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Oncology Surgery

Overview​

Oncology surgery, also known as surgical oncology, is a specialized field of medicine that focuses on the surgical treatment of cancerous tumors and other related conditions. This branch of surgery plays a crucial role in the management of various types of cancers, often serving as both a diagnostic and therapeutic tool.

Key Concepts​

Tumor Biology​

Understanding tumor biology is essential for effective oncology surgery:

  • Cancer cells exhibit uncontrolled growth and division
  • They invade surrounding tissues and metastasize to distant sites
  • Tumors may benign (non-cancerous) or malignant (canerous)

Surgical Techniques​

Several techniques are employed in oncology surgery:

  1. Open surgery: Traditional method involving a large incision
  2. Minimally invasive surgery: Less invasive procedures using small incisions
  3. Robotic-assisted surgery: Utilizes robotic systems for enhanced precision
  4. Laparoscopic surgery: Uses a laparoscope for visualization

Preoperative Evaluation​

Before performing oncology surgery, thorough preoperative evaluation includes:

  • Imaging studies (e.g., CT scans, MRI)
  • Blood tests (e.g., complete blood count, liver function tests)
  • Nutritional assessment
  • Psychological evaluation

Surgical Approaches​

Depending on the cancer type and location, oncology surgeons may employ various approaches:

  • Enucleation: Removing the entire tumor
  • Resection: Removing a portion of an organ
  • Debulking: Reducing tumor size to improve quality of life
  • Palliative surgery: Relieving symptoms in advanced cases

Common Oncological Conditions Treated​

Breast Cancer​

Breast cancer is one of the most common cancers treated surgically:

  • Mastectomy: Removal of one or both breasts
  • Lumpectomy: Removal of the tumor and surrounding tissue
  • Axillary lymph node dissection: Removal of lymph nodes under the arm

Colorectal Cancer​

Colorectal cancer often requires surgical intervention:

  • Colectomy: Removal of part or all of the colon
  • Proctocolectomy: Removal of the rectum and part of the colon
  • Hemicolectomy: Removal of half of the colon

Lung Cancer​

Oncology surgery plays a crucial role in lung cancer treatment:

  • Lobectomy: Removal of a lobe of the lung
  • Pneumonectomy: Removal of an entire lung
  • Segmentectomy: Removal of a segment of the lung

Gastrointestinal Stromal Tumor (GIST)​

GISTs are rare tumors originating from the digestive tract:

  • Resection of the primary tumor
  • Metastasectomy: Removal of metastatic lesions

Postoperative Care​

Proper postoperative care is vital for patient recovery:

  • Pain management
  • Wound care
  • Nutrition counseling
  • Follow-up appointments and surveillance

Immunotherapy​

Immunotherapy has revolutionized cancer treatment:

  • Checkpoint inhibitors: Enhance immune system's ability to fight cancer cells
  • CAR-T cell therapy: Genetically modified immune cells targeting specific cancers

Precision Medicine​

Tailored treatments based on individual genetic profiles:

  • Genetic testing to determine optimal treatment plan
  • Targeted therapies for specific mutations

Robotics and Artificial Intelligence​

Enhanced precision and reduced recovery times:

  • Robotic-assisted surgery for complex procedures
  • AI-powered diagnostic tools for earlier detection

Conclusion​

Oncology surgery continues to evolve rapidly, offering new hope for cancer patients worldwide. As medical students, understanding the principles and techniques outlined in this guide will serve as a solid foundation for future practice in this field. Always remember that oncology surgery is not just about removing tumors; it's about improving patients' quality of life and fighting against this devastating disease.

Additional Resources​

Glossary​

  • Adjuvant therapy: Treatment given after the primary treatment to reduce the risk of recurrence
  • Chemoradiation: Combination of chemotherapy and radiation therapy
  • Neoadjuvant therapy: Treatment given before the primary treatment to shrink tumors
  • Palliation: Treatment aimed at relieving symptoms rather than curing the disease
  • Recurrence: Return of cancer after initial treatment
  • Sentinel lymph node biopsy: Procedure to identify the first lymph node to which cancer cells spread
  • Staging: Determining the extent of cancer spread
  • Tumor board: Multidisciplinary team discussion for complex cancer cases

Case Studies​

Case Study 1: Breast Cancer​

Patient: 45-year-old woman diagnosed with stage II breast cancer

Treatment:

  1. Preoperative evaluation: CT scan, mammography, and blood tests
  2. Modified radical mastectomy: Removal of the affected breast and axillary lymph nodes
  3. Reconstruction: Immediate implant reconstruction
  4. Adjuvant therapy: Radiation therapy and hormone therapy

Outcome: No evidence of recurrence after 5 years of follow-up

Case Study 2: Colorectal Cancer​

Patient: 60-year-old man diagnosed with stage III colorectal cancer

Treatment:

  1. Preoperative evaluation: Colonoscopy, CT scan, and blood tests
  2. Right hemicolectomy: Removal of the right side of the colon
  3. Lymphadenectomy: Removal of lymph nodes along the colon
  4. Adjuvant therapy: Chemotherapy

Outcome: Complete remission after 10 years of follow-up

Case Study 3: Lung Cancer​

Patient: 65-year-old woman diagnosed with stage IV lung cancer

Treatment:

  1. Preoperative evaluation: PET scan, bronchoscopy, and blood tests
  2. Stereotactic body radiotherapy: Minimally invasive treatment for small tumors
  3. Palliative care: Pain management and symptom relief
  4. Targeted therapy: Molecularly targeted drugs

Outcome: Improved quality of life and prolonged survival

FAQs​

Q: What is the difference between curative and palliative surgery? A: Curative surgery aims to cure the disease, while palliative surgery focuses on symptom relief and improving quality of life.

Q: How do oncologists decide which surgical approach to use? A: Factors considered include tumor size, location, patient health status, and potential impact on quality of life.

Q: Can surgery be used as a standalone treatment for cancer? A: While surgery is often combined with other treatments, it can sometimes be sufficient for early-stage cancers or in specific situations.

Q: Are there any risks associated with oncology surgery? A: Like any major surgery, oncology surgery carries risks such as infection, bleeding, and complications related to anesthesia. However, modern techniques have significantly reduced these risks.

Q: How does immunotherapy work in oncology surgery? A: Immunotherapy enhances the body's natural defenses against cancer cells, allowing the immune system to recognize and attack cancerous growths more effectively.

Q: What is the role of nutrition in oncology surgery recovery? A: Proper nutrition supports healing, helps prevent complications, and aids in faster recovery. Patients may need specialized diets or supplements depending on their condition and treatment.

Q: How do oncologists assess the success of a surgical procedure? A: Success is typically evaluated through imaging studies, blood tests, and clinical examinations. Follow-up appointments are crucial for monitoring for signs of recurrence or progression.