Surgical Treatment for Cancer
Can We Just Cut It Out?
Surgery is often one of the first things that comes to mind following a cancer diagnosis, though it is not always the first step taken. Your cancer type and other individual factors will determine if and when surgery is a treatment option for you.
Surgery remains one of the only possible curative treatments for some cancer types, but not all patients are candidates for surgery.
When Will I Have Surgery?
- Some patients may have surgery immediately after diagnosis, before being treated with anything else
- Other patients may have surgery only after first using treatments like immunotherapy, chemotherapy, or targeted therapy to reduce the size of tumors and overall cancer burden. This is referred to as conversion therapy when the purpose of neo-adjuvant treatment is to convert a patient from inoperable (cannot have surgery) to operable (can have surgery).
- Some patients may have their primary tumor surgically removed, then undergo a period of systemic or localized therapy, and then head back to the operating room for surgical excision of metastases in affected organs.
- Some patients may have multiple surgical resections due to metastatic spread or recurrence
- Surgery may not be recommended for some patients
Am I Operable?
This is likely one of the first questions you should ask your oncologist if you have not had surgery up until that point, though the best person to answer this question for you is a surgeon. Determining operability is based on imaging, lab tests, location of tumors, number/spread of tumors, and other individual factors. Don't rule out surgery as an option until you've been told by at least 2 surgeons that you're inoperable. Hearing it from an oncologist, radiologist, or other specialist not involved in surgery is not the same as hearing it from a surgeon. This is their wheelhouse. If you've been told you're inoperable by multiple surgeons, ask them if that could change down the road if the status of your cancer evolves. Will I ever be operable? And if so, what would need to happen for that to be the case?
If you have stage 4 cancer, discuss the possibility of surgery as close to the time of diagnosis as possible. Do not wait to have a surgery consult. If you are operable, it may be the only option that offers you a cure, and operability is a moving target: if the tumor(s) get too big or too small (vanishing metastases) then you may become ineligible for surgery. Furthermore, if your metastases are in tough locations, you may not be operable due to location alone regardless of tumor size or overall tumor burden. You don't want to endure 9 months of conversion therapy (e.g. chemotherapy with the hope of surgery as a next step) if surgery is NOT and will NOT be a possibility. Understanding your surgical options is paramount to deciding which treatment options to pursue and making an informed decision with complete information.
Finding & Meeting a Surgeon
Finding the right surgeon isn’t always easy. You may need to meet with a surgeon before you meet with an oncologist, or you may meet a surgeon later in the treatment process.
Start your search by calling your insurance company to get a list of in-network general surgeons, surgical oncologists, and specialty surgeons (e.g. GI surgeons if you have colorectal cancer, or thoracic surgeons if you have lung cancer) within a reasonable distance of your home.
From there, ask for recommendations from your primary care doctor, oncologist, another medical professional you trust, or people you know locally who have had similar surgeries. You can also do research on your own by reading reviews online and verifying licenses, education, and board certifications. Visit the Care Team Options page and scroll down to Resources for credible sites to use in researching providers.
Once you’ve narrowed your list down to 3-4 doctors, call each office to see if they’re accepting new patients and how quickly you can get in for a surgery consultation/first appointment. If your insurance will cover it, book a minimum of 2 consults with different surgeons so you can get a feel for who is best for you. You'll also want to verify that the surgeon you're considering has hospital privileges at a hospital that is in-network for your insurance plan.
What am I looking for in a surgeon?
- In-network for your insurance plan
- Within a reasonable distance of your home
- Has hospital privileges at a hospital in-network for my plan
- Has current licenses and board certifications
- Has access to multidisciplinary team of surgeons should they need an extra set of eyes or hands during your surgery. This could come into play if, during your surgery, your surgeon discovers cancer has invaded or metastasized into other tissues or organs and they want to call in a specialty surgeon for advice and collaboration on the spot.
- Has deep experience performing the type of surgery you will need; performs this procedure on a regular basis as opposed to "once in a while"
- Is as specialized as possible for your cancer type and the procedure you'll be receiving
- Has the bedside manner, personality, or communication style you desire
We'll be adding more surgery content and resources soon, including preparing for surgery, hospitalization, hospital discharge, recovery and more. In the meantime, please take advantage of the sections included below (terminology and ostomies) and the collection of resources at the very bottom of the page. You can also download Cut It Out: Inpatient Surgery Preparation & Navigation Guide in the Education Shop.
da Vinci Robotic-Assisted Surgery Systems
Surgery-Related Terminology
Relevant Terminology:
- Adjuvant: treatment given after an initial treatment has completed its course to try to prevent recurrence; for example: if you have surgery followed by chemotherapy, the chemo would be referred to as adjuvant; sometimes adjuvant chemo is casually referred to as "clean-up chemo"
- Anastomosis: the rejoining of surgically separated tissues and associated blood vessels e.g. reconnecting the two ends of a surgically resected colon
- Biopsy: a procedure that removes a tissue sample from the body for pathologic analysis (cell and tissue analysis)
- Colectomy: the surgical removal of the colon (or part of the colon: semicolectomy) to remove cancer
- Conscious Sedation: also called twilight; type of anesthesia that can block pain signals but allows the patient to be awake during the procedure, breathing on their own and talking, if needed
- Conversion Therapy: a treatment intended to make inoperable patients eligible for surgery
- Curative Treatment: treatment that has the intention of completely killing and removing cancer from your body; intended to cure your cancer
- Foley Catheter: a flexible tube inserted into the bladder through the urethra and held in place in the bladder with an inflatable "balloon," used to drain urine into a bag outside of the body
- Ileus: the "freezing" of the intestines following surgery (or other trauma) that inhibits the passage of materials and can lead to serious blockages; a condition in which peristalsis (the involuntary, pulsing contractions that propel contents down the esophagus and through the intestines) is impaired or disabled due to surgery or other trauma
- Inpatient: a patient who is admitted to the hospital, often for an overnight stay or a procedure that requires a patient to stay overnight in the hospital
- Insufflation: introduction of air into the abdominal cavity to provide space for the maneuvering of surgical instruments, used during laparoscopic and robotic surgeries
- Intravenous Anesthesia: also called general anesthesia; patient is put into a drug-induced unconsciousness (sleep) and is unable to speak, react, move, or feel pain during a procedure
- IV Infusion: the delivery of a substance intravenously, or through a vein
- Laparoscopic Surgery: a minimally invasive surgical technique using small incisions through which long surgical instruments and a camera are inserted into the body, all guided and controlled by a surgeon
- Laparotomy: incision into the abdomen, medical term for "open cut" surgery
- LAR: lower anterior resection
- Lobectomy: the surgical removal of an entire lobe of the lungs to remove cancer
- Lumpectomy: the surgical removal of a portion of the breast to remove a tumor (breast-conserving surgery)
- Lymph Node: small filtering structures packed with immune cells that are found throughout the body, part of the lymphatic system; lymph nodes filter lymph (the fluid that travels through the lymphatic system) in an attempt to remove waste, infections, and other foreign substances from circulation. Lymph nodes can "collect" circulating cancer cells, and the presence of cancer in lymph nodes can indicate that the cancer is spreading beyond the site of origin.
- Lymphedema: swelling (edema) caused by the buildup of lymph fluid in the body
- Margins: the area around a tumor that is free of cancerous cells or tissue; you want "good" margins after surgical removal of a tumor
- Mastectomy: the surgical removal of the breast in its entirety
- Metastectomy: the surgical removal of metastases (metastatic tumors) from the body
- Micrometastasis: refers to a very small or microscopic cluster of tumor cells somewhere in the body not near the primary tumor, usually less than 1 cm in size and undetectable (or not easily seen) on scans
- Neo-Adjuvant: treatment given before surgery (or before the primary treatment) to reduce the size of tumors and overall tumor burden
- Ostomy: a surgical procedure that creates an opening in the body (called a stoma) that allows either 1) the draining and removal of waste (feces, urine) from the body as is the case with a colostomy, ileostomy, or urostomy or 2) the entry of air into the body through the trachea, bypassing the mouth and nose for oxygen intake, called a tracheostomy
- Outpatient: a patient who receives services or care from a facility and returns home the same day or a procedure that takes place in a medical
- Palliative Treatment: treatment that has the intention of controlling the cancer so it doesn't grow larger or spread further; not intended to cure your cancer
- Pathology: gross and microscopic study of bodily fluids, cells, tissue, and organs that have been removed from the body
- PICC Line: Peripherally inserted central catheter; a catheter implanted in the upper arm (usually) for easy access to the bloodstream for infusions and blood draws
- Port: Port-a-cath; a catheter implanted surgically in the chest that allows easy access to the bloodstream for infusions and blood draws
- Resection: surgical procedure in which some or most of an organ is removed in the process of removing a tumor or multiple tumors
- Robotic Surgery: a minimally invasive surgical technique using small incisions through which the instrumental arms of a robotic machine (Da Vinci), controlled by a surgeon, are manipulated inside of the body, may also be called robotic-assisted laparoscopic surgery (RALS)
- Systemic Treatment: a treatment that travels through the blood or digestive system, potentially impacting all areas of the body since more of the body is exposed to the treatment
Comparison of Surgical Approaches
You're Cutting --What-- Out of Me?
The suffix -ectomy means to surgically remove or cut out, and the prefix indicates which organ or tissue is being removed. You may hear surgical resections described as full/complete (entire organ removed) or partial (a portion removed), e.g. a full hysterectomy or a partial colectomy.
The list below includes the names of some common surgical procedures and the organ with which they are associated.
The -Ectomies
- Splenectomy: spleen
- Vaginectomy: vagina
- Cystectomy: bladder
- Cholecystectomy: gallbladder
- Hepatectomy: liver
- Nephrectomy: kidney
- Oophorectomy: ovary
- Salpingectomy: fallopian tube
- Cervicectomy/Radical Trachelectomy: cervix
- Orchiectomy: testicle
- Lobectomy: lobe of lung
- Esophagectomy: esophagus
- Mandibulectomy: mandible/lower jaw
- Colectomy: colon
- Proctectomy: rectum
- Mastectomy: breast
- Lumpectomy: lump in breast
- Hysterectomy: cervix and uterus
- Metastectomy: metastatic tumor
- Prostatectomy: prostate
Ostomy Care
Ostomies
An ostomy is a surgical procedure that creates an opening in the body (called a stoma) that allows either 1) the draining and removal of waste (feces, urine) from the body as is the case with a colostomy, ileostomy, or urostomy or 2) the entry of air into the body through the trachea, bypassing the mouth and nose for oxygen intake, called a tracheostomy.
An ostomy can be either temporary with plans to reverse it in the future, or it can be permanent.
Below is a short list of tips from cancer patients who have or had ostomies themselves. You can also check out the resources section at the bottom of this page for more information and support on ostomies.
Ostomy Tips from Patients:
- Give your body time to adjust to new foods
- Be generous with the skin prep
- Empty the bag often
- Always have a backup stash of supplies with you
- Get extenders for extra support if you sweat a lot
- Try Convatec Stomahesive paste for leaks
- Keep the skin around your stoma clean and dry
- Try different brands and products to see what works best for you
- Have patience as you get the hang of it
- Have someone help you until you get comfortable managing it on your own and don't hesitate to call your stoma/wound care nurse for help at any time.
- Eat foods that bulk up the stool to reduce leaks
- Call different medical supply companies and ask for samples to save money on supplies
- Try not to panic
- Ask for an ostomy belt to hold the bag closer to your body
- Ask for a convex wafer and pouch system if you're experiencing leaks
- Try Medline Marathon No Sting Cyanoacrylate Skin Protectant (provides protective skin barrier)
- High output can be a sign of dehydration so be careful
- Ask about a home health nurse or ostomy nurse to help you when you're stuck
- The stoma (opening) can get smaller over time
- You can try Tegaderm (adhesive waterproof film) to keep it sealed around the edges
- Consider convex bags if you're having problems with filling/leaking
- Always empty the bag before leaving home
- Amazon has good ostomy bag covers in different colors
- Coloplast has good flanges
- Devrom chewable tablets are helpful for the odor
- Have a good adhesive remover on hand
- Try using snug bathing suit bottoms to hold your bag in place so you can swim
- A bidet or toilet sprayer attachment is handy for cleaning out the bag
- Check out Kindred Box, a 501(c)(3) charitable organization in the United States, that distributes donated ostomy supplies to support the care of uninsured and underinsured ostomates in America struggling with financial hardship. https://www.kindredbox.org/
