AIMS AND TYPES OF OPERATIVE TREATMENT

Surgical intervention is usually considered to be the most definitive treatment of most forms of cancer. When considering the influence of cancer on a patient, the most important concern is how to remove as much of the cancerous tissue as possible while doing the least possible degree of harm to the patient’s appearance or physiologic function. Also, the use of artificial blood vessels, bones, and other structures as substitutes for the excised body parts complicate surgery and increase its cost. Thus the decision to make a patient undergo surgery is not an easy one to make.

Operative treatment is divided into radical surgery, which attempts to achieve complete cure, and palliative surgery, which aims merely to reduce the severity of the patient’s symptoms or remove an immediate threat to the patient’s life. In radical surgery the objective is to cut away the original focus of infection as well as the adjoining affected organs and lymph nodes to which the cancer might spread.

Palliative surgery is decided upon in cases wherein the tumor is too large to operate on or cannot entirely be cut away without seriously damaging surrounding structures. It is used to debulk, or reduce the size of the tumor. Thus reduced, the tumor may respond better to chemotherapy or irradiation. Furthermore, the symptoms of the patient related to the size of the tumor may also be relieved, such as if it is obstructing some section of the digestive tract. If the tumor begins to bleed an operation could be undertaken to stanch the bleeding.

Operations may be classified into three categories, these being: shrinking operations, standard operations, and enlarging operations, all with regards the scope and extent of surgery and the amount of tissue removed. They may be used for tumors in various levels of development, from early to late stages of cancer.

The ultimate goal of surgery is to effect a radical cure by removing the tumor and focus without harming the original functions of other organs. Some operations are necessary for the sole purpose of restoring or conserving the function of a certain organ or organ system; for instance, function conservation operations are sometimes performed to relieve the sexual and urinary hindrances imposed by tumors of the urinary tract.

Restorative operations are those which are intended to reconstruct the patient’s body after the deforming effects of previous surgery. Transplantation and artificial organs may be as aesthetic and physiological substitutes for the damaged or missing structures. Some examples of operations requiring reconstructive surgery are breast cancer and cancer of the tongue, head and neck.

Another aid to diagnosis and early treatment is the use of fiberoptic technology. The endoscope is one well-known application of fiberoptics. It helps the physician diagnose tumors of the digestive tract that are too small to manifest clinical symptoms. The detection of these tumors makes treatment more feasible and increases the possibility of a cure. Furthermore, surgery can be performed through the endoscope, and operations conducted in this manner on small tumors may have the same effect as more radical open operations. This is particularly effective when used against polyps (mushroom-shaped tumors) in a procedure known as a polypectomy. A wire apparatus inserted at the tip of the endoscope is used to snare the tumor after it has been anesthetized with local anesthetic through another attachment on the tip of the scope. The laser endoscope is equipped with a laser that can be used to cauterize early stage cancers in the digestive or respiratory systems.