Treatment – Surgery

Surgery

Surgery is the common term used for cancer treatments because 65% cancer patients will undergo either by itself or may include other therapies too.
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Several Types of Cancer Surgery:

Curative Surgery: This type of surgery mainly involves the removal of a tumour i.e., affected portion. This surgery works well on localized cancers, as they haven’t spread to the other body parts. The procedure includes radiation therapy or chemotherapy to get a conclusion that all cancer affected cells have been removed. Types of Curative Surgery:

  • Robotic Surgery
  • Minimally Invasive Surgery
  • Preventive Surgery
    • Preventive Surgery helps in prevention of cancer from occurring. This includes the process of removing precancerous polyps from the body so that it stops polyps becoming vicious. Suppose if a woman is affected by breast cancer and was at high risk, then she may decide to have her breasts removed rather than getting suffered from cancer which may lead to death in future.
  • Reconstructive Surgery:
    • The name itself describes that reconstruction of parts after the cancer treatment, which means getting back to the normal functioning conditions of the body parts. The most regenerative type of surgery is breast reconstruction and other examples are testicular implants and facial reconstruction.
  • Biopsy (Diagnostic Surgery):
    • In this Surgery, some of the cancer affected or total portion is removed and held for examination, where a tumour is cancerous or not.
    • Fine Needle Aspiration (FNA): A need is inserted into a tumour and the material is drawn out and inspected under a microscope.
    • Incisional or Excisional biopsy: The patient is kept under the supervision of regional anaesthesia, which makes the area senseless and the surgeon removes a large piece of a tumour which is an incisional way or else removes an entire affected part, an excisional one for further examination.
    • For the tumours in chest or abdomen, general anaesthesia is used.
  • Staging Surgery:
    • Staging Surgery helps in determining the extent of cancer, this procedure is done by using small cameras (scopes) attached to a tube which is a flexible one, this process doesn’t involve in any incision because the scopes are inserted into the natural openings of the body. For this type, an endoscope is used in hollow body cavities and organs like lungs, urinary tract and intestinal tract, through which surgeons can view the suspicious areas that are not visible.
    • Laparoscopy is mainly used to view the abdominal cavity; laparotomy involves a small incision in the cavity, carried out under regional anaesthesia, laparotomies are generally used only when the suspicious areas are unable to examine through less invasive procedures.
    • Supportive Surgery is helpful in other cancer treatments in which some of the chemotherapy devices may have requirement of connecting device or part to insert into the body.
  • Palliative Surgery:
    • Palliative Surgery is used to ease the person from pain, disability or any other complications that occur due to advancement in cancer level. This will neither cure nor an anti-cancer treatment. It just improves the quality of life.

Leaser Surgery

Transoral Laser Microsurgery

Transoral laser microsurgery (TLM) was first proposed in 1972 and is now widely used for tumors of the throat and larynx (voice box)
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With TLM, a highly specialized carbon dioxide (CO2) laser beam is used instead of a scalpel to cut through the tissue. Unlike other types of lasers, the CO2 laser beam generates minimal heat energy. This limits damage to normal structures around the tumor, such as important nerves, blood vessels and muscles, which are important for speech and swallowing. The surgery is performed directly through the mouth and does not leave a visible scar. The surgeon inserts a thin endoscope through the mouth, and a specially designed microscope lets the surgeon see the tumor and surrounding tissue during the surgery. At MD Anderson, your surgeon will help you decide if TLM is right for you. Patients undergoing transoral laser microsurgery for throat or larynx cancer are placed under general anesthesia. Different CO2 laser systems are available for use with transoral laser microsurgery. If you are diagnosed with early-stage cancer of the larynx, then Digital AcuBlade™ laser surgery may be used. With this method, CO2 laser is delivered through a specialized robotic adapter that creates precise incisions. The system, designed by Lumenis Surgical specifically for larynx and vocal cord surgery, uses a computer with an operating microscope. The surgeon programs the computer by entering information about the specific type of procedure that will be performed, the laser beam pattern, the incision length and the depth that the laser will penetrate. The surgeon positions the laser beam on the larynx or vocal cord and performs the procedure by manipulating a joystick on an operating microscope. The CO2 laser moves in straight, curved, or circular patterns to sculpt the most precise incision with the least effect on surrounding normal tissue. Another type of laser used with TLM is flexible fiber-optic CO2 laser. In 2004, surgeons at MD Anderson were the first to use fiber-optic CO2 laser to reach areas in the throat that otherwise could not be reached and to perform a 360-degree resection around tumors in ways that were previously not possible. If your surgery for throat cancer has a high risk of bleeding, surgeons at MD Anderson may use thulium laser instead of CO2 laser. The thulium laser is used instead of a scalpel to cut through tissue. It is very precise and is designed to minimize the risk of blood loss during surgery. The skilled surgeons at MD Anderson will choose between a pulsed laser beam and a continuous laser beam to perform the best surgery for you.

Robotic Surgery

Robotic surgery systems consist of one or more robotic arms
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Precisely controlled by surgeons seated at a console, which enlarges 3-D views of the surgery site. The arms are tipped with an endoscope for viewing the treatment area, or surgical instruments that can fit into an incision less than an inch long. The instrument handles that control the robotic arms have the added benefit of reducing surgeon fatigue during long or complicated surgeries and eliminating “hand tremor.” MD Anderson uses the Da VinciĀ® robotic surgery system, which has four robotic arms like the one pictured right. Although the robotic arms are doing the actual surgery, they still require direct input from the surgeon and cannot be merely programmed to operate without human intervention. Candidates for robotic-assisted surgery include patients undergoing prostatectomy, hysterectomy, thoracic procedures and some general surgeries.

Ablation

Ablative cancer treatments use either heat or cold to destroy, or ablate, cancer tumors without the need for more invasive surgery.
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Advantages of ablative therapies include :

  • ♦ Minimal pain
  • ♦ Shorter recovery time than surgery or radiation therapy
  • ♦ Usually does not require an overnight hospital stay
  • ♦ Can be used in conjunction with other cancer treatments
  • ♦ Treatments can easily be repeated if necessary

Cryoablation

Cryoablation is also known as cryotherapy or cryosurgery. A special probe is inserted into the tumor and then cooled to . A ball of ice forms at the tip of the probe, freezing and destroying prostate tissue. Cryotherapy is not as invasive as surgery, and can sometimes be performed as an outpatient procedure. Cryotherapy is currently being used to treat breast, prostate and kidney cancers. The biggest disadvantage with using cryotherapy to treat prostate cancer is that most men (about 80%) will lose the ability to have an erection. However, for men who already have erectile dysfunction, cryotherapy is a convenient and effective prostate cancer treatment. MD Anderson is conducting research to focus cryotherapy to treat just the tumor instead of the entire prostate, with the goal of preserving erectile function.

Radiofrequency Ablation (RFA)

A needle-thin probe delivers radiofrequency waves directly to the tumor, heating the tissue until it is destroyed. Radiofrequency ablation is best for smaller, localized tumors. RFA can be used to treat a variety of cancers :

  • Bone cancer: RFA is mostly used to alleviate pain from cancer that has spread to the bone, usually from the colon
  • Liver cancer: Radiofrequency ablation can be combined with local chemotherapy to treat liver cancers
  • Lung cancer
  • Kidney cancer

High Intensity Focused Ultrasound for Prostate Cancer

Also known as HIFU, this procedure is used to treat prostate cancer. A special probe uses high-frequency ultrasound to produce heat that kills cancerous tumors. The probe is inserted into the rectum and guided to the proper position using computer imaging. High intensity focused ultrasound can either treat the entire prostate (“full” HIFU) or just certain portions of the prostate (“focused” HIFU). The entire procedure takes from 1-4 hours. HIFU has been used in Europe, particularly the United Kingdom, to treat prostate cancer for about 10 years. However, it is not currently approved by the Food & Drug Administration for use in the United States. MD Anderson urologists have been treating patients with HIFU as part of clinical trials to test this treatment method. Because the treatment is relatively new, available data on its effectiveness is still maturing.

Minimally Invasive Surgery

MD Anderson surgeons are constantly refining their techniques to treat cancer effectively while decreasing the physical impact of cancer surgery.
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Minimally invasive surgery techniques are being used to treat an increasing variety of cancers. Here are some of the minimally invasive procedures available at MD Anderson :

  • ♦ Endoscopic thyroid surgery
  • ♦ Endoscopic throat cancer surgery
  • ♦ Video-assisted thoracoscopic surgery (VATS) for lung and esophageal cancers
  • ♦ Endoscopic skull base tumor surgery

What is Minimally Invasive Surgery ?

Minimally invasive, or endoscopic, surgery takes advantage of advances in computer imaging and robotics to provide effective surgical cancer treatment with a much smaller impact on the patient. An endoscope is a long, thin tube with special lighting and a narrow lens through which the surgeon can view organs and tissue inside of the body. The endoscope is inserted through tiny incisions, often less than an inch in length, near the tumor location. A microscope provides an excellent image of the tumor. Small, specialized surgical instruments are also inserted through small incisions so that the surgeon can perform the operation without an external incision. Advantages of minimally invasive surgery include :

  • ♦ Less blood loss
  • ♦ Decreased need for blood transfusions
  • ♦ Shorter hospital stays
  • ♦ Decreased pain and need for postoperative pain medications
  • ♦ Earlier resumption of regular diet
  • ♦ Quicker recovery and return to normal activities
  • ♦ Less scarring and improved cosmetic appearance
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