Surgery is the oldest effective cancer therapy. It can be used alone or in combination with other modalities (see also Overview of Cancer Therapy). The size, type, and location of the cancer may determine operability and outcome. The presence of metastases typically precludes surgery.
Factors that increase operative risk in cancer patients include
Age
Comorbid conditions
Debilitation resulting from cancer
Cancer patients may have poor nutrition resulting from anorexia and the catabolic influences of cancer. These factors may inhibit or slow recovery from surgery. Patients may be neutropenic or thrombocytopenic or may have clotting disorders; these conditions increase the risk of sepsis and hemorrhage. Therefore, preoperative evaluation is paramount.
Primary Tumor Resection
If a primary tumor has not metastasized, surgery may be curative. Establishing a margin of normal tissue around the primary cancer is important for success. Intraoperative examination of tissue sections by a pathologist may be needed. Immediate resection of additional tissue is done if margins show cancer.
Surgical resection may include removal of local and regional lymph nodes and/or resection of an involved adjacent tissue or organ.
Neoadjuvant chemotherapy or radiation therapy may be given before surgery to reduce the cancer size, limit the extent of surgery, and improve success rates. Adjuvant chemotherapy or radiation therapy may be given after surgery to decrease the risk of recurrence.
Resection of Metastases
Local and regional lymph nodes are sometimes removed during surgery to evaluate the extent of cancer spread and reduce likelihood of cancer recurrence. Limited numbers of metastases, especially in the lungs, liver, or brain, can sometimes be resected or treated with radiation therapy.
Tumor Debulking (Cytoreduction)
Tumor debulking (surgical resection to reduce cancer size) is sometimes done when removing all the cancer is impossible. Tumor debulking may increase the sensitivity of the remaining cancer to other treatment modalities through unclear mechanisms.
Palliative Surgery
Surgery to relieve symptoms and preserve quality-of -life is reasonable even when cure is unlikely or when an attempt at extensive surgery is precluded. Resection may be indicated to control pain, reduce the risk of hemorrhage, or relieve obstruction of a vital organ.
Reconstructive Surgery
Reconstructive surgery may improve a patient’s comfort or quality-of-life after surgery (eg, breast reconstruction after mastectomy).
