Surgery is one of the most common treatments for cancer. Roughly half of all people diagnosed with cancer in the UK will have an operation as part of their cancer treatment. Surgery is also possibly the oldest treatment we have for cancer. So how exactly is surgery used to treat cancer? How much has it changed over the years and what will cancer surgery look like in the future? We answer your questions below.
What is cancer surgery?
Cancer surgery is a general term that is often used to mean any operation that is done to remove all, or part, of a person’s cancer. This type of surgery is usually a fairly major procedure, and is carried out while the patient is asleep, under general anaesthetic.
When is surgery used to treat cancer?
Surgery is sometimes the ‘primary treatment’, used to try and treat or cure the cancer. IN other cases surgery is used in combination with other treatments, especially for more advanced cancers that might have spread. This type of treatment is called ‘combination therapy’.
When surgery is used as part of combination therapy, the surgeon will try and take out as much of the cancer as possible, and other treatments such as chemotherapy, radiotherapy, or immunotherapy are used to try and shrink or destroy the rest of the tumour - either before or after the surgery. Surgery can sometimes also be used to help relieve symptoms or prevent cancer from developing in the first place.
What is the history of cancer surgery?
Cancer surgery is the oldest type of cancer treatment we have, and is still one of the most important today. Surgical treatment of cancer is even mentioned in medical texts from the ancient Greeks and Romans.
Of course things have improved since then. Cancer surgery is no longer carried out by barbers for one thing, and the advent of anaesthesia in the mid-1800s made a big difference for both the patient and surgeon, as you might imagine. From then, operations to remove cancer became much safer, more effective, and more common.
And research has continued to make a huge difference to how we do surgery, allowing a better understanding of how cancer grows and develops, which has then helped to improve technical surgical skills.
And huge advances in MRI and CT scan imaging techniques have also greatly reduced the need for invasive ‘exploratory surgery’- an initial operation that was often needed to gather samples for testing to determine exactly where the cancer is located in the body.
How effective is cancer surgery?
The success rate for cancer surgery varies depending on the type and stage of cancer and the prognosis is different for every person. Surgery works best on solid cancers, including breast cancer and prostate cancer, rather than blood cancers such as leukaemia. It also works better if the cancer has not spread.
As we learn more about cancer, science breakthroughs are helping more people live for longer after surgery for cancer. Recent research indicates that taking the cancer drug olaparib before surgery for breast cancer could reduce the risk of the cancer coming back.
What are the risks and benefits of cancer surgery?
Surgery is the most effective treatment for a lot of cancers. Surgeons can help to remove as much of a cancer as possible, and can sometimes remove it completely. Nearby lymph nodes are also sometimes removed during surgery since they are a common place for cancer to spread to.
Surgery can also be used to reduce the risk of developing cancer. If you have an inherited gene mutation you might chose to have risk-reducing surgery which can help prevent cancer.
As with all operations, there are risks associated with cancer surgery. These vary depending on the specific operation so always speak to your oncologist about your recommended treatment. Complications can include pain, infections and blood clots.
The different types and techniques of cancer surgery:
Open surgery
One large cut (incision) is made so the surgeon can see inside the body. It can take longer to recover from this type of surgery.
Minimally invasive surgery
Smaller cuts are made, and cameras and small tools are used to carry out the surgery inside the body. Keyhole surgery (laparoscopy) is a minimally invasive type of surgery where very tiny cuts are made for a camera (a laparoscope) to be inserted, and the surgery takes place inside the body, using the laparoscope to see. It can take less time to recover, with less pain, for these types of surgery.
Preventative cancer surgery
As research-led improvements in genetic knowledge lead to earlier and more accurate cancer prediction and diagnosis, preventative surgery is also becoming more common. This is when people can choose to have an area of the body that is very likely to develop cancer removed, as a protective measure.
Some people with certain versions of the BRCA gene or who have a very strong family risk of developing breast or ovarian cancer might choose to have surgery to remove their breasts or ovaries, for example.
Tumour removal
This is when the surgeon aims to cut out all of the tumour. This is also sometimes called tumour resection, or tumour excision. During this type of surgery, the whole tumour is removed, along with some healthy tissue around the outside. This bit is called the ‘margin’.
The surgeon might also remove lymph nodes around the tumour, to check if the tumour has spread to the lymph system. This is a network of tubes around the body that acts like a drainage system for waste fluid, and is often the first place that cancer cells spread to.
Tumour debulking
Involves removing a large part of the tumour, but not all of it. This might be because it is too difficult or risky to the patient’s health to try and remove the entire tumour.
Debulking procedures might also be carried out as part of palliative surgery, which is when surgery is used to remove part of the cancer to help ease symptoms and improve the patient’s quality of life. Palliative surgery might be used to reduce painful pressure of the tumour on nerves for example, reduce bleeding, or remove blockages.
Cryosurgery
Cryosurgery uses very cold substances to freeze and kill cancer cells. Cryosurgery is most commonly used to remove some types of external skin cancer. It is also sometimes used to remove some tumours from inside the body, for example in the liver or the kidney. In the UK, cryosurgery is also currently being tested and developed as treatment for prostate cancer.
Other procedures
There are also other types of procedures used in cancer which include ‘surgery’ in their name, but which may use very different techniques compared to traditional surgery. For example, using carefully positioned radiation beams to target the tumour from outside the body. Incisions in the skin are not usually needed.
How is research changing the future of cancer surgery?
Advances in imaging, robotics, and AI all look set to radically change cancer surgery. The development of ‘smart’ surgical tools and probes that can sense the difference between cancer cells and healthy cells are also a very exciting area of research right now. Together, these innovations will continue to make cancer surgery more precise and less invasive for patients. Researchers even predict these advances could one day result in fully functional AI-driven robotic ‘surgeons’.
As a cancer research charity, we are proud to see that research we funded in 2005 has led to a clinical trial testing a new combination therapy for patients with bowel cancer. Professor Awen Gallimore and her colleagues at Cardiff University have started a trial, called BICCC, investigating whether very low doses of a chemotherapy drug called cyclophosphamide after surgery could help prevent bowel cancer from returning.
This specific type of combination treatment has never been tested before and, if successful, could point the way to a new treatment for patients with bowel cancer, who currently live with the risk of their cancer returning.
Your cancer surgery FAQs:
What types of cancer are treated with surgery?
There are over 200 different types of cancer and surgery is an option for a lot of them, depending on the individual patient. Surgery is more suitable for solid tumours including prostate cancer, breast cancer and lung cancer.
How does surgery work alongside chemotherapy or radiotherapy?
Surgery can be used in the first instance to remove a cancer, with radiotherapy or chemotherapy used afterwards to reduce the risk of cancer coming back.
Alternatively other treatments can be used before surgery in order to shrink the tumour and improve the chance that surgery will be able to remove all of a cancer.
Every patient and every cancer is different and your oncology team will be able to advise the best treatment combination for you.
Is surgery always an option for cancer patients?
No, surgery is not always an option. It is rarely used to treat blood cancers because these affect blood throughout the body so surgery would be impossible.
Sometimes surgery is not a viable option if the cancer has spread too much, and in other cases chemotherapy or radiation may be a better option.
What is the future of cancer surgery?
Surgery for cancer is becoming more precise, meaning more of a cancer is removed without affecting healthy tissue. Technology is helping surgery become less invasive, making it kinder for cancer patients. More operations can be conducted using keyhole surgery so patients have less pain, smaller scars and quicker recovery times.
Thanks to you, Worldwide Cancer Research scientists are involved in discovery research driving forward innovations in cancer surgery. Professor Edward Tate and his team at Imperial College London have made a discovery that could one day help to make surgery to remove tumours more successful, developing a cutting-edge ‘chemical probe’ to track the activity of a specific protein in pancreatic cancer - which could one day help surgeons clearly see the boundaries of tumours, making surgery easier and less invasive and reducing the risk of cancer cells being left behind to regrow.
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