Sunday, November 25, 2012
ROLE OF SURGICAL ONCOLOGY IN MANAGEMENT OF CANCER
The next presentation was by Dr. K. Sreekanth, M.S., M.Ch. (Surgical Oncology) Chief Surgical Oncologist Yashoda Cancer Institute, Hyderabad, who covered the topic of ROLE OF SURGICAL ONCOLOGY IN MANAGEMENT OF CANCER
According to Dr. Sreekanth, it is the fear and ignorance that leads to misconceptions about cancer. Cancer is a malady with dangerous capabilities but it can be overcome with proper treatment and attitude shown by the patient.
He rightly presented the example of Yuvaraj Singh who had battled cancer to make a comeback to play cricket once again. Attitude is everything in a person’s life. Positive attitude wins half the battle with cancer.
Cancer is associated with the lifestyles of people which are strongly related to economic development. The incidences of cancer of breast, lung and colon are rising in developing countries. The industrialized nations and urban areas register higher rate of cancer cases.
The surgeon plays an important role in prevention of cancer by identifying and removing lesions, polyps or tumors that could flare up into cancer cases when left untreated. The oncology surgeons have expertise in multidisciplinary management of major cancers that require surgery as a primary treatment along with radiation and chemotherapy. They are specially trained in removal of tumors with safe margins in cases of breast cancer, colorectal cancer, pancreatic cancer, liver cancer, melanoma and stomach cancer.
Surgical oncologist needs to have crucial cultural and interdisciplinary approach of cancer. He needs to have knowledge about biology, pathology, radiology, chemotherapy, and radiotherapy so that he will be capable of defining the limits of intervention keeping in mind the natural history of tumors.
Diagnosis of cancer
The signs and symptoms of cancer vary depending on the type, location and size of tumor. The methods used to diagnose cancer are
· Fine needle aspiration biopsy (FNAB) in which the doctor uses a very thin needle attached to a syringe to withdraw small amount of tissue from the suspicious area to determine the presence of cancer cells
· In Core Needle Biopsy of Tru Cut Biopsy a larger and hollow needle is used to withdraw tissues from abnormal suspicious area under local anesthesia.
· Another form of Biopsy is Surgical (open) biopsy also known excision biopsy where the whole tumor is removed for further pathological study.
· Blood tests
· CT, MRI, PET, Mammogram and other types of screening
After diagnosis, if the tumor is found to be malignant then the surgeon will decide upon the surgical treatment of cancer. Surgically removing cancer tumor is the best chance of disease-free survival.
There are some important points to remember to make the surgery a success and increase the chances of recovery in the patient which every surgeon should keep in mind. Also proper preventive methods should be taken to prevent cancer metastasis because it proves to be more fatal then primary cancer.
Keeping sufficient margins is important, but it is also important to keep the mutation in check. In case of indispensable organs it is very important to maintain accurate margins so that there will be no loss of important tissue. Resection of breast cancer with good surgical margins is one of the primary aspects of breast conserving surgery.
Removing the margins clearly, can significantly reduce the chances of residual cancer recurring, especially with invasive form of cancer. So often recurrences occur due MRC (minimal residual cancer) or within a contiguous field of preneoplastic cells.
The goal of surgery in Metastatic breast cancer is prolongation of life and palliation in addition to prevent the symptoms from flaring up. Metastatic cancers are generally assumed to be incurable and often the metastatic recurrence is more serious than the primary tumor proving life threatening in many cases.
Surgeries under oncology emergencies are often performed to stop internal bleeding, exsanguinating hemorrhage or any other potentially life-threatening conditions which may prove fatal without immediate intervention.
Oncology surgeries are also preformed for Percutaneous abscess drainage, especially in gynecologic cancer patients.
Palliative surgeries are those that are performed not for life saving, but to improve on quality of life, reduce the severity of suffering, relieve pain, or remove infection.
Colostomy or gastroenterostomy is for removing obstruction or stop the bleeding in urinary bladder, cordectomy to relieve pain, cystectomy to give relief from hemorrhage and amputation for removal of necrotic or infectious organ are some of the palliative surgeries performed.
Pain palliation is another challenging care needed for patients under severe pain, where the focus in on relieving and preventing the suffering of patients as much as possible.
Venous access catheters are quite helpful during the treatment of cancer, as it keeps the veins readily available for doctors and nurses to give medication andr nutrients or draw blood from the patient sparing the troublesome repeated pricks of needle.
Oncology surgery not involves removal of the cancerous tumors and tissues, but also helps in building the confidence of survivors through reconstructive and rehabilitative surgeries.
Dr. Sreekanth then shared with the delegates a video of Laparoscopic Esophagectomy explaining the details and complications involved in the surgery.
Surgical oncologist cannot perform as an individual, but needs the constant support of medical team to achieve success. The motto of this team is – Don’t just add years to life but add life to years.
Hope is one of the most important things in this struggle against cancer. He gave example of Lance Armstrong who battled cancer and defeated it, and moreover went on to win 7 Tour De France Championship. He has brought out his experience wonderfully in his autobiography, “It's not about the Bike: My Journey Back to Life.
Finally the session ended with the surgeon thanking his team, his supporters and his teachers.
Paper presented by Dr. Sreekanth
Surgery is the oldest form of cancer treatment and surgical oncologist is a specialist who focuses on the surgical treatment of variety of tumors with a goal to remove the cancer with clear margins. However, the contribution of surgical oncologist goes beyond what is done on the day of surgery itself and as a part of multidisciplinary team, he plays a major role in the holistic management of a cancer patient from curative to palliative care. Although technological developments will continue to play a role in cancer therapy, research in molecular biology and genetics will dictate the future of cancer treatment. The paper will deal with the basics of cancer diagnosis, early detection, screening, surgical management of cancers in community practice including advances.