Surgery

Surgery

Early surgical techniques were radical, removing both the cancer and surrounding healthy tissue, often resulting in long recovery times, life-changing disability, and in some cases, severe cosmetic disfigurement. Today's surgical techniques and technologies are more precise with fewer complications. Women with early-stage breast cancer can now avoid disfiguring mastectomies, people with colon and rectal cancer can maintain their bowel function, and men with prostate cancer can often avoid incontinence and loss of sexual function.

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2015

More extensive surgery helps patients with early oral cancer live longer

More extensive surgery helps patients with early oral cancer live longer

A large study resolves a decades-long debate, confirming that for patients with certain types of early oral cancers, it’s better to remove both the primary tumor and nearby lymph nodes during initial surgery for oral cancer, rather than postponing lymph node removal until the cancer comes back. The study finds that performing more extensive surgery initially lowers the risk of cancer returning and extends survival. However, the study also noted this surgical approach has a higher risk of health complications, including difficulty moving the neck and shoulders and problems with talking and swallowing.

2010

Pre-surgery chemotherapy proven an effective option for women with advanced ovarian cancer

Pre-surgery chemotherapy proven an effective option for women with advanced ovarian cancer

Major European trial reports that giving chemotherapy prior to surgery (called neo-adjuvant chemotherapy) or after surgery (called adjuvant chemotherapy) is equally effective in women with advanced ovarian cancer. These results resolve long-standing debate and provide an important treatment alternative, particularly for women with larger tumors. In this group, giving chemotherapy first can shrink the tumors so that less extensive surgery is needed later on in the course of therapy.

Removing fewer lymph nodes for some breast cancer patients does not impair survival

Removing fewer lymph nodes for some breast cancer patients does not impair survival

Two large clinical trials confirm that less extensive lymph node surgery in women with early-stage disease does not reduce their likelihood of survival. Specifically, researchers find that removing additional underarm lymph nodes to look for breast cancer in women with limited or no disease spread in the "sentinel" node – where cancer is most likely to spread – does not make a significant difference in survival, compared to removing fewer nodes. Removing fewer nodes decreases the risk of side effects, such as pain and swelling in the affected arm.

2009

Preventive surgery confirmed to reduce breast and ovarian cancer risk in women with BRCA gene mutations

Preventive surgery confirmed to reduce breast and ovarian cancer risk in women with BRCA gene mutations

A major review of previously published studies confirms that surgical removal of the ovaries and fallopian tubes in healthy premenopausal women with BRCA gene mutations reduces the risk of breast cancer by 51 percent and the risk of ovarian and fallopian tube cancers by 79 percent. Among postmenopausal women with BRCA gene mutations, this surgery is found to significantly reduce the incidence of ovarian cancer but not breast cancer.

Without the surgery, women with inherited mutations in the two BRCA genes have up to an 84 percent lifetime risk of breast cancer and up to a 46 percent risk of ovarian and fallopian tube cancers. With these data, women with these mutations have a proven option for reducing their cancer risk, although it comes with many side effects (including early-onset menopause) and prevents women of child-bearing age from having children.

2008

Refined eligibility criteria for liver transplantation leads to longer survival
Minimally invasive surgery shown to be effective for cervical cancer

Minimally invasive surgery shown to be effective for cervical cancer

In a small study, researchers find that two minimally invasive techniques – laparoscopic and robotic radical hysterectomy (removal of the uterus) with radical pelvic lymphadenectomy (removal of surrounding pelvic lymph nodes) – are as effective as traditional radical hysterectomy and lymphadenectomy in women with cervical cancer. The procedures, which are performed through small incisions, are associated with less blood loss and shorter hospital stays than traditional, open surgery. While both of the new techniques had already been put into limited practice, this study provided evidence to support their widespread use.

2007

Lymph node sampling for staging is refined

Lymph node sampling for staging is refined

Researchers determine that at least 12 abdominal lymph nodes need to be removed and analyzed during colon cancer surgery to accurately determine the stage of the tumor. This study finds that the more lymph nodes that were sampled, the longer a patient lived on average following therapy. Accurate staging is necessary to identify which patients are at high risk of recurrence and are therefore candidates for adjuvant chemotherapy following surgery.

2006

Chemically "illuminating" glioma tumors during surgery postpones recurrence

Chemically "illuminating" glioma tumors during surgery postpones recurrence

The use of 5-aminolevulinic acid, a substance that reacts with and illuminates malignant glioma cells, is shown to improve surgeons' ability to remove tumor tissue. Patients treated with this technique during surgery were significantly less likely to have any tumor growth after six months, compared to those who underwent conventional surgery.

2005

Removal of additional lymph nodes shown to help improve survival

Removal of additional lymph nodes shown to help improve survival

While gastric cancer surgery had long involved removal of both the tumor and surrounding lymph nodes to prevent further spread, an open question was whether removing lymph nodes further away from the tumor – to find additional signs of cancer's spread and guide treatment decisions – could help improve survival.

In 1999, Dutch researchers initially report no survival benefit with more extensive lymph node surgery, a procedure known as D2 surgery, compared to removal of just the nearby lymph nodes (known as D1). However, longer follow-up from the same study ultimately reveals that the more extensive D2 dissection is in fact associated with fewer recurrences and gastric cancer-related deaths. Today, D2 resection is the global standard for gastric cancer surgery.

2004

Laparoscopic colon cancer surgery effective, better tolerated

Laparoscopic colon cancer surgery effective, better tolerated

A study by researchers at multiple cancer centers finds that laparoscopic surgery to remove colon tumors was as effective as conventional open abdominal surgery, and was associated with shorter hospital stays and less pain after surgery. Laparoscopic surgery involves removing the tumor through multiple small incisions and a telescoping camera device. This less-invasive approach is now widely used.

2003

Chemotherapy "wafer" active against malignant gliomas

Chemotherapy "wafer" active against malignant gliomas

Use of a surgically implanted biodegradable wafer containing the anticancer medication carmustine (BCNU) is found to delay tumor growth and improve overall survival in some patients with gliomas. The wafer provides continuous chemotherapy directly to the tumor site to kill remaining cancer cells and to prevent or slow regrowth of the cancer. Today it is used in patients with recurrent malignant glioma and newly diagnosed glioblastoma, a highly aggressive form of glioma.

2002

Chemo-embolization offers improved survival for select patients

Chemo-embolization offers improved survival for select patients

Unlike other organs, the liver has two major sources of blood supply, instead of one. For unknown reasons, cancer only develops around the lower of these arteries, the hepatic artery, and uses this blood supply to fuel its growth. Doctors have long debated whether temporarily blocking – or embolizing – this artery to starve the tumor of blood can improve overall outcomes.

In 2002, two studies show that repeatedly (every 2-6 months) injecting the chemotherapy drug doxorubicin and then embolizing the hepatic artery increases survival in a set of patients whose tumors cannot be removed surgically. However, the approach is still debated by researchers, who question its overall impact.

2000

Combination of kidney removal and immunotherapy extends life