Cancer Surgery
with Frank Rotolo, MD
Can surgery help prevent cancer?
The American Cancer Society recognizes surgery as the oldest form of cancer treatment. It is also one of the most reliable treatment options for early-stage disease. “When cancers are caught early, surgery can be a cure,” says Frank Rotolo, MD, FACS, Surgical Oncologist at GBMC. Early stage cancers typically include small tumors that have not yet spread to other organs or the lymph nodes.
In recent years, minimally invasive surgery has become well known for its reduction in scaring, shorter hospital stays and quicker recovery times. However, open surgical techniques have advanced as well. “We still do traditional types of surgery. Emerging technology allows us to perform what’s considered invasive surgery but still preserve form and function,” says Dr. Rotolo.
For instance, today’s breast cancer treatments may require open surgery but usually do not lead to radical mastectomy (total breast removal). “Often, we can remove the tumor and the nearest lymph node without removing the breast or the underlying chest wall muscles,” says Dr. Rotolo. Many of these procedures take only one to two hours to complete and are done on an outpatient basis.
Although surgery is a mainstay of cancer treatment, it is not the sole option. “The treatment of cancer is multi-modality,” says Dr. Rotolo. “We still use surgery, radiation therapy and chemotherapy.” GBMC holds a weekly tumor conference during which surgeons, medical oncologists, radiation oncologists, pathologists and other cancer experts discuss complex cases and decide on the best treatment for each patient.
Even prior to treatment, surgical techniques may be used to help prevent, diagnose and determine the stage of cancer. Preventive surgery is used to remove tissue that has a high likelihood of becoming cancerous. This type of surgery may be an option for patients at risk for colorectal cancer. “Patients with polyps that can’t be removed through colonoscopy can have them surgically removed to help prevent cancer,” says Dr. Rotolo.
Preventive surgery may also be an option for women with a strong genetic predisposition to breast cancer. “A woman with a breast cancer gene may choose to undergo surgery to decrease her risk of developing breast cancer,” says Dr. Rotolo.
Diagnostic surgery, which includes some forms of biopsy, is used to obtain tissue samples that can be examined for cancerous cells. An excisional biopsy is used to remove an entire tumor for diagnostic testing, while an incisional biopsy removes only part of a larger tumor for evaluation. Both procedures are performed by surgeons, and require the use of anesthesia.
Staging surgery provides an assessment of the amount of cancer, as well as how far it has spread. Minimally-invasive techniques such as laparoscopy are often used along with physical exams, lab tests and computer-imaging to help surgeons assign the cancer a stage between I and IV, with IV being most serious.
According to Dr. Rotolo, surgery may also be used to treat complications of late-stage cancer. “Sometimes, if the cancer cannot be cured because it has already spread, surgery can be used to relieve symptoms,” he says. “For example, abdominal pain from a large obstructing colon tumor that has already spread to the liver can often be relieved through the surgical removal or bypass of the bowel obstruction.” Surgery that strictly offers comfort or relief from symptoms is known as palliative surgery.
In some non-surgical treatment plans, cancer surgeons play a supportive role. For instance, a catheter port can be surgically placed into a large vein. The port can then be used to deliver chemotherapy as well as to draw blood for lab tests, which significantly limits the number of times a patient needs to have needles inserted.
