Surgery is the main method of control of solid tumours…that is “lumps” rather than tumours that affect the whole body such as lymphoma.
It is used in a number of ways:
Biopsy. This is where we recover a small piece of tissue for analysis by a pathologist to identify the type of tumour that is present. Usually we need a biopsy before bigger surgery so that we can plan that surgery to achieve the maximum benefit. On some occasions it may be that the biopsy is done at the same time as the definitive surgery…where for example the biopsy would be as invasive as the definitive surgery, or where the biopsy would not change the treatment plan.
Curative-intent surgery. This is where perform an operation with the aim of removing the entire tumour in a single operation. Some cancers can be cured by surgery, indeed more tumours are cured by surgery than any other method of treatment, and we will always look for a surgical option if possible. Curative-intent surgery is only useful where the disease in one place.
Sometimes surgery is combined with other treatment to improve the prognosis for the disease. Occasionally we will use chemotherapy before the surgery to try to reduce the size of the tumour and make the surgery easier.
Cytoreductive surgery. This is surgery that removes all the visible tumour, accepting that there will some microscopic disease remaining. Doing this surgery will usually mean that some other form of treatment would be used to control the remaining tumour cells to improve the outlook for our patients.
This surgery is unlikely to result in a cure, but often will result in long term control.
Palliative surgery. This is surgery to remove a tumour that is causing pain or disease, accepting that the surgery is not curative. Because we know that we are not going to cure the disease we try to keep this surgery as simple as possible, so that recovery is a quick as possible.
No surgery can be considered without considering pain management. Animals that are not in pain make a faster recovery and can be discharged from the hospital more quickly following the operation, and some surgeries to remove painful tumours mean that our patients are more comfortable after the surgery than before.
For any surgery we always think carefully about providing adequate pain-relief and we routinely use multi drug analgesic “cocktails” that provide pain relief in a number of different ways. These combinations are started prior to any surgery and continued during the surgery and into the post-operative period.