Tumor Removal

Tumor Removal

 

Definition

Tumor removal is a surgical procedure to remove an abnormal growth.

Purpose

A tumor can be either benign, like a wart, or malignant, in which case it is a cancer. Benign tumors are well circumscribed and generally are easy to remove completely. In contrast, cancers pose some of the most difficult problems in all of surgery.
Currently 40% of all cancers are treated with surgery alone. In 55% of cases, surgery is combined with other treatments—usually radiation therapy or chemotherapy.
The doctor needs to decide if surgery should be done at all. Because cancers spread (metastasize) to normal tissues, sometimes at the other end of the body, the ability of surgery to cure must be addressed at the outset. As long as the cancer is localized, the initial presumption is that cure should be attempted by removing it as soon as possible.
Non-curative surgery may make other treatments more effective. "Debulking" a cancer-making it smaller-is thought to assist radiation and chemotherapy to get to the remaining pieces of the cancer and be more effective. Physicians apply standards and guidelines based on research to the specific situation of a given patient s situation to decide the best approach. For example, reports released in 2003 said a study of patients with a common form of brain tumor called glioma had a more favorable outcome if their tumors were removed than if a biopsy were just performed.
Another important function surgery performs in cancer treatment is accurately assessing the nature and extent of the cancer. Most cancers cannot be adequately identified without a piece being placed under a microscope. This piece is obtained by surgery. Surgery also is the only way to determine exactly how far the tumor has spread. There are a few standard methods of comparing one cancer to another for the purposes of comparing treatments and estimating outcomes. These methods are called "staging." The most universal method is the TNM system.
  • "T" stands for "tumor" and reflects the size of the tumor.
  • "N" represents the spread of the cancer to lymph nodes, largely determined by those nodes removed at surgery that contain cancer cells. Since cancers spread mostly through the lymph system and this is a useful measure of their ability to disperse.
  • "M" refers to the metastases, how far they are from the original cancer and how often they have multiplied.
Other methods of staging include Duke's method and similar systems, which add the degree of invasion of the cancer into the surrounding tissues to the above criteria.
Staging is particularly important with such lymphomas as Hodgkin's disease. These cancers may appear in many places in the lymphatic system. Because they are very radiosensitive, radiation treatment often is curative if all the cancer is irradiated. Therefore, it must all be located. Surgery is a common, usually essential, method of performing this staging. If the disease is too widespread, the staging procedure will dictate chemotherapy instead of radiation.

Precautions

Curative cancer surgery demands special considerations. There is a danger of spreading or seeding the cancer during the process of removing it. Presuming the cancer cells can grow almost anywhere in the body to which they spread, the surgeon must not "spill" cells into the operating field or "knock them loose" into the blood stream. Special techniques called "block resection" and "no touch" are used. Block resection means taking the entire specimen out as a single piece. "No touch" means that only the normal tissue removed with specimen is handled; the cancer itself is never touched. This prevents "squeezing" cancer cells out into the circulation. Further, in this technique pains are taken to clamp off the blood supply first, preventing cells from leaving by that route later in the surgery.

Description

Diagnostic biopsies

There are four types of biopsy techniques. The physician will choose the appropriate technique depending on the tumor type, location, size, and other factors. Some types of biopsy are more invasive than others.
  • Aspiration biopsy. A needle is inserted into the tumor and a sample is withdrawn.
  • Needle biopsy. A special cutting needle is inserted into the core of the tumor and a core sample is cut out.
  • Incisional biopsy. A portion of a large tumor is removed, usually before complete tumor removal.
  • Excisional biopsy. A whole lesion is removed along with surrounding normal tissue.

Complete tumor removal

Once surgical removal has been decided, an oncologic surgeon will remove the tumor whole, taking with it a large section of the surrounding normal tissue. The healthy tissue is removed to minimize the risk of possible seeding.

Cytoreduction

When surgical removal of a tumor is unacceptable as a sole treatment, a portion of the tumor is removed to "debulk" the mass. Debulking aids radiation and chemotherapy treatments.

Aftercare

Retesting and periodical examinations are necessary to ensure that a tumor has not reformed after total removal.
A comparison of benign (top of illustration) and malignant tumor characteristics.
A comparison of benign (top of illustration) and malignant tumor characteristics.
(Illustration by Hans & Cassady, Inc.)

Risks

The possibility of mestastasis and seeding are risks that have to be considered in consultation with an oncologist. The advancement in imaging techniques has led to some tumor staging by techniques like positron emission tomography (PET) scanning. A needle biopsy may still be required to confirm a diagnosis or staging decision, but in some cases, imaging can replace an initial need for biopsy.

Resources

Periodicals

"PET Scan, Endcoscopic Ulrsound Show Promise in Staging for Lung Cancer Surgery." Biotech Week July 9, 2003: 181.
"Study of Brain Tumors Points to Resection Over Biopsy as One Key to Survival." Cancer Weekly October 28, 2003: 20.
Gale Encyclopedia of Medicine. Copyright 2008 The Gale Group, Inc. All rights reserved.
References in periodicals archive ?
However, effective treatment in our case was post delivery tumor removal. Thus, it is important for obstetricians/gynecologists to know that teratoma is one of the etiologies of AIHA during pregnancy.
The extent of tumor resection was noted using Simpson grading system: grade I--complete removal of tumor with excision of its dural attachment and any abnormal bone including resection of venous sinus if involved; grade II--complete tumor removal with coagulation of its dural attachment; grade III--complete tumor removal of intradural tumor without resection or coagulation of its dural attachment or extradural extension; grade IV--partial tumor removal, leaving intradural tumor in situ; and grade V--decompression with or without biopsy (7).
While speaking to police, Liu initially denied having given birth and said she went to the clinic for a tumor removal. However, upon further questioning, she confessed to the crime and said she killed the baby to take revenge on her ex-boyfriend.
Their aim is that one day, surgeons will be able to spray the solution onto sites of tumor removal directly after surgery.
The surgeon informed him of the tumor removal process and shared that Nunez would never speak again.
Concretely, the recurrence rate is up to 10-25%,[6] and the prognosis for IMTUB is related to the tumor size, histological expression, and tumor removal. With the application of minimally invasive techniques such as laparoscopy, advanced treatment of chemotherapy or ALK inhibitor therapy is suggested to be carried out first for tumor >5 cm in diameter, followed by laparoscopic partial cystectomy or radical resection after tumor shrinking.
Optimal surgical treatment of GISTs entails complete tumor removal with clear surgical margins and avoidance of tumor rupture and in some cases, necessitating the resection of adjacent organs.
In previous studies, primary tumor removal has been shown to disturb disease homeostasis, and might trigger early recurrences.
The rate of tumor removal depends upon its size and extension, which is a predicting factor for the outcome of surgery.
The researchers are looking for cats of any age who are having a biopsy or tumor removal for a suspected or confirmed carcinoma.