Treatment

Surgery

In most cases, when the tumor can be removed, surgery is the best option for cure. When the tumor has spread beyond the initial site or when surgeons can’t be sure they removed all the cancer cells, surgery may be done in conjunction with radiation therapy or chemotherapy.

Open Surgery: Surgery sometimes must be done through an open incision where the surgeon can directly visualize the tumor and surrounding tissue. In other cases, the surgeon has more options:

  • Laparoscopic surgery: During the surgical procedure, small incisions of up to half an inch are made and plastic tubes called ports are placed through these incisions. A high-powered camera and the instruments are then introduced through the ports which allow access to the inside of the patient. The camera transmits an image of the targeted organs onto a television monitor. The surgeon uses the image from the video camera positioned inside the patient’s body to perform the procedure. Pain and hemorrhaging are reduced with the small incisions; and recovery time is shorter.
  • Robot-assisted surgery: Robotic surgery allows doctors to perform many types of complex procedures with more precision, flexibility and control than is possible with conventional techniques. Robotic surgery is usually minimally invasive surgery, performed through tiny incisions, but it is also sometimes used in certain traditional open surgical procedures.

 

Laser, radiofrequency or cryosurgery: Though not technically surgery, surgeons use precise heat from a targeted laser or radiofrequency device to remove cancerous tissue. Cryosurgery accomplishes the same thing with freezing.

Sometimes, when a tumor is too large to remove safely from surrounding critical tissues, chemotherapy or radiation can be given first to shrink the tumor and make it easier to remove. That’s why a multidisciplinary team reviews difficult cases to make sure the best combination of approaches is chosen for each patient.

History of Excellence

  • This team is one of the most experienced in the world in performing nerve-sparing bladder removal and construction of new bladders that preserve urinary continence in both men and women with bladder cancer. You continue to urinate normally while preserving sexual potency and comfort with intercourse.
  • Siteman offers a novel breast conservation strategy that allows the performance of multiple lumpectomies for 2-3 small tumors instead of a full mastectomy. If you are an appropriate candidate, cosmetic touch-ups for multiple tumors can preserve the breast.
  • Physicians at Siteman were the first in the area to perform laparoscopic colectomy for colon cancer. If your cancer is confined to the colon, your surgery will be less invasive and your recovery time shorter.
  • Siteman surgeons offer leading-edge treatments in head and neck tumor removal, such as transoral laser microsurgery for cancers of the larynx and pharynx, allowing them to remove tumors through the mouth without opening the patient’s neck. This form of therapy has markedly reduced side effects and hospital lengths of stay, all without external incisions.
  • Surgeons at Siteman utilize a grid-search approach to finding small primary head and neck tumors. Human papillomavirus tumors can be only one to three millimeters, below the resolution of PET or anatomic imaging, yet still metastasize to adjacent lymph nodes. The grid-search technique examines tissue in the tonsils and tongue with a powerful endoscope and telescope, and finds the tiny primary tumor 90 percent of the time. With such tiny tumors, the surgeon can use the laser right then to remove it, without external incisions, lessening the chances of further spread. This approach has dramatically reduced the need to do follow-up radiation on the throat, sparing you from long-term problems from the radiation.
  • Siteman is one of only a few facilities in the country with a dedicated chest surgery unit, treating the most difficult cases. Each year, these surgeons perform about 400 lung removals. Siteman surgeons remove an entire lung only when absolutely necessary. They often perform a “sleeve resection,” in which the cancer in the main bronchus, or air tube, is removed and the ends of the tube are reconnected to salvage the healthy part of the lung so the lung can function better.
  • Ten to 15 years ago, tumors in the lower third of the rectum usually required taking out the anal sphincter muscle and giving the patient a colostomy, a drainage site routed to the abdomen where a bag collected solid waste. Now surgeons understand that any cancer not directly involving the sphincter muscle or pelvic floor, and with enough distance between it and normal tissue to achieve a clear margin, makes it possible to preserve normal bowel function.
  • Transanal endoscopic microsurgical (TEM) excision is a surgery only offered at Siteman that allows for the removal of benign polyps and early cancers from the rectum. The approach is minimally invasive and allows better visualization and access to nearby lesions than traditional methods. It is also being used in appropriate patients to remove more advanced cancers in conjunction with radiation therapy.
  • Siteman surgeons are adept at video-assisted thoracoscopic surgery (VATS), a type of thoracic surgery performed using a small video camera that is introduced into the patient’s chest via a scope. The camera and instruments are inserted through separate small holes in the chest wall, greatly reducing the chance for infection and healing problems from a large incision. Many lung cancer procedures are done this way.
  • Minimally invasive head and neck endoscopy: Many tumors of the skull base can be treated with endoscopic endonasal skull-base surgery, in which, rather than make an opening through the face or skull, the surgical team advances an endoscope through the nasal cavity to view the anatomy and perform the surgery. Endonasal procedures are done for conditions such as: pituitary tumors, chordomas, chondrosarcomas, craniopharyngiomas, cysts, and meningiomas.
  • Whipple Procedure (pancreatoduodenectomy): The standard operation for pancreatic cancer patients is the intricate Whipple procedure, which involves removal of the head of the pancreas, the duodenum, common bile duct, gallbladder, surrounding lymph nodes and usually part of the stomach. Siteman is one of the highest volume centers for this type of surgery nationwide. In a recent study of 185 Whipples done by our group of Washington University physicians, not a single postoperative death was reported.
  • Male lumpectomy: This novel approach to treating prostate cancer destroys the tumor in place. By visualizing the tumor with precision on MRI, surgeons can destroy the tissue with a laser or freeze it with a special needle. It can be done outpatient with no risk of incontinence or sexual dysfunction.
  • Limb-sparing surgery: This surgery removes the tumor in an arm or leg without amputation, so the use and appearance of the limb is saved. Most patients with osteosarcoma in a limb can be treated with limb-sparing surgery. The tumor is removed by wide local excision. Tissue and bone that are removed may be replaced with a graft taken from another part of the patient’s body, or with an implant such as artificial bone. Today, Siteman surgeons can replace any joint in the body – knee, hip, shoulder, or elbow – with custom-designed artificial prostheses or bone grafts. To replace structurally significant segments of bone, they often use bone grafts. The choice of technique depends upon the patient’s individual situation.
  • Mohs micrographic surgery: Used mostly for tumors on the face, Mohs surgery involves cutting the tumor from the skin in thin layers. During surgery, the edges of the tumor and each layer of tumor removed are viewed through a microscope to check for cancer cells. Layers continue to be removed until no more cancer cells are seen. This type of surgery removes as little normal tissue as possible.
  • Cancer in the parafollicular cells of the thyroid, or medullary cancer, is rare and is often associated with the inherited MEN2 syndrome. Siteman has more experience in treating medullary cancer than many other centers around the world, and has pioneered several aspects of its management, including surgery. This disease requires meticulous removal of the thyroid gland and the lymph nodes around it.