Tumor removal



Definition

A tumor is an abnormal growth caused by the uncontrolled division of cells. Benign tumors do not have the potential to spread to other parts of the body (a process called metastasis) and are curable by surgical removal. Malignant or cancerous tumors, however, may metastasize to other parts of the body and will ultimately result in death if not successfully treated by surgery and/or other methods.


Purpose

Surgical removal is one of four main ways that tumors are treated. Chemotherapy, radiation therapy, and biological therapy are other treatment options. There are a number of factors used to determine which methods will best treat a tumor. Because benign tumors do not have the potential to metastasize, they are often treated successfully with surgical removal alone. Malignant tumors, however, are most often treated with a combination of surgery and chemotherapy and/or radiation therapy (in about 55% of cases). In some instances, non-curative surgery may make other treatments more effective. Debulking a cancer—making it smaller by surgical removal of a large part of it—is thought to make radiation and chemotherapy more effective.

Surgery is often used to accurately assess the nature and extent of a cancer. Most cancers cannot be adequately identified without examining a sample of the abnormal tissue under a microscope. Such tissue samples are procured during a surgical procedure. Surgery may also be used to determine exactly how far a tumor has spread.

There are a few standard methods of comparing one cancer to another for the purposes of determining appropriate treatments and estimating outcomes. These methods are referred to as staging. The most commonly used method is the TNM system.

Staging is particularly important with such lymphomas as Hodgkin's disease, which may appear in many places in the lymphatic system. Surgery is a useful tool for staging such cancers and can increase the chance of a successful cure, since radiation treatment is often curative if all the cancerous sites are located and irradiated.


Demographics

The American Cancer Society estimates that approximately one million cases of cancer are diagnosed in the United States each year. Seventy-seven percent of cancers are diagnosed in men and women over the age of 55, although cancer may affect individuals of any age. Men develop cancer more often than women; one in two men will be diagnosed with cancer during his lifetime, compared to one in three women. Cancer affects individuals of all races and ethnicities, although incidence may differ among these groups by cancer type.


Description

Surgery may be used to remove tumors for diagnostic or therapeutic purposes.


Diagnostic tumor removal

A biopsy is a medical procedure that obtains a small piece of tissue for diagnostic testing. The sample is examined under a microscope by a doctor who specializes in the effects of disease on body tissues (a pathologist) to detect any abnormalities. A definitive diagnosis of cancer cannot be made unless a sample of the abnormal tissue is examined histologically (under a microscope).

There are four main biopsy techniques used to diagnose cancer. These include:

Therapeutic tumor removal

Once surgical removal has been decided, a surgical oncologist will remove the entire tumor, taking with it a large section of the surrounding normal tissue. The healthy tissue is removed to minimize the risk that abnormal tissue is left behind.

When surgical removal of a tumor is unacceptable as a sole treatment, a portion of the tumor is removed to debulk the mass; this is called cytoreduction. Cytoreductive surgery aids radiation and chemotherapy treatments by increasing the sensitivity of the tumor and decreasing the number of necessary treatment cycles.

In some instances the purpose of tumor removal is not to cure the cancer, but to relieve the symptoms of a patient who cannot be cured. This approach is called palliative surgery. For example, a patient with advanced cancer may have a tumor causing significant pain or bleeding; in such a case, the tumor may be removed to ease the patient's pain or other symptoms even though a cure is not possible.


Seeding

The surgical removal of malignant tumors demands special considerations. There is a danger of spreading cancerous cells during the process of removing abnormal tissue (called seeding). Presuming that cancer cells can implant elsewhere in the body, the surgeon must minimize the dissemination of cells throughout the operating field or into the blood stream.

Special techniques called block resection and no-touch are used. Block resection involves taking the entire specimen out as a single piece. The no-touch technique involves removing a specimen by handling only the normal tissue surrounding it; the cancer itself is never touched. These approaches prevent the spread of cancer cells into the general circulation. Pains are taken to clamp off the blood supply first, preventing cells from leaving by that route later in the surgery.


Diagnosis/Preparation

A tumor may first be palpated (felt) by the patient or by a health care professional during a physical examination . A tumor may be visible on the skin or protrude outward from the body. Still other tumors are not evident until their presence begins to cause such symptoms as weight loss, fatigue, or pain. In some instances, tumors are located during routine tests (e.g. a yearly mammogram or Pap test).

Aftercare

Retesting and periodical examinations are necessary to ensure that a tumor has not returned or metastasized after total removal.


Risks

Each tumor removal surgery carries certain risks that are inherent to the procedure. There is always a risk of misdiagnosing a cancer if an inadequate sample was procured during biopsy, or if the tumor was not properly located. There is a chance of infection of the surgical site, excessive bleeding, or injury to adjacent tissues. The possibility of metastasis and seeding are risks that have to be considered in consultation with an oncologist.


Normal results

The results of a tumor removal procedure depend on the type of tumor and the purpose of the treatment. Most benign tumors can be removed successfully with no risk of the abnormal cells spreading to other parts of the body and little risk of the tumor returning. Malignant tumors are considered successfully removed if the entire tumor can be removed, if a clear margin of healthy tissue is removed with the tumor, and if there is no evidence of metastasis. The normal results of palliative tumor removal are a reduction in the patient's symptoms with no impact on survival.


Morbidity and mortality rates

The recurrence rates of benign and malignant tumors after removal depend on the type of tumor and its location. The rate of complications associated with tumor removal surgery differs by procedure, but is generally very low.


Alternatives

If a benign tumor shows no indication of harming nearby tissues and is not causing the patient any symptoms, surgery may not be required to remove it. Chemotherapy, radiation therapy, and biological therapy are treatments that may be used alone or in conjunction with surgery.


Resources

books

Abeloff, Martin D., James O. Armitage, Allen S. Lichter, and John E. Niederhuber. "Cancer Management." Clinical Oncology , 2nd ed. Philadelphia, PA: Churchill Livingstone, Inc., 2000.

"Principles of Cancer Therapy: Surgery." Section 11, Chapter 144 in The Merck Manual of Diagnosis and Therapy , edited by Mark H. Beers, MD, and Robert Berkow, MD. Whitehouse Station, NJ: Merck Research Laboratories, 1999.


organizations

American Cancer Society. 1599 Clifton Rd. NE, Atlanta, GA 30329-4251. (800) 227-2345. http://www.cancer.org .

National Cancer Institute (NCI). NCI Public Inquiries Office, Suite 3036A, 6116 Executive Boulevard, MSC8332, Bethesda, MD 20892-8322. (800) 4-CANCER or (800) 332-8615 (TTY). http://www.nci.nih.gov .

Society of Surgical Oncologists. 85 West Algonquin Rd., Suite 550, Arlington Heights, IL 60005. (847) 427-1400. http://www.surgonc.org .


other

American Cancer Society. All About Cancer: Detailed Guide , 2003 [cited April 9, 2003]. http://www.cancer.org/docroot/CRI/CRI_2_3.asp .


J. Ricker Polsdorfer, MD Stephanie Dionne Sherk

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?



Tumors are usually removed by a general surgeon or surgical oncologist. The procedure is frequently done in a hospital setting, but specialized outpatient facilities may sometimes be used.

QUESTIONS TO ASK THE DOCTOR





User Contributions:

1
barbara
I do not understand. If there is only one tumor and it is cancerous then how can you say that someone still has cancer if the entire tumor is removed successfully?
I was just diagnosed with a brain tumor and had it surgically removed. Waiting for the next step to fight this dreadful disease. Your information was very helpful. Thank you.
My son recently had an MRI after 6 months of intense headaches. He had a tumor & Cyste. He was operated within the week. All went well but now we wait for the pathology results!! Is it a Pilocytic astrocycloma Grade 1?? If it is can he get on with his life & put this frightening moment behind him?
4
maria
my mom was just told that the big lesion on her leg is cancer. she has had it for over 2 months now. did she wait to long to see a doctor? has it possibly spread through her body?
5
ashlie
My boyfriend and I are expecting a little boy on Christmas eve. He's .such an amazing guy, and would do anything for me.. But his health conditions are starting to worry me.. He has a tumor in his stomach , and there's a blood clot near it so many hospitals have said it's un-operable . I have to watch him s suffer in lain 24/7 and I would like to know if anyone knows of any really good recommended surgeons that would be able to see other wise . We live in mass but at this point im willing to go anywhere for him please help
6
Kelsey Tollett
What is a tumor that has been taken out labeled? By the way, I have a nub. What should I do about it?
7
ajaykumar
Surgeon used to perform excisional biopsy of tumor located in mid of left forearm. Non ionic ct was done and all the body organs from neck to abdonen looks normal. What will oncologist do next.
8
Mary Mbelekete
I need help. I don't know if its a tumour or a growth on the back of my head. I've had it for about five or more, it was not painful & remained the same size until last week when felt a bit of pain arrount it, now as I'm writting I'm feeling it spread & grows more & is beggining to be very painful. The pain affects the back of my ear & even my neck. I wasn't worried before cause it was painless & sumtimes even forgot is there, bt now I'm extremely woried and need help ASAP. Please help
i have just been diagnosed with stage 2 breast cancer, my husband has just left this week and I now cannot afford the treatment, can I remove my tumours successfully on my own? im not afraid of the pain just more afraid of if I leave it and don't do anything then I will die and leave my children without a mother
im now desperate any info would be fantatstic
10
Ally
i have a tumor very close to my heart and my dr said its beyond the removal stage. What does that mean?? i also was told its not cancer but it can still kill me... i was given 4 months to live
11
Jessica
I just find out that a have a tumor on my uterus. I found this article very informative.
12
Gloria Saundry
ave had a biopsy,which is benign, but ever since I have ringing in right ear which they say a Tintinus, will this cure on its own
13
herbert moore
I have been diagnosed to have a tumor in my groin area caused by a faulty hip joint that i had 7 years ago, i have been advised to have it replaced, will they remove the tumor while replaceing the joint. what is your oppinion
14
Jaafar Jawad
I have just removed two tumors from my bladder. Is it possible to have another one after one week from the operation?
15
Lynn Martin
Yes my husband when to someone that is not a Dr. Who is a nurse practitioner and my husband told him that he had a knot on his back that had been there for 3 years and it was getting bigger. So this practitioner told me and my husband that is was a tumer and that it needed to come out. So he said I can take it out here in my office. So he did and I got it all on video . Now there is a knot there and it's big. I sent him pics of it he said my husband will have to come back in because it's a blood clot and he needs to remove it so there want be a knot any more. I am worried no because my dad went in and had open heart surgery and he had a knot like this with in 3 days and my daddy had cancer. And passed 3 mouths down the Raod. OMG what do we need to do now. See a ER are a Dr. Pls can someone help
16
Naina
My brother is having tumor in spine c2 location.he was operated but tumor was not removed due to risky location.need to know if anyone went through same situation and went for any other treatment?
17
betty s mullis
I have Cancer in my left leg in lower part and if They do a biopsy of it are they a risk that it will spread right now it's in the bone but I would like to know if it's going to spread if they do a biopsy
18
samanjoy
About three years back my mom had a surgical removal of a tumour under abdominal ..but recently my mom says that she can feel it as like before..so iam totally worried about my mom whether it will be possible or not to do second time surgery ...pls your little info will be great in this moment.
19
brenda singh
i was dignoies with a 1.3 cm noulde ongolist won.t to remove my left lower lobe blood work good lung funtion test 90 percent i ask why not do a bisopsy to see if it cancer or not he said you smoke it cancer do you thank i need a second opionion
20
gajanan s
my father diagnose a tuberculosis tumor on his neck by slant cut biospy.
cont. with treatment of anti tuberculosis.
but after biospy he is neck and shoulder pain continuously treated with higher pain killer but not workingkindly help
21
Diane
My husband has just found it that h has breast cancer. The results came back and it's in its early stages as results show it has not spread in bone or tissues. My question is he has to wait 12 days for surgery, can it spread in this time while waiting for surgery
22
Akoa
A friend of my diagnosis tumor around his Lever
and was advised to be operated immediately..My question is das he need any chimotharapy after was
23
Nancy Radcliffe
My husband had a stage 4 cancerous tumor removed from his backbone. The surgeon got as much as he could, but more would lead to
paralysis. A rod was inserted. He had no further treatment. Now, 9 months later 3 hard lumps have formed on that rod. Can you tell me
what they are?
24
lindiwe
diagnosed with beningn tumour on the arm will go for surgery to remove soon will update yo
25
Michele
My partner had a tumor on her hip and went through chemo and radiation. It went away but now the doctor found a new tumo on the Same hip. My question is .. can she have radiation on that same hip? What are the alternatives?
26
Monique
I've previously had ovarian cancer &it was treated with chemotherapy after a hysterectomy, I found out that it is back & I can't have surgery due to too much scar tissue from unrelated bowel surgeries and the tumor is too large (8.2 cm) to have chemo get rid of it. My question is does anyone have any suggestions on how to get rid of a large cancerous tumor without surgery or chemo? I appreciate and welcome any and all suggestions
27
rachael
much pain after and how is the tumor removed when have a few
28
Mal Mundy
On a TV Quiz show some years ago a question was asked "In the early 19th century a woman removed a breast tumour herself using surgical instruments. What age did she live till" The answer the show gave was 82. I am searching for confirmation this occurred and the year and place. I would appreciate your assistance please
29
David K
had a 1 cm and a 3 cm mass removed from my bladder only yesterday.Dr. says there is a high probability they will return and i will have to be watched closely down the road. This my 3rd bout with cancer > Prostate,Lung and now this. And my PSA number continues to climb when it should be 0 because i have no prostate,from 0.95 to 1.74 in just 1 yr.
30
Linda
I have stage 4 cancer of the lungs, it has spread to my brain and to my bones and possible my liver. I am currently doing radiation for my brain cancer. They say its more important to get that done first , since your brain controls everything in your body. They say the kind of cancer I have there is no cue for .. It's called small cell carconoma. and it is metaistsized. I also have a tumor over my right breast now. This cancer is in my lymph node gland and is under my skin and is said to spread very fast. They doctor said that now is the time for me to go to all the places i ever wanted to go and see and to make ammends with any one i have argued with.. And plan my funeral . I have about 2 to 4 months to live. This is all from smoking cigarettes for over 40 years and drinking beer.. if you smoke or drink.. stop now before it's to late.
31
ARUNLAL
my father affected by NHL,and was dignoised and treated in amruta hospital eranakulam,cancer was in the fourth stage.After several month's treatment my beloved father passed away.one mr doctor pavitran treated him,he suggested palliative radlo therapy no kemotherapy and surjury .was this treatment sufficient for my father,is NHL is not curable
32
Joeprince
I’m having a stomach tumor that causes pains in my abdomen..What should I do?

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