Surgical Oncology Health Article

Definition

Surgical oncology is a specialized area of oncology that engages surgeons in the cure and management of cancer.

Purpose

Cancer has become a medical specialty warranting its own surgical area because of advances in the biology, pathophysiology, diagnostics, and staging of malignant tumors. Surgeons have traditionally treated cancer patients with resection and radical surgeries of tumors, and left the management of the cancer and the patient to other specialists. Advances in the early diagnosis of cancer, the staging of tumors, microscopic analyses of cells, and increased understanding of cancer biology have broadened the range of nonsurgical cancer treatments. These treatments include systematic chemotherapy, hormonal therapy, and radiotherapy as alternatives or adjunctive therapy for patients with cancer.

Not all cancer tumors are manageable by surgery, nor does the removal of some tumors or metastases necessarily lead to a cure or longer life. The oncological surgeon looks for the relationship between tumor excision and the risk presented by the primary tumor. He or she is knowledgeable about patient management with more conservative procedures than the traditional excision or resection.

Demographics

According to the American Association of Cancer Registries, the most commonly diagnosed cancers for males in the United States during 1995–1999, with total of over 1.7 million cases for all races, were:

• prostate–28.6%
• lung–16.3%
• colon and rectum–11.7%
• bladder–6.6%
• non-Hodgkin's lymphoma 4.2%

White males make up more than 1.4 million of the total prostate cancer cases, with African Americans and Hispanic Americans accounting for 160,356 and 75,237 cases respectively. Each of the latter groups had higher stomach cancer incidence in the top five list, replacing non-Hodgkin's lymphoma. For women, the total cases for all races was over 1.6 million, and white women made up more than 1.4 million of this number. There were 140,888 female African American cases and 76,810 Hispanic American female cases.

Leading cancers for all groups were:

• breast–30.7%
• lung–12.5%
• colon & rectum–12.2%
• corpus & uterus–5.9%
• ovary–3.9%

African American women had higher rates of cervical cancer, replacing ovarian cancer in the top five list.

Description

Surgical oncology is guided by principles that govern the routine procedures related to the cancer patient's cure, palliative care, and quality of life. Surgical oncology performs its most efficacious work by local tumor excision, regional lymph node removal, the handling of cancer recurrence (local or widespread), and in rare cases, with surgical resection of metastases from the primary tumor. Each of these areas plays a different role in cancer management.

Excision

Local excision has been the hallmark of surgical oncology. Excision refers to the removal of the cancer and its effects. Resection of a tumor in the colon can end the effects of obstruction, for instance, or removal of a breast carcinoma can stop the cancer. Resection of a primary tumor also stops the tumor from spreading throughout the body. The cancer's spread into other body systems, however, usually occurs before a local removal, giving resection little bearing upon cells that have already escaped the primary tumor. Advances in oncology through pathophysiology, staging, and biopsy offer a new diagnostic role to the surgeon using excision. These advances provide simple diagnostic information about size, grade, and extent of the tumor, as well as more sophisticated evaluations of the cancer's biochemical and hormonal features.

Regional lymph node removal

Lymph node involvement provides surgical oncologists with major diagnostic information. The sentinel node biopsy is superior to any biological test in terms of prediction of cancer mortality rates. Nodal biopsy offers very precise information about the extent and type of invasive effects of the primary tumor. The removal of nodes, however, may present pain and other morbid conditions for the patient.

Local and regional recurrence

Radical procedures in surgical oncology for local and regional occurrences of a primary tumor provide crucial information on the spread of cancer and prognostic outcomes. However, they do not contribute substantially to the outcome of the cancer. According to most surgical oncology literature, the ability to remove a local recurrence must be balanced by the patient's goals related to aesthetic and pain control concerns. Historically, more radical procedures have not improved the chances for survival.