Chapter 11
Oncology: Nursing management in cancer care
237
depth to vaporise cancer cells. Stereotactic radiosurgery (SRS)
treats the tumour with a precise delivery of a single, high dose
of radiation in a 1-day session. Focused radiation beams are
delivered to a specific area used in some types of brain, head
and neck cancers. SRS is limited to the head and neck, because
these areas can be immobilised with skeletal fixation devices
that completely restrict the head’s movement, permitting the
most precise and accurate treatment. This type of radiation
has such a dramatic effect on the target area that the changes
are considered to be comparable to more traditional surgical
approaches (International Radiosurgery Association, 2010).
(Radiation therapy is discussed later in this chapter.)
A multidisciplinary approach to patient care is essential
during and after any type of surgery. The effects of surgery
on the patient’s body image, self-esteem and functional
abilities are addressed. If these effects are anticipated, a plan
for postoperative rehabilitation is made before the surgery is
performed.
The growth and dissemination of cancer cells may have
produced distant micrometastases by the time the patient
seeks treatment. Therefore, attempting to remove wide
margins of tissue in the hope of ‘getting all the cancer cells’
may not be feasible. This reality substantiates the need for
a coordinated multidisciplinary approach to cancer therapy.
Once the surgery has been completed, one or more addi-
tional (or adjuvant) modalities may be chosen to increase
the likelihood of destroying the cancer cells. However, some
cancers that are treated surgically in the very early stages are
considered to be curable (e.g. skin cancers, testicular cancers).
Prophylactic surgery
Prophylactic surgery involves removing non-vital tissues or
organs that are likely to develop cancer. The following factors
are considered when doctors, nurses, patients and families
discuss possible prophylactic surgery:
•
Family history and genetic predisposition
•
Presence or absence of symptoms
•
Potential risks and benefits
•
Ability to detect cancer at an early stage
•
Patient’s acceptance of the postoperative outcome
Colectomy, orchidectomy, mastectomy and oophorectomy
are examples of prophylactic surgical procedures. Recent
developments in the ability to identify genetic markers indic-
ative of a predisposition to develop some types of cancer may
play a role in decisions concerning prophylactic surgeries.
Some controversy, however, exists about adequate justification
some instances, the aspiration biopsy does not yield enough
tissue to permit accurate diagnosis. A needle core biopsy uses a
specially designed needle to obtain a small core of tissue. Most
often, this specimen is sufficient to permit accurate diagnosis.
Surgery as primary treatment
When surgery is the primary approach in treating cancer, the
goal is to remove the entire tumour or as much as is feasible
(a procedure sometimes called debulking) and any involved
surrounding tissue, including regional lymph nodes.
Two common surgical approaches used for treating primary
tumours are local and wide excisions. Local excision is war-
ranted when the mass is small. It includes removal of the mass
and a small margin of normal tissue that is easily accessible.
Wide or radical excisions (en bloc dissections) include removal
of the primary tumour, lymph nodes, adjacent involved struc-
tures and surrounding tissues that may be at high risk for
tumour spread (Szopa, 2005). This surgical method can result
in disfigurement and altered functioning. Wide excisions are
considered, however, if the tumour can be removed completely
and the chances of cure or control are good.
In some situations, video-assisted endoscopic surgery is
replacing surgeries associated with long incisions and extended
recovery periods (Swanson et al., 2007). The surgical instru-
ments are inserted into the surgical field through one or two
additional small incisions, each about 3 centimetres long.
The camera in the endoscope transmits the image of the
involved area to a monitor so the surgeon can manipulate the
instruments to perform the necessary procedure. This type of
procedure is now being used for many thoracic and abdominal
surgeries.
Salvage surgery is an additional treatment option that uses
an extensive surgical approach to treat the local recurrence
of the cancer after a less extensive primary approach is used.
A mastectomy to treat recurrent breast cancer after primary
breast conserving surgery and radiation is an example of
salvage surgery.
In addition to the use of surgical blades or scalpels to excise
the mass and surrounding tissues, several other types of surgical
interventions are available (Table 11-5). Electrosurgery makes
use of electrical current to destroy the tumour cells. Cryosurgery
uses liquid nitrogen to freeze tissue to cause cell destruction.
Chemosurgery uses combined topical chemotherapy and layer-
by-layer surgical removal of abnormal tissue. Laser surgery
(
l
ight
a
mplification by
s
timulated
e
mission of
r
adiation) makes
use of light and energy aimed at an exact tissue location and
Table 11-5 Selected Techniques Used to Remove or Destroy Tumours
Type of procedure Description
Examples of use
Electrosurgery
Use of an electric current to destroy tumour cells
Basal and squamous cell skin cancers
Cryosurgery
Use of liquid nitrogen or a very cold probe to freeze tissue
Cervical and prostate cancers
and cause cell destruction
Chemosurgery
Use of chemicals or chemotherapy applied directly to
Intraperitoneal chemotherapy for ovarian cancer
tissue to cause destruction
involving the abdomen and peritoneum
Laser surgery
Use of light and energy aimed at an exact tissue location
Dyspnoea associated with endobronchial obstructions
and depth to vaporise cancer cells (also referred to as
photocoagulation or photoablation)
Photodynamic therapy Intravenous administration of a light-sensitising agent
Palliative treatment of dysphagia associated with
(haematoporphyrin derivative [HPD]) that is
oesophageal and dyspnoea associated with
taken up by cancer cells, followed by exposure to laser
endobronchial obstructions
light within 24–48 hours; causes cancer cell death
Radiofrequency
Uses localised application of thermal energy that destroys
Non-resectable liver tumours, pain control with bone
ablation (RFA)
cancer cells through heat: temperatures exceed 50
8
C
metastasis
