Surgical Therapy

Surgical Therapy



Yvette Payne


Surgery was the earliest form of cancer therapy and today 60% of cancer patients will be treated with surgery alone or surgery in combination with other treatment modalities. Surgeons must be knowledgeable about current therapeutic approaches to the treatment of particular cancers and about specific tumor, patient, and environmental factors when making surgical decisions. Surgery is part of a multidisciplinary approach to therapy, and surgical oncologists must carefully consider the impact surgery will have on future treatment decisions in the overall care of a patient. Surgery is used in the prevention, diagnosis, staging, and treatment of cancer and in restoration or rehabilitation.



PREVENTION


As our knowledge of tumorigenesis has increased, so has the use of surgery to prevent cancer. Surgery is used to remove nonvital benign or precancerous tissue that may predispose an individual to cancer. The National Comprehensive Cancer Network (NCCN) has written consensus guidelines that include the prevention and risk reduction of cancer. Examples of surgical interventions used for cancer prevention include removal of precancerous polyps. This is a common procedure to prevent colon cancer. Less commonly seen, but recommended by the NCCN for a small subset of women at high risk for development of ovarian cancer is a bilateral salpingo-oophorectomy.



DIAGNOSIS


Surgery is the primary therapy used to obtain the tissue or cells necessary for the definitive diagnosis of cancer. Surgical oncologists use multiple techniques to obtain tissue for diagnosis. Incisional and excisional biopsies and the use of endoscopy to obtain tissue or cells are common procedures in the diagnosis of cancer. In an effort to obtain tissue in a less invasive way, some newer technologies being used to diagnose cancer include image guided or stereotactic biopsies and nipple fluid aspirate to collect cells in individuals suspected of having breast cancer.



STAGING OF DISEASE


An adequate staging workup is required to determine which therapies will benefit the patient. Exploratory surgeries can help define the extent of tumor involvement that cannot be gained from our current radiographic technology. An example is an exploratory laparotomy in the staging of ovarian cancer. Sentinel lymph node biopsy, which carries less morbidity than complete lymph node dissection, has replaced complete lymph node dissection in some cancers.



TREATMENT OF DISEASE AS A CURE


Surgery usually represents the best option of treatment when cancer is diagnosed at an early stage. The surgical approach, especially when the goal is cure, is to remove all of the tumor while maintaining function and appearance. Early-stage solid tumors and in situ tumors lend themselves to traditional en bloc resections where the entire tumor and surrounding tumor-free margin are removed. If the primary tumor is larger or invades a functional area, it may be surgically resected and followed by radiation or chemotherapy to meet the goal of cure.

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Mar 1, 2017 | Posted by in NURSING | Comments Off on Surgical Therapy

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