hypertension, chronic inflammatory processes in the bronchi will be felt in the postoperative period. In addition, in parallel, chemotherapy and radiation also weaken the body and can cause poor health.
Surgical treatment of malignant tumors remains the primary method of controlling the disease, although most patients do not experience such fear as in the case of need of chemo or radiation, it is better to get on the operating table as early as possible, then the result of the operation will be much better, and the consequences are not so dangerous and unpleasant.