Surgical Oncology: Treatment Options
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Your surgical treatment plan
At CTCA, we understand you may be feeling overwhelmed with questions and concerns about your diagnosis and what it all means. We also understand how important it that you have a voice in your care so you can regain some control.
Eastern’s surgical oncology team is here to present you with options and empower you to make informed decisions about your care. Using results from your diagnostic tests, your care team will work with you to develop an individualized treatment plan that is tailored to your needs.
The type of surgery you receive will vary, depending on factors such as the location, size, type, grade, and stage of the tumor, as well as your age, general health, and other factors.
In addition, the goal of surgery may be to remove the cancer (e.g., excisions, resections, debulking, cytoreductive surgery), reconstruct a part of the body (e.g., restorative surgery), and/or to relieve symptoms such as pain (e.g., palliative surgery).
Each month, Eastern’s Department of Surgical Oncology performs about 200 surgical procedures to treat all forms of cancer. For example, the surgical oncology team is experienced in surgeries for all different types of primary and metastatic tumors, including melanomas, stomach, esophageal, and head and neck cancers.
Some treatment options by cancer type
The following are some additional examples of common cancer types and the specific surgeries the surgical oncology team provides:
- Bone and soft tissue sarcomas: Your surgical oncologist will collaborate with the orthopedic oncology team to provide procedures for cancers that have spread to the bone, such as breast, lung, and prostate. Examples of surgeries include intramedullary rodding of the femur, total hip replacement, excisions, and amputation.
- Breast cancer: Procedures for breast cancer may include breast conservation surgery (e.g., partial mastectomy/lumpectomy), mastectomy, sentinel node biopsy, excision of recurrent breast cancer, and breast reconstruction.
Since many breast cancer patients develop lymphedema (a condition in which excess fluid collects in tissue and causes swelling) after surgery, the department also offers an individualized Lymphedema Management Program.
“Everybody who is having an axillary node dissection will see the lymphedema folks up front. They’ll learn about lymphedema and lymphedema prevention. We evaluate them so in their return visit, if they are showing any signs of lymphedema, we can intervene early. It’s a comprehensive program,” says Dr. Standiford.
- Colorectal cancer: Some common procedures for colon and/or rectal cancer include resections, colectomy and colostomy. The surgical oncology team also performs transanal excisions to remove rectal cancer without entering the abdomen, which can help avoid a large abdominal operation and the risk of a colostomy. In addition, the team performs extended resections for recurrent colon cancer.
- Gastrointestinal cancer: The team commonly performs endoscopies and other procedures for cancers of the gastrointestinal (digestive) system, including stomach cancer.
- Liver cancer: One innovative procedure used to treat liver cancer without having to operate on the tumor is radiofrequency ablation (RFA). A type of local hyperthermia, radiofrequency ablation is an innovative form of localized cancer treatment which uses high-energy radio waves, or radiofrequency energy, to heat and destroy cancerous cells.
In RFA, a thin, needle-like probe is temporarily placed into a tumor through an incision in the abdomen, using CT scan or ultrasound guidance. The probe then releases electrodes that heat and destroy cancer cells. Your surgical oncologist may recommend RFA if surgical resection of a tumor is not possible.
- Lung cancer: Your surgical oncologist will collaborate with the interventional pulmonology team, including Dr. Mark Lund, to provide bronchoscopies with stent, laser ablation, or photodynamic therapy. Other procedures include lobectomy, wedge resection for metastatic tumors, thoracoscopic biopsies, thoracotomy, and video-assisted thoracoscopic surgery (VATS). The team also performs various palliative procedures to help control malignant pleural effusions (fluid around the lung).
- Pancreatic cancer: If the tumor is contained entirely within the pancreas and looks like it can be removed, Eastern’s surgical oncologists have extensive experience in performing Whipple procedures. This is a very complicated procedure that requires a great deal of skill to perform. It involves removing the head or front half of the pancreas, part of the small intestine, and some of the tissues around it. Other examples of pancreatic cancer surgeries include distal and total pancreatectomies.
If surgery to remove the entire tumor is not possible, your surgical oncologist may perform palliative surgeries, including surgical biliary bypass, endoscopic stent placement, and gastric bypass. These procedures can help relieve the jaundice and itching associated with pancreatic cancer, prevent treatment interruptions, prevent liver damage, and improve quality of life. In order to make a previously inoperable pancreas resectable, your care team may provide chemotherapy and radiation therapy prior to surgery.
In addition, some pancreatic cancer patients suffer from ascites (abnormal build up of fluid in the abdomen), which can be very uncomfortable. The surgical oncology team inserts tunneled catheters to help pancreatic cancer patients who are experiencing ascites feel less full. By regaining their appetite, patients are able to maintain their nutritional status.
- Prostate cancer: Your surgical oncologist collaborates with the radiation oncology team to place brachytherapy catheters for focused radiation therapy treatments, such as High-Dose Rate (HDR) brachytherapy procedures.
Port placement procedures
Your surgical oncologist will also collaborate with the rest of your care team to provide surgical procedures in conjunction with your other cancer treatments.
For instance, before you receive a treatment like chemotherapy, your surgical oncologist may perform a port placement procedure. In this procedure, a vascular access device (VAD), or port, is surgically implanted into a blood vessel in the chest. Through the port, intravenous fluids and drugs may be given, or blood samples may be obtained.
In 2007 alone, Dr. Standiford performed 180 port placement surgeries. The surgery usually takes 30 to 45 minutes. Your port stays in place for several months, until your doctor determines you no longer need it. Examples include venous access ports, port-o-caths, central venous access catheters, Hickman catheters, and Peripherally Inserted Central Catheter (PICC).
A port is a reliable way to get fluids, blood drawn, and chemotherapy treatments without multiple needle pricks. Since you don’t have to endure all of the poking and prodding of needles, ports can help provide you with a better quality of life.
Percutaneous endoscopic gastrostomy (PEG) tube procedures
The surgical oncology team performs percutaneous endoscopic gastrostomies, which involve putting a feeding tube (PEG tube) into the stomach. The surgery is relatively simple and involves little risk or discomfort. It can help improve your nutritional status.