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SURGERY FOR CANCER

Surgery is the oldest form of treatment for cancer and aims to maximise local control and
minimise the likelihood of distant dissemination
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The commonest form of malignancy occurs with skin cancers, and there are 3 major
types of skin cancer:
a
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It is most commonly caused by too much exposure to UV
light
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Squamous cell carcinoma – a non-melanoma skin cancer and is also caused by
too much UV light exposure
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c
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e
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2
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Superficial spreading – 70% of melanomas are of this type and are most
common in people with pale skin and freckles
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b
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They usually appear as a changing lump on the
skin, which might be black to red in colour
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Lentigo maligna melanoma/Hutchinson’s freckle – this occurs in 10% of patients
with melanomas
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e
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d
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They are common in people
with dark skin but can occur on any skin type
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When it comes to staging melanoma – “the thicker the lesion, the worse the
prognosis
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Techniques used to determine the staging includes: Breslow tumour thickness
where they measure the height from the granular layer to maximum depth of
invasion, and Clark level of invasion which measures the extent of dermal
penetration
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Thickness rather than depth is most important
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Thermal imaging allows the surgeon to remove the melanoma laterally and deeply,
and all the nodes involved and avoiding the unnecessary clearance in node negative
cases
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Sentinel node biopsy is very common in determine the staging of the cancer
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This is the commonest male cancer and kills more individuals than any other cancer,
where more than 80% of cases are due to smoking
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Once diagnosed, the chance of a 5-year survival drops to 15%
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There are two main subtypes:
- Small cell lung cancer (SCLC) – is a disease that is metastatic by the time it
manifests and thus surgery is not an option for these patients
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Symptoms of lung cancer include:
- Persistent cough
- Coughing blood – as the lesion produces a haemorrhage
- Weight loss
- Finger clubbing – where the ends of the fingers become more nodular, which
could be a sign of other cancers

5
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6
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This
allows determination of what treatment is needed
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Treatment depends upon what stage of cancer and the patient’s performance
status, i
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if the patient comes in a wheelchair and can barely breathe, there is no
point for surgery as the patient would not be able to breathe on their own
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Unfortunately, people with lung cancer, have heart disease and emphysema which
all debilitate their lung function
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Furthermore, 50% of patients will have a disease that is not cured by the surgery due
the surgery not being able to prevent it all
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This is the second most common cancer in males – where quite a number of men
have prostate cancer but often die from other diseases
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Those who are diagnosed with the cancer, 80% occur after the age of 65, and
autopsies done on 80-year-old men, 50% will have malignancies on their prostate
glands
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Diagnosis is based on a digital rectal examination and core needle biopsy
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One of the ways in which we can check for metastasis is using PSA (Prostate specific
antigen), which will be elevated in those with malignancy
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Robotic prostatectomies are more common and the results are better compared to
ten years ago
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However, randomised trials of men with localised prostate cancer, and either had a
radical prostatectomy or watchful waiting
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This revealed that in the WW, there were a few more deaths, but mostly in the
younger men and essentially, you have to treat 8 men to prevent 1 death
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This points to the fact that a doctor must be careful on what treatments are picked
for their patients
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50% of the cancers occur in the rectum and is responsible for a large number of
deaths in the United Kingdom
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Symptoms include:
- Change in bowel habit
- Blood in the faeces

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Breast Cancer:
1
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2
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e
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3
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10
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Radical mastectomy – where the whole breast is removed, the contents of the
axilla and the pectoral muscle
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Modified RM – the pectoral muscle is not removed
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The sentinel lymph node is defined as the first lymph node to which cancer cells are
most likely to spread from a primary tumour
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The sentinel lymph node biopsy (SLNB) is a procedure in which the sentinel lymph
node is identified, removed, and examined to determine whether cancer cells are
present
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A surgeon injects a radioactive substance or a blue dye near the tumour to locate the
positon of the sentinel lymph node then uses a device that detects this substance in
turn in order to remove the node
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A negative SNLB result suggests that the cancer has not developed the ability to
spread to nearby lymph nodes or other organs
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Whereas a positive SLNB result indicates that cancer is present in the sentinel lymph
node and may be present in other nearby lymph nodes and possibly other organs
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This information can help a doctor determine the stage of the cancer and develop an
appropriate treatment plan
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This technique does not have 100% sensitivity because you could miss some positive
nodes and we are still unaware of the impact on mortality
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Surgery:
1
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e
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2
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3
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4
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5
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- DCIS associated microcalcification in over 4cm of the breast
- Invasive cancer in over 4cm
- Relapse after breast conserving therapy
- Women with family history, i
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BRAC genes





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