Conditions That May Benefit from Oncologic Surgery
Cancer surgery remains the fundamental treatment used to both diagnose and treat a variety of cancers.
Esophageal cancer is cancer that occurs in the esophagus — the long tube that runs from your throat to your stomach. Esophageal cancer affects over 14,000 people in the United States each year. Treatment is dependent on the stage of your cancer and your overall health, but surgery is the main treatment for localized esophageal cancer.
Gastric cancer refers to cancer that begins in the mucus-producing cells on the inside lining of the stomach. Stomach cancer is uncommon in the United States, and the number of people diagnosed each year is declining.
Our program for the treatment of gastric cancer integrates state-of-the-art care from multiple specialties, including radiology and gastroenterology. We use minimally invasive surgical techniques, such as laparoscopy and laparoscopic ultrasound, along with surgical lymphadenectomy. Decisions regarding preoperative versus post-operative chemotherapy and/or radiation are made based on your unique needs and circumstances.
Associated with sun exposure in early childhood, melanoma is the sixth most common cancer in the United States. Sunblock and protective clothing are helpful measures in preventing this disease.
The program for treatment of patients with metastatic colorectal cancer to the liver integrates the most advanced treatments in a multidisciplinary approach. Our surgeons work in collaboration with radiologists and oncologists to identify those individual who may benefit from liver-directed surgical treatment.
Procedures we perform include:
- Liver Resection. We integrate the newest techniques in evaluation of the liver with intraoperative ultrasonography. Patients who are candidates for liver resection, based on careful screening and staging, have the best potential for survival.
- Ablative Therapies. Patients who are not candidates for removal of their tumors are candidates for ablative therapies – most commonly, radiofrequency ablation. This procedure destroys the tumor cells with heat while preserving the liver.
- Hepatic Artery Infusion Chemotherapy. Hepatic artery infusion chemotherapy involves the placement of a catheter into the blood vessel that goes to the liver. Chemotherapy drugs are then infused directly into the catheter, allowing for direct treatment of liver tumors. This type of treatment results in lower systemic symptoms typically associated with chemotherapy treatment.
- Minimally Invasive Surgical Techniques. Minimally invasive liver surgery is performed laparoscopically via smaller incisions than traditional surgery. Laparoscopy can be used to aid with liver biopsy or even to remove a portion of the liver that contains a cyst or mass. This technique may be combined with radiofrequency ablation, hepatic artery infusion, chemotherapy and/or cryotherapy.
The Division of Surgical Oncology Program treats and evaluates a significant number of patients with both extremity and soft tissue sarcomas and remains a regional and national leader in this disease.
We use an interdisciplinary approach in evaluating and treating patients to allow for preservation of the limb, optimal recovery and optimal tumor control. Strategies such as the integration of preoperative radiation therapy, intraoperative brachytherapy (localized radiation therapy), or postoperative radiation therapy for control are used. Additionally, we collaborate with the Plastic Surgery Department to optimize your recovery and healing.
The best treatment will depend on the size and stage of your cancer:
Sentinel Lymph Node Mapping and Biopsy
Depending on the results from a biopsy, your surgeon may recommend a sentinel lymph node biopsy. Sentinel lymph node mapping and biopsy is an outpatient procedure involving the removal of lymph nodes from under the axilla (armpit) or the groin. The procedure involves injecting dye into the area affected by cancer to identify the lymph nodes that are draining to the tumor. Typically, one or two lymph nodes are identified and removed and tested for the presence of cancerous cells.
If the sentinel lymph nodes come back negative, then no further lymph node surgery is needed. If the sentinel lymph nodes are positive, then an axillary or complete lymph node dissection will be advised.
Axillary Lymph Node Dissection
Axillary lymph node dissection involves removing the majority of lymph nodes under the axilla. It often performed for breast tumors or melanoma. The procedure requires an overnight stay in the hospital.
Isolated Limb Perfusion
Isolated limb perfusion (ILP) is a procedure used to treat a type of metastatic melanoma called in-transit metastases. In-transit metastases means that cancer has spread along lymphatic vessels in the skin, causing the formation of nodules in the skin or under the skin but away from the primary melanoma site.
Isolated limb perfusion (ILP) is a specialized surgical procedure on the blood vessels to and from the extremity. Your surgeon will place tubes into the artery, through the leg and out of the vein leaving the leg. A heart lung bypass machine then circulates very high doses of a chemotherapeutic drug called melphalan through the leg for an hour. This allows high doses of chemotherapy to be given without the associated side effects.
Over the last three decades, we have performed ILP several thousand times. It has proven highly successful. Melanoma tumor nodules have disappeared completely in over 60 percent of patients, and have significantly decreased in the other 40 percent.
Medical Breakthroughs: Heated Intraperitoneal Chemotherapy (HIPEC)
Some types of cancers are more difficult to treat than others. Cancer that has spread to the lining of the abdominal cavity is one example. Heated/Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is one of the most innovative treatments available today for complex abdominal cancers, and our team of surgeons is among a small number of academic medical centers in the region performing it.
HIPEC involves filling the abdominal cavity with heated chemotherapy drugs for approximately 90 minutes after all visible signs of the tumor have been surgically removed so that any remaining cancer cells are destroyed.
HIPEC has several benefits including:
- Enabling the use of a high concentration of chemotherapy drugs that would not be tolerated systemically
- Allowing better penetration of the chemotherapy solution into the cancerous tissue
- Reaching cancer cells that are too small to see and often undetected
HIPEC therapy is used for the treatment of patients with:
- Pseudomyxoma peritonei
- Primary peritoneal mesothelioma
- Certain patients with carcinomatosis from appendiceal, colorectal, gastric and ovarian primary cancers with disease confined to the abdominal cavity
At Penn Medicine, procedures involving HIPEC are a multidisciplinary effort involving surgical and medical oncologists, anesthesiologists experienced in performing extended surgeries, and critical care specialists who provide aftercare.
Thanks to clinical trials, many of which are conducted at Penn Medicine, more patients are benefiting from breakthrough therapies and treatments than ever before. Once such area of extensive research is in immunotherapy.
There is considerable evidence that the immune response can be harnessed to fight cancer. We have several active clinical trials available that are aimed at activating the immune response. These include trials in melanoma and breast cancer with plans to open additional trials for patients with gastrointestinal tumors, such as pancreatic cancer.