Decades ago, almost every patient who was diagnosed with a cancerous mass was recommended for surgery. In recent years, however, doctors have been thinking more creatively– crafting individual courses of care for each patient. So in today’s new era of cancer treatment, who should still undergo surgery, and who should explore other options?
Determining whether or not someone is a candidate for upfront surgery is now decided on a case-by-case basis–it’s determined by the overall health of the patient and the extensiveness of the disease.
Read MoreAdvanced age could also deem some patients ineligible for surgery. Younger patients are more likely than older patients to be surgery-eligible. Older patients can sometimes have unique health complications. Elderly patients are at higher risk for the previously mentioned diseases (heart disease and diabetes) and they are susceptible to the natural decline of organ function that comes with advanced age. All of these factors could make it dangerous for elderly patients to undergo anesthesia, and could make them surgery-ineligible.
The nutritional status of a patient is also a key factor in the decision to operate. Poor nutritional status can lead to aforementioned heart disease and diabetes, and can contribute to complications during procedures. If the patient does not display proper nutrition, then surgery might not be right for them.
As said previously, years ago eligibility for surgery was granted to nearly every patient, but this has changed over time. In addition to determining risk factors in patients, doctors now test the extensiveness of the disease and decide whether or not they can safely remove an adequate amount of this disease during surgery. The key to this decision is the amount of residual disease that is in the body post-surgery. Residual disease is the diameter of the largest tumor mass remaining after surgery.
"Decades ago we would take everyone to surgery first and we would really accept if you left behind disease that was one centimeter or less, and over the past several years that criteria of one centimeter, we have learned that it's unacceptable," says Dr. Elizabeth Jewell, a gynecologic surgeon at Sloan-Kettering Cancer Center. Over the years the criteria has changed, and individuals are only eligible for surgery if safe surgery can leave five millimeters of cancer or less inside the body. The ideal situation is if the surgery can leave the patient with no gross residual disease, or no cancerous mass left in the body post surgery.
If a patient meets all of these criteria, then they will be deemed eligible for surgery. If a patient isn’t surgery-eligible, doctors will explore with her alternative treatment options including chemotherapy, cutting-edge medications, and participation in clinical trials. Doctors now feel that conducting surgery does not have upside to the patient if the procedure won’t safely remove enough of the tumor or if the patient is susceptible to harm while on the operating table.
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