5 - Surgical principles

Summary

Introduction

Surgery has various applications in the management of cancer. These roles may change according to the site and extent of the tumour, the general health of the individual and the patient';s wishes. In general, the roles that can be performed by surgery include:

1. • diagnosis

2. • staging

3. • treatment

4. • reconstruction

5. • palliation.

Diagnosis

In general, the diagnosis of a cancer will be made by means of a biopsy taken either as an outpatient procedure or under general anaesthesia, such as hysteroscopy, cervical biopsy or vulval biopsy. This investigation may also incorporate part of the staging procedure. For ovarian cancer, the definitive diagnosis may be confirmed only at laparotomy or when the histology results from laparotomy are available. Sometimes the diagnosis is made by means of interventional radiology, such as core biopsy of a distant metastasis.

Staging

Staging is a process whereby the extent of the disease at presentation is defined using agreed international guidelines. Most gynaecologists use the FIGO staging system (Appendix 1) but the TNM system (tumour, nodes, metastases) is also used, particularly with vulval cancer (see Chapter 12). Staging may be clinical or surgical.