Everything you need to know about Surgical Oncology by Dr Jitender Rohila

Introduction:

Surgical Oncology is a specialized field within the broader discipline of oncology that focuses on the surgical management of cancer. It plays a crucial role in the comprehensive approach to cancer treatment, working in conjunction with other modalities such as medical oncology and radiation oncology. This branch of oncology aims to diagnose, stage, and treat cancer through surgical interventions. 

Scope of Surgical Oncology:

Surgical Oncologists are highly trained surgeons with specialized expertise in the management of cancer. Their primary goal is to remove tumors and cancerous tissues while preserving as much healthy tissue and function as possible. Surgical procedures may be used for various purposes, including surgical removal of cancer, performing biopsy to confirm diagnosis and start cancer directed treatment, staging procedures to confirm the exact stage of cancer, and palliative procedures to provide relief from cancer related symptoms in advanced cancers. The scope of Surgical Oncology encompasses a wide range of cancers, including those affecting the breast, lung, gastrointestinal tract, genitourinary system, head and neck, gynaecology and more, however the organ specific approach in surgical oncology offers precision and excellence in cancer care.

Key Procedures in Surgical Oncology:

1. Tumor Resection:
   • Surgical Oncologists perform radical tumor resections to remove cancerous masses. It is pertinent to remove the cancerous tissue with margins of normal tissue for an adequate surgery which is oncologically safe.The extent of the resection depends on factors such as the type and stage of cancer, as well as the overall health of the patient. These all are major & complex surgeries and better outcomes are expected in hands of well trained and experienced surgical oncologists.
2. Biopsy:
   • Biopsies involve the removal of a small sample of tissue for diagnostic purposes. This helps determine the type of cancer, its stage, and guides further treatment decisions.
3. Lymph Node Dissection:
   • Many cancers spread to nearby lymph nodes. Lymph node dissection is an important component of performing oncologically safe cancer surgeries. Surgical Oncologists are specially trained in performing lymph node dissection to remove affected nodes, aiding in both staging and treatment.
4. Reconstructive Surgery:
   • After tumor removal, reconstructive surgery may be necessary to restore the appearance and function of the affected area. This is common in breast cancer and head and neck cancer cases.

Advancements in Surgical Oncology:

1. Robotic aided Surgery:
   • Minimally invasive surgical techniques such as laparoscopy and robotic-assisted surgery have revolutionized Surgical Oncology, allowing for smaller incisions, reduced recovery times, and fewer complications.
2. Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) surgery:

• Used in advanced abdominal cancers like ovarian, colorectal & stomach cancer with peritoneal disease, peritoneal surface malignancies like pseudomyxoma peritonei (PMP) which have dismal outcomes with conventional treatments. CRS HIPEC is an extensive surgical procedure involving removing all visible disease from the abdomen followed by the delivery of heated chemotherapy directly into the abdominal cavity to kill any remaining cancer cells.

3. Sentinel Lymph Node Biopsy:
   • This technique helps identify the first lymph node(s) that cancer is likely to spread to, allowing for targeted removal and reducing the need for extensive lymph node dissections. This is particularly useful in early breast cancer, gynaecology cancers & urology cancers.
4. Fluorescence-guided cancer surgeries 
   • This technology uses the fluorescence imaging which enables the surgeons to identify subtle or hidden tumors, assess the extent of tumor margins, and precisely remove cancerous tissue with minimal impact on surrounding healthy cells. This is particularly useful in colorectal cancers ,breast cancer, gynaecology cancers and urooncology.

Role of Surgical Oncology in Cancer Care:

1. Multidisciplinary Approach:
   • Surgical Oncology works closely with medical oncologists, radiation oncologists, pathologists, and other specialists to ensure a comprehensive and coordinated tumour board approach to cancer care.
2. Curative and Palliative Care:
   • Surgical procedures may aim to cure cancer or provide palliative relief by alleviating symptoms and improving quality of life, especially in advanced cases.
3. Postoperative Care:
   • Surgical Oncologists are involved in postoperative care, monitoring patients for complications and collaborating with other healthcare professionals for adjuvant therapies.

Conclusion:

Surgical Oncology is a dynamic and evolving field at the forefront of cancer care. Through a combination of traditional surgical techniques and cutting-edge advancements, Surgical Oncologists play a pivotal role in the diagnosis, treatment, and management of various cancers. Organ specific oncosurgery programme improves excellence in surgical care and should be adopted. The multidisciplinary approach, coupled with advances in surgical oncology such as robotic aided surgery continues to improve outcomes for cancer patients, offering hope and a path towards a better quality of life.


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