The most common initial treatment of cancer is surgery. For many cancer patients surgery is the best primary treatment. If the tumor is still localized, the only effective cancer treatment is to remove it.
Even the malignant growth has already spread beyond the limits of surgical resection, removal of the main tumor may still result in cure by ridding the body of the main tumor burden, leaving the body’s immune systems to mop up or constrain any malignant cells that have already escaped. Finally, even in totally incurable situations surgery may be of some value for the relief of distressing symptoms.
The type of surgery to be performed depends upon the anatomical site of the tumor, its size and the extend of local spread, and the technical problems of reconstruction and repair.
The really significant improvements in the treatment of cancer during the last thirty years have come from advances in surgery, the development of need techniques, and especially from improved methods of anesthesia the availability of antibiotics to control post-operative infections, better blood transfusion services, and a better understanding and practice of procedures of intensive care.
These broad advances have enabled surgeons to undertake with confidence extensive resections in stage 3 cancers patients that could not have been contemplated a quarter of a century ago. By enabling more and more such patients to survive the immediate post operative period after cancer resection, they give a better chance of long term survival. It is ironic that the significant improvements in cancer survival compared to thirty years ago owe very little to research on cancer itself.
Bigger surgery, however, does not mean better surgery, and a technical triumph for the surgeon and his team may be a disaster for the patient. Evaluating the real worth of an extensive operating procedure should be based on the subsequent quality of life of the patient rather than just on the prolongation of his survival.
The fact that bigger surgery is not necessarily better surgery is well illustrated by the current dilemma facing surgeons in the treatment of the most common of all cancers among women, cancer of the breast. For many years the standard treatment has been the operation of radical mastectomy that was pioneered by William Halsted, around the turn of the century.
The operations originally devised consisted of removing the entire breast with a large circle of skin overlying the tumor, removing the two underlying main chest wall muscles leading to the shoulder, with careful dissection of these structures from the ribcage, and the careful and meticulous surgical dissection and removal of all the lymph nodes in the axial.
This was an extensive and very mutilating procedure, leaving the woman not only without a breast but also with a deep depression where the underlying muscles had been removed, an ugly scar, and almost always a permanent brawny swelling of the arm because of the surgical interference with its lymphatic drainage’s.
Over the years, the operation was slightly modified by the removal of less skin and sometimes less muscle, but the basic extend of the resection remained much the same.
A recent study of the problem of the treatment of breast cancer reached the following conclusions:
1. Radical mastectomy is equivalent in terms of survival experience to simple mastectomy plus postoperative radiotherapy.
2. For patients without clinical evidence of involved nodes, local removal of the tumor plus radiotherapy appears to be equivalent in terms of survival experience to radical mastectomy.
3. Postoperative radiotherapy seems, however, too fer little benefit and may be detrimental for some patients.
So, surgical intervention is effective, at least at some stages, against cancer of the breast, stomach, small and large intestines, bladder, uterus, kidney, testis, ovary, brain, bone, and muscle. Wile surgery, if possible, must always remain the first line of treatment for cancer, a rather conservative approach may often be justified. There are probably few indications now, exept for the relief of particularly distressing symptoms, for the type of very extensive anatomical dissections that modern techniques of anesthesia resuscitation have made possible.
For many cancer patients surgery is the best primary treatment.