What is Oncologic Surgery?
Oncology [ong-KOL-uh-jee] is the part of medicine that deals with cancer, which is a rapid growth of cells in a certain part of the body. A cancerous tumor is made up cells that are growing out of control. Sometimes a tumor takes years to form, but more aggressive cancers grow faster.
Oncologic [ong-kuh-LOJ-ik] surgery can also be called surgical oncology. It is done by an oncology surgeon. (Another name for this doctor is surgical oncologist [on-KOL-uh-jist].) In this operation, a surgeon cuts or changes the body to remove a cancer tumor. If it is not possible to remove the entire cancerous tumor, the oncology surgeon will remove as much as possible. This is called debulking.
Sometimes, the surgeon also removes a small area of healthy tissue from around the tumor, called the margin. They might also remove nearby lymph [LIMF] nodes (called a lymph node biopsy) to test for cancer. Taking the margin of tissue and the nearby lymph nodes can help improve the chances that all cancer cells are removed during surgery and can help your doctor find out more about your child’s cancer. After surgery, the tumor, the margin of tissue, and any lymph nodes are sent to a pathologist [puh-THOL-uh-jist]. The pathologist will examine them under a microscope. They do this to learn more about the cancer and to see if the margin and nodes are free of cancer cells.
Surgery is part of the treatment plan for most patients with cancer. The goal of any treatment plan is to make your child become cancer-free. This surgery might be the first big step in your child’s treatment plan. If the tumor needs to be smaller before the surgery is done, your child may have chemotherapy or radiation therapy to shrink the tumors first.
The type of surgery your child needs depends on what kind of cancer your child has and where the cancer is in your child’s body. The types of surgery usually done include:
- Resection, when part or all of an organ is removed.
- Amputation, when a limb (such as an arm or leg) is removed.
- Limb-sparing or limb-salvage surgery, which is an alternative to amputation. An implant might be used to replace the part of the limb that is removed
- Craniotomy [CRAY-nee-OT-oh-MEE] with resection, when part of the skull is removed and then the resection is done by a neurosurgeon [NOO-roh-SUR-jun]
Another surgery your child might need as part of their cancer treatment is reconstructive surgery, which is done by a plastic surgeon. The goal of this is to rebuild or reform parts of the body that were changed in an oncologic surgery.
What are the risks and/or side effects?
After surgery, your child will be in pain. Their doctor will work to manage the pain with medicine. Some risks that are shared for all kinds of surgery include:
- Infection. Because surgery involves cutting the body, there is always a risk of infection at the site where the surgeon makes the incision (cut). Infection risks are low but you should talk to your child’s doctor if you think your child might have an infection from surgery.
- Damage. Some surgery can cause damage to the part of the body that the surgeon is operating on and might lead to needing another surgery for reconstruction.
Sometimes, oncologic surgery does not remove all of your child’s cancer. Your child might need a second oncologic surgery if a margin is not clear or if the cancer comes back and forms a new tumor.
If your child’s lymph nodes are removed for a biopsy, your child is at a higher risk for getting lymphedema (swelling). This risk gets higher when more lymph nodes are taken.
Other side effects are emotional. Your child may be helped by seeing a counselor. They might also like to meet other children who have had similar surgeries done and have recovered.
Your child’s care team will help to prepare you and your child for all the side effects of surgery.
What are the benefits?
How do I prepare?
Before the surgery, your child:
- May need to avoid eating or drinking. The surgeon will tell you how long your child will need to fast.
- Will be prepared for surgery in a special room. They will need to change their clothes for a gown. The surgeon will come into the room and meet with you before the operation takes place.
- Will need anesthesia [an-uhs-THEE-zhuh]. General anesthesia is medicine that will put your child into a deep sleep where they will not feel pain. In a few cases, regional anesthesia (for an arm or leg) or local anesthesia (for a small area) might be used to cause numbness.
- Might be given medicine that will help with the side effects of anesthesia, such as feeling queasy.
How is it done or administered?
Once anesthesia is working, your child will be moved to the operating room (OR) for surgery. The surgery will either be open surgery or laparoscopic [LAP-er-uh-SKOHP-ik] surgery.
- Open surgery. The surgical oncologist may use small knives called scalpels to make an incision and remove the tumor. This is called open surgery.
- Laparoscopic [lap-ruh-SKA-pic] surgery. This might also be called minimally invasive surgery. It is not the best option for some cancers. The recovery from this surgery is shorter than with open surgery because a few small incisions are used instead of one big incision. During this surgery, the surgeon puts a laparoscope (a small tube with a camera at the end) into one of the small incisions. They move the tube into a place where the surgeon can see the tumor inside your child. Then, they insert their surgical tools through other incisions and use them to remove the tumor and margin.
After the surgery:
- Your child will be taken to a special area where they are monitored while they wake up. Most of the time, your child will need to stay in the hospital overnight. They will be moved to a hospital room once they are awake.
- A nurse or another medical team member will talk to you and your child about what your child can and can’t do while recovering. They will also teach you how to care for the incision and can answer your questions.
When will I know the results?
After your child’s surgery, their tumor, margin of tissue, and any lymph nodes that were removed are sent to a pathologist. The pathologist will examine them under a microscope to learn more about the cancer and to determine if the margin and nodes were free of cancer cells.
They will write a report on what they find and send it to your child’s surgeon or doctor. It may take a week or a few weeks to get this report, so someone will let you know when to make an appointment. At the appointment, your child’s doctor or the surgeon can explain what the pathologist found. You may have a copy of the report to keep.
What are follow-up requirements and options?
After having oncologic surgery:
- Your child may need other therapy (such as chemotherapy or radiation therapy) to continue to treat their cancer.
- Your child’s doctor will continue to follow your child’s health and progress even after your child is in remission (a period of being temporarily or permanently free of any signs of cancer).
- Your child may need physical therapy, rehabilitation, or both if your child’s surgery was an amputation or a limb-sparing surgery.
What should I expect during recovery?
Because oncologic surgery requires that a surgeon cut into your child’s skin as well as muscles, soft tissue, or bone, your child may need a long time to heal. Sometimes, recovery can take months. Your child’s doctor will work to manage the pain with medicine, and physical therapy might help to strengthen and return flexibility to the area that was operated on.
Because some side effects are emotional, consider talking to a social worker at your child’s hospital about having your child:
- See a counselor or psychologist [sahy-KOL-uh-jist]
- Meet other children who have gone through similar treatment
It can be very helpful for your child to meet other kids who have had amputations or other major surgeries as part of their cancer treatment. If your child sees these other children being active, it might inspire them to engage in their recovery.