Surgery is the oldest effective cancer therapy. It can be used alone or in combination with other modalities (see also Overview of Cancer Therapy). The size, type, and location of the cancer may determine operability and outcome. The presence of metastases typically precludes surgery.
Factors that increase operative risk in cancer patients include
Cancer patients may have poor nutrition resulting from anorexia and the catabolic influences of cancer. These factors may inhibit or slow recovery from surgery. Patients may be neutropenic or thrombocytopenic or may have clotting disorders; these conditions increase the risk of sepsis and hemorrhage. Therefore, preoperative evaluation is paramount.
If a primary tumor has not metastasized, surgery may be curative. Establishing a margin of normal tissue around the primary cancer is important for success. Intraoperative examination of tissue sections by a pathologist may be needed. Immediate resection of additional tissue is done if margins show cancer.
Surgical resection may include removal of local and regional lymph nodes and/or resection of an involved adjacent tissue or organ.
Neoadjuvant chemotherapy or radiation therapy may be given before surgery to reduce the cancer size, limit the extent of surgery, and improve success rates.