Diagnostic surgery

The aim of diagnostic surgery is to obtain material that will contribute to the diagnosis. The surgical procedure most often employed is the biopsy. A biopsy consists of taking a sample of cells or tissue and analyzing it under a microscope.

This analysis, called pathological analysis, is used to determine the presence of cancer cells. If such cells are found, the specialist then determines the type of tumour in question.

Prophylactic or preventive surgery

Prophylactic surgery is a surgery performed to prevent cancer. It involves removing an organ before cancer develops.

Preventive surgery is indicated for those who have diseases or genetic mutations that greatly increase the risk of developing cancer.

Curative surgery

The aim of curative surgery is to remove the entire tumour while respecting a safety margin. The safety margin is the area around the tumour. This will be analyzed to check for the absence or presence of cancer cells. The size of the safety margin may vary, depending on the type of cancer and the location of the tumour.

Lymph nodes in the vicinity of the tumour may also be removed in order to determine whether cancer cells are present or to prevent them from growing (lymph nodes are small organs that play a role in the immune system).

Curative surgery can be either radical or conservative:

• It is said to be radical when the organ containing the tumour is removed in its entirety.
• It is said to be conservative when the surgeon preserves the role of the organ or its appearance. In this case, the surgeon removes only part of the organ. Conservative surgery is not always possible, depending on various factors such as the stage of the tumour.

The goal of curative surgery is to find the right balance between effective local control of the disease (i.e. removing all the tissue affected by the tumour or cancer cells) and preserving quality of life.

Tumour reduction surgery or surgical cytoreduction

The purpose of this type of surgery is to reduce the size of a tumour when it cannot be removed completely:

• The tumour is too big;
• The tumour cannot be removed completely without damaging neighboring organs. 

In such cases, as much of the cancerous tissue as possible is removed (surgical cytoreduction). Once this surgery has been performed, further treatment with radiotherapy and/or chemotherapy will be carried out. In certain types of cancer, tumour reduction can increase the effectiveness of chemotherapy and radiotherapy.

Reconstructive or restorative surgery

Some oncology surgeries can leave significant effects that affect quality of life. Reconstructive or restorative surgery is one way to address these long-term effects.

Reconstructive or restorative surgery has several objectives:

• To restore organ function or physiological function;
• Restore physical appearance;
• Reduce the side effects of other treatments (e.g. after radiation therapy). 

Reconstruction may take place immediately after removal of the tumour or a few weeks to a few months later.

The timing of reconstructive or restorative surgery depends on a number of criteria, including:

• The type of cancer;
• Its extent;
• Other prescribed treatments;
• The patient’s wishes. 

Palliative surgery

The aim of palliative surgery is to relieve symptoms and improve quality of life. Examples of situations in which palliative surgery may be indicated:

• To reduce a tumour that has spread and is compressing (crushing) organs or tissues around it. This compression can be reduced by surgery.
• To create a bypass (an artificial pathway) (e.g. in the airways to facilitate breathing or in the digestive tract to facilitate feeding).
• To administer various palliative treatments via natural respiratory, digestive or urinary tracts.
• To strengthen bone that has metastasized and become brittle in order to prevent fracture and relieve pain.

The use of this type of intervention sometimes arises in emergency situations. Decisions often have to be made quickly.

Surgery for secondary cancers or metastases

Surgery can be used to remove a metastasis. A metastasis is a secondary tumour that develops in another organ due to cancer cells originating in the primary tumour that have spread to other parts of the body.

Metastatic surgery is performed especially if:

• There is only one metastasis or a small number of metastases;
• The intervention can increase survival and sometimes bring about remission;
• The patient’s general state of health permits the surgical intervention;
• The cancer is “controlled locally,” i.e. there is no recurrence or local spread. 

Surgery to support treatment

Surgery is sometimes used to support treatments or the functions of an organ affected by treatments. Here are some examples of supportive surgery:

• Installation of a central venous catheter under the skin, a small device known as a Port-a-Cath. This allows the patient to receive chemotherapy, antibiotics, blood products or nutrients intravenously (I/V).
• Installation of a gastronomy (feeding) tube in the stomach for those who can no longer eat or drink.
• Installation of a tracheotomy (opening in the trachea) to allow the passage of air when there is an obstruction or risk of obstruction.

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Types of surgery