23451 Madison Street
Torrance, California 90505
Suite 340 (Main Reception)
Suite 360 (Vein Center)
Suite 300 (Bariatric Surgery)
Telephone: (310) 373-6864
Facsimile: (310) 373-6065
Advanced Endovascular Interventions
Advanced Laparoscopic Surgery
Carotid Duplex Examination
Dialysis Access Surgery
Gastroesophogeal Reflux Disease
Peripheral Vascular Disease
Sentinel Lymph Node Mapping
Varicose Vein Disease
Venous Doppler Evaluation
Venous Reflux Examination
Surgery is the oldest form of treatment for cancer. It also has an important role in diagnosing and staging (finding the extent) of cancer. Advances in surgical techniques have allowed surgeons to successfully operate on a growing number of patients. Today, more limited (less invasive) operations are often done to remove tumors while preserving as much normal function as possible.
Surgery offers the greatest chance for cure for many types of cancer, especially those that have not yet spread to other parts of the body. Most people with cancer will have some type of surgery.
Why Is Surgery Used for Cancer?
Surgery can be done for any of several reasons. It is often done to achieve more than one of these goals:
Preventive (prophylactic) surgery is done to remove body tissue that is not malignant (cancerous) but is likely to become malignant. For example, this type of surgery may be used if you have a precancerous condition such as polyps in the colon.
Sometimes preventive surgery is used to remove an entire organ when a person has an inherited condition that makes development of a cancer very likely. For example, some women with a strong family history of breast cancer are found to have a change (mutation) in their DNA in a breast cancer gene (BRCA1 or BRCA2). Because their risk of getting breast cancer is high, these women may want to consider prophylactic mastectomy (breast removal).
Diagnostic surgery is used to get a tissue sample to tell whether or not it is cancerous or to tell what type of cancer it is. The diagnosis of cancer often can be confirmed only by looking at the cells under a microscope. Several surgical techniques can be used to obtain a sample. These are described in the next section.
Staging surgery helps determine the extent and the amount of disease. While the physical exam and the results of lab and imaging tests can help determine the clinical stage of the cancer, surgical staging is usually a more accurate assessment of how far the cancer has spread. For more information, please see our document on "Staging." Examples of surgical procedures commonly used for staging cancers, such as laparotomy and laparoscopy, are described in the next section.
Curative surgery is the removal of a tumor when it appears to be confined to one area. It is done when there is hope of taking out all of the cancer. Curative surgery is thought of as primary treatment of the cancer. It may be used alone or along with chemotherapy or radiation therapy, which can be given before or after the operation. In some cases, radiation therapy is actually used during an operation (intraoperative radiation therapy).
Debulking (cytoreductive) surgery is done when removing a tumor entirely would cause too much damage to an organ or surrounding areas. In these cases, the doctor may remove as much of the tumor as possible and then try to treat what’s left with radiation therapy or chemotherapy. Debulking surgery is commonly used for advanced cancer of the ovary.
Palliative surgery is used to treat complications of advanced disease. It is not intended to cure the cancer. It can also be used to correct a problem that is causing discomfort or disability. For example, some cancers in the abdomen may grow large enough to obstruct (block off) the intestine. This may require surgery for effective relief. Palliative surgery may also be used to treat pain when it is hard to control by other means.
Supportive surgery is used to help with other types of treatment. For example, a vascular access device such as a catheter port can be surgically placed into a large vein. The catheter can then be used to deliver chemotherapy treatments or draw blood for testing, reducing the number of needle sticks needed.
Restorative (reconstructive) surgery is used to restore a person’s appearance or the function of an organ or body part after primary surgery. Examples include breast reconstruction after mastectomy or the use of tissue flaps, bone grafts, or prosthetic (metal or plastic) materials after surgery for oral cavity cancers. For more information on these types of reconstructive surgery, please see "Breast Reconstruction After Mastectomy" and "Oral Cavity and Oropharyngeal Cancer."
What Surgical Techniques Are Used to Diagnose Cancer?
A biopsy is a procedure done to remove a tissue sample for diagnostic tests. Some biopsies may require surgery, but several types of biopsies can remove tumor samples through a thin needle or an endoscope (a flexible lighted tube). Biopsies are often done by surgeons, but they can be performed by other doctors as well.
Fine Needle Aspiration Biopsy Fine needle aspiration (FNA) uses a very thin needle attached to a syringe to withdraw a small amount of tissue from a tumor. If the tumor can’t be felt near the surface of the body, the needle can be guided into the tumor by viewing it with an imaging technique such as an ultrasound (US) or CT (computed tomography) scan. The main advantage of FNA is that it does not require a surgical incision (cutting through the skin). A drawback is that in some cases the needle can’t remove enough tissue for a definite diagnosis. A more invasive type of biopsy may then be needed.
Needle Core Biopsy This type of biopsy uses a slightly larger needle. The advantage of core biopsy is that it usually collects enough of a sample to diagnose the tumor. A core biopsy can be aspirated (removed) with a needle if the tumor can be felt at the surface. Core biopsies can also be guided by imaging techniques if the tumor is too deep to be felt.
Excisional or Incisional Biopsy These procedures involve a surgeon cutting through the skin to remove the entire tumor (excisional biopsy) or a small part of a large tumor (incisional biopsy). They can often be done with local or regional anesthesia (numbing medicine used just in the area of the biopsy). If the tumor is inside the chest or abdomen, general anesthesia (putting you into a deep sleep) may be needed.
Endoscopy This procedure uses a flexible tube with a viewing lens or a video camera and a fiber optic light on the end. If a video camera is used, it is connected to a television screen, allowing the doctor to clearly see any masses in the area. Endoscopes can be passed through natural body openings to view suspicious areas in places such as the:
Endoscopy has several advantages:
Laparoscopy is similar to endoscopy, but requires a small incision to be made in the skin in the abdomen. A thin tube called a laparoscope is then inserted through the incision into the abdomen to look for possible areas of cancer that can be biopsied. When this type of procedure is done in the chest it is called a thoracoscopy or mediastinoscopy.
Open Surgical Exploration (Laparotomy, Thoracotomy, Mediastinotomy)
When less intrusive tests can’t provide enough information about a suspicious area in the abdomen, a laparotomy may provide an answer. In this procedure, a surgeon makes an incision, usually from the bottom of the sternum (breastbone) down to the lower part of the abdomen, allowing him or her to look directly at the area in question. The location and size of the involved area and any surrounding areas can be evaluated, and a biopsy can be taken, if needed. Because this is a major surgical procedure, it requires general anesthesia (where you are asleep). A similar operation involving the chest is called a thoracotomy or mediastinotomy.
Special Surgery Techniques
When most people think of surgery, they picture a doctor using a scalpel and other surgical instruments to remove, repair, or replace parts of the body affected by disease. But newer techniques, using different types of instruments, have expanded the concept of what surgery is. Some of these newer techniques are described below.
What Is Laser Surgery?
A laser is a highly focused and powerful beam of light energy, which can be used in medicine for very precise surgical work such as repairing a damaged retina in the eye. It can also be used to cut through tissue (instead of using a scalpel) or to vaporize cancers of the cervix, larynx (voice box), liver, rectum, or skin.
Some surgeries can be made less invasive by using laser light. For example, with fiber optics the light can be directed to parts of the body without having to make a large incision.
Laser surgery is also called photoablation or photocoagulation. This type of surgery is often used to relieve symptoms, such as when large tumors press on the windpipe or esophagus, causing problems with breathing or eating.
What Is Cryosurgery?
Cryosurgery involves the use of a liquid nitrogen spray or a very cold probe to freeze and kill abnormal cells. This technique is sometimes used to treat precancerous conditions such as those affecting the cervix. Cryosurgery is also being studied as a treatment of some cancers such as those of the prostate.
What Is Electrosurgery?
High-frequency electrical current can be used to destroy cells. It is used for some cancers of the skin and mouth.
What Is Mohs Surgery?
Mohs micrographic surgery, also called microscopically controlled surgery, is a technique to remove certain skin cancers by shaving off one layer at a time. After each layer is removed, a specially trained dermatologist (skin doctor) or pathologist looks at the tissue layer under a microscope. When all the cells look normal under the microscope, the surgeon stops removing layers of tissue.
This technique is used when the extent of the cancer is not known or when as much healthy tissue as possible needs to be preserved (as in cancers around the eye). It is performed under local anesthesia by a specially trained surgeon.
Chemosurgery is an older name for this surgery and refers to certain chemicals applied to the tissue before it is removed. The procedure does not involve use of cancer chemotherapy drugs.
What Is Laparoscopic Surgery?
A laparoscope is a long, flexible tube placed through a small incision to view the inside of the body. It is sometimes used to take biopsy samples. In recent years, doctors have found that by creating several small holes and using special instruments, the laparoscopic technique can be used to perform surgery without the need for a large incision. This can help reduce blood loss during surgery and pain afterwards, and can also shorten hospital stays. It is commonly used today to remove gallbladders and to repair hernias.
Its role in cancer, however, remains less clear. Doctors are now studying whether it is safe and effective in surgeries for cancers of the colon, prostate, and kidney, among others. It may prove to be as safe and effective as conventional surgery while being less invasive. Some studies have hinted at this being the case. But until larger, long-term studies are completed, laparoscopic surgery for most forms of cancer is still considered investigational.
Are There Other Forms of Surgery?
Newer ways to remove or destroy cancerous tissue are always being explored. Some are beginning to blur the lines between what we commonly think of as "surgery" and other forms of therapy. Researchers are testing many new techniques, using things such as high intensity focused ultrasound (HIFU); microwaves or radio waves (radiofrequency ablation, or RFA); or even magnets in an attempt to get rid of unwanted tissue. While promising, these techniques are still largely experimental.
As doctors learn how to better control the energy waves used in radiation therapy, some newer radiation techniques are almost at the precision level of surgery. By using radiation sources approaching from different angles, stereotactic radiation therapy delivers a large precise radiation dose to a small tumor area. The doses are so precise that the term stereotactic surgery is sometimes used, even though no incision is actually made. In fact, the machines used to deliver this treatment have names like Gamma Knife and CyberKnife, although no actual knife is involved. The most common site being treated with this technique is the brain, but it is also being used in head, neck, lung, and spine tumors. Researchers are looking for ways to use it with other types of cancer as well.
What Questions Should I Ask My Doctor About Surgery?
Before undergoing surgery, find out all you can about the benefits, risks, and side effects of the operation. Answers to the following questions will help you feel comfortable about your decision.
What Does Surgery Involve?
A person’s experience with surgery can depend on many factors, including the disease being treated, the type of operation being performed, and the person’s overall health. There are probably as many different surgical techniques as there are diseases to treat, so each case is different. It’s not possible to get into the specifics of each type of operation here, but more detail is provided in the treatment sections of our documents on particular types of cancer.
Still, some aspects of the surgical experience are common to most operations. They include preoperative testing and preparation, the surgery itself (usually including some type of anesthesia), and a recovery period.
Planning and Preparation
Both you and your doctor need to prepare before surgery to make sure you have the best chance for a good outcome. For your part, this involves knowing what to expect (as much as possible) and being comfortable that the decision you’ve made is the best one for you. People differ as far as how involved they want to be in the decision making process, but knowing as much as you can about what lies ahead can at the very least help reduce your level of stress.
It is not unusual for patients to wait several weeks from the time they receive a cancer diagnosis to have surgery. You have time - time to educate yourself about your cancer, time to talk to others who have been through it, time to explore your treatment options, time to organize your thoughts, and time to find the right medical team for you. You may want a second opinion. Scheduling surgery requires all the team members from various disciplines to have input about the procedure. Also, pre-approval for the procedure by your insurance provider may be required. In almost all cases, a slight delay in surgery should have no impact on the positive outcome of the surgery. If you have some type of urgent medical symptom, surgery will be scheduled as soon as possible.
Informed consent: Informed consent is one of the most important parts of your preparation for surgery. It is a process during which you give your written permission for your doctor to perform surgery, after you have been informed of all aspects of the treatment. Although the specifics may vary from state to state, the informed consent form usually affirms that your doctor has explained these items:
Your signature means that you have received this information and that you are willing to have the surgery. It is important that you read the consent form and understand each of the above issues before signing. Make sure your doctor answers all of your questions and that you understand the answers. Having a family member or friend go over it with you may also be helpful.
Preoperative testing: Several tests are usually needed in the days or weeks before your surgery, especially if a major operation is planned. These are done to make sure your body is able to endure surgery and anesthesia, and may also be done to assess your condition and help plan the surgery. Not all of these may be necessary (especially if you are having a minor procedure in a doctor’s office). The tests commonly used include:
Blood tests to assess your blood counts, the risk of bleeding or infection, and functioning of your liver and kidneys. Your blood type may also be determined in case you require blood transfusions during the operation.
Urine test (urinalysis) to look at kidney function and possible infections.
Chest x-ray and EKG (electrocardiogram) to assess lung and heart function.
Other tests as needed, such as CT scans to identify the size and location of tumors and whether or not they are involved with surrounding structures in the body.
In addition, your doctor will ask you questions about high blood pressure, heart disease, diabetes, and other conditions that could affect surgery. Letting your doctor know about any allergic reactions you’ve had in the past is very important. If you are having general anesthesia (being put into a deep sleep), you will likely also be examined by an anesthesiologist (doctor who specializes in giving anesthesia). Other specialists may be consulted if you have another condition that could affect the surgery.
Preparing for surgery: Depending on the type of operation you have, you may need to do more or less in terms of preparation.
Emptying your digestive tract is important if you will be asleep during surgery. Vomiting under anesthesia can be very dangerous because the material could enter the lungs and cause an infection. For this reason, you will be asked not to eat or drink anything starting the night before the surgery. You may also be asked to use a laxative or an enema to ensure your intestines are empty.
You may need to have an area of your body shaved to keep hair from entering the incision site. The area will be cleaned thoroughly before the operation to reduce the risk of infection. Other, special preparations may also be needed.
Again, although each type of surgical procedure is different, they usually have certain factors in common.
Anesthesia: Anesthesia makes the body unable to feel pain for a period of time. Depending on the type and extent of the operation, it may or may not involve having you asleep. In some cases, you may have an option as to which type of anesthesia you prefer.
Local anesthesia is often used for minor surgeries, such as biopsies near the body surface. Medicine is injected into the site beforehand to numb the nerves that cause pain. You remain awake and usually feel only slight pressure during the procedure. Topical anesthesia is a type of local anesthesia that is rubbed or sprayed onto a body surface instead of being injected. It is sometimes used in the throat before endoscopy.
Regional anesthesia (a "nerve block") affects a larger area of the body while still allowing you to remain awake. It usually involves injecting an area around the spinal cord, which affects certain nerves coming out of it, but may also involve injecting around nerves in the arms or legs. The location of the injection determines the area affected. Medicine may be given as a single injection or as a continuous infusion if needed. While you remain awake, you may be given something to help you relax.
General anesthesia puts you into a deep sleep for the surgery. It is commonly started by having you breathe into a facemask or injecting a drug into a vein in your arm. Once you are asleep, an endotracheal (ET) tube is placed in your throat to continue giving the medicine and to allow your doctor to monitor your vital signs (heart rate, breathing rate, and blood pressure). A doctor or nurse who specializes in giving anesthesia watches you throughout the procedure and until you wake up. They also remove the ET tube once the operation is over.
If you’ve received only a local anesthetic, you may be allowed to go home shortly after the procedure. Those receiving regional or general anesthesia are taken to the recovery room to be monitored while the effects of the anesthesia wear off. This may take several hours. People waking up from general anesthesia often feel "out of it" for some time. Things may seem hazy or dreamlike for a while, and you may not feel like you are fully awake until the following day.
Recovery in the period right after surgery depends on many factors, including your state of health before the operation and how extensive the operation was. You will continue to receive medicine for pain while in the hospital, and beyond if needed. Throughout your hospital stay, be aware that there are many different medicines available to help you control your pain. If you continue to have pain that is interfering with your recovery, be sure to let your health care team know.
Your throat may be sore for a time as a result of having had the ET tube in place. You may also notice that you have a catheter (tube) leading out from your bladder, which allows urine to exit your body. This may be removed shortly, but may need to be put back in for a few days if you are having trouble urinating on your own.
You may also have a tube or tubes ("drains") coming out of the incision site. Drains allow the excess fluid that collects at the site of the surgery to leave the body. Your doctor will likely remove them once they stop collecting fluid, usually a few days after the operation. This may be done while still in the hospital or at the doctor’s office after you have been sent home.
You may not feel much like eating or drinking, but this is an important part of the recovery process. Your health care team may start you out with ice chips or water at first. They will check that you are urinating normally at this time, and may want to measure the amount of urine you produce by having you go in a special container.
The digestive tract (stomach and intestines) is one of the last parts of the body to recover from the effects of anesthesia, and things need to be moving down there before you will be allowed to eat. In addition to checking your surgical scar and other parts of your body, your doctor will listen with a stethoscope for bowel sounds in your abdomen, and will ask if you have passed gas. You will likely be on a clear liquid diet until this happens. Once it does, you may be allowed to try solid foods.
Your health care team will probably try to have you moving, maybe even out of bed and walking, as soon as possible, even the day after your surgery. While this may be difficult at first, it helps speed your recovery by getting the digestive tract moving. It also helps get your circulation going and prevents blood clots from forming in your legs. Again, be sure to let your team know if you are experiencing a lot of pain, as this can be controlled with medicine.
Your team may also encourage you to do deep breathing exercises. This helps fully inflate the lungs and reduces the risk of pneumonia.
Once you are eating and walking, you may be considered for discharge home. Of course, this will depend upon other factors as well, such as the results of the surgery and tests done afterward. Your doctor will want to make sure you are well enough to be home. Before leaving, be sure that you understand the following:
You may require help at home for a while after surgery. If family members or friends are unable to do all that is needed, your team may be able to arrange to have a nurse visit you at home on a regular basis.
Other aspects of recovery may be more long term in nature. Wounds heal at different rates in different people. Some operations, such as a mastectomy (breast removal), may result in permanent changes to your body. Others, such as a limb amputation or an ostomy (opening in the abdomen connected to the end of your intestine) affect how your body functions, and may require that you learn new ways of doing things.
Understanding beforehand what the result of the operation will be is an important part of helping you adjust to your new body. Be sure that all of your questions are answered up front. Get as specific as you need to with your questions, and make sure your health care team gives specific answers, as well.
What Are the Risks and Side Effects of Surgery?
There are risks associated with any type of medical procedure, and surgery is no exception. Of course, there are risks with almost everything we do in life. What is important is whether or not the risk is outweighed by the possible benefits.
Doctors have been performing surgeries for as long as there have been doctors. Advances in surgical techniques and in our understanding of how to prevent infections have made surgery safer and less invasive than it has ever been. But there is always an element of risk involved, no matter how small.
Before you decide to undergo any medical procedure, it is important that you understand the risks. Different procedures may have different kinds and levels of risks and side effects. This section is not meant to provide a list of all of the possible complications of every type of surgery. Be sure to discuss your particular case with your doctor, who can give you a better idea about what your actual risks are.
Possible complications during surgery may be due to the surgery itself, to the anesthesia, or to an underlying disease. Generally speaking, the more complex the surgery, the greater the risk.
Minor operations and biopsies usually pose less risk than major surgery. Pain at the site of the incision is the most common problem. Infections at the site and reactions to local anesthesia are also possible.
Complications in major surgical procedures are not common, but can include:
Bleeding during surgery that may require blood component transfusions. Doctors try to minimize this risk by checking your blood counts beforehand and being careful near surrounding blood vessels during the operation. Still, some operations often involve a certain amount of controlled blood loss. For certain procedures, you may want to consider banking some of your own blood in the weeks before surgery so you can receive it during the operation (autologous transfusion) if needed.
Damage to internal organs and blood vessels during surgery. Again, doctors are careful to minimize this as much as possible.
Reactions to anesthesia or other medicines. Although rare, these can be serious because they can result in lowering of blood pressure. Your doctors will monitor your vital signs throughout the procedure to look for this.
Problems with other organs, such as the lungs, heart, or kidneys. These are very rare but can also occur and can be life-threatening. They are more likely to happen among people who already have problems with these organs, which is why doctors obtain a thorough patient history to assess the risk before an operation.
Some problems after surgery are fairly common, but are not usually life-threatening.
Pain is probably the most common side effect. Almost without exception, people experience some level of pain after surgery. As with any kind of trauma, your body lets you know loud and clear when it’s been cut. Some pain is normal, but it should not be allowed to interfere with your recovery. There are many ways of dealing with surgical pain. Medications for pain range from aspirin and acetaminophen (Tylenol) to stronger agents such as opioids.
Infection at the site of the wound is another possible problem. Although doctors take great care to minimize this risk by cleaning the area and maintaining a sterile environment around it, infections do occur. Antibiotics, either in pill form or given through a vein in your arm, are able to treat most infections.
Other problems are rare, but may be more serious.
Pneumonia can occur, especially among patients with reduced lung function to begin with, such as smokers. Performing deep breathing exercises as soon as possible after surgery helps lessen this risk.
Other infections can develop within the body, especially if the digestive tract was opened during the operation. Doctors take great care to try to ensure this does not happen. If it does, powerful antibiotics may be used to treat it.
Bleeding, either internally or externally, can occur if a blood vessel was not sealed off during surgery, or if a wound reopens. Serious cases may require a return to the operating room to find the source of the bleeding and stop it.
Blood clots can form in the deep veins of the legs after surgery, especially if a person remains in bed for a long time. Such a clot could become a serious problem if it were to travel to another part of the body, such as a lung. This is why you will be encouraged to get out of bed and sit, stand, and walk as soon as possible.
Slow recovery of other body functions, such as movement in the intestines, can occasionally become serious problems as well.
Other life-threatening complications are very rare, but do occasionally happen.
Some longer-term side effects are specific to the type of procedure used. For example, people undergoing colorectal cancer surgery may need a colostomy (an opening in the abdomen to which the end of the colon is attached), while men undergoing radical prostatectomy (removal of the prostate) are at risk for losing control of urination or becoming impotent.
Does Surgery Cause Cancer to Spread?
In nearly all situations, the answer is no. But there are some important exceptions, and doctors who are experienced in taking biopsies of cancers and treating them with surgery are very careful to avoid these situations.
The chances of a needle biopsy causing a cancer to spread are extremely low. In the past, larger needles were used for biopsies, and the chance of spread was more significant. Most types of cancers can be safely sampled by an incisional biopsy, but there are a few exceptions, such as certain tumors in the eyes or in the testicles. For these types of cancer, doctors may treat without a biopsy or may recommend removing the entire tumor if it is likely to be cancerous. In other cases a needle biopsy can be safely used and, if it indicates the tumor is a cancer, it can be removed by surgery.
One common myth about cancer is that it will spread if it is exposed to air during surgery. Some people may believe this because they often feel worse after the operation than they did before. It is normal to feel this way when beginning to recover from any surgery. Cancer does not spread because it has been exposed to air. If you delay or refuse surgery because of this myth, then you may be cheating yourself by passing up effective treatment.
The best chance of a cure from most types of cancer is to remove all of the cancer as soon as possible after diagnosis. If you have a solid tumor, sometimes surgery alone will provide a cure, but often chemotherapy, radiation therapy, or biologic therapy is also needed. Your health care team will discuss your best treatment options with you.
If you have any concerns about surgery and cancer spread, discuss this issue with your surgeon and other members of your cancer care team.
Should I Get a Second Opinion Before Surgery?
One of the ways to find out if a suggested operation is the best one for you may be to get the opinion of another surgeon. Your doctor should not mind this. In fact, some insurance companies require you to get a second opinion. You may not need to have tests done again because you can often bring the results of your original tests to the second doctor.
Check with your insurance company before proceeding with a surgery. Making an informed decision about your health is almost always better than making a quick one.
23451 Madison Street
Torrance, California 90505
Suite 340 (Main Reception)
Suite 360 (Vein Center)
Suite 300 (Bariatric Surgery)
Telephone: (310) 373-6864
Facsimile: (310) 373-6065
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