Understanding Cancer Surgery: A Guide for Patients and Families

+ -Text Size

TOPICS

Special surgery techniques for cancer

When most people think of surgery, they picture a doctor using a scalpel and other surgical instruments to cut into and remove, repair, or replace parts of the body affected by disease. But newer techniques, using different types of instruments, have expanded the concept of what surgery is. Some of these techniques are described here.

Laser surgery

A laser is a highly focused and powerful beam of light energy which can be used for very precise surgical work, such as repairing a damaged retina in the eye. It can be used instead of a blade or scalpel to cut through tissue. It can also be used to vaporize (burn and destroy) some cancers of the cervix, voice box (larynx), liver, lung, rectum, or skin.

Some laser surgeries involve less cutting and damage (they are less invasive). For instance, with fiber optics and special scopes the laser can be directed inside a natural body opening without having to make a large cut (incision [in-sih-zhun]). The laser is then precisely aimed to destroy the tumor. See “Endoscopy” in the section called “Surgery to diagnose and stage cancer.

Lasers are also used in a type of surgery called photoablation (foe-toe-uh-BLAY-shun) or photocoagulation (foe-toe-ko-ag-you-LAY-shun). This means lasers are used to destroy tissue or to seal tissues or vessels. This type of surgery is often used to relieve symptoms, such as when large tumors block the windpipe (trachea) or swallowing tube (esophagus), causing problems breathing or eating.

You can learn more about lasers in our document called Lasers in Cancer Treatment.

Cryosurgery

Cryosurgery (cry-o-SUR-juh-ree) uses a liquid nitrogen spray or a very cold probe to freeze and kill abnormal cells. This technique is sometimes used to treat pre-cancerous conditions, like those affecting the skin, cervix, and penis. Cryosurgery is also used to treat some cancers, like those in the liver and prostate. A scan (like an ultrasound or CT scan) is used to guide the probe into the cancer and watch the freezing of the cells. This limits damage to nearby healthy tissue.

Electrosurgery

High-frequency electrical current can be used to destroy cells. This may be done for some cancers of the skin and mouth.

Mohs surgery

Mohs micrographic surgery, also called microscopically controlled surgery, is used to remove certain skin cancers by shaving off one very thin layer at a time. After each layer is removed, a doctor looks at the tissue under a microscope. When all the cells look normal under the microscope, the surgeon stops removing layers of tissue.

Mohs surgery is used when the extent of the cancer is not known or when as much healthy tissue as possible needs to be saved, such as when treating skin cancers around the eye. It’s done by a specially trained surgeon after the skin to be treated is numbed (under local anesthesia [an-es-THEE-zhuh]).

Chemosurgery is an older name for this type of surgery and refers to certain drugs that may be put on the tissue before it’s removed. Mohs surgery does not involve use of chemotherapy drugs.

Laparoscopic surgery

A laparoscope (LAP-uh-ruh-scope) is a long, thin, flexible tube that can be put through a small cut (incision) to look inside the body. It’s sometimes used to take pieces of tissue (biopsy [by-op-see] samples) to check for cancer. In recent years, doctors have found that by creating small holes and using special instruments, the laparoscope can be used to perform surgery without making a large cut. This can help reduce blood loss during surgery and pain afterward. It can also shorten hospital stays and allow people to heal faster. Laparoscopic (lap-uh-ruh-SKAH-pick) surgery is used commonly today to remove gallbladders and repair hernias.

The role of laparoscopic surgery in cancer treatment is now well established, but not for all cancers. Doctors can safely and effectively to use laparoscopic surgeries for cancers of the colon, rectum, liver, prostate, uterus, and kidney, among others. Uses on other types of cancer are still being studied. It may prove to be as safe and work as well as standard surgery with less cutting and less damage to healthy tissues (it’s less invasive). Some studies have hinted at this being the case. But larger, long-term studies still need to be done.

Robotic surgery

Robotic surgery is a type of laparoscopic surgery where doctors use a machine to control the laparoscope. Special instruments are used to perform surgery without making a large cut. The advantages of this type of surgery are the same as laparoscopic surgery: It can help reduce blood loss during surgery and pain afterward. It can also shorten hospital stays and allow people to heal faster.

Robotic surgery has been found to be safe and effective for cancers of the colon, prostate, and uterus, but its use in operating on other organs is still being studied.

Thorascopic (thor-uh-skah-pick) surgery

A thoracoscope (thor-AH-kuh-scope) is a narrow, rigid tube with a camera on the end that can be put through a small cut (incision) into the chest after the lung is collapsed. This allows the doctor to see inside the chest. Tissue samples of any areas of concern on the lining of the chest wall can be taken out (biopsied), fluid can be drained, and small tumors on the surface of the lung can be removed.

This type of surgery leads to less cutting and has even been used to remove parts (lobes) of the lung that contain cancer. Studies have shown that for early stage lung cancer, results using this approach are much the same as removing part of the lung through a cut in the side of the chest. (When the chest is cut open it is called a thoracotomy (thor-uh-KAH-tuh-me); see the above section.)

Other forms of surgery

Doctors are always looking for new ways to remove or destroy cancer cells. Some of these methods are blurring the line between what we commonly think of as surgery and other forms of treatment.

Researchers are testing many new techniques, like using high intensity focused ultrasound, microwaves or radio waves (called radiofrequency ablation, or RFA), and even high-powered magnets to try to get rid of unwanted tissue. These techniques are promising but are still largely experimental.

As doctors have learned how to better control the energy waves used in radiation therapy, some newer radiation techniques that work almost as well as surgery have been found. By using radiation sources from different angles, stereotactic radiation therapy delivers a large precise radiation dose to a small tumor area. The process is so exact that this is sometimes called stereotactic surgery, even though no cut is actually made. In fact, the machines used to deliver this treatment have names like Gamma Knife and CyberKnife, but no knife is involved. The brain is the most common site that is treated using this technique, but it is also used on head, neck, lung, and spine tumors. Researchers are looking for ways to use it to treat other types of cancer, too.


Last Medical Review: 08/19/2013
Last Revised: 08/19/2013