How does surgery treat cancer?

By physically removing the cancer from your body. Surgery is a local treatment, meaning it only treats the part of the body where the cancer is. That single fact explains most of what follows.

It works best for solid tumors contained in one area. It is not used for leukemia, which is a blood cancer, and it is not used for cancers that have already spread widely.

Three different jobs, not one

Surgery is not always aimed at cure, and it helps to know which goal yours has.

Removing the entire tumor is the first, used when the cancer sits in one place. The surgeon usually takes some healthy tissue around it, and sometimes nearby lymph nodes.

Debulking is the second. Here the surgeon removes some but not all of a tumor, because taking all of it would damage an organ or the body. Removing part of it can help other treatments work better.

Easing symptoms is the third. Surgery can remove a tumor that is pressing on something and causing pain.

Ask which of these three your operation is for. It changes what "success" means afterward, and it changes what you should expect from the follow-up scan.

Open, keyhole, and no cuts at all

In open surgery, the surgeon makes one large cut. In minimally invasive surgery, they make a few small cuts and insert a laparoscope, a long thin tube with a tiny camera that shows the inside of the body on a monitor. Special tools go through the other small cuts. Recovery from minimally invasive surgery takes less time, because the cuts are smaller.

Several techniques do not use a scalpel at all. Cryosurgery uses extreme cold from liquid nitrogen or argon gas to destroy abnormal tissue, and it is used for early-stage skin cancer, retinoblastoma, and precancerous growths on the skin and cervix. Lasers cut with focused light and can treat tumors on the body's surface or the lining of internal organs. Photodynamic therapy uses drugs that switch on when hit by a particular light, killing nearby cancer cells. Hyperthermia heats small areas of tissue, which can kill cancer cells or make them more sensitive to radiation and some chemotherapy drugs. NCI notes hyperthermia is not widely available and is still being studied in trials.

Anesthesia comes in three forms. Local numbs one small area. Regional numbs a part of the body, such as an arm or leg. General causes loss of feeling and complete loss of awareness.

The risks worth asking about

Pain is expected. How much depends on the extent of the surgery and where it was. Talk about pain control before the operation, not after, and say something if the plan is not working.

Infection is the next common problem. Follow your nurse's instructions on caring for the site. Call your team the same day for spreading redness, increasing pain, pus or foul-smelling drainage from the wound, a wound that opens, or a fever, since surgical infections are treated with antibiotics and get worse if left.

If chemotherapy is also part of your treatment, a fever after surgery is a medical emergency rather than a same-day call. CDC gives that instruction: ring your cancer team at once at any hour, and go to an emergency department if you cannot reach them.

Other risks are bleeding, damage to nearby tissue, and reactions to anesthesia.

Where it fits with everything else

Sometimes surgery is the only treatment you need. More often it is one part of a plan that also includes chemotherapy, radiation, or drug therapy, given before surgery to shrink a tumor or after to clear cells left behind.

Cost varies with the type of surgery, how many specialists are involved, the anesthesia used, whether it happens in an office, an outpatient clinic, or a hospital, and how long you stay. Our overview of surgery for cancer covers preparation and recovery, and the piece on adjuvant and neoadjuvant therapy explains treatment given around an operation.

Sources

• https://www.cancer.gov/about-cancer/treatment/types/surgery