types of cancer surgery

There are several reasons why you may have surgery as treatment for cancer…

Surgery to cure the cancer

If the cancer is in one organ or area of the body, it may be possible to remove it before it spreads. The surgeon will take out the cancer and some of the nearby tissues that may contain cancer cells. S/he may also take out some lymph nodes, if there is a chance that the cancer has spread to them.

Often, other treatments such as radiotherapy or chemotherapy are given as well as surgery, to try to make sure that all the cancer cells are killed.

Unfortunately, surgery with the aim of cure isn't always possible. The cancer may be in a place the surgeon can't safely get to - for example it may be close to a major blood vessel. Some patients may be too ill to get through major surgery. If this is the case, doctors may be able to offer another treatment - such as radiotherapy - to try to cure the cancer.

If the cancer has spread widely through the body there may be no point in surgery, because cure isn't possible. (However, a few cancers have high cure rates even if they have spread - testicular cancer and thyroid cancer are examples.)

Sometimes, even if the cancer has spread, the main cancer may still be removed, to make the patient feel better.

Your surgeon may not know, until s/he starts the operation, whether s/he will be able to remove all of the cancer. It's important your surgeon talks with you beforehand, to explain what may happen in your case.

Surgery to relieve symptoms and improve quality of life

If cancer is causing a problem such as a blockage in the bowel or windpipe or gullet, surgery may be offered to relieve it, even though the cancer can't be cured.

Reconstructive surgery

This may be offered so that the treated area looks as normal as possible.

For example, many women who have a breast removed because of cancer are able to have surgery to make a new breast. Plastic surgery may be offered to patients who have had cancer in the head or neck.

Reconstructive surgery can also restore function to an area that has been removed or altered. A bladder cancer patient may need to have an artificial bladder made, to store their urine. A bowel cancer patient may need a new bowel opening on their abdomen (a stoma).

Your doctor and surgeon will talk with you about whether surgery may be right for you. They will explain the risks and benefits of the operation, and how it may affect you afterwards. They should also explain your other treatment options to you.

You will need to agree to the treatment before it can start. This is called giving your consent. Don't be afraid to ask if there is anything you don't understand.

Laparoscopic Surgery

Laparoscopes (the thin rigid tubes used to get passage to the inside of the body) are used for surgery, as well as for internal viewing. Operations on the gall bladder, pancreas, bowel, kidneys, bladder, prostate, ovaries and womb can all be done laparoscopically. It is a type of ‘key-hole’ surgery.

Small cuts (less than 1 centimetre long) are made in the skin and muscle of the abdomen. A hollow needle is passed through one, and carbon dioxide gas is injected to stretch the abdomen and separate the wall of the abdomen from the organs inside. This makes it easier and safer for the laparoscope to be passed in through the other cuts, and to give a good view of all the organs.

A fibre-optic light and a telescope attached to a microchip camera, are passed through the middle of one laparoscope. This lets the surgeon see live pictures of the inside of the belly on a video monitor. Other laparoscopes let the surgeon use fine operating tools to perform the necessary surgery. Surgeons who do this are specially trained. Sometimes ultrasound is used as well, to help the surgeon position the ‘scopes.

You will need a general anaesthetic. The Royal College of Anaesthetists have a series of leaflets all about anaesthetics.

Though laparoscopic surgery may take longer than conventional, open surgery, many patients recover more quickly from it.

Some laparoscopic surgery is carried out through specialist centres in the UK, as not all types of laparoscopic surgery are available on the Isle of Man.

Lymphadenectomy

Removing lymph glands
Surgery to remove lymph glands is called a lymphadenectomy. It is done to see whether the cancer has spread and also to prevent it from spreading further. It is quite a big operation and you will need a general anaesthetic.

Lymph glands are arranged in groups around the body, especially at the neck, armpits and groin. Your surgeon will remove the group closest to your tumour.

Usually, you will be admitted to hospital the day before the operation and will spend several days recovering in hospital afterwards. How long depends on how long the tubes for draining the wound must be left in. You may have some pain, for which you will be given pain-killers.

There are common side-effects when lymph glands are removed. They include swelling due to build up of lymph fluid, called lymphoedema, stiffness, and sometimes pain in the limb closest to the site of the operation. Your medical team will tell you how the side-effects can be controlled, and refer you to the Lymphoedema Clinic for ongoing help.