Tumor surgery is usually part of a holistic approach to the treatment of cancer. It deals with the surgical removal of solid tumors. The aim is to cure the patient as far as possible, improve their well-being or prevent a recurrence. Here you will find further information as well as selected tumor surgery specialists and centers.
Aprerequisite for an optimal therapy concept is knowledge of
The findings from molecular biology research and technological developments have a significant influence on modern oncological surgery. Precise diagnostics at the start of any cancer treatment is therefore crucial.
Frequently used diagnostic procedures include
Depending on the results of the diagnosis, cancer treatment may consist of
consist of a combination of these three therapy options.
Tumor surgery can be preceded and/or followed by chemotherapy and/or radiotherapy. This is referred to as preoperative(neoadjuvant) or postoperative(adjuvant) chemotherapy or radiotherapy.
Brain tumor surgery © Evgeniy Kalinovskiy | AdobeStock
The primary goal of tumor surgery is to cure the cancer while maintaining the highest possible quality of life. For this reason, the tumor and the surrounding lymph nodes should always be completely removed using oncological surgery.
However, the surrounding healthy tissue must be spared as far as possible. The therapy should also minimize the risk of the tumour recurring (relapse).
Just a few years ago, it was difficult to cure a tumor with surgery. In the meantime, medicine has gained a better understanding of cancer and surgical procedures have been further improved. This is why tumor surgery is now a crucial part of cancer treatment.
Minimally invasive techniques are now increasingly being used in surgical oncology.
If the cancer is still at an early stage, it can often be cured by oncological surgery alone.
In the case of advanced cancer, combined therapy approaches with tumor surgery and radiotherapy and chemotherapy are usually required to treat the tumor.
The aim of curative tumor surgery is to cure the patient, i.e. to remove the tumor and prevent recurrence.
Curative tumor surgery aims to cure the patient completely and prevent the formation of a recurrence (new tumor growth). As a rule, curative tumor surgery requires localized tumor growth.
Furthermore, it must be possible to remove the tumor in a healthy state. This means that part of the surrounding healthy tissue is removed along with the tumor for safety reasons.
It must be possible to reconstruct the function of removed organs (e.g. via an artificial bowel outlet).
In the past, this curative therapeutic approach has led to ever more extensive interventions. Under certain circumstances, this was accompanied by reduced quality of life and increased morbidity.
For this reason, today's approach to oncological surgery is to combine less destructive interventions with adjuvant therapy measures. This therapeutic principle can be found, for example, in breast-conserving tumor surgery with adjuvant radiotherapy. It can replace a radical mastectomy (complete removal of the breast).
In oncological surgery, cytoreductive tumor surgery aims to create a good starting situation for subsequent therapies.
An attempt is made to remove as much tumor tissue as possible (so-called reduction of the tumor burden). This is intended to increase the chances of killing the remaining tumor tissue that has not been removed by radiotherapy and/or chemotherapy.
This procedure is also known as debulking. It is only used if other effective treatment options are available in addition to tumor surgery. Debulking is used, for example, for advanced ovarian cancer.
Molecular biological diagnostics can increasingly identify people who are currently healthy but could later develop cancer.
Changes in the BRCA1 or BRCA2 gene, for example, make it more likely that the women affected will develop breast cancer (breast carcinoma). Depending on the gene mutation, the therapy may
offer.
Palliative tumor surgery is used for tumors that cannot be cured. It aims to improve the patient's well-being by eliminating or alleviating the symptoms of the tumor disease or co-existing illnesses.
It can also be performed preventively in order to avoid complications caused by metastasis and to maintain the patient's condition without symptoms for as long as possible.
This includes
In principle, only solid cancer can be operated on. Solid tumors are initially localized, but can later spread to the surrounding tissue or even metastasize.
Solid tumors can originate from various internal organs and can be benign (benign) or malignant (malignant).
In contrast, cancers of the lymphatic system or the hematopoietic system, for example, cannot be treated using oncological surgery methods.
Surgical oncology is used when
Tumors of the digestive tract (e.g. colon carcinomas) and tumors of the thyroid gland are treated particularly frequently in tumor surgery.
Oncological surgery is also responsible for port implantations. A port is a permanent access to the body that is required for chemotherapy or pain treatment, for example.
A port is placed to improve access for drug therapies © Photozi | AdobeStock
The treatment of thyroid carcinoma in oncological surgery usually involves the removal
In the case of esophageal cancer, it is usually necessary to open the chest and abdominal cavity. If the oesophagus has to be removed, it can often be reconstructed from parts of the stomach.
In the case of stomach cancer, it is very often necessary to remove the entire stomach as well as the corresponding lymph nodes.
This means that the patient has to change their diet after a complete removal of the stomach. This means that they can only eat smaller meals, but several times a day.
Operations on the pancreas are among the most technically demanding procedures in oncological surgery. Common procedures for pancreatic cancer are
In pancreatic left resection, the "tail" of the pancreas is removed. In order to remove the entire tumor in the head section of the pancreas, Whipple's operation involves removing the pancreatic head as well as
is removed.
Location of the pancreas and illustration of pancreatic cancer © lom123 | AdobeStock
In a total pancreatectomy, the entire pancreas is removed together with the duodenum
removed.
Tumor surgery is very frequently used in the treatment of colon cancer (colon carcinoma), in which parts of the bowel are removed. In the past, an artificial bowel outlet often had to be created after tumor surgery on the bowel. Today, this can be avoided in many cases thanks to improved surgical procedures.
A small and localized rectal carcinoma(rectal cancer) can be removed in oncological surgery. In the case of larger tumors, radiotherapy and chemotherapy must often be carried out prior to tumor surgery. Occasionally an abdominoperineal rectal extirpation, i.e. a complete removal of the rectum and anus, is necessary. Patients are then dependent on an artificial anus.
Today, many procedures, especially for tumor surgery of the bowel, can be performed using minimally invasive techniques (keyhole tumor surgery).
Today's successes in this area are due not only to improved surgical procedures but also to the fast-track concept(fast-track surgery). The main pillars of this treatment concept consist of
If a tumor is not treated in time, it can form metastases, for example in the liver.
Surgery can be curative if
In oncological surgery, mainly lung and liver metastases from colorectal carcinomas, soft tissue and bone sarcomas and hypernephromas are performed. Metastases from other primary tumors can also be removed in tumor surgery.
Prophylactic lymph node removal (elective lymph node dissection)
The larger the tumor, the more likely it is that cancer cells are present in the lymph nodes. They can then drain the affected area of the body (so-called regional lymph nodes).
The cancer cells in the lymph nodes are not always macroscopically visible. For this reason, the lymph nodes of the tumor-dependent lymphatic drainage area are also removed, even if there is no clinical or histological evidence of lymph node involvement at the time of the tumor operation.
This is referred to as elective lymph node dissection or prophylactic lymph node removal. The reasons for this are
Therapeutic lymph node removal (selective lymph node dissection)
If the lymph nodes are only removed because they are either enlarged or already affected, this is referred to as selective lymph node removal. However, this procedure is rarely used in oncological surgery.
Sentinel lymphadenectomy
The concept of sentinel lymph nodes (also known as sentinel lymph nodes) is used to diagnose and treat malignant tumors. It is used in particular for
are used.
Sentinel lymph nodes are the lymph nodes that are located first in the drainage area of the lymph fluid of a malignant tumor. If tumor cells have already been transferred to this sentinel lymph node with the lymph flow, subsequent lymph nodes are probably also affected. If the sentinel lymph node is not affected, the subsequent lymph nodes are probably not affected either.
In sentinel lymphadenectomy, not only the sentinel lymph node is often removed, but also the entire affected lymphatic tissue.
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