Surgical diagnosis and treatment of cancer prevention

2021-02-06 12:00 AM

The basic principle in multimodal therapy is to use the advantages of one treatment to complement the disadvantages of the other and vice versa.

Outline

It is the earliest emerging method and until now it is still an important weapon in cancer treatment.

According to the International Cancer Organization (UICC), about 80% of cancer patients are treated with surgery.

Today, thanks to a clear understanding of pathogenesis mechanisms as well as advancement in cancer diagnosis and treatment, the role of cancer surgery is becoming more diverse and progressive. Reasonable surgery trend, maximum organ conservation, in coordination with other treatment methods (radiation therapy, chemotherapy, immunotherapy ...) to improve the quality of life of patients. increasingly widely applied in many countries 

In developing countries, due to the lack of other means of treatment, surgery remains the predominant weapon of application.

Based on the purpose of treatment, surgical principles for cancer can be summarized in the following order:

Preventive surgery

It is more and more identifying diseases that develop into cancer over time. Treating these diseases with many methods of which surgery is the main method that will eliminate the risk of cancer such as:

Lower testicles misplaced.

Remove colorectal polyps before the age of 20, surgery for bleeding colorectal inflammation.

Thyroidectomy to prevent medullary thyroid cancer in MEN II Multiple Adenoma.

Extensive ablation in leukoplakia.

Removal of the mammary gland or ovary due to abnormal healing in families with high rates of breast and ovarian cancer.

Diagnostic surgery

Mainly exploration to take patient samples for histological tests. Including types: biopsy aspiration, anatomy or biopsy surgery.

Rule:

Take a typical tissue sample with sufficient margins of normal tissue.

No biopsy into necrotic tissue.

Avoid transplanting to nearby normal tissue.

The biopsy skin incision should be in the tissue that will be removed by a subsequent radical surgery.

Gives clinical information necessary to the pathologist.

Rated surgery

According to AJCC there are the following types of cancer ratings:

Clinical ranking: clinical examination, biopsy, imaging ...

Surgical ranking: lymph node biopsy, investigative chest surgery, investigative abdominal surgery. Mediation ...

Postoperative ranking: survey of tissue samples obtained after surgery.

Ranking for Re-Treatment: a rating for either additional treatment, or 2nd treatment.

Rank by death

Surgical treatment for cancer

Radical surgery

Indicated when the tumor is small, localized. It is necessary in the absence of the assistance of other means of treatment.

Radical surgery is to extensively remove the primary tumor and nearby organs to ensure that there is no tumor left and wide removal of regional lymphatic organizations. What about widespread ablation, there are many different opinions?

Many authors suggest that the tumor should be cut at least 2 cm and the tumor and its surrounding organization should be removed into a mass. It is best to use an immediate biopsy to ensure the cut area does not contain cancer.

According to the World Cancer Organization (UICC), the minimum tumor cutting distance for some types of cancer is as follows:

Basal cell type skin cancer: 2mm.

Tongue cancer: 2cm.

Esophageal cancer: 10 cm.

Software (Muscle) cancer: Removes an entire muscle group.

Stomach cancer: 6cm.

Colorectal cancer: 3 - 6 cm.

Thyroid cancer: Total or thyroidectomy or thyroidectomy (depending on the stage).

Breast cancer: If the tumor is less than 2cm, it should be cut 2-3cm away from the tumor. If u> 2cm should remove all mammary glands.

Radical surgery can be combined with other treatments:

Surgery can be combined with radiation before, during and after surgery.

For large-diameter primary tumors, first-ray treatment should be used to shrink the tumor for easy removal.

For tumors that are not sure to be removed by surgery, supportive radiation therapy should be treated after surgery to destroy the remaining tumor organization.

Chemical surgery and endocrine surgery: can be used before or after surgery to avoid systemic metastasis.

Surgery can be combined with radiation and chemicals.

Temporary surgery

Indicated in cases of cancer that has spread, surgical purposes of a temporary nature:

Smaller the tumor and then will be supportive treatment by other methods.

Surgical cleaning to make the patient comfortable.

Surgery to open the blockages such as opening the stomach, making an artificial anus, draining the bladder, bringing the urethra to the skin, draining the kidneys ...

Surgical hemostasis, anti-pain ...

Surgical treatment of recurrence and metastasis Apply in the following cases

Recurrence after the first surgery, after radiation or chemotherapy.

Some have isolated distant metastases, with little results from radiation and chemicals.

Reconstructive and restorative surgery

Surgery is not only to cure the illness, but also to bring the patient back to a normal life. Reconstructive surgery has the meaning of restoring function, health and aesthetics.

Breast imaging after breast cancer surgery is a surgery that is commonly used using a fluid sac, abdominal flap transfer, or skin mass with a stem.

Head, face and neck surgeries are often accompanied by plastic surgery.

Emergency surgery

In the natural progression of each cancer, some situations that require emergency surgery such as bleeding cannot stop, organ perforation ...

Surgery in polymorphic therapy

The basic principle in multimodal therapy is to use the advantages of one treatment to complement the disadvantages of the other and vice versa. Basically, a combination of three weapons: Radiation-Chemotherapy-Surgery.

Statistics show that, about 70% of single surgeries fail due to cancer cells left in place, in the region or by microscopic metastases already at the surgery. Include:

Surgery before surgery.

Coordination after surgery.

Coordination in surgery.

Surgery as an aid to radiation therapy or chemotherapy.