Surgery for cancer - everything you need to know

12th September 2023

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.

How is surgery used to treat cancer?

Surgery might be used as a ‘primary treatment’, to try and treat or cure the cancer, or it might be used for other reasons, such as to help relieve symptoms, or prevent cancer from developing in the first place.

Different types of cancer surgery can include

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.

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.

How is cancer surgery carried out?

Two common surgical techniques used in cancer treatment include open surgery and minimally invasive surgery:

With 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.
With 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.

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.

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.

When is surgery used with other cancer treatments?

It is now quite common to use surgery 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.

These other therapies may be given before surgery, to reduce the size the tumour as much as possible and increase the chances of being able to remove all of the tumour during surgery (this is called ‘neoadjuvant treatment’).

Or they could also be used after surgery, to help clear up any parts of the tumour that were missed during surgery, and to prevent the cancer from spreading or coming back (this is called ‘adjuvant treatment').

Testing a new combination therapy for bowel cancer

Thanks to your support, exciting results from research that we funded in 2005 have helped Professor Awen Gallimore and her colleagues at Cardiff University start a clinical trial testing a new form of combination therapy for patients with bowel cancer.

The study, called BICCC, is investigating whether giving very low doses of a chemotherapy drug called cyclophosphamide after surgery could potentially help to prevent bowel cancer from coming back.

This specific type of combination treatment has never been tested before, and if successful, it could point the way to a new treatment option for patients with bowel cancer, who currently must live with the risk of their cancer returning.

Prof Awen Gallimore

We hope that [the study known as] BICCC will be important for people with colorectal cancer as currently after surgical resection and chemotherapy, there is no other treatment. People must hope that their cancer will not return. BICCC offers a new immune-based intervention that could significantly increase the chance of remaining cancer free.

When was the first cancer surgery?

Cancer surgery is the oldest type of cancer treatment we have, and it is still one of the most important today. Surgical treatment of cancer is even mentioned in medical texts used by the ancient Greeks and Romans.

Of course things have improved since Roman times. Cancer surgery is no longer carried out by barbers for one thing (!), and the advent of anaesthesia in the mid-1800s was a big benefit for both the patient and surgeon, as you might expect. From this point on, operations to remove cancer became much safer, more effective, and more common.

And medical advances since then have continued to make a huge difference to how we do surgery. Research has led to better understanding of how cancer grows and develops, and this has helped to improve technical surgical skills.

Huge advances in MRI and CT scan imaging techniques since the 1970s 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 is research changing the future of cancer surgery?

New high-tech advances in imaging, robotics, and artificial intelligence (AI) all look set to radically change cancer surgery in the 21^st century. 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 increasingly more precise and less invasive for patients. Researchers even predict that these advances could one day result in fully functional AI-driven robotic ‘surgeons’.

Thanks to your support, Worldwide Cancer Research scientists are already involved in the front-line discovery research required to drive forward some of these innovations in cancer surgery. For example, a Curestarter-funded project in London has already made a discovery that could one day help to make surgery to remove tumours more successful.

Professor Edward Tate and his team at Imperial College London have been able to develop a cutting-edge ‘chemical probe’ to track the activity of a specific protein in pancreatic cancer.

As well as helping them understand vital new information about how this protein is involved cancer growth, the researchers also hope that probes like this could one day be used to detect cancer cells with high levels of certain proteins in the body- and help the surgeon clearly see the boundaries of tumours which produce this protein compared to healthy cells.

Any new advance that can help to ‘flag-up’ tumour cells to the surgeon like this could help to make surgery easier and less invasive for the patient, and reduce the risk of cancer cells being left behind to regrow, or spread to other parts of the body.

Whatever the next amazing advances that come with cancer surgery, we’re hugely grateful to our incredible Curestarters It's thanks to you that we can continue giving the green-light to more of the most innovative cancer research.

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