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DEPARTMENT
OF SURGICAL ONCOLOGY
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| Department
of Surgical Oncology at DCHRC is dedicated to the
surgical management of all solid cancers. The Department
consists of full time dedicated consultants to cater
to the needs of patients with solid cancers, supplemented
with part time consultants in a number of allied
specialties. |
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emphasis is on maximizing the cure rates while minimizing
the functional and cosmetic impact of the surgery. |
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attention is given to pre- and post-operative care
to minimize the complication rate and contain the
cost of treatment. |
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The Department has been carrying out a wide range
of surgical procedures (for head & neck cancers,
thoracic cancers, gastro-intestinal cancers, pelvic
cancers, musculo-skeletal cancers, etc.) with very
good results since the inception. Organ and function
conservation strategies have been adopted with enthusiasm
and are applied as and when suitable. |
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AVAILABLE
FACILITIES |
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Operation Theatres
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The hospital has seven state-of-the-art operation
theatres with laminar airflow and HEPA filters to
ensure absolutely sterile operative environment.
Facilities exist to carry out the entire range of
cancer surgeries. |
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Diagnostic and therapeutic endoscopies and minimally
invasive surgery
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There is an exclusive suite to perform all endoscopies
(UGI endoscopy, colonoscopy, bronchoscopy, cystoscopy
etc.). The theatres are also equipped to perform
minimally invasive surgeries. |
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Frozen section and other pathology services |
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Frozen section examination of intra-operative biopsy
specimens is an essential component for good quality
cancer surgery. It helps in the intra-operative
diagnosis for all those cancer patients whose diagnosis
of cancer is not certain pre-operatively and avoids
second surgery / anesthesia. This reduces the treatment
cost and simplifies the treatment. In addition,
frozen section assessment of resection margins reduces
the chances of disease recurrences. |
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Intensive care unit |
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Fully equipped intensive care unit with latest monitoring
and therapeutic facilities to cater to the post-operative
needs of patients undergoing extensive surgeries.
Elective post-operative ventilation is used to minimize
post-operative pulmonary complications when indicated. |
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Blood bank with facilities for blood component therapy |
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Round the clock provision of whole blood and blood
components has augmented the surgical oncology services
in a big fashion. The blood bank is equipped with
a cell separator. |
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Super Deluxe, deluxe, single, double and semi
paying beds. |
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All types of in-patient accommodation are available
that provide comfortable and pleasing stay to the
patients and relatives. In combination with efficient
and courteous nursing and other staff, the objective
is to make the patient "feel at home".
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PATIENT INFORMATION |
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What is Surgical Oncology? |
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Surgical Oncology refers to the branch of medicine
involved in treatment of cancers by surgery. Surgery
was the first modality to be used in the treatment
of cancer. With the developments of general anesthesia
in the 19th century, major surgical procedures that
are necessary for the treatment of cancer became
possible. With advances in pre- and post-operative
care, blood transfusion, antisepsis and development
of antibiotics, such surgical procedures could be
carried out with very low complication rates and
negligible chances of death due to treatment. This
led to an explosion in the field of surgical management
of cancer. Originally, surgical treatment of cancers
was carried out by general surgeons and other surgical
specialists. Extensive surgical resections complemented
with plastic and reconstructive surgery have been
successful in the management of a large variety
of cancers at all stages. Surgeons dedicated
exclusively to cancer care are known as surgical
oncologists. |
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Why should one prefer dedicated cancer surgeons? |
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developments in the field of oncology leading to
integration of multimodality management, it has
become imperative that a surgeon dedicated exclusively
to cancer care be involved in the surgical management
of cancers in all cases. This leads to improved
patient outcome in terms of better diagnostic and
staging assessment, proper integration of surgical
and non-surgical treatments, customization of surgery
to the needs of the patient (extensive surgery in
some cases to get cures and limited surgery in other
cases for organ and function conservation).
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Does surgery lead to a flare in the disease?
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is a dangerous misconception among the public. There
is no evidence that surgery for cancer patients
leads to the disease flaring up or becoming more
aggressive. Because of this fear, a large number
of cancer patients do not undergo the appropriate
treatment at the right time. Delay often leads to
the disease becoming advanced and the opportunity
for cure is lost. |
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basic nature of cancer is to grow. Often, there
are cancer cells remaining in the body after the
surgery even when the complete tumor has been removed
adequately by surgery with a wide margin. These
cells would grow over period of time and lead to
the disease coming back. However, the recurrence
is not caused by surgery. It is the inherent nature
of disease. |
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Such remaining cancer cells need to be taken care
of by post-operative adjuvant therapy such as radiotherapy
or chemotherapy that significantly reduces the chances
of the disease coming back. Currently, a large percentage
of patients need to be treated with post-operative
adjuvant therapy, either chemotherapy or radiation
therapy or both to minimize the chances of disease
recurrence. Thus, every cancer patient should
have his case discussed in the tumor board after
apparently complete surgery to decide about the
need for further therapy. |
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must be stressed that surgical treatment is one
of the basic components of curative treatment in
nearly all solid cancers. Often, if a patient's
disease is inoperable, it may be beyond the chance
of cure.
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Is cancer surgery very disfiguring? |
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No! Cancer surgery is not a disfiguring surgery
as it is practiced today. With the progress that
has happened in the last century, majority of cancers
can be managed without disfigurement. |
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of the reasons for this is significant progress
in plastic and reconstructive surgery. Use of various
types of plastic surgical procedures leads to excellent
cosmetic outcome and good functional status in almost
all cases of cancer. In fact, it is possible to
use plastic surgery to reconstruct breasts after
they have been removed for breast cancer.
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thorough knowledge of plastic surgical procedures
available and their application in the management
of different cancers is another factor that distinguishes
cancer surgeons. Proper selection of the plastic
surgical reconstruction in a given case can make
a lot of difference to the outcome. |
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Is cancer surgery very risky?
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the supportive services at the disposal of a surgeon
in current times, the risk involved in major surgeries
required for cancer treatment has become negligible.
In fact, there are large series of a number of different
major surgeries where there is no loss of life related
to the surgical treatment.
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has been a significant reduction in the complication
and mortality rates related to major surgeries over
the last 20 to 30 years. Surgery for esophageal
cancer can now be carried out with a mortality of
less than 5%. Resection of liver, pancreatic surgery,
extensive pelvic surgery, etc. can all be carried
out now at low mortality rates if the modern methods
of pre- and post-operative care are combined with
a good surgical procedure.
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What is the role of cancer surgery?
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| Surgery
can be used for various purposes in the treatment
of cancer. |
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Diagnosis: Biopsy of different tumors
is a pre-requisite to treatment. Biopsy allows
confirmation of malignancy and allows accurate
typing of tumor. Nowadays, fine needle aspiration
cytology (FNAC) is the preferred first investigation
and biopsy is carried out if required. Biopsy
can be incisional or excisional. Sometimes,
frozen section examination is done to get
intra-operative confirmation of diagnosis
and carry out the necessary surgical treatment
under the same anesthesia. |
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Curative Surgery: Surgery for cure
of cancer is used in most of the solid cancers
of the body e.g. cancers of the head & neck,
salivary glands, thyroid, breast, lung and
esophagus, liver, gastro-intestinal tract,
kidney, urinary bladder and prostate, ovary,
uterus and cervix, bone and soft tissues,
external genitalia, etc. In a number of these
cases, surgery may be followed by further
treatment with radiation or chemotherapy to
consolidate the gains. |
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Supportive
and Palliative Surgery: Sometimes, surgery
is required for relief of symptoms without
cure of disease. Tracheostomy, feeding gastrostomy
and jejunostomy, colostomy, and many such
surgical procedures are carried out to provide
relief of symptoms and be lifesaving without
curing the disease. Surgery can also be done
for control of bleeding from the tumor. Venous
access surgery like placement of venous ports
makes it easier for medical oncologists to
do repeated administration of chemotherapy
without causing distress to the patient. Arterial
ports may be placed for intra-arterial chemotherapy.
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Is cancer surgery very costly?
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is not so. In fact, a surgery carried out for cancer
of any part is no more costly than a similar surgery
carried out for non-cancerous diseases of the same
area of body. Today, surgery for breast cancer is
carried out at DCHRC at about the same cost as the
surgery for gall bladder stones. There are a number
of major surgical procedures in cancer surgery that
are more extensive that surgery for non-cancerous
diseases. In such cases, longer hospital stay may
also be required and the overall cost of treatment
may be slightly higher. Overall, at DCHRC, our objective
is to minimize the hospital stay and treatment costs
for the patients. With this in mind, one of the
approaches followed is to minimize pre-operative
hospital stay. Patients are many times called in
the morning of surgery for admission if they do
not have significant medical illness or do not need
pre-operative preparation. Similarly, post-operative
care is standardized to minimize post-operative
hospital stay. |
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