Cancer involves abnormal cells growing uncontrollably, invading nearby tissues, and spreading to other parts of the body through metastasis.
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The treatment phase in surgical oncology is when the plan made during diagnosis is put into action. This means physically removing the tumor, but the approach depends on the body’s structure and how cancer works. Surgery can range from small, minimally invasive procedures to large operations that remove and rebuild several organs. Today’s surgical oncologists use a mix of open, laparoscopic, and robotic methods to get the best results for both cancer control and patient function.
A key idea in cancer surgery is the “En Bloc” resection. This means taking out the tumor and a rim of healthy tissue all at once, without cutting into the tumor. Cutting into the tumor during surgery can release cancer cells and cause the cancer to come back. For cancers in the abdomen or chest, surgeons often also remove nearby lymph nodes to catch any cancer cells that may have started to spread.
Technological advancements have ushered in the era of Minimally Invasive Surgery (MIS). Laparoscopic surgery uses small incisions and long instruments to perform operations that previously required significant open cuts. This reduces trauma to the abdominal wall, decreases pain, and speeds up recovery. Robotic surgery takes this a step further. The robotic platform offers 3D high-definition visualization and instruments with “wristed” articulation that exceeds the range of motion of the human hand. This allows for precise dissection in confined spaces like the deep pelvis (for rectal or prostate cancer) or the throat (for head and neck cancer), sparing nerves and preserving function while ensuring clear margins.
Not all tumors are removed surgically. Ablative therapies use thermal energy to destroy tumors in situ. Radiofrequency Ablation (RFA) and Microwave Ablation use heat to cook the cancer, while Cryoablation uses extreme cold to freeze it. These are often used for liver or lung metastases that are too numerous or difficult to resect surgically. They are performed percutaneously (through the skin) or laparoscopically, minimizing patient impact.
For advanced cancers that have spread to the lining of the abdomen (peritoneal carcinomatosis), Cytoreductive Surgery (CRS) combined with Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is an option. CRS involves the surgical removal of all visible tumor deposits from the abdominal organs and lining. Immediately after, a heated chemotherapy solution is circulated through the abdomen for 90 minutes. The heat helps the chemotherapy penetrate the remaining microscopic cells and enhances its killing power. This aggressive combination is a prime example of surgery and biology working together.
Surgical Technologies and Innovations
The “oncology” part of surgical oncology is removing the cancer; the “surgical” part often involves putting the patient back together. Reconstruction is vital for the quality of life. In breast cancer, this means oncoplastic surgery or flap reconstruction to restore the breast mound. In head and neck cancer, it involves microvascular free flaps taking tissue from the leg or arm and reconnecting the tiny blood vessels in the neck to rebuild a jaw or tongue. In sarcoma, it means limb-salvage surgery, replacing bone with metal implants to avoid amputation. The goal is to restore the patient’s form and function so they can return to everyday life.
Surgery is usually combined with other treatments. Neoadjuvant therapy, given before surgery, helps shrink large tumors so they can be removed more easily and sometimes lets doctors save more of the organ. It also treats small cancer cells that may have spread. Adjuvant therapy, given after surgery, aims to kill any remaining cancer cells. Surgeons work closely with other doctors to plan the timing of surgery, making sure the patient is ready to heal but not waiting so long that the cancer returns.
The application of energy is critical. Bipolar energy devices seal blood vessels by denaturing collagen and elastin, creating a permanent seal. Monopolar cautery cuts through tissue by vaporizing cells. The surgeon must balance the need for hemostasis (stopping bleeding) with the need to minimize thermal spread that could damage nerves or compromise the healing of the surgical margin. Understanding the physics of these devices how electricity flows through tissue and how heat dissipates is a fundamental skill of the surgical oncologist.
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HIPEC stands for Hyperthermic Intraperitoneal Chemotherapy. It is a procedure used during surgery for advanced abdominal cancers. After the surgeon removes all visible tumors, a heated chemotherapy solution is circulated inside the abdomen to kill any remaining microscopic cancer cells. The heat helps the drug penetrate the tissue and increases its effectiveness.
A free flap is a piece of tissue (skin, muscle, bone, or fat) that is disconnected from its original blood supply and moved to another part of the body to repair a defect after cancer surgery. The surgeon uses a microscope to sew the tiny blood vessels of the flap to the blood vessels at the new site to keep the tissue alive.
A clear margin means that no cancer cells are seen at the outer edge of the tissue removed during surgery. This is the most critical factor for preventing the cancer from growing back in the same spot (local recurrence). If margins are unclear, patients may need additional surgery or radiation.
Laparoscopic surgery uses small incisions, a camera, and long instruments. Because it avoids significant cuts through muscle and skin, patients typically experience less pain, have a lower risk of wound infection, recover bowel function sooner, and have a shorter hospital stay compared to traditional open surgery.
Ablation is a technique to destroy tumors without removing them. It involves inserting a needle-like probe into the tumor and using extreme heat (radiofrequency/microwave) or extreme cold (cryoablation) to kill the cancer cells. It is often used for tumors in the liver, kidney, or lung that are difficult to remove surgically.
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