Surgical treatment of tumors

General approaches to neoplasm treatment

The treatment strategy directly depends on the nature of the neoplasm. Malignant tumors always require urgent and prompt treatment due to their tendency toward invasive growth and metastasis. At the same time, benign tumors are operated on according to strict indications:

• The neoplasm disrupts the normal function of the affected organ.
• The tumor causes a pronounced cosmetic defect.
• The formation is a precancerous condition.
• There is a justified suspicion of malignancy (malignant transformation of the process).

In modern clinical practice, there are four main methods of tumor treatment: surgical, radiation, chemotherapy, and hormone therapy. In practice, isolated use of only a single method is rare. Most often, combined treatment is employed.

Popular combination options include combining surgery with pre- or postoperative irradiation. Combinations of radiation therapy and chemotherapy without surgery are also possible (e.g., in the treatment of multiple myeloma or Hodgkin lymphoma).

It is important to remember the contraindications to surgical treatment. Surgery is not performed if the disease can be completely cured using radiation or drug therapy (a classic example is lip cancer). The second absolute contraindication is patient inoperability, which is diagnosed in the presence of distant metastases that rule out any possibility of radical surgical intervention.

Basic principles of oncosurgery

Surgical treatment of malignant neoplasms is fundamentally different from interventions for non-oncological pathologies. Oncosurgery is based on two inseparable principles: ablastics and antiblastics.

1. Ablastics This is a set of preventive measures aimed at preventing the dissemination (spreading) of tumor cells while the surgeon is operating. To adhere to ablastics, the following rules must be observed:

• Operate strictly within visually and histologically healthy tissues.
• Remove the affected organ en bloc along with regional lymph nodes.
• Perform preliminary ligation of lymphatic and blood vessels even before starting active manipulations on the tumor itself.
• Completely exclude trauma to the neoplasm (it is strictly forbidden to dissect the tumor or open the affected organ directly in the surgical wound).

2. Antiblastics If ablastics is prevention, then antiblastics consists of methods for actively destroying those tumor cells that could still remain in the body or wound after the removal of the primary focus. Antiblastics are of three types:

• Physical: the use of a laser, electrosurgical knife, or ultrasonic scalpel directly during the surgical intervention.
• Radiation: irradiation of the tumor itself or zones of potential metastasis in the pre- and postoperative periods.
• Chemical: systemic or intra-arterial administration of cytostatics before and after the surgery.

Types of oncological surgeries

Depending on the goals of the intervention and the stage of the pathological process, all operations in oncology are divided into radical and palliative.

Radical surgeries Such an intervention implies the complete removal of the entire affected organ (e.g., hysterectomy or mastectomy for breast cancer) or a significant part of it (subtotal gastric resection, extensive bowel resection). A mandatory condition for radicality is the removal of the regional lymphatic apparatus.

Radical surgeries are based on the principle of zonality. Its rationale is that cancer cells often leave the borders of the primary organ and are hidden in surrounding tissues, lymphatic vessels, and nodes. The essence of the method consists in removing the organ en bloc with the surrounding fascia and fatty tissue. Example: in the surgical treatment of breast cancer, the gland itself, surrounding fatty tissue, fascia, pectoralis major muscle, as well as axillary and supraclavicular lymph nodes are removed en bloc. If the tumor process grows into neighboring organs, extended surgeries are performed — resection or complete removal of the involved neighboring organ along with the primary focus.

Palliative surgeries These are performed in cases where a radical cure is no longer possible (e.g., due to the presence of unresectable metastases). The main goal of palliative surgery is to alleviate the patient's severe condition or eliminate life-threatening complications.

Indications for palliative interventions include tumor breakdown accompanied by profuse bleeding, or perforation of the wall of a hollow organ (intestine, stomach). Palliative surgeries are divided into two groups:

1. Forced removal of an organ or part of it — performed exclusively to relieve acute complications.
2. Symptomatic operations without tumor removal — aimed at restoring function. These include: creation of a gastrostomy for stenosing esophageal cancer, formation of an enteroenteric anastomosis for tumor-induced intestinal obstruction, and tracheostomy for laryngeal cancer blocking the airways.

Briefly: answers to topical questions

Class and exam questions

What else to study on this topic

• Mechanisms of malignant tumor metastasis (lymphogenous, hematogenous, implantation).
• Features of preoperative preparation and postoperative management of oncological patients.
• Classification of chemotherapeutic drugs (cytostatics) and principles of their combination with surgery.
• Detailed analysis of extended radical surgeries using pelvic organ surgery as an example.
• The role of hormone therapy in combination with surgical tumor removal.

Other topics in "CHAPTER 14. TUMORS"

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.