Surgery to treat cancer

Surgery is cutting away tissue from the body. You may have it as an inpatient or an outpatient. It usually means having either a local or general anaesthetic. You may have surgery

• To diagnose cancer
• As a treatment to cure cancer
• To reconstruct a part of your body
• To prevent or reduce the risk of cancer
• To control symptoms or extend life
• As part of other treatments

To diagnose cancer

To diagnose cancer a surgeon may remove a small piece of tissue. This is called a biopsy. If the biopsy contains cancer cells, it may show what type of cancer it is and how slowly or quickly it may grow.

As a treatment to cure cancer

Surgery is one of the main treatments for cancer. It may be the only treatment you need. Surgery is a local treatment - it only treats the part of the body operated on. So it may cure cancer that is completely contained in one area and has not spread. Usually, the earlier a cancer is found the easier it is to remove it.

Your surgeon removes

• The tumour
• Some normal tissue from around the cancer (known as a ‘clear margin')

The surgeon may also remove the lymph nodes nearest to the cancer, in case they contain cancer cells.

The surgeon sends all the tissue that they remove to a laboratory to be examined under a microscope. This gives more information about the cancer. It helps doctors decide whether you need any further treatment to reduce the risk of the cancer coming back. This is called adjuvant treatment and is most often chemotherapy or radiotherapy.

Some people have treatment before surgery to help shrink a cancer and make it easier to remove. This is called 'neo-adjuvant' treatment.

During an operation, surgeons sometimes find that a cancer has spread further than they expected. When this happens, the operation may take longer than planned, or may have to be stopped altogether.

If cancer has spread to another part of the body, surgery cannot usually cure it. It may be better to have a treatment that works throughout your body, such as chemotherapy, biological therapy or hormone therapy.

To reconstruct a part of your body

If you have part of your body removed, it may be possible to have reconstructive surgery. The part of the body is recreated using other body tissues or a false body part (prosthesis). For example, after removal of a breast (mastectomy) it may be possible to have breast reconstruction. Or if you have your bladder removed it may be possible to make a new bladder.

To prevent or reduce the risk of cancer

If you are at high risk of a particular type of cancer, you may be able to have surgery to reduce that risk. For example, people who have a rare inherited condition called Familial Adenomatous Polyposis (FAP) have an increased risk of bowel cancer. So they may choose to have surgery to remove their large bowel. Women who have a high risk of breast cancer may choose to have their breasts removed.

To control symptoms or extend life

People may have surgery to relieve symptoms if their cancers cannot be completely removed, or cured, with other treatments. For example, cancers in the abdomen can sometimes block the bowel and cause sickness and pain. An operation to remove or bypass the blockage can relieve these symptoms.

Surgery may also sometimes help to control pain by removing cancer that is pressing on a body organ or nerve.

Occasionally it is possible to remove cancer that has spread into nearby organs or to another part of the body. For example, people who have bowel cancer that has spread to the liver may be able to have surgery to remove the liver tumours. The surgery is unlikely to cure the cancer but can reduce symptoms and may help some people to live longer.

As part of other treatments

Some operations are done so that you can have other treatments for cancer. For example, you may have a small operation to put a thin tube called a central line into a main vein in your chest. The tube stays in throughout your treatment. It makes having chemotherapy or biological therapy easier because you don’t need to have a needle put into a vein each time you have treatment. You can also have blood taken from the tube.

Some operations are done to help doctors give treatments to areas inside the body. The surgery allows surgeons to give treatments such as radiofrequency ablation or cryotherapy.

For some cancers, surgery is the only treatment you may need. It is likely to cure small, early stage cancers that have not spread to other parts of the body. Whether surgery is an option depends on

• The type of cancer you have
• The stage and position of your cancer
• Your general health

If your cancer has spread or is at an advanced stage, surgery may not be the best treatment for you. It may be better to have a treatment that reaches all parts of your body, such as chemotherapy, biological therapy or hormone therapy.

Surgery is not used for some types of cancer of the lymphatic system (lymphoma) or blood system (leukaemia) because the cancer cells are spread throughout the body and surgery won’t get rid of them all.

Sometimes surgery is not possible because of the position of the tumour - for example, if the tumour is near a blood vessel or other delicate tissue. In this situation, surgery may cause too much damage to the surrounding tissue.

You can read more about specific operations in the treatment pages of the section about your cancer type.