What is the role of surgery in cancer?
Surgery is responsible for removal of all the visible cancer tissues. This is done by wide excision of the cancer. Today there is very little role of incomplete removal, though this does happen because of the extensiveness of cancer. When this happens the longtime outcomes are bad.
The contribution of surgery towards cure of cancer is more than 80% in most of the cancers. So, . Whatever else is done after surgery is only to reduce the risk of recurrence, only surgery is done to remove cancer in entirety.
Why do patients want to avoid surgery?
Patients are scared of pain and delayed recovery. This was a problem in the days when we used to perform open surgeries. Today in the era of laparoscopic and robotic surgery the pain is less and recovery time is short. Surgery is performed though very small wounds which heal very quickly.
The relatives always feel their patient is old and unfit. A good surgeon will never accept an unfit patient for surgery. There are specific criteria used for assessment of fitness (eg ECOG). We also put the patient on fitness protocol (eg. ERAS) so that the recovery is enhanced.
What is the role played by radiotherapy?
Radiotherapy and chemotherapy are called adjuvant therapy. The adjuvant mean ‘helping towards’. These help you move towards cure.
Radiotherapy kills the cells by burning (oxidation injury) them with Gamma Rays. The burnt tissue is left behind in the body. When this is used as primary modality of treatment, the burnt cancer tissue as well as the adjoining burnt normal tissue cause long-term side-effect. As there is high likelyhood of cancer cells left behind, there can be as much as 60% recurrence if surgery is not performed.
Can we cure with medicines alone?
Medicine for cancer is called chemotherapy. This is the most difficult part of the treatment for the patient due to the side effects. The role of chemotherapy in most cancers is to reduce the risk of recurrence after surgery.
There are times when chemotherapy is given before surgery. The principle with which chemotherapy works does not allow it to kill all the cancer cells. At the end of it, some cells are expected to remain even though physically cancer may seem to have disappeared. This is why even if most advanced scans don’t pickup the disease, cancer can still come back if surgery is not performed.
A good quality surgery is key to cancer cure.