Surgery in cancer patient: Introduction, Types of surgery, Minimally Invasive Surgery (MIS)

Introduction:

A team of professionals, including an oncologist, surgeon, and pathologist, work together to make the best diagnosis and treatment decisions for cancer patients.

Surgery is the removal of the tumor and surrounding tissue during an operation. Surgery is the oldest and traditional type of cancer therapy, diagnosis, and remains an effective treatment for many types of cancer today

 The goals of surgery vary. It is often used to remove all or some of the cancerous tissue after diagnosis. However, it can also be used to diagnose cancer, find out where the cancer is located, whether it has spread, and whether it is affecting the functions of other organs in the body. In addition, surgery can be helpful to restore the body’s appearance or function or to relieve side effects.

 Therefore, surgery plays a major role in the diagnostic, staging and treatment of cancer. It is also an integral part of the rehabilitation and palliation for the clients with cancer. Many of the aspects of surgery in other conditions are similar to cancer surgery but here the patient has to be prepared and has to understand that type of changes occur after surgery. The preparation includes emotional preparation to cope with the diagnosis, similarly preparation like blood transfusion and nutritional therapy may be required before surgery.

Types of conventional surgery:

Diagnostic surgery

The diagnosis of cancer is established by microscopic identification of malignant cells from tumor tissue in order to determine if the cells are cancerous.

Biopsy always remains a procedure and method to true diagnosis in most types of cancer.  

The surgeon accomplished with the medical team a cut in the skin carefully and removed it during a surgical biopsy.

 Basically, there are two main types of surgical biopsies.

If the tumor is large, only a part of the tumor is excised which is called an incisional biopsy. Similarly, if the tumor size is small, the entire tumor is excised for examination; this method of biopsy is called an excisional biopsy.

 Needle biopsy is a simple method for obtaining tissue samples. In affine needle aspiration, tumor cells are withdrawn from the tumors with a needle and syringe

Staging surgery

Staging surgery is the procedure that is performed to find out the size of the tumors and if or where it has spread. In addition, this also can be used to help stage these cancers. This often included removing some lymph nodes, which are tiny, bean-shaped organs that help fight infection, near the cancer to find out if it has spread there. Together with the physical examination, biopsy, result of the laboratory, and imaging tests this surgery helps doctors to decide the best option of treatment and predict the patient’s prognosis, which is the chance of recovery. 

Curative or primary surgery

The most common type of cancer surgery is the removal of the malignant (cancerous) tissue, and some of the tissue surrounding the tumors. The tissue surrounding the tumors is called the margin.

This type of treatment is often considered the primary treatment where surgeons remove part or all of the cancerous organ or tissue, and a small amount of healthy tissue around it. 

Surgery is performed in 55% of clients with cancer. Of the clients who undergo cancer surgery, 40% are treated with surgery alone and others may be combined with chemotherapy, radiation therapy, or others treatments, which may be given before or after surgery. The extent of the excision is determined by the type of tumors.

It is widely believed that tumors grow from their original organ to nearby tissue, then to nearby lymph nodes, and lastly to distant locations. In order to remove this tumor development pattern as widely as possible, surgery was the most common surgical procedure. However, the current theory holds that the tumor most likely released cells into the bloodstream throughout its growth, therefore systemic treatments like chemotherapy and biotherapy should be used in conjunction with surgery.

Reconstruction Surgery (Restorative surgery)

This is also called reconstructive or plastic surgery that is done after primary cancer surgery. It may be performed at the same time during the primary surgery removing tumors or it may also be done after a patient is receiving supporting treatments or healing.

Examples of reconstructive surgery include breast rebuilding the breast tissue and shape after a mastectomy, and surgery to restore a person’s appearance, improve speech, swallowing, function, and overall quality of life after surgery to the head, oral, and neck area.

Preventive Surgery (prophylactic surgery)

This is a type of surgery is performed particularly to a patient at unusual high risk for cancer

due to clinical history, genetics, family history, or other factors to minimize the chances of developing health issues in the future.

 Certain conditions or diseases increase the risk of cancer occurrence so significantly that removal of the target organ is justified to prevent cancer development. 

For example, women with a strong family history of breast or ovarian cancer or known genetic mutations to the BRCA1 and BRCA2 breast and ovarian cancer genes may decide to undergo mastectomy (the removal of the breast tissue), or an oophorectomy (the removal of the ovaries), to reduce the risk of developing breast or ovarian cancer in the future.

Furthermore, doctors often recommend colorectal surgery (such as the removal of polyps or even parts of the colon) for those with a family history of colorectal cancer.

Minimally Invasive Surgery (MIS)

As mentioned above, conventional surgery or open surgery often requires large incisions. However, in some situations surgery can be performed through one or more small incisions, which typically results in quick recovery times, less bleeding, less health complications, reduced risk of infection, and lower pain.

Some of minimally invasive procedures and surgeries.

Laparoscopic Surgery (Keyhole Surgery)

The doctor performs surgery through small incisions in the skin using a thin, lighted tube with a guide of camera in some cancers, such as liver, cervical, rectum, colon, liver, pancreas, gallbladder, and ovarian.

In addition, it refers to an invasive procedure that is commonly practiced in order to treat and diagnose many other non-cancerous health conditions such as repairing hernias, ectopic pregnancy, removing organs such as appendix and gallbladder. 

Laser Surgery

LASER (Light Amplification by Stimulated Emission of Radiation) surgery is one of the precise surgical procedures that uses a narrow thin beam of high-intensity light to cut, remove or destroy cancerous tissue. In addition, it is widely used during eye surgery, removing scars, tattoos, and soft tissue surgery by targeting using the proper wavelength of the laser. 

Cryosurgery

This is also known as cryotherapy is a latest technique that uses freezing or cooling temperatures to kills abnormal tissue and cancerous cell by creating ice balls within the tumors mostly under local anesthesia Eventually, the ice-ball can be visualized on USG, CT or MRI for further investigations, diagnosis, and prognosis.

Liquid nitrogen or argon is used depending on the system. Retinoblastoma, skin cancers, including basal cell and squamous cell carcinomas, early-stage prostate cancer are some of the cancers that can be treated using cryosurgery.

Argon or liquid nitrogen is used depending upon the system directly to the abnormal area with a cotton swab or spraying device.

Mohs micrographic surgery (Microscopically controlled surgery)

 This procedure is used to treat the most common types of skin cancer such as basal cell carcinoma (BCC) and squamous cell carcinoma (SCC).

During the surgery, the dermatologist removes the tissue from the suspected area until the samples no longer contain cancer cells until the tumor has negative histologic margins or reports after examination under a microscope to examination for cancer cells. The tissue is removed until all cancerous cells are removed. 

Endoscopy

It is a procedure in which a doctor inserts a thin flexible tube to examine the interior surfaces of an organ using an instrument known as endoscope equipped with light and camera.

 This plays a crucial role in early detection by allowing direct visualization of mucosal surfaces (such as mouth, rectum, or vagina) where cancers typically develop.

In addition, it also facilitates the removal of biopsy samples of suspicious lesions or potentially abnormal tissue, enabling histopathological examination and accurate diagnosis.

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