Palliative and Reconstructive Surgeries
In addition to diagnostic, curative, and preventive surgeries, surgical procedures are also performed to improve the patient's quality of life. They can restore the function or appearance of organs or tissues that were either removed or changed by cancer treatment.
Cancer causes pain to most cancer patients as does the treatment. It is estimated that 80% of cancer patients have two or more episodes of pain. More patients experience pain with advanced disease. The quality of life of those patients in great pain, resulting from either the disease or the treatment, is greatly compromised. Under such circumstances, palliative surgery may be performed. For example, the procedure may involve the removal of a painful primary or metastatic tumor mass such as a solitary spinal metastasis.
The purpose of palliative surgery is mainly to reduce pain for the patient. The surgery may not necessarily aim to eradicate cancer tissue in the patient. In fact, palliative surgery is often deemed as worthwhile and feasible by cancer specialists when the disease is not responsive to any type of curative treatment. A successful palliative surgery may not only make the patient's life more comfortable, but it may also prolong the cancer patient's life in some cases. Palliative surgery which removes cancer tissue is recorded as cancer-directed surgery. Palliative surgery such as a nerve block procedure to interrupt pain signals in the nervous system, or a stent placement to alleviate obstruction, etc., which does not remove cancer tissue is not recorded as cancer-directed surgery. Palliative procedures are recorded as non-cancer directed surgery.
Reconstructive surgeries are performed on patients with physical deformities and abnormalities caused by traumatic injuries, birth defects, developmental abnormalities, or disease.
The goals of reconstructive surgery differ from those of cosmetic surgery; while cosmetic surgery is performed to reshape normal structures of the body to improve the patient's appearance and self-esteem, reconstructive surgery is performed on abnormal or damaged structures of the body. In many cases, the reason for the surgery is to repair the damage caused by the curative surgery, as well as to improve functions of certain anatomic parts of the body. In cancer treatment, if curative surgical procedures cause any disfigurement, dysfunction, or deformity, reconstructive surgery may be necessary. Breast reconstruction following surgical treatment for breast cancer is perhaps the most common example of reconstructive surgery.
For many simple or modified radical mastectomy patients, breast reconstruction may be possible during the same surgical procedure. In this type of reconstructive surgery, additional surgery is avoided and patients do not wake up to the "shock" of losing a breast. While a mastectomy is performed by the cancer surgeon, reconstructive surgery is usually performed by the plastic surgeon. Breast reconstruction may interfere with adjuvant treatment such as chemotherapy or radiation therapy. In these cases, reconstructive surgery may be delayed.
Sometimes, a one-stage reconstruction may not be enough; multiple stages may be necessary for optimal results when delayed tissue transfer is required. As with all other types of surgeries in cancer treatment, careful discussions between cancer patients and their doctors and plastic surgeons are encouraged so that the decisions regarding cancer surgery and reconstructive surgery can be made in the best interest of the patient.