Surgical Oncology

Surgical Oncology specialists at Wayne Health provide advanced surgical treatment and patient care for a wide variety of cancers using leading-edge approaches that improve outcomes. Our multidisciplinary approach combines the expertise of a team of specialists to provide patients with the latest information, a thorough diagnosis and effective treatments based on individual needs.

Surgical Oncology involves surgical removal of a cancerous tumor and a small amount of surrounding normal tissue, called the “margins.” Not all cancer patients need surgery. But if you do, Wayne Health specialists will work together as a multidisciplinary team to create a treatment plan that is specific to your needs.

Surgical oncologists remove cancerous, pre-cancerous or benign tumors. They also perform surgery to relieve debilitating symptoms of cancers.

• Colorectal and anal cancers
• Stomach and small bowel cancers
• Pancreatic and bile duct cancers
• Primary and metastatic liver cancers
• Endocrine tumors
• Melanoma and other skin cancers
• Breast cancer
• Lung cancer
• Soft tissue tumors (sarcomas)
• Bone cancer

Wayne Health Surgical Oncology offers a wide range of surgical services for many types of cancer. Some of the more common procedures for treating breast cancer, liver cancer, lung cancer and pancreatic cancer are described below.

Breast-conserving surgery (lumpectomy):

Breast-conserving surgery (lumpectomy) removes the cancer and just enough tissue to get all the cancer. The goal is to keep the breast looking as normal as possible after the surgery while reducing the chances of the cancer coming back.

The size and location of tumors differs from one person to another, so the amount of tissue removed during surgery also differs.

Some of the lymph nodes under the arm may also be removed during breast-conserving surgery. This is done with a separate incision. If cancer is found in those lymph nodes, more lymph nodes may be removed.

Most people who have breast-conserving surgery also have radiation therapy. You may also have chemotherapy, hormone therapy, or both.

Mastectomy

A mastectomy is the surgical removal of the breast. It is used to treat breast cancer.

Mastectomy procedures include:

• Total or simple mastectomy, which is the removal of the whole breast
• Modified radical mastectomy, which is the removal of the whole breast and the lymph nodes under the arm (axillary lymph nodes)
• Radical mastectomy, which is the removal of the breast, chest muscles, and all of the lymph nodes under the arm (axillary lymph node dissection). This surgery is rarely used now.

Depending on the location of the tumor in the breast and other factors, some women may be able to have a skin-sparing or nipple-sparing mastectomy. Skin-sparing mastectomy leaves most of the skin that was over the breast, except for the nipple and the areola. Nipple-sparing mastectomy saves the skin over the breast and it saves the nipple and areola.

The removal of a breast before cancer is diagnosed is called a prophylactic mastectomy. This type of mastectomy can be used to prevent breast cancer in women who have an extremely high risk of developing the disease

Liver resection surgery: 

Liver resection is surgery to remove a piece of the liver. Up to one-half of your liver can be removed if the rest of it is healthy. The doctor makes a cut (incision) in your belly to take out part of the liver. If the doctor removes the right side of your liver, your gallbladder will also be removed.

Liver resection requires general anesthesia. The surgery can take 2 to 5 hours.

You will probably stay in the hospital for 5 to 14 days after surgery. You will need to take it easy for 4 to 8 weeks at home.

Lung surgery for lung cancer: 

Lung cancer is the rapid growth of abnormal cells in the lung tissue. Surgery to remove all or part of a lung may be done by making a cut on one side of your chest (thorax) during a procedure called a thoracotomy. Surgery that uses this approach avoids areas in the chest that contain the heart and the spinal cord.

After the cut is made between the ribs, all or part of the lung is removed, depending on the location, size and type of lung cancer that is present.

The types of lung surgery are:

• Wedge resection (segmentectomy). The surgeon removes a small wedge-shaped piece of lung that contains the lung cancer and a margin of healthy tissue around the cancer. This is likely to be done when your lung function would be decreased too much by removing a lobe of lung (lobectomy). The risk of lung cancer coming back (recurring) is higher with this method.
• The right lung has three lobes and the left lung has two lobes. A lobectomy removes the entire lobe of your lung that contains the cancer. Your lungs can function with the lobes that remain.
• A pneumonectomy removes your entire lung that contains the lung cancer. A pneumonectomy is done only when needed, because it will greatly reduce your overall lung function.
• Sleeve resection. The surgeon removes the cancerous part of the bronchus and reconnects the healthy ends. The bronchus is the part of the trachea (windpipe) that branches off into each side of the lungs.

A chest tube is used after lung surgery to drain fluid and blood out of your chest cavity and help your lung refill with air.

A video-assisted thoracoscopic surgery (VATS) may be done before or instead of a thoracotomy. This procedure involves inserting a long, thin tube (videoscope) with a camera attached and small surgical instruments into your chest through small cuts made between your ribs.

Pancreatic cancer surgery: 

Surgery for pancreatic cancer removes part or all of the pancreas. Other organs might also be removed. You and your doctor will plan your surgery based on your wishes and the stage of the cancer. Every person’s treatment plan and surgery are different. Your doctor will tell you what will be removed.

Your doctor may:

• Take out the narrow end (tail) of the pancreas and the spleen. This is called a distal pancreatectomy.
• Take out the whole pancreas, part of the stomach, part of the small intestine, and the bile duct, gallbladder, spleen and nearby lymph nodes. This is called a total pancreatectomy.
• Take out the thick end (head) of the pancreas. Your doctor may also remove the body of the pancreas, part of the stomach, part of the small intestine, nearby lymph nodes, and the gallbladder and common bile duct. This is called a Whipple procedure.

You will be in the hospital for 1 to 2 weeks after the surgery. You will probably be able to go back to work or your normal routine in about 1 month. It will probably take about 3 months until your strength is back to normal. You may need more treatment for the cancer. This may include chemotherapy or radiation.

You may need to take enzyme supplements. These replace the enzymes the pancreas makes. You may also need to take anti-ulcer pills.

The pancreas makes insulin. So you may develop diabetes after surgery. If this is the case, you may have to check your blood sugar levels and take insulin.

When you find out that you have cancer, you may have many emotions and need some help coping. Seek out family, friends and counselors for support. You also can do things at home to help you feel better while you go through treatment. Your doctor can guide you to many local resources for support and more information. Call the American Cancer Society (1-800-227-2345) or visit its website at www.cancer.org for more information.

What are some common concerns after surgery?

The most common problems right after surgery are pneumonia, bleeding, infection, clotted blood at the surgery site and reactions to the anesthesia.

In the first 48 hours after surgery, the most likely risks are bleeding and heart or lung problems. From 48 hours to 30 days after surgery, the most common risks are infection, blood clots and problems with other body organs.

Another concern is pain control. Inflammation or nerve injury from the surgery can cause pain. Your doctor may give you more than one medicine for pain. Often opioids are given.

Anesthesia can have side effects. Two of the most unpleasant ones are nausea and constipation. Nausea will soon wear off, but constipation can be uncomfortable for several days after surgery. You may get a medicine to help you move your bowels. But eating may be the best way to end constipation. That’s because food pushes waste through your system.

Wayne Health’s Surgical Oncology services range from standard procedures to advanced, minimally invasive techniques that allow for quicker healing and improved patient outcomes.

One new minimally invasive procedure available at our partner hospitals is Electromagnetic Navigation Bronchoscopy (ENB). This procedure allows a physician to diagnose and treat lung tumors in outer areas of the lung that are not accessible with a traditional bronchoscopy procedure.

Other new diagnostic and minimally invasive procedures include:

• Ultrasound-guided bronchoscopy and biopsy
• Argon treatment of obstructing tumors in the respiratory tract and the upper part of the digestive tract
• Stents and robotic lung surgery using the da Vinci Robotic Surgical System

Physicians and researchers at Wayne Health are also faculty members of the Wayne State University School of Medicine who partner with the Karmanos Cancer Institute to conduct research and clinical studies. This makes the latest treatments and clinical trials available to you sooner than other health providers without a medical school affiliation.

As educators and researchers, our surgeons embrace change that benefits patients. Together with biomedical engineers in the futuristic Smart Sensors and Integrated Microsystems (SSIM) Lab, our surgeons are actively engaged in developing new treatment methods and technologies, and in teaching the next generation of surgeons, to accelerate progress toward the medicine and surgery of the future.

For more information, please visit the links below at the WSU School of Medicine.