The Role of Surgery in the Management & Treatment of Cancer
by Dr. C.H. Weaver M.D. updated 9/19/2018
Nearly all patients with cancer will have some kind of surgery.
Surgery may be used to perform a biopsy in order to obtain a specimen for determining an accurate diagnosis, provide local treatment of the cancer, and obtain other information to help determine whether additional treatment is necessary. Surgical techniques continue to improve, and surgeries are now less invasive and often performed on an outpatient basis.
In order to diagnose a cancer, a physician will typically perform a biopsy of a suspicious area, lump or mass suspected of being cancer. A biopsy can be performed on an outpatient basis. During a biopsy, part or all of the suspected cancer is removed and cells contained in the sample are sent to a pathology laboratory to determine whether cancer is present. Other information including genomic testing is obtained from the biopsy sample and can play an important role in treatment decisions. Patients should discuss the role of genomic testing with their doctor to make sure the tissue removed during surgery is available to evaluate whether precision cancer medicines might be a treatment option. If the biopsy indicates that cancer is present, additional tests to determine the stage of cancer will be performed. Surgery may be performed as part of the staging evaluation and/or as part of treatment after the patient and doctor determine the overall treatment plan.
The successful treatment of cancer often requires the involvement and coordination of several different treatment approaches. This is referred to as multi-modality treatment and may consist of surgery, radiation therapy, systemic treatment with precision cancer medicines or chemotherapy and/or hormonal therapy. It is important to understand that surgery is a local treatment and is only capable of treating the cancer cells removed during surgery. By the time a cancer is diagnosed, many patients will already have experienced spread of cancer cells through the blood and lymph system to other locations in the body. These cancer cells are referred to as micrometastases.
Information obtained during surgery and from other tests determines the likelihood of the cancer having spread and whether additional systemic treatment with precision cancer chemotherapy, hormonal therapy or radiation is necessary to kill the cancer micrometastases responsible for a cancer recurrence. The following sections may answer additional questions that you have about undergoing surgery.
Post Surgical Care
Following any surgery, the wound must be kept clean to avoid infection.
Patients will typically have a sterile bandage placed on the wound and may have a drain inserted to prevent body fluid from collecting at the surgical site. This should help minimize swelling and pain, and also allow for quicker healing. Patients may have more than one drain. Each drain consists of a collection tube that is stitched to your skin so that it does not fall out. A small plastic plug at the end of the tube allows the fluid to be emptied. The color of the fluid may be dark red at first because of the large amount of blood cells in the area. Gradually, the color should change to pink-tinged and then finally a yellow straw color. The amount of drainage may vary. The more active you are, the more fluid will be produced. Gradually, the fluid will decrease.
Notify your surgeon if the following occurs:
- 100.5 F. fever or chills
- Increased areas of redness around the insertion site
- Increased swelling around the insertion site
- Drainage from the wound itself – that is the incision site and not the tubing
- Cloudy fluid that has a bad odor
- Your drain is collecting thick yellowish or green fluid
- Drainage bulb does not stay flat after being emptied
- Wound edges begin to separate
- Pain is not relieved by your pain medication
- Your drainage is increasing instead of decreasing, or if you have a sudden increase in drainage
The surgeon will remove your drain(s) during a follow-up office visit. This usually occurs when the drainage is reduced to between 20 to 50 cc (1 to 3 tablespoons) per a 24 hour period OR four weeks after surgery, whichever comes first. You may feel a pulling sensation with moderate amount of pain only lasting a few seconds when the drain is removed. A small bandage will be placed over the drain site. This will need to be watched for infection for the next several days.
Do not swim or soak in a tub for two days but you may shower. The site should close within 3 to 4 days. You may notice some fluid oozing from the site until healing occurs.