Fundamentals Of Surgical Oncology

What is Surgical Oncology?

Surgical oncology is the specialized area of oncology that is used to manage and treat cancer.   Surgical OncologyThis branch of surgery refers to all the different types of surgeons that are engaged in treatment and management of all the different types of cancers and tumors. One of the main tasks of an oncology surgeon is to determine the relationship between removal of tumor and the risk associated by the initial tumor. The surgeon is more experienced in patient management through more conservative procedures than the conventional resection and excision methods of treatment.

What conditions are treated with Surgical Oncology?

Surgical treatment of cancer is usually the last resort in cancer management when all other alternatives and non-surgical cancer treatments have been unsuccessful. Surgical treatment in oncology is used to treat the following types of cancers:

  • Breast cancer
  • Colon and Rectal cancer
  • Endometrial cancer
  • Renal (Kidney) cancer
  • Lung cancer
  • Skin cancer
  • Pancreatic cancer
  • Prostate cancer
  • Thyroid cancer
  • Oral cancer
  • Brain tumors
  • Throat cancer

What are the different Surgical Oncology techniques?

The treatment of most cancer is attempted with many different non-surgical techniques such as radiation therapy, chemotherapy, etc and if these treatments are unsuccessful in relieving the symptoms or treatment of the cancer then the doctor will suggest a surgical treatment for it.

There are different surgical techniques in oncology and the type of technique suitable for you will depend upon various factors such as your overall health, age, stage of cancer, location of cancer, etc. The doctor will take such factors into consideration and suggest the most efficient and best surgical technique for the treatment of your cancer.

These are the different surgical techniques:

Diagnostic

Many cancers require a biopsy to make a definite diagnosis. A surgical biopsy of a suspected cancer/tumor requires the surgeon to make an incision in the skin and reach the cancerous area to remove a small piece of the suspected cancer tissue. The two types of surgical biopsies are ‘incision biopsy’ which involves removal of a small part of the suspected area for extensive pathological examination and the ‘excision biopsy’ that requires the removal of the entire suspected area such as an abnormal lump or a mole.

A biopsy is performed to make the tissue available for a detailed and extensive pathological examination in which the pathologist examines the tissue cells and determines the presence of cancer as well as the type of cancerous cells in it.

Staging

This surgery is required to determine the size and the extent of the area in which the tumor has metastasized (spread). This usually involves removing the lymph nodes near the cancerous area. The doctor will get a better idea regarding the type of treatment ideal to cure that particular cancer with the help of physical examination, biopsy, staging surgery and results from the imaging tests and pathology laboratory.

Curative

This is also known as ‘primary surgery’ or simply ‘tumor removal’ and is the most common type of oncology surgery. This surgery requires removal of the tumor as well as part of the surrounding tissues, called ‘margin’. This procedure may be performed as a singular procedure for cancer treatment or it could be done in combination with chemotherapy or radiation therapy, before or after the curative surgery.

The curative surgery may use either the conventional method which requires the surgeon to make large cuts and incisions into the skin and shifting of underlying muscles, bones and other tissues to reach the cancerous area, or it could be done with a minimally invasive method that requires smaller and lesser number of incisions that are advantageous due to lesser surgery time and faster recovery.

De-bulking

This method is used to remove as much portion of the tumor that can be removed without causing damage to the body in situations where complete removal of the tumor is not possible. Usually, the doctor uses radiation or chemotherapy to shrink the remaining tumor.

Palliative

Palliative surgery aims to relieve the symptoms and side effects caused by a tumor. This helps improve the patient’s quality of life. These are the different palliative surgeries and their aims:

  • In case a tumor is putting undue pressure on a nerve or the spinal cord the surgery can help in relieving the pain and restore the restricted physical functions.
  • Palliative surgery is also used to stop bleeding in cases where the cancer occurs in areas with higher number of blood vessels such as in the uterus and other organs where there is a higher chance of the tumor experiencing friction. Bleeding may also be caused due to a side-effect of chemotherapy. Suture ligation is the most common surgical technique to stop bleeding which involves tying the bleeding blood vessels with surgical thread.
  • This also involves inserting different types of tubes for delivery of medication, feeding, etc.
  • Palliative surgery is also used in providing external support to cancer weakened bones by inserting metal rods and fixing them along the weakened bones to provide support and prevent fractures in these fragile bones.

Reconstruction

Plastic surgery or reconstructive surgery is helpful in restoring the body’s normal appearance after a primary cancer surgery especially. This is usually done right after the tumor is removed to save time. It may also be done at a later time in case the person’s health is not suitable for an additional surgery. Breast reconstruction after a mastectomy and other plastic surgeries for the neck and the face after oral cancer surgery are examples of more common forms of reconstructive cancer surgeries.

Preventive

Certain surgeries are also performed to prevent cancers such as removal of pre-cancerous polyps in the colon to prevent colon cancer. At times a mastectomy is also preformed as a preventive procedure in women who have a strong family history of breast cancer or show gene mutations in the BRCA 1 and BRCA 2. Some women with ovarian cancer genes may also undergo an oophorectomy to remove the ovaries and prevent ovarian cancer from occurring in the future.

Laparoscopic

This is a type of minimally invasive surgical method. This is performed using a thin and flexible surgical tube (laparoscope) that has a video camera, light and other tiny surgical instruments attached to its end. This procedure requires very minute (keyhole) incisions and lesser number of incisions as compared to a conventional surgery.

Laser

This surgical method uses a focused beam of high-frequency light to destroy the cancerous cells without needing any incisions.

Endoscopic

This is a non-invasive type of surgical procedure in which a thin and flexible tube (endoscope) with a camera and light attachment at its end is inserted into the patient’s body through either, the mouth, rectum or vagina to examine the internal organs. Endoscopic surgery is also useful in obtaining samples of cancerous tissues (biopsy) for detailed pathological examination.

Cryosurgery

This type of surgery is performed using highly cooled liquid nitrogen to freeze and destroy cancerous cells.

Mohs micrographic method

This type of surgery is also known as microscopically controlled surgery which requires the surgeon to chip off very thin layers of the skin affected with skin cancer until all the layers appear to be normal when viewed microscopically.

What does a Surgical Oncologist do?

A surgical oncologist is a doctor who specializes in the surgical treatment methods of cancer. This is one of the three basic clinical disciplines in the field of oncology.

A surgical oncologist is trained in the removal of tumor and cancerous cells through a surgical procedure. The surgical oncologist also performs biopsies which involves removal of a small piece of suspected cancerous tissue or a suspected tumor so that it can be sent for a detailed and extensive examination to the pathological laboratory.

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