A Guide to Cancer Surgery

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Surgery to diagnose and stage cancer

A biopsy is a procedure done to remove tissue (called a sample) from an area that may be cancer. A doctor looks at the sample under a microscope to see if there are cancer cells in it. Some biopsies may need to be done during surgery. But many types of biopsies are done by taking out small pieces of tumor through a thin needle or through a flexible lighted tube called an endoscope. Biopsies are often done by surgeons, but they can be done by other doctors, too.

Some of the more common ways to do a biopsy are described here.

Fine needle aspiration biopsy

Fine needle aspiration or FNA uses a very thin needle attached to a syringe to pull out small bits of tissue. If the tumor can’t be felt, the needle can be guided into the tumor using an imaging test, like an ultrasound or CT scan.

The main advantage of FNA is that there’s no need to cut the skin, so there’s no surgical incision. A drawback is that in some cases the needle can’t take out enough tissue for an exact diagnosis. A more invasive type of biopsy (one that uses larger needles or a cut in the skin) may then be needed.

Core needle biopsy

This type of biopsy uses a larger needle to take out a thin core of tissue. Core biopsies can be guided by imaging tests (like an ultrasound or CT scan) if the tumor is too deep to feel through the skin.

The advantage of core biopsy is that it usually collects enough tissue to find out whether the tumor is cancer.

Excisional or incisional biopsy

For these biopsies a surgeon cuts through the skin to remove the entire tumor (called an excisional biopsy) or a small part of the tumor (called an incisional biopsy). These surgeries can often be done with local or regional anesthesia. This means drugs are used to numb just the area where the biopsy will be done. If the tumor is inside the chest or belly (abdomen), drugs that put you into a deep sleep and keep you from feeling pain will probably be needed. This is called general anesthesia.


Endoscopy is a procedure that uses a long, thin, flexible tube with a tiny viewing lens or video camera and a light on the end. This allows the doctor to see any tumors in the area and take biopsy samples from them. Endoscopes can be passed through natural body openings to look at areas of concern in places such as those listed in the table. Any of these procedures can be called an endoscopy, but the more specific name is given as well.

Body part

Specific name

How to say it

pharynx (throat)



larynx (voice box)



esophagus (swallowing tube)






small intestine



colon (large intestine)



sigmoid colon (lower part of colon)






cervix and vagina (womb)



respiratory tract (windpipe, smaller breathing tubes, and lungs)



Some of the advantages of endoscopy are:

  • The doctor can look right at the tumor and get a good idea of where it is and how big it is.
  • A sample of tissue can be taken out through the scope to find out if it’s cancer.
  • An open surgical cut (incision) is usually not needed.
  • Drugs to put you in a deep sleep (general anesthesia) may not be needed.

Local numbing medicines are needed before some types of endoscopy. Medicines may also be given to make you relax or go into a light sleep.

Endoscopic ultrasound

Ultrasound devices can be attached to the end of some endoscopes. This lets doctors get pictures of the layers of the swallowing tube (esophagus), main breathing tubes (trachea and bronchi), or parts of the bowel (large intestine) by using sound waves. Nearby lymph nodes and other organs can be seen, too. Using the ultrasound pictures as a guide, a needle can be put through the endoscope and cells can be taken from tissues that do not look normal.

Laparoscopy, thoracoscopy, or mediastinoscopy

Laparoscopy is much like endoscopy, but a small cut is made in the skin of the belly (abdomen). A thin tube called a laparoscope is then put through the cut and into the belly to look for areas that may be cancer. If any are seen, some of the cells can be taken out to be checked for cancer by using a needle that’s put in through the laparoscope. General anesthesia is most often used for laparoscopy (you are given drugs to put you into a deep sleep while it’s done).

When this type of procedure is done to look inside the chest it may be called a thoracoscopy or mediastinoscopy. General anesthesia is also used for this procedure. The scope is put in the body through a small cut next to the breastbone, or a small cut between the ribs. Cells for testing are taken out through the scope.

Open surgical exploration (laparotomy or thoracotomy)

A laparotomy may be needed when less invasive procedures do not give enough information about an area of concern in the belly (abdomen). In this procedure, a surgeon makes a cut, usually from the bottom of the breastbone down to the lower part of the belly, to look right at the area in question. The location and size of the tumor and the nearby tissues can be seen, and tissue can be taken for testing. This is a major surgical procedure, so the patient is given medicines to cause a deep sleep and prevent pain (general anesthesia).

An operation much like this can be done to open and look inside the chest. This is called a thoracotomy. You can read more about these procedures in the next section.

Last Medical Review: 09/03/2014
Last Revised: 09/29/2014