Cancer Surgery
What is cancer?
Cancer is a disease characterised by the abnormal growth of certain cells in the body. It can occur in any cell in the body and is named depending the organ it affects.
How does cancer develop?
The body is made up of many types of cells. Normally, cells grow and divide to replace old and dead cells as they are needed to keep the body healthy. Sometimes, this orderly process of division goes wrong. New cells form when the body does not need them, and old cells do not die when they should. The extra cells form a mass of tissue called a growth or tumour, which can become cancerous.
What are the types of cancer?
Not all tumours are cancerous; tumours can be:
Benign
Benign tumours are not cancer. They can often be removed and, in most cases, they do not come back. Cells in benign tumours do not spread to other parts of the body. Most importantly, benign tumours are rarely a threat to life.
Malignant
Malignant tumours are cancerous. Cells in malignant tumours are abnormal and divide without control or order. Cancer cells invade and destroy the tissue around them. Cancer cells can also break away from a malignant tumour and enter the bloodstream or lymphatic system, and spread to other parts of the body.
The organ where a cancer starts is called a primary tumour, and when this tumour spreads to another part of the body, it is called secondary tumour. There are more than 200 different cancers, some of the common ones include lung cancer, bone cancer, leukaemia, breast cancer, kidney cancer and prostate cancer.
What are the symptoms of cancer?
Cancer can cause a variety of symptoms. Possible signs of cancer include the following:
- New thickening or lump in the breast or any other part of the body
- New mole or an obvious change in the appearance of an existing wart or mole
- A sore that does not heal
- Nagging cough or hoarseness
- Changes in bowel or bladder habits
- Persistent indigestion or difficulty swallowing
- Unexplained change in weight
- Unusual bleeding or discharge
When these or other symptoms occur, they are not always caused by cancer. They can be caused by infections, benign tumours, or other problems. It is important to see a doctor about any of these symptoms or about other physical changes. Only a doctor can make a diagnosis. A person with these or other symptoms should not wait to feel pain because early cancer usually does not cause pain.
What are the causes of cancer?
Scientists have learned that cancer is caused by changes in genes that normally control the growth and death of cells. Certain lifestyle and environmental factors can change some normal genes into genes that allow the growth of cancer. Many gene changes that lead to cancer are the result of:
- Tobacco use
- Diet
- Exposure to ultraviolet (UV) radiation from the sun
- Exposure to carcinogens (cancer-causing substances) in the workplace or in the environment
Some gene alterations are inherited (from one or both parents). However, having an inherited gene alteration does not always mean that the person will develop cancer; it only means that the chance of getting cancer is increased.
Scientists continue to examine the factors that may increase or decrease a person's chance of developing cancer.
Although being infected with certain viruses, such as the human papillomavirus (HPV), hepatitis B and C (HepB and HepC), and human immunodeficiency virus (HIV), increases the risk of some types of cancer, cancer itself is not contagious. A person cannot catch cancer from someone who has this disease. Scientists also know that an injury or bruise does not cause cancer.
How is cancer diagnosed?
Early detection of cancer is the key to effective treatment outcomes and improved survival rates. If symptoms occur, your doctor may perform a physical examination, order blood work and other tests, and/or recommend a biopsy. In most cases, a biopsy is the only way to know for certain whether cancer is present. During a biopsy, your doctor removes a sample of tissue from the abnormal area. A pathologist studies the tissue under a microscope to identify cancer cells. Sometimes a biopsy of a lymph gland in the abdomen is required for diagnostic purposes. This can be done via laparoscopy.
What are the stages of cancer?
During diagnosis, the cancer is staged from Stage 0 through Stage IV. Staging indicates the severity of the cancer, size of the tumour and if it is confined to its original site or has spread to other parts of the body. This is an important step that determines the appropriate treatment plan.
What are the consequences if cancer is not treated?
Left untreated, cancer can spread across the body, invading key organs such as the brain, lungs, kidneys and liver, interfering with their functions and leading to death.
What are the options for cancer treatment?
Cancer treatment depends on the type and stage of cancer. The main types of cancer treatment include:
Surgery
Your surgeon attempts to remove the cancer from your body using fine scalpels. It is not only used as a method of treatment but is also indicated to prevent, diagnose and stage cancer. Other forms of surgery that do not use scalpels include:
Cryosurgery
Extremely low temperatures produced by liquid nitrogen is targeted on the cancer to kill the abnormal cells.
Lasers
High intensity rays of light called laser beams are focussed on the cancer to either precisely destroy or shrink the cells.
Hyperthermia
Extremely high temperatures are focused to damage and kill the cancer cells.
Photodynamic therapy
Drugs are introduced into the body that are sensitive to certain types of light. When exposed to this light, these drugs act by destroying the cancer cells.
Radiation therapy
High intensity radiation is directed onto your body to kill cancer cells. This can be performed before a surgery to shrink the tumour to a size that can be easily removed or after surgery.
Chemotherapy
Cancer killing drugs are introduced into your body.
Immunotherapy
This therapy improves your immune system and enables it to fight against the cancer.
Targeted therapy
In this therapy, the factors that cause cells to divide, grow and spread across the body are targeted so that the cancer can be stopped in its roots.
Hormone therapy
Hormone therapy slows down or stops the growth of certain cancers such as breast and prostate cancers by attacking the hormones that encourage them to grow.
Stem cell transplant
Progenitor cells are transplanted into your body to restore the stem cells that form blood, after extensive destruction by chemo or radiotherapy.
Precision medicine
Your doctor designs the most effective treatment modality by studying and understanding the genetic basis of your cancer.
Palliative care
Serious or life-threatening cancer is usually treated with palliative care, which is not aimed at curing but preventing or treating symptoms and side effects of its treatment. Along with this, social, spiritual and psychological help is also given. It can be given along with the other treatments. Palliative care can become the primary focus of care when the other treatments do not guarantee the destruction of cancer.
These treatments can be given alone or in combination with each other.
How do I prepare for cancer surgery?
Before cancer surgery, your doctor will examine you to see if you are fit enough to withstand the surgery. You will be advised to stop eating or drinking anything for a few hours before the surgery. Your bowels will be cleared with enema.
Am I a candidate for cancer surgery?
Surgery is usually recommended to treat solid tumours that are restricted to a specific region. It is not advised for malignant cancers.
How is cancer surgery performed?
Cancer surgery can be performed under local, regional or general anaesthesia. Your surgeon makes an incision on your body, locates the tumour, carefully separates it from the surrounding tissues and removes it. While excising the tumour, a margin of healthy tissue is also removed along with the tumour to ensure that there are no cancer cells left behind. Adjacent lymph nodes and tissues may also be removed, for further examination of the cancer having spread to beyond its original site.
Today, less invasive operations often can be performed to remove tumours while saving as much normal tissue and function as possible.
What can I expect after cancer surgery?
After cancer treatment, your health will be closely monitored. You can go home after you are able to eat and walk comfortably. Pain medication will be prescribed to keep you comfortable. You will be taught deep breathing to prevent the development of pneumonia.
What are the benefits of cancer surgery?
Surgery is one of the oldest forms of cancer treatment and offers good chance for cure from many types of cancers, especially those that have not spread to other parts of the body. It helps completely remove tumours that are contained in a specific region.
What are the outcomes of cancer surgery?
Surgery helps remove the cancer in its entirety. However, as with most invasive procedures, cancer surgery is potentially associated with certain complications such as infection, bleeding, blood clots, pain and injury to nearby organs.
Certain cancer surgeries can have more drastic long-term outcomes such as the removal of a breast (breast cancer), reduced fertility (cancer of the reproductive organs), and incontinence or impotence (prostate cancer).
How long will I be off work?
Depending on how extensive your surgery is, you will be able to return to work after 1 day or after many weeks. If your work demands extensive physical activity, you may require more time.
What is my post cancer surgery recovery and care?
Following cancer surgery, you may not have any interest in eating or drinking, but are advised to eat nutritious food. Surgeries of mouth, throat, stomach and intestine may affect eating. Your doctor may introduce a feeding tube or administer nutrients through IV.
Consult your doctor as soon as you experience a high fever, chills, bleeding, worsening or unusual pain, urination problems or shortness of breath.
What is the cost of the procedure?
We will provide you with a full explanation of the costs of the operation to assist you in your decision to proceed. The costs will vary depending on your level of private health insurance.
What are the current research regarding laparoscopic bile duct surgery?
Ongoing research on cancer surgery include:
- Balentine CJ, Richardson PA, Mason MC, Naik AD, Berger DH, Anaya DA. Postacute Care and Recovery After Cancer Surgery: Still a Long Way to Go. Ann Surg. 2017 May;265(5):993-999.
