ONCOSURGERY (CANCER CARE)

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What is the Role of Surgery?

Surgery is the oldest form of cancer treatment, and for most patients, part of the curative plan includes surgery. The most important part of the consultation with the surgeon is a complete history and physical exam. Before surgical resection, diagnostic and staging studies should be performed. This helps the surgeon determine if the cancer is resectable (removable with surgery), and allows him or her to plan the surgical approach. Due to improved screening techniques, many patients have disease that is curable with surgery alone at diagnosis. In such cases, after surgery, the patient’s follow-up care includes close observation and/or radiology and lab tests.

The goals of the surgical oncologist are to remove the cancer and an area of healthy tissue surrounding it, also known as a clear margin or clear excision, in order to prevent the cancer from recurring in that area (which is called a local recurrence). Sometimes it is not possible to remove the whole tumor, and a surgery known as “debulking” may be done to remove as much of the tumor as possible and to relieve symptoms such as pain, airway obstruction, or bleeding. However, the contribution of the surgical oncologist goes beyond what is done on the day of surgery itself. As part of the multidisciplinary care team, he or she provides expert opinion about biopsy techniques, optimal image guidance, the likelihood of achieving clear margins (especially in borderline resectable cases), and what role there is, if any, for surgical management of more advanced disease.

TAlthough chemotherapy and radiation therapy are commonly used either pre- or post-operatively, a quality surgery is critical because it is not clear that chemotherapy or radiation can correct or compensate for an inadequate surgery. Excision of lymph nodes in the area of the tumor may be done at the time of surgery, depending on the type of cancer. The information regarding lymph node status (i.e. do they contain cancer cells or not?) can help determine prognosis as well as further treatment options. For example, if a patient has a small rectal cancer that is thought to be node-negative pre-operatively, but there is nodal involvement discovered after surgery, this finding gives a less favorable prognosis than if all the nodes had been negative. Additionally, chemotherapy and/or radiation would be recommended for node-positive disease, but with node-negative disease and an absence of other risk factors, observation alone after surgery may be recommended.

What is Surgical Oncology?

Surgery as a medical field has been changing rapidly since the late 1800s, in large part thanks to the development of safe and effective anesthesia. Surgical oncology is a specialty that focuses on the surgical treatment of a variety of tumors. Ephraim McDowell did the first reported resection of an ovarian tumor in 1809, but as early as the 7th century, ancient Egyptians described techniques for removing breast tumors. Today, general surgeons can pursue additional training after their residency in the form of a surgical oncology fellowship. However, a surgeon does not have to do a surgical oncology fellowship in order to be a surgical oncologist. What is more common is that a surgeon who is trained in a particular body site may develop expertise in cancers of that site, and thus have experience in the multidisciplinary approach to the prevention, diagnosis, and treatment of those cancers. For example, a thoracic surgeon who is a surgical oncologist may devote most of his practice to lung cancer, while a head and neck surgical oncologist would be involved in treatment of cancers specific to his or her training, such as cancer of the larynx.

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Cancer care at Sarvadnya Multispeciality Hospital has a three-point approach:

Prevention & Early detection:

Cancer screening services are offered here using the latest techniques in radiology, biopsy and surgical treatment.

Treatment:

Our comprehensive cancer treatments include surgery, radiation and chemotherapy
Cancer Surgery is now conducted with the help of the most advanced surgical techniques in the following areas: