Historically, surgery was the first type of cancer treatment. In current practice, it is used alone or in combination with other modalities for treatment of solid tumors (see also Overview of Cancer Therapy). The size, type, and location of the cancer as well as the patient's functional status may determine operability and outcome. The presence of metastases often precludes surgery as part of primary treatment, but resection of solitary metastases or cytoreductive procedures may be indicated in specific situations.
Factors that increase operative risk in patients with cancer include
Functional status (ability to perform daily activities)
Comorbid conditions
Surgical risk for patients with cancer is evaluated based not on chronologic age but on functional status and comorbidities. Patients may have preexisting comorbidities or others caused by the cancer or cancer treatment. They may have poor nutrition resulting from anorexia and the catabolic influences of cancer. These factors may inhibit or slow recovery from surgery. Patients may be neutropenic or thrombocytopenic or may have clotting disorders; these conditions increase the risk of sepsis and hemorrhage. Therefore, preoperative evaluation is paramount. For some patients, the risk of surgery is too high and alternative treatments are used (eg, radiation therapy).
Primary Tumor Resection
If a primary tumor has not metastasized, surgery is potentially curative. It is important for the resected tumor to have a clear margin (an area of normal tissue around the primary tumor) to confirm complete resection and decrease risk of recurrence. Intraoperative examination of tissue sections by a pathologist may be needed. Immediate resection of additional tissue is done if margins show cancer.
Surgical resection may include removal of local and regional lymph nodes and/or resection of an involved adjacent tissue or organ.
Neoadjuvant chemotherapy or radiation therapy may be given before surgery to reduce the cancer size, limit the extent of surgery, and improve efficacy. Adjuvant chemotherapy or radiation therapy may be given after surgery to decrease the risk of recurrence.
Resection of Metastases
Local and regional lymph nodes are sometimes removed during surgery to evaluate the extent of cancer spread and reduce likelihood of cancer recurrence. Limited metastases (in size, number, or location), especially in the lungs, liver, or brain, can sometimes be resected or treated with radiation therapy.
Tumor Debulking (Cytoreduction)
Tumor debulking (surgical resection to reduce cancer size) is sometimes done when complete resection is impossible. Tumor debulking may increase the sensitivity of the remaining tumor to other treatment modalities (eg, chemotherapy) through unclear mechanisms.
Palliative Surgery
Surgical resection of tumor to relieve symptoms and preserve quality-of-life is sometimes reasonable even when cure is unlikely or when an attempt at extensive surgery is precluded. Resection may be indicated to control pain, reduce the risk of hemorrhage, or relieve obstruction of a vital organ.
Reconstructive Surgery
Reconstructive surgery may improve a patient’s comfort or quality-of-life after surgery (eg, breast reconstruction after mastectomy).
