Читать книгу Cancer is a Word, Not a Sentence - Miriam Stoppard - Страница 18

Surgery is the oldest method of treating any type of cancer and there are records of surgical techniques going back many hundreds of years.

The important point to realise here is that surgery is treatment for the local disease, that is, the disease in one particular part of the body. Sometimes that’s all that is needed, but sometimes it’s not enough. You can help yourself to ask the right kind of question by focusing on the following four topics:

Which area of the body is involved? This largely determines what the surgery is going to be like: if it is going to be a big operation or a small one, and what the effect will be on nearby organs. After surgery in the abdomen, for example, how quickly will bowel function return; in the lungs what will your breathing be like afterwards, and so on?

After the surgery, will additional local therapy be required? In other words, is the chance of the cancer recurring in the same area high, or low, or moderate? If it’s moderate or high, often radiotherapy will be recommended to reduce that chance of a local recurrence.

After the surgery, will additional systemic treatment—such as chemotherapy, hormone, or biologic therapy, that reaches all areas of the body—be recommended?

Are there alternatives to surgery or alternatives to big surgery? For example, in prostate cancer, what are the risks and benefits of using radiotherapy instead of surgery? In breast cancer, what are the risks and benefits of using radiotherapy after lumpectomy, compared to the bigger operation, mastectomy, which removes the entire breast?

In thinking about and discussing these topics with your surgical team, remember one important point (often a source of confusion, and even doubt). Whether or not further treatment is required after surgery depends on the type of cancer and on the way it is likely to behave, not on the personal skill of your surgeon!

In other words, the need for chemotherapy and/or radiotherapy after surgery does not mean that your surgeon didn’t succeed or did not do a good job. It means that in your particular case, the cancer itself poses a significant risk of recurring or spreading. It is very common for the surgery to be successful, meaning that all the visible tumour was removed and the phrase ‘we got it all’ is accurate about the local cancer, but there may still be a significant chance of recurrence or spread. For that reason, further therapy may be recommended after surgery.

This occurs often, and there can be some confusion on the patient’s part about whether the right operation was done or was performed properly. Hopefully what I am saying here will clear up that common sense of confusion!