types of surgery and its approaches

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TYPES OF SURGICAL PROCEDURE

Surgery is the oldest form of treatment for cancer. It also has animportant role in diagnosing and staging (finding the extent) of cancer.

Advances in surgical techniques have allowed surgeons to successfullyoperate on a growing number of patients. Today, less invasive operationsare often done to remove tumors and to try to preserve as much normaloral cavity structure and function as possible. Surgery offers the greatestchance for cure for many types of cancer, especially those that have notyet spread to other parts of the body. When the disease is localized, asurgical procedure may be able to remove the cancer in its entirety. Mostpeople with cancer will have some type of surgery: Diagnostic surgery,Curative surgery, Preventive surgery, Palliative surgery, andReconstructive surgery

1. Diagnostic Surgery

There are many ways to detect or confirm a suspicion of the

presence of a cancer. Microscopic

examination of biopsy samples is

the ideal way that a positive

diagnosis of cancer can be made.

This procedure involves

physically removing all or part

(tissue, cells, or fluid) of asuspected tumor and examining

this material under a microscope.

The purpose of a biopsy is to

identify the histologic type of

cancer and possibly stage of

disease.

Any organ in the body can

be biopsied utilizing a variety of

techniques. Some may requiremajor surgery, while others may

not even require local anesthesia.

Types of biopsies

include incisional

biopsy, excisional

biopsy, endoscopic

During a core needle biopsy, a special

needle is inserted into the suspiciousarea in this case, a breast lump and a small, solid core of tissue iswithdrawn. Ultrasound a procedure

that uses sound waves to create images

of the suspicious area on a monitor might be used to help guide the needle.


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Discussion by Professor Sheryl Renomeron-Morales

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biopsy,colposcopic biopsy, bone marrow biopsy, fine needle aspiration

biopsy, stereotactic biopsy, and core biopsy, to name a few. Biopsies

typically leave gross tumor in the body.

A pathologist performs the microscopic examination of the biopsied

material. After careful evaluation, a benign or malignant diagnosis can

usually be established. A written report prepared by the pathologist is

sent to the doctor who treats the cancer patient. This doctor will then

make decisions regarding treatment based on the information found in

this report.

Take breast cancer for example: If a breast abnormality is detected

with mammography or physical exam, the patient will typically be

referred for additional breast imaging with diagnostic

mammography, ultrasound, or other imaging tests. While all of thesemethods of diagnosis can help detect a breast abnormality, biopsy

followed by pathological (microscopic) analysis is really the only definitive

way to determine if cancer is present.

The method of biopsy chosen will depend on, How suspicious the abnormality appears The size, shape, and location of the abnormality The number of abnormalities present The patient's medical history The patient's preference The training of the physician who is performing the biopsy The breast imaging center or surgical center where the biopsy is

performed.

Side effects and risks of biopsy do exist, depending on the type of

biopsy performed and certain biopsy techniques. Cytology procedures,

needle biopsies, and core biopsies, sometimes may not even come up

with a positive cancer diagnosis due to inadequate quantities of cells or

tissue removed from the patient. In rare cases, an incorrect diagnosis

could be made in the situation where the needle misses the tumor and

removes only healthy or non-cancerous tissue. As with the case of

preventive surgery, patients are strongly encouraged to discuss the

advantages and disadvantages of the different biopsy methods with their

physician(s) prior to undergoing the procedure(s).


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A biopsy that removes only a fragment or portion of the tumor,

primary or metastatic, is recorded in the abstract as non-cancer-directed

treatment.

2. Curative Procedure

In a curative procedure, a certain amount of normal tissue as well

as cancerous tissue may be

removed to obtain adequate

margins. The purpose is to

minimize the risk of any cancer

cells being left behind, which may

result in a recurrence of thecancer. For the same purpose, the

surgeon may also remove the

lymph nodes that are adjacent to

the tumor.

Resection of isolated

metastases (removal of solitary

metastases) may be performed in

some cases, especially if there

has been a disease-free intervalof more than one year after the surgery. Second-look operations are

sometimes performed following adjuvant therapies, but they have little

effect on the final outcome in the great majority of cancer patients.

3. Preventive Surgery

In a preventive surgery, the surgeon removes the tissue that does

not yet contain cancer cells, but has the probability of becoming

cancerous in the future. This may also e referred to as prophylacticsurgery.

The Whipple procedure is the most

common type of curative surgery forcancer of the pancreas when the tumor islocated in the head of the pancreas


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Preventive mastectomy

is another example of

a surgery with

preventive purpose. In

the past, the surgeon

may have removed the

breast tissue but

spared the nipple

(subcutaneous

mastectomy). The

total mastectomy

(removal of the entire

breast and nipple) is

considered in an effortto prevent or reduce

the risk of breast

cancer.

Pros and cons exist for preventive surgeries. Some patients may

not choose preventive mastectomy or oopherectomy due to their concerns

about with sexual and reproductive function and self-image, even if the

procedure may add years to their life expectancy. Due to unique risk

factors for cancer of each individual patient, a preventive surgery does

not guarantee the patient will never develop cancer. Therefore, the

decision of a preventive surgery should only be considered after a careful

discussion between the surgeon and the patient.

4. Palliative Surgery

Cancer causes pain to most cancer patients as does the treatment.

It is estimated that 80% of cancer patients have two or more episodes of

pain. More patients experience pain with advanced disease. The quality

of life of those patients in great pain, resulting from either the disease orthe treatment, is greatly compromised. Under such circumstances,

palliative surgery may be performed. For example, the procedure may

involve the removal of a painful primary or metastatic tumor mass such

as a solitary spinal metastasis.

Breast-conserving surgery. Dotted lines show the area

containing the tumor that is removed and some of the lymph

nodes that may be removed.


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The purpose of palliative surgery is mainly to reduce pain for the

patient. The surgery

may not necessarily

aim to eradicate

cancer tissue in the

patient. In fact,

palliative surgery is

often deemed as

worthwhile and

feasible by cancer

specialists when the

disease is not

responsive to any type

of curative treatment.

A successful palliativesurgery may not only

make the patients life

more comfortable, but it may also prolong the cancer patients life some

cases.

5. Reconstructive Surgery

Reconstructive surgeries are performed on patients with physical

deformities and

abnormalities caused by

traumatic injuries, birth

defects, developmental

abnormalities, or diseases.

The goals of reconstructive

surgery differ from those

cosmetic surgery; while

cosmetic surgery is

performed to reshape normal

structures of the body toimprove the patients

appearance and self-esteem,

reconstructive surgery is

performed on abnormal or

damaged structures of the

body. The reason for the surgery is to repair the damaged caused by the

Upper Lip Defect Reconstruction. Patient

underwent a bilateral transposition flap, borrowingcheek skin to reconstruct the upper lip.


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curative surgery, as well as to improve functions of certain anatomic

parts of the body.

Approaches of Surgery

a. Open surgery An open surgery is one in which the patient is cutopen. A typical open surgery involves the sued of a scalpel to

make an incision into the skin and cut through the various layers

of the dermis and sub-dermal layers and tissues to get to the

desired tissue or organ. Some open surgeries use a laser to make

the incision.

b. Endoscopic surgery Endoscopy is a surgical technique thatinvolves the use of an endoscope, a special viewing instrument that

allows a surgeon to see the images of the bodys internal structure

through a very small incision.

The endoscope

An endoscope consists of two basic parts: A tubular probe fitted

with a tiny camera and bright light, which is inserted through a small

incision; and a viewing screen, which magnifies the transmitted images

of the bodys internal structures. During surgery, the surgeon watches

the screen while moving the tubes of the endoscope through the surgical

area.

Advantages of Endoscopy:

All surgery caries risks and every incision leaves a scar. However,

with Endoscopic surgery, scars are likely to be much smaller an some of

the after effects or surgery may be minimized.

In a typical Endoscopic procedure, only a few small incisions, each

less than one inch long, are needed to insert the endoscope probe and

other instruments. For some procedures, such as breast augmentation,only two incisions may be necessary. For other such as forehead lift,

three or more short incisions may be needed. The tiny eye of the

endoscopes camera allows a surgeon to view the surgical site almost as

clearly as if the skin were opened from a long incision.


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References:

The Oral Cancer Foundation. Surgery. Retrieved January 4, 2013, fromhttp://www.oralcancerfoundation.org/facts/surgery.htm

SEER Training Modules, Types of Surgery. U. S. National Institutes ofHealth, National Cancer Institute. Retrieved January 4, 2013 fromhttp://training.seer.cancer.gov/treatment/surgery/types/

Thomas Jefferson University Hospital (2007, September 18). Advances in

Pancreatic Cancer Care: Pylorus Preserving Pancreaticoduodenectomy(Mini-Whipple Procedure). Maketwire.com. Retrieved January 4,

2013 from http://www.marketwire.com/press-release/reminder-orlive-

Cancer Topics, Treatment Option Overview. National Cancer Institute.

Retrieved January 4, 2013 from

http://www.cancer.gov/cancertopics/pdq/treatment/breast/Patie

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