Learn more about cancer surgery for both diagnosis (biopsy) and tumour removal; including 12 questions to ask your surgeon, along with non-surgical alternatives increasingly being used.
Approximately 60% of cancer patients will have surgery; it can take different forms and it is important to ask questions about what may happen. We also cover what to expect from surgery for cancer.
Using surgery to examine and discover
Some operations may involve endescopes, where an instrument is inserted through a hole made in the body. The endescope allows the surgeon the ’see’ inside the body via a camera and take a small amount of tissue for examination.
Some operations may involve a similarly small treatment. For example, the majority of bladder cancers only affect the bladder lining, and can be removed through a cytoscope (a tube passed into the bladder). The bladder can continue to work normally and even if the cancer returns, it may be possible to work on it again in this way.
Some operations, whilst requiring the surgeon to open up the body, may only be to take tissue for testing. This is called a biopsy.
For example, in cases of brain tumours - the surgeon may open up the skull, take some tissue from the tumour, and then use titanium screws to hold the skull back in place. At a later date, if there is a need for a full or second operation, the plate can be lifted.
Many men have prostate biopsies. These are invasive, go through the rectum and can result in infection and a stay in hospital. Worse, biopsy for prostate cancer breaks through the surrounding prostate capsule and can cause spread or metastasis. There are several studies. Fortunately, less invasive examinations are being developed; a measurement of glutamate levels in the plasma accurately provides a Gleason Score - which was what the biopsy was providing.
Surgery in these examples is diagnostic. The surgeon uses his skills and, with the aid of pathology and histology reports, to then make an accurate assessment of the problem. From this stage and grade may be determined.
It should be stressed that in the majority of these cases, the results will indicate that the problem is not malignant.
Using Surgery to remove - tumours
Surgery is used for many cancers and works best when there is a tumour confined to one area - it is then said to be a solid tumour. This is ideal for surgery and the whole tumour may be removed effectively. Indeed it must be. There is
clear research on breast cancer that surgery which has clear margins increases survival times! As if the surgeon feels he will be able to get good margins.
Sometimes - for example in ovarian or endometrial - the surgery doesn't just remove the tumour, but it is precaustionary and a hysterectomy or more may be used.
If the tumour has started to spread, the surgeon may also remove some of the surrounding tissue, and if it has moved to lymph glands he may well remove some of those too. In rare occasions a surgeon might remove many lymph nodes resulting in a problem called lymphoedema,
Go to: manual lymphatic drainage and lymphoedema
These days, a surgeon would always prefer to confine his surgery to a localised removal e.g. breast lumps using lumpectomies; or bowel tumours and prostate cancer using key hole surgery, rather than having to perform larger cuts, greater tissue removal and extended recovery times. The former is ’clean’ and limited, causes less inflammation, less stress on the body and less release of growth hormone; and considerably improves the quality of the patient’s life.
However, sometimes the evidence shows it is best to remove the whole organ - for example in HER2 breast cancer - mastectomy increases survival times.
If the cancer has spread, or there is a risk it may have done, surgery may well be followed by radiotherapy and/or chemotherapy. Further surgery is also a possibility but is only needed in a small number of cases.
Fortunately, some surgeons are choosing 'surgical systems' other than the scalpel. In lung cancer, or kidney cancer, small tumours may be killed (removed) by using Radio-frequency ablation, where the tumours are heated and burnt, or cryoablation where they are frozen to death. Newer procedures are also used - such as the Nanoknife IRE for inaccessible or deep seated tumours. two probes are inserted, one either side of the tumour and a current is passed between them.
Go to: Ablation, Nanoknife, HIFU
Before any operation your surgeon should explain exactly what is to be done. You should feel free to ask the surgeon any and all questions, and he should be happy to answer them.
You may feel you want a second opinion. This should not upset the surgeon. Try to obtain a second opinion from a hospital or training school outside the environment of your first surgeon. The local health authority can help, as can the cancer charities. You can even submit your file (including x-rays, scans and histology and pathology reports) to hospitals via the Internet. Since the 2000 Cancer Act you have a legal right to your medical records within 10 days, the surgeon should have them, or you may have to obtain them via your GR. But if you do ask and receive them you must not be upset by the ’clinical’ nature of the reporting!
Prepare yourself for the surgery with supplements to aid your healing, others to prevent yeast build up, and others to prevent cancer cells being released in your body.
Go to: 10 ways to prepare yourself for surgery naturally
You should also radically review your diet. You need to be eating a diet based on colourful vegetables and fruits, cutting down your toxins (alcohol, smoking, sugar, salt, caffeine, and saturated fat, while increasing your intake of good fats.
Go to: CANCERactive dietary guidelines for surgery
Finally, remember one important fact. The surgeon will do his level best to cut out all the cancer from your body that he can safely do. But your diet, the products you use and your lifestyle may well have brought on the cancer in the first place. You were most probably doing something that made you ill in the first place; very few people are victims.
If you do not change your diet, the products you use and your habits and lifestyle other cells in your body may well turn cancerous, not merely because the original one had spread.
And next time the surgeon may not be able to save you. For a short while your life may be in his hands. But in the longer term, it’s in your own.
12 questions to ask your surgeon
1: Please describe the operation in detail. How long will it take?
2: What are the risks during the operation?
3: Will the surgery cure the problem, or merely slow it down?
4. For breast cancer - will the surgeon get good margins?
5: What does the surgeon consider to be success?
6: What are the short-term and long-term effects?
7: What treatment (s) will be needed after surgery?
8: Will I ever need another operation?
9: How likely is my cancer to come back after surgery?
10: How often has the surgeon performed this particular operation before?
11. Is there an alternation to the scalpel - could we use ablation, or the Nanoknife?
12. How long am I realistically going to take to recover?