Surgery - what types are there?

Surgery is such an umbrella term for the many different types of operations that someone undergoing cancer may have. Some patients may have a number of these treatments, whereas some may not need any procedures at all. But when you are faced with a client who tells you they have had surgery for cancer - do you know what that actually means?

Here we discuss what a number of different surgical procedures are - I bet you've heard their names before, but what do they really entail?

Surgery

• Surgery is the removal of the tumour and surrounding tissue during an operation.
• Surgery is commonly used as a treatment for cancer it is the oldest type of cancer treatment. Surgery can help to diagnose and to provide information about the cancer
• Different types of surgery are used depending on the type of cancer, where it is located, and the goals of surgery. Some surgeries are less invasive and have a shorter recovery time.

 Types of surgery

There are many and varied types of surgery during treatment for cancer – the following list is not exhaustive:

Diagnostic

For most types of cancer, a biopsy is the only way to make a definitive diagnosis. During a surgical biopsy, the surgeon makes a cut in the skin and removes some or all of the suspicious tissue. There are two main types of surgical biopsies.

• An incisional biopsy - the removal of a piece of the suspicious area for examination.
• An excisional biopsy - the removal of the entire suspicious area, such as an unusual mole or a lump. 

After a biopsy, the tissue removed is examined the surgeon or oncologist makes a diagnosis. 

Staging

Staging surgery is performed to find out the size of the tumour and if or where it has spread. This often includes removing some lymph nodes near the cancer to find out if it has spread there. This surgery helps the doctor decide which kind of treatment is best and predict the chance of recovery.

Tumour removal

The most common type of cancer surgery is the removal of the tumour and some of the tissue surrounding the tumour. The tissue surrounding the tumour is called the margin. Tumour removal may be the only treatment, or it may be combined with chemotherapy, radiation therapy, or other treatments, which may be given before or after surgery.

Conventional surgery requires large cuts, called incisions, through skin, muscle, and sometimes bone. However, in some situations, surgeons can use surgical techniques that are less invasive, which may speed recovery and reduce pain afterwards.

Debulking

When the complete removal of a tumour is not possible or might cause excessive damage to the body, surgery is used to remove as much of the tumour as possible. Other treatments, such as radiation therapy or chemotherapy, may sometimes also be used to shrink the remaining cancer.

Palliation

Palliative surgery is used to relieve side effects caused by a tumour. It plays an important role in improving quality of life for patients with advanced cancer or widespread disease.

• Surgery may be used to help relieve pain or restore physical function if a tumour presses on a nerve or the spinal cord, blocks the bowel or intestines, or creates pressure or blockage elsewhere in the body.
• Surgery may be used to help stop bleeding. Certain cancers are more likely to cause bleeding because they occur in areas with a high concentration of blood vessels, such as the uterus, or organs in which the tumours are fragile and can easily bleed when food and waste products pass through, such as the oesophagus, stomach, and bowel. In addition, bleeding may be a side effect of some drugs used to treat cancer.
• Surgery may be used to insert a feeding tube or tubes that deliver medications. If the cancer or cancer treatment has made it difficult to eat, a feeding tube may be inserted directly into the stomach or intestine through the abdominal wall. Or a tube may be inserted into a vein to deliver pain medication or chemotherapy.
• Surgery may be used to prevent broken bones. Bones weakened by cancer or cancer treatment can break easily and often heal slowly. Inserting a metal rod may help prevent fractures of weak bones and relieve pain during healing.

Reconstruction

 After primary cancer surgery, surgery may be an option to restore the body's appearance or function. This is called reconstructive or plastic surgery. Reconstructive surgery may be done at the same time as surgery to remove the tumour. It may be done later after a person has healed or received additional treatment. Examples of reconstructive surgery include breast reconstruction after a mastectomy and surgery to restore a person’s appearance and function after surgery to the head and neck area.

Prevention

Some surgery is performed to reduce the risk of developing cancer. For example, doctors often recommend the removal of precancerous polyps in the colon to prevent colon cancer. In addition, women with a strong family history of breast or ovarian cancers or known mutations to the BRCA1 and BRCA2 breast and ovarian cancer genes may decide to have a mastectomy, which is the removal of the breast, or an oophorectomy, which is the removal of the ovaries, to lower the risk of developing breast or ovarian cancer in the future.

Types of minimally invasive surgery

Conventional surgery often requires large incisions. In some situations, surgery can be performed through one or more small incisions, which typically results in shorter recovery times and less pain afterwards.

Laparoscopic surgery

The doctor performs surgery through small incisions in the skin using a thin, lighted tube with a camera. A laparoscopy refers to a minimally invasive surgery of the abdomen, and mediastinoscopy and thoracoscopy are terms used when the same type of procedure is performed in the chest.

Laser surgery

A narrow beam of high-intensity light is used to remove cancerous tissue.

Cryosurgery

Liquid nitrogen is used to freeze and kill abnormal cells.

Mohs micrographic surgery, also called microscopically controlled surgery.

A dermatologist shaves off a skin cancer, one layer at a time, until all cells in a layer appear to be normal cells when viewed under a microscope.

Endoscopy

A thin, flexible tube with a light and camera on the tip, called an endoscope is inserted into an opening of the body (such as the mouth, rectum, or vagina) to examine the internal organs.

During an endoscopic procedure, it is possible to remove samples of potentially abnormal tissue for further examination.

We learn more about the different types of cancer treatment in our Advanced Cancer Awareness qualification.