~ Authored by Dr Rahul Kumar Chavan, Consultant Surgical Oncologist, Fortis Hiranandani Vashi ~

Cancer is rapidly assuming epidemic proportions and it is amongst the top three killers globally. In fact, in India, the incidence of Cancer is unusually high. Over the past decade, there has been a great revolution in the treatment of Cancer. With the advent of newer diagnostic imaging modalities, specialized tools, genetic, pathologic and molecular studies, our knowledge about Cancer has significantly enhanced. Now we understand Cancer from the tissue level to the molecular level, which is reflected in an increased survival rate of the patients, compared to a few years ago.

Surgery is still the fundamental modality of treatment for solid organ Cancer. Most people with solid organ Cancer will have to undergo surgery during their treatment; the main goal of surgery is to extirpate Cancer tissue from the adjoining areas with Cancer cells, such as Lymph Nodes. Along with other aspects of Cancer treatment, surgical techniques have changed enormously due to a better understanding of Cancer. Minimally Invasive Surgery (MIS), also called keyhole surgery, is one of the significant milestones in Cancer surgeries. It is associated with creating small holes in the body and performing complex major surgeries through these tiny holes. Many scientific studies have proven the oncological equal outcome of MIS with open surgery.

Further, robotic surgery, a form of minimally invasive surgery (MIS), is a breakthrough in surgical technology. It allows the surgeon to access the most difficult parts of the human body with ease (eg. the Prostate) and improves the  skill to successfully remove the tumor. VATS – Video-Assisted Thoracic Surgery is a form of MIS performed in the chest cavity, while laparoscopy is a form of MIS for abdominal operations. All these techniques of MIS, apart from enhancing precision and personalizing treatment, also reduce the complication rates, cause reduced pain,  less bleeding & scarring, shorten overall treatment duration and deliver far better results including patients’ satisfaction.

Today, with a better understanding of Cancer and the availability of superior chemotherapy and radiation techniques, organ preservation and further allowing the affected organ to maintain its function have become important aspects of the treatment. That is why the complete sacrifice of the organ due to Cancer is now a thing of the past. Patients need not necessarily lose an entire affected cancerous organ as preservation has become an emerging concept  for cancers of organs like the Breast, Rectum, Kidneys, Bladder, bones, Larynx, Thyroid, and others. With advanced plastic surgical and microvascular reconstructive techniques, we can help patients get a normal aesthetic look in cancers like the head & neck and oral cavity. Such techniques help to maintain patients’ appearance, voice and swallowing function; these techniques also boost moral of the patient.

The management of Breast Cancer has also evolved into a multidisciplinary, evidence-based surgical speciality, emphasizing on conservative surgery. Once upon a time, removing the entire breast used to be the routine process for Breast Cancer surgery, and many women hesitated to approach doctors sheerly due to this fear. With an improved molecular understanding of Breast Cancer, we can now conserve 60-70% of the breast. After Breast Cancer surgery, enhanced cosmetic outcomes can be achieved with breast reconstruction that will positively affect the quality of life of the patient. This has given rise to field of  Oncoplastic Breast Surgery, which aims to provide an acceptable breast appearance while maintaining oncological effectiveness. There has been a reduction in swelling of arms post breast surgery (Lymphoedema) as surgical approach to axilla has become increasingly conservative over the last few years.

With the advancement in systemic therapy agents, even in metastatic conditions of Cancer (stage IV), surgeons can now perform extensive surgeries and multi-visceral resections. Metastasectomy, which removes the distant organ affected  primarily due to Cancer  spread from somewhere else,  has become routine in Cancer surgeries like Sarcoma, Cancer of Colon/ Rectum and few others. So spread of Cancer from one organ to other now  does not necessarily mean Cancer is incurable. We can still give a life to such a patient.  In Cytoreductive Surgery with HIPEC, we tediously remove all visible Cancer tissue in an advanced stage of malignancy and  instill chemotherapy agents within the abdomen. This technique has helped save lives in advanced stages of cancers like Ovaries, Rectum, stomach, Pleura and others.

Additionally, advances in anaesthesia have also helped Cancer patients recover faster after surgery with minimal pain. The pain management system is now a part of the Enhanced Recovery Program After Surgery (ERAS). This has made it possible for the patients to experience minimal pain even after complex supra major surgeries. Patients can resume their normal duties at times within a day after Cancer surgery.

In conclusion, there have been significant enhancements in Cancer surgery over the past few years. Cancer is no longer associated with disfigurement of body shape, losing entire body part, painful surgery, or prolonged hospitalization and recovery from complex surgery. That being said, patients need to be alert ans undergo screening to detect Cancer as early as possible. If they have even the slightest suspicion, they should overcome their fear of surgery and consult an Oncologist at the earliest to achieve the maximum survival benefit. Going ahead, surgery remains the gold standard for many cancers.