Each year, more than 23,000 new cancer cases are diagnosed in Malaysia. To combat this debilitating disease, cancer treatment may require one or a combination of the following: surgery, radiotherapy, and systemic therapy (which includes chemotherapy, targeted therapy, endocrine therapy, and immunotherapy).

According to the American Cancer Society, surgery is used to prevent, diagnose, stage, and treat cancer as well as relieve (palliate) discomfort or problems related to cancer. In this article, let’s look at the different types of cancer surgery.

1. Curative Surgery
Example: early-stage breast cancer
Surgery is one of the most critical components of cancer care, and its role has expanded to more than just curative surgery (surgery to remove all cancer cells with the intent of cure). Curative surgery is usually recommended as the primary treatment when the cancer is still confined to only one part of the body. However, it may be used with other treatments like chemotherapy or radiotherapy before or after the operation. An example is early-stage breast cancer, in which the curative surgery to remove the tumour, part of the breast or the whole breast together with some surrounding lymph nodes is done.

2. Diagnostic Surgery
Before someone is diagnosed with cancer, surgery is one of the methods to help diagnose cancer. In most cases, the only way to know if a person has cancer, and type of cancer, is by taking out a small piece of the abnormal tissue (sample) from the tumour and testing it. This procedure is called a biopsy. Sample retrieval depends on the location of the tumour and the suspected type of cancer. An example will be the surgical removal of an enlarged neck node in suspected head and neck cancer.

3. Staging Cancer
Besides imaging investigation such as a CT scan, surgery is also critical in staging cancer. The area around the tumour, including the lymph nodes and nearby structures, is examined during surgery. This is to find out how much and far cancer has spread. This is important as it provides information to guide the doctor on future treatment decisions. Colon cancer is one such example where the report after surgery will help to stage cancer and guide the subsequent treatment.

4. Debulking Surgery
In some instances, surgeons may only partially remove the tumour. This is called debulking surgery, which is usually done due to a large tumour or because the tumour is located very close to vital organs or tissues. An example is locally advanced ovarian cancer, in which the doctor will take out as much of the tumour as possible and then treat the remaining cancerous cells with chemotherapy.

5. Palliative Surgery
At times, surgery may not be done to treat or cure cancer itself. In these cases, palliative surgery is recommended to help correct a problem causing discomfort or disability to patients with advanced cancer. For example, some cancers in the bowel may grow large enough to block (obstruct) the intestine. But due to its advanced stage (cancer that has spread and involves other parts of the body), surgery will not be curative but mainly to remove the blockage or bypass it. This is done to make the patient feel better and more comfortable.

6. Supportive Surgery
Supportive surgery makes it easier for patients to get other treatments. This surgery incorporates a vascular access device such as a chemoport, a thin, flexible tube that can be surgically placed into a large vein and connected to a small drum-like device placed under the skin. A needle is put into the drum of the chemoport to give treatment such as chemotherapy, fluids, blood transfusion, or medications while cancer care is in progress. This is particularly helpful for patients with poor vascular access.

7. Reconstructive Surgery
Another type of surgery in cancer care is reconstructive surgery, which is used to improve the way a person looks after a major cancer surgery. It also helps restore the function of an organ or body part after surgery. Examples include breast reconstruction after mastectomy (surgical removal of the whole breast) or the use of tissue flaps from other parts of the body, bone grafts, or prosthetic (metal or plastic) materials after surgery for head and neck cancers.

8. Preventive Surgery
Another form of surgery in cancer management is preventive surgery. The surgery removes body tissues or parts that are likely to become cancer, even though there are no signs of cancer at the time of surgery. Sometimes the whole organ is removed when a person has a medical condition that puts them at very high risk of having cancer. For instance, a woman with a strong family history of breast cancer may have inherited a breast cancer gene (e.g. BRCA 1 and BRCA 2 gene). Due to the high risk of developing breast cancer, doctors may recommend removing the breasts before the cancer has developed.

Other Specialised Cancer Surgeries

• Cryosurgery: uses extremely cold temperatures to kill cancer cells; often used for skin cancer and cervical cancer
• Laser surgery: uses beams of light energy instead of instruments to remove very small cancers (without damaging surrounding tissue), shrink or destroy tumours, or activate drugs to kill cancer cells; ideal for areas that are difficult to reach (skin, cervix, rectum, and larynx)
• Electrosurgery: uses electrical current to kill cancer cells; used for skin cancer and oral cancer
• Microscopically controlled surgery: layers of skin are removed and examined microscopically until cancerous cells cannot be detected; useful when cancer affects delicate parts of the body, such as the eye

Source: stanfordhealthcare.org

Dr Tan Chih Kiang,
Consultant Clinical Oncologist, MBBS (IMU), MCO (UM),
Tung Shin Hospital