Principles of surgical treatment in oncology


 * Surgery was the first to deal with and often cure tumors.

Inoperability

 * Surgical:
 * due to extent, location (grows, clings to large vessels, located in the trunk, generalized…);
 * for internal reasons - old age, comorbidities, GA cannot be administered.
 * Oncological:
 * type is inappropriate to operate due to histological type ( malignant lymphoma, erysipeloid variant ca breast );
 * tumor size is associated with a high probability of micrometastases;
 * generalized tumor process.

Prophylactic surgery

 * It is rarely used.
 * in some congenital abnormalities and disorders (eg prophylactic colectomy in polyposis, orchidopexy in cryptorchidism, bilateral ablation in BRCA positive…).

Diagnostic surgery

 * basic procedure for making a diagnosis irreplaceable.

Curative surgery

 * only in localized forms or in situ tumors;
 * the prerequisite is perfect removal of the tumor, or lymphadenectomy;
 * however, we often have to add other modalities, as many solid tumors have to be considered as systemic diseases;
 * Some less invasive procedures have been used lately - for example, using the sentinel node method (we put a dye or radiopharmaceutical in the tumor area, the nodes stain within a few minutes, are removed and examined; if they are negative, radical lymphadenectomy does not have to be done…)

Palliative surgery

 * an important part of comprehensive treatment;
 * by removing the tumor, we reduce the mass of tumor cells in the body and improve the effect of other modalities (chemotherapy);
 * therefore, there is no point in removing the tumor unless it improves the effect of the treatment;
 * another indication is if there is a risk of local complications (obstruction of the GIT, bile ducts, spinal cord compression);
 * in the GIT we solve this with various anastomoses, lumen-retaining endoprostheses, stents…;
 * for superficially accessible tumors, we perform so-called remediation operations - removal of exulcerations (smells, bleeds, become infected).

Surgical treatment of metastases

 * palliative performance, only in certain circumstances (the size of the resection does not affect organ function, acceptable performance morbidity…);
 * most often in liver meta;
 * unresectable meta up to 3 cm can be treated by injection installation of 98% ethanol, or use cryodestruction;
 * other organs - lungs, brain, bones (excochleation and cement filling - fracture prevention);
 * pain surgery - myelotomy, chordotomy….

Other methods

 * LASER - esophagus, larynx, ca lungs;
 * cryosurgery - treatment of superficial (skin) tumors;
 * radiosurgery - gamma knife ….

Source

 * BENEŠ, Jiří. Study materials [online]. [feeling. 2010-03-31]. < http://jirben.wz.cz >.

Source
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