Surgery is the oldest form of treatment for cancer. It also has an important role in diagnosing and staging (finding the extent) of cancer. Advances in surgical techniques have allowed surgeons to successfully operate on a growing number of patients. Today, less invasive operations are often done to remove tumors and to try to preserve as much normal oral cavity structure and function as possible. Surgery offers the greatest chance for cure for many types of cancer, especially those that have not yet spread to other parts of the body. When the disease is localized, a surgical procedure may be able to remove the cancer in its entirety. Most people with cancer will have some type of surgery: Diagnostic surgery, Curative surgery, Preventive surgery, Palliative surgery, and Reconstructive surgery 1. Diagnostic Surgery There are many ways to detect or confirm a suspicion of the presence of a cancer. Microscopic examination of biopsy samples is the ideal way that a positive diagnosis of cancer can be made. This procedure involves physically removing all or part (tissue, cells, or fluid) of a suspected tumor and examining this material under a microscope. The purpose of a biopsy is to identify the histologic type of cancer and possibly stage of disease. Any organ in the body can be biopsied utilizing a variety of techniques. Some may require major surgery, while others may not even require local anesthesia. Types of biopsies include incisional biopsy, excisional biopsy, endoscopic

During a core needle biopsy, a special needle is inserted into the suspicious area — in this case, a breast lump — and a small, solid core of tissue is withdrawn. Ultrasound — a procedure that uses sound waves to create images of the suspicious area on a monitor — might be used to help guide the needle.

2 biopsy,colposcopic biopsy, bone marrow biopsy, fine needle aspiration biopsy, stereotactic biopsy, and core biopsy, to name a few. Biopsies typically leave gross tumor in the body. A pathologist performs the microscopic examination of the biopsied material. After careful evaluation, a benign or malignant diagnosis can usually be established. A written report prepared by the pathologist is sent to the doctor who treats the cancer patient. This doctor will then make decisions regarding treatment based on the information found in this report. Take breast cancer for example: If a breast abnormality is detected with mammography or physical exam, the patient will typically be referred for additional breast imaging with diagnostic mammography, ultrasound, or other imaging tests. While all of these methods of diagnosis can help detect a breast abnormality, biopsy followed by pathological (microscopic) analysis is really the only definitive way to determine if cancer is present. The method of biopsy chosen will depend on, How suspicious the abnormality appears The size, shape, and location of the abnormality The number of abnormalities present The patient's medical history The patient's preference The training of the physician who is performing the biopsy The breast imaging center or surgical center where the biopsy is performed. Side effects and risks of biopsy do exist, depending on the type of biopsy performed and certain biopsy techniques. Cytology procedures, needle biopsies, and core biopsies, sometimes may not even come up with a positive cancer diagnosis due to inadequate quantities of cells or tissue removed from the patient. In rare cases, an incorrect diagnosis could be made in the situation where the needle misses the tumor and removes only healthy or non-cancerous tissue. As with the case of preventive surgery, patients are strongly encouraged to discuss the advantages and disadvantages of the different biopsy methods with their physician(s) prior to undergoing the procedure(s).

Discussion by Professor Sheryl Renomeron-Morales

3 A biopsy that removes only a fragment or portion of the tumor, primary or metastatic, is recorded in the abstract as non-cancer-directed treatment.

2. Curative Procedure In a curative procedure, a certain amount of normal tissue as well as cancerous tissue may be removed to obtain adequate margins. The purpose is to minimize the risk of any cancer cells being left behind, which may result in a recurrence of the cancer. For the same purpose, the surgeon may also remove the lymph nodes that are adjacent to the tumor. Resection of isolated The Whipple procedure is the most metastases (removal of solitary common type of curative surgery for metastases) may be performed in cancer of the pancreas when the tumor is some cases, especially if there located in the head of the pancreas has been a disease-free interval of more than one year after the surgery. Second-look operations are sometimes performed following adjuvant therapies, but they have little effect on the final outcome in the great majority of cancer patients. 3. Preventive Surgery In a preventive surgery, the surgeon removes the tissue that does not yet contain cancer cells, but has the probability of becoming cancerous in the future. This may also e referred to as prophylactic surgery.

Discussion by Professor Sheryl Renomeron-Morales


Preventive mastectomy is another example of a surgery with preventive purpose. In the past, the surgeon may have removed the breast tissue but spared the nipple (subcutaneous mastectomy). The total mastectomy (removal of the entire breast and nipple) is considered in an effort to prevent or reduce the risk of breast cancer.

Breast-conserving surgery. Dotted lines show the area containing the tumor that is removed and some of the lymph nodes that may be removed.

Pros and cons exist for preventive surgeries. Some patients may not choose preventive mastectomy or oopherectomy due to their concerns about with sexual and reproductive function and self-image, even if the procedure may add years to their life expectancy. Due to unique risk factors for cancer of each individual patient, a preventive surgery does not guarantee the patient will never develop cancer. Therefore, the decision of a preventive surgery should only be considered after a careful discussion between the surgeon and the patient. 4. Palliative Surgery Cancer causes pain to most cancer patients as does the treatment. It is estimated that 80% of cancer patients have two or more episodes of pain. More patients experience pain with advanced disease. The quality of life of those patients in great pain, resulting from either the disease or the treatment, is greatly compromised. Under such circumstances, palliative surgery may be performed. For example, the procedure may involve the removal of a painful primary or metastatic tumor mass such as a solitary spinal metastasis.

Discussion by Professor Sheryl Renomeron-Morales

5 The purpose of palliative surgery is mainly to reduce pain for the patient. The surgery may not necessarily aim to eradicate cancer tissue in the patient. In fact, palliative surgery is often deemed as worthwhile and feasible by cancer specialists when the disease is not responsive to any type of curative treatment. A successful palliative surgery may not only make the patient’s life more comfortable, but it may also prolong the cancer patient’s life some cases. 5. Reconstructive Surgery Reconstructive surgeries are performed on patients with physical deformities and abnormalities caused by traumatic injuries, birth defects, developmental abnormalities, or diseases. The goals of reconstructive surgery differ from those cosmetic surgery; while cosmetic surgery is performed to reshape normal structures of the body to improve the patient’s appearance and self-esteem, Upper Lip Defect Reconstruction. Patient reconstructive surgery is underwent a bilateral transposition flap, borrowing performed on abnormal or cheek skin to reconstruct the upper lip. damaged structures of the body. The reason for the surgery is to repair the damaged caused by the Discussion by Professor Sheryl Renomeron-Morales

6 curative surgery, as well as to improve functions of certain anatomic parts of the body. Approaches of Surgery a. Open surgery – An “open” surgery is one in which the patient is cut open. A typical open surgery involves the sued of a scalpel to make an incision into the skin and cut through the various layers of the dermis and sub-dermal layers and tissues to get to the desired tissue or organ. Some open surgeries use a laser to make the incision. b. Endoscopic surgery – Endoscopy is a surgical technique that involves the use of an endoscope, a special viewing instrument that allows a surgeon to see the images of the body’s internal structure through a very small incision. The endoscope An endoscope consists of two basic parts: A tubular probe fitted with a tiny camera and bright light, which is inserted through a small incision; and a viewing screen, which magnifies the transmitted images of the body’s internal structures. During surgery, the surgeon watches the screen while moving the tubes of the endoscope through the surgical area. Advantages of Endoscopy: All surgery caries risks and every incision leaves a scar. However, with Endoscopic surgery, scars are likely to be much smaller an some of the after effects or surgery may be minimized. In a typical Endoscopic procedure, only a few small incisions, each less than one inch long, are needed to insert the endoscope probe and other instruments. For some procedures, such as breast augmentation, only two incisions may be necessary. For other such as forehead lift, three or more short incisions may be needed. The tiny “eye” of the endoscope’s camera allows a surgeon to view the surgical site almost as clearly as if the skin were opened from a long incision.

Discussion by Professor Sheryl Renomeron-Morales



The Oral Cancer Foundation. Surgery. Retrieved January 4, 2013, from http://www.oralcancerfoundation.org/facts/surgery.htm SEER Training Modules, Types of Surgery. U. S. National Institutes of Health, National Cancer Institute. Retrieved January 4, 2013 from http://training.seer.cancer.gov/treatment/surgery/types/ Thomas Jefferson University Hospital (2007, September 18). Advances in Pancreatic Cancer Care: Pylorus Preserving Pancreaticoduodenectomy (Mini-Whipple Procedure). Maketwire.com. Retrieved January 4, 2013 from http://www.marketwire.com/press-release/reminder-orliveCancer Topics, Treatment Option Overview. National Cancer Institute. Retrieved January 4, 2013 from http://www.cancer.gov/cancertopics/pdq/treatment/breast/Patie nt/page5

Discussion by Professor Sheryl Renomeron-Morales

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