Most of surgical oncology intervention in relation to nutrition

1. SURGICAL INTERVENTION
FOR ONCOLOGY PATIENTS
Written by
Dr fatma.elshamy
MD,NCI,cairo university

2. Cancer surgery is an operation or procedure
to take out a tumor and possibly some
nearby tissue. It is the oldest kind of cancer
treatment, and it still works well to treat many
types of cancer today. A doctor who
specializes in cancer surgery is called a
"surgical oncologist.“
Staging. Staging surgery is done to learn
how large the tumor is.
tumor removal. Removing a tumor is a
common type of cancer surgery. This may
also be called a "resection" or "excision."
Tumor removal generally requires a larger
incision, or cut, than a biopsy. Sometimes,
there are less invasive surgical options for
tumor removal, like laparoscopic surgery or
robotic surgery. These use small instruments
and incisions. With a less invasive surgery,
you usually have less pain and recover
faster.

3. • debulking. Debulking is a surgery that removes part, but not all, of a tumor.
• Palliative surgery. The goal of palliative surgery is to relieve side effects caused by a tumor. It
can improve the quality of life.
• Reconstructive surgery. Treating cancer can change the way the patient look or how their
body works. Reconstructive surgery can help with the effects of cancer treatment. Sometimes,
reconstructive surgery is done at the same time the tumor is removed.
• Prevention. The patient might have surgery to lower the risk of getting cancer. For example, if a
small growth called a polyp is found during a colonoscopy,

4. ARE THERE DIFFERENCES IN
SURGICAL TECHNIQUES
Cancer surgery is often a major
surgery. That's why researchers
continue to work on ways to
reduce surgery's overall effects
on the body.
In an "open surgery," 1 large cut
(incision) is often needed.
Laparoscopic surgery. During
laparoscopic surgery, the doctor
makes several small cuts in the
skin. They insert a thin, lighted
tube with a camera through one
of the incisions. They place small
instruments through the other
cuts to do the operation.
Laser surgery. A narrow beam of
high-intensity light is used to
destroy tissue.
Cryosurgery. Liquid nitrogen is
used to freeze and kill abnormal
cells.
Mohs surgery. This type of
surgery is done to treat skin
cancer. It is also called
microscopically controlled
surgery.

5. PALLIATIVE SURGICAL
TREATMENT
palliative surgery
depends on local
anatomy and
preoperative
clinical
symptoms.
A bleeding tumor
is more to be
resected than an
obstructive one
for which a by-
pass might be
recommended.

6. gastroenterological surgery involves direct manipulation of the
gastrointestinal (GI) tract and/or hepatobiliary and pancreatic
organs,
patients may not be able to ingest adequate amounts of food
after surgery.
In some cases, restarting oral food intake is postponed until day
7. In the worst scenario, anastomotic leakage or a surgical site
infection develops, such that patients cannot ingest food for
several weeks

7. ESOPHAGEAL CANCER
Most people with esophageal cancers can achieve long-term
disease control with a combination of esophagectomy,
chemotherapy and radiation therapy.
Esophageal cancer surgery alone also often provides good
outcomes for people with early-stage esophageal cancers.
• The location of the tumor within your esophagus determines the type of
surgery you have. We offer three types of esophagectomies:
• Transhiatal esophagectomy
• Ivor Lewis esophagectomy
• Thoracoabdominal gastrectomy

8. What Is an Esophagectomy?
Esophagectomy is the most common form of surgery
for esophageal cancer. During the procedure,
surgeons:
1. Remove all or part of the esophagus and nearby
lymph nodes through incisions in the chest,
abdomen or both
2. Reconstruct the esophagus using the stomach or
colon
Esophagectomies are major operations — surgeons
must cross two to three body cavities (abdomen,
chest and neck) during the four- to six-hour
procedure. Patients then recover in the hospital for
about eight days.

10. TRANSHIATAL ESOPHAGECTOMY
Transhiatal esophagectomy is the most common type of esophageal cancer surgery performed. This approach
involves only a neck incision.
During a transhiatal esophagectomy, we:
1.Remove most of the esophagus and a little bit of the stomach
2.Bring the rest of the stomach up to the neck and attach it to the remaining esophagus
Ivor Lewis Esophagectomy
Ivor Lewis esophagectomies are the second most common type of esophagectomy we perform. This approach
involves incisions in the abdomen and chest. During this procedure, we:
1.Remove part of the esophagus
2.Make a tube (conduit) out of part of the stomach
3.Connect the stomach conduit to the esophagus in the chest

11. THORACOABDOMINAL GASTRECTOMY
The thoracoabdominal approach is the least common.
We use it when a tumor is in the lower esophagus or
gastroesophageal (GE) junction (where the esophagus
joins the stomach).
During this procedure, they :
1.Make an incision in the abdomen that goes to the left
side of the chest
2.Divide the esophagus in the left chest
3.Bring either the stomach or small intestine up to the
left chest to create a new connection

13. Three weeks after surgery:the patient undergo a swallow study. If the connection is
healed, the patient go through about a 10-day diet transition from clear liquids to full
liquids and then to soft foods.
About eight days:the patient go home with a temporary feeding tube. The feeding tube
generally stays in place for six to eight weeks.
48 hours or less: the patient get out of the hospital bed and walk.
Here are some milestones that happen after the procedure:

14. Patients have special
nutritional needs during
treatment for esophageal
cancer.
Many people with esophageal cancer
find it hard to eat because they have
trouble swallowing.
The esophagus may be narrowed by
the tumor or as a side effect of
treatment. Some patients may
receive nutrients directly into a vein.
Others may need a feeding tube (a
flexible plastic tube that is passed
through the nose or mouth into
the stomach) until they are able to eat
on their own.

15. Esophageal stent. A device (stent) is placed in the esophagus to keep it open to allow food and
liquids to pass through into the stomach.

16. Endoscopic
percutaneous
gastrostomy tube in
cancer oephagus and
head neck cancer
pallative

17. Cancer stomach
The extension of
gastric resection
depends on the
location of the tumor.
Cancer located to the
body or the corpus of
the stomach requires
total gastrectomy.
Reconstruction of
digestive continuity is
then realized by a
Roux-en-Y
oesojejunostomy.
Pouch and Roux-en-
Y reconstruction
seem to improve
postoperative quality
of life after total .
Cancer of the antrum
(distal third and
pylorus:, may be
managed by sub-total
distal gastrectomy..

19. Roux-en-Y gastrojejunostomy has been proposed to avoid bile-reflux in the gastric remnant, but
vagotomy is mandatory to prevent anastomotic peptic ulcer, depending on the size of the
gastric remnant.

20. pancreatic cancer
Palliative surgery may be done if tests show that the cancer is too widespread to be
removed completely. This surgery is done to relieve symptoms or to prevent certain
complications like a blocked bile duct or intestine, but the goal is not to cure the cancer.
Potentially curative surgery is used when the results of exams and tests suggest that it’s
possible to remove (resect) all the cancer.
two general types of surgery can be used for pancreatic cancer:

21. One of the following types of surgery may be used to take out the tumor:
 Whipple procedure: A surgical procedure in which the head of the pancreas,
the gallbladder, part of the stomach, part of the small intestine, and the bile duct are
removed. Enough of the pancreas is left to produce digestive juices and insulin.
 Total pancreatectomy: This operation removes the whole pancreas, part of the stomach,
part of the small intestine, the common bile duct, the gallbladder, the spleen, and
nearby lymph nodes.
 Distal pancreatectomy: Surgery to remove the body and the tail of the pancreas. The
spleen may also be removed if cancer has spread to the spleen.
PDQ® Adult Treatment Editorial Board. PDQ Pancreatic Cancer Treatment. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available
at: https://www.cancer.gov/types/pancreatic/patient/pancreatic-treatment-pdq. Accessed <MM/DD/YYYY>. [PMID: 26389396]

23. POTENTIALLY CURATIVE SURGERY
Whipple procedure (pancreaticoduodenectomy)
This is the most common operation to remove a cancer in the head of the pancreas.

24. special nutritional needs
Patients with pancreatic cancer have special nutritional needs.
• Surgery to remove the pancreas may affect its ability to make pancreatic enzymes that help
to digest food. As a result, patients may have problems digesting food and
absorbing nutrients into the body.
• To prevent malnutrition, the doctor may prescribe medicines that replace these enzymes.
• It’s possible to live without a pancreas But when the entire pancreas is removed, people
are left without the cells that make insulin and other hormones that help maintain safe blood
sugar levels.
• These people develop diabetes, which can be hard to manage because they are totally
dependent on insulin shots.
• People who have had this surgery also need to take pancreatic enzyme pills to help them
digest certain foods.

25. Palliative surgery
If the cancer has spread too far to be removed completely, any surgery being considered would be palliative
(intended to relieve symptoms). Because pancreatic cancer can spread quickly, most doctors don’t advise
major surgery for palliation, especially for people who are in poor health.
If the cancer has spread and cannot be removed, the following types of palliative surgery may be done to
relieve symptoms and improve quality of life:
 Biliary bypass: If cancer is blocking the bile duct and bile is building up in the gallbladder, a biliary bypass
may be done. During this operation, the doctor will cut the gallbladder or bile duct in the area before the
blockage and sew it to the small intestine to create a new pathway around the blocked area.

26.  Endoscopic stent placement: If the tumor is blocking the bile duct, surgery may be done to put in a stent
(a thin tube) to drain bile that has built up in the area. The doctor may place the stent through
a catheter that drains the bile into a bag on the outside of the body or the stent may go around the
blocked area and drain the bile into the small intestine.
 Often this is part of an endoscopic retrograde cholangiopancreatography (ERCP).
 Gastric bypass: If the tumor is blocking the flow of food from the stomach, the stomach may be sewn
directly to the small intestine so the patient can continue to eat normally.
The stent helps keep the bile duct open even if the surrounding cancer presses on it.
But after several months, the stent may become clogged and may need to be cleared or replaced.
Larger stents can also be used to keep parts of the small intestine open if they are in danger of being blocked
by the cancer.

27. Having a stent placed is often easier and the recovery is much shorter, which is why this is done more often
than bypass surgery. But surgery can have some advantages, such as:
 It can often give longer-lasting relief than a stent, which might need to be cleaned out or replaced.
 It might be an option if a stent can’t be placed for some reason.
 During surgery, the surgeon may be able to cut some of the nerves around the pancreas or inject them with
alcohol.

28. Still, even under the best circumstances, many patients have complications from
the surgery. These can include:
 Leaking from the various connections between organs that the surgeon has
to join
 Infections
 Bleeding
 Trouble with the stomach emptying after eating
 Trouble digesting some foods (which might require taking some pills to help
with digestion)
 Weight loss
 Changes in bowel habits
 Diabetes

29. LIVER
Types of liver cancer
Hepatocellular carcinoma and bile duct cancer (cholangiocarcinoma) are the main types of adult primary
liver cancer.

30. LIVER CANCER
When possible, the cancer is removed by surgery. The types of surgery that may be done are:
 Partial hepatectomy: The part of the liver where cancer is found is removed by surgery. The part removed
may be a wedge of tissue, an entire lobe, or a larger part of the liver, along with a small amount of normal
tissue around it.
 Total hepatectomy and liver transplant: The entire liver is removed by surgery, followed by a transplant of
a healthy liver from a donor. A liver transplant may be possible when cancer has not spread beyond the
liver and a donated liver can be found. If the patient has to wait for a donated liver, other treatment is
given as needed.
 Resection of metastases: Surgery is done to remove cancer that has spread outside of the liver, such as to
nearby tissues, the lungs, or the brain.

31. Treatment of localized liver cancer
Treatment of localized liver cancer may include the following:
 surveillance for lesions smaller than 1 centimeter
 ablation of the tumor using one of the following methods:
o radiofrequency ablation
o microwave therapy
o percutaneous ethanol injection
o cryoablation

32. Ablation therapy
Ablation therapy removes or destroys tissue. Different types of ablation therapy are used for liver cancer:
 Radiofrequency ablation: Special needles are inserted directly through the skin or through an incision in
the abdomen to reach the tumor. High-energy radio waves heat the needles and tumor which kills cancer
cells.
 Microwave therapy: The tumor is exposed to high temperatures created by microwaves. This can damage
and kill cancer cells or make them more sensitive to the effects of radiation and certain anticancer drugs.

33.  Percutaneous ethanol injection: A small needle is used to inject ethanol (pure alcohol)
directly into a tumor to kill cancer cells. Several treatments may be needed. Usually
local anesthesia is used, but if the patient has many tumors in the liver, general anesthesia
may be used.
 Cryoablation: An instrument is used to freeze and destroy cancer cells. This type of
treatment is also called cryotherapy and cryosurgery. The doctor may use ultrasound to
guide the instrument. To learn more, see Cryosurgery to Treat Cancer.
 Electroporation therapy: Electrical pulses are sent through an electrode placed in a tumor
to kill cancer cells. Electroporation therapy is being studied in clinical trials.

34. Embolization therapy
Embolization therapy is used for patients who cannot have surgery to remove the tumor or
ablation therapy and whose tumor has not spread outside the liver.
Embolization therapy is the use of substances to block or decrease the flow of blood through
the hepatic artery to the tumor. When the tumor does not get the oxygen and nutrients it
needs, it will not continue to grow.

35. BILE DUCT CANCER
(CHOLANGIOCARCINOMA)?
Bile duct cancer is a rare disease in which malignant (cancer) cells form in the bile ducts. Bile
duct cancer is also called cholangiocarcinoma.
The following types of surgery are used to treat bile duct cancer:
 Removal of the bile duct: This surgical procedure is done to remove part of the bile duct if
the tumor is small and is in the bile duct only. Lymph nodes are removed and tissue from
the lymph nodes is viewed under a microscope to see if there is cancer.
 Partial hepatectomy: This is a surgical procedure to remove the part of the liver where
cancer is found. The part removed may be a wedge of tissue, an entire lobe, or a larger part
of the liver, along with some normal tissue around it.
 Whipple procedure: During this surgical procedure the head of the pancreas,
the gallbladder, part of the stomach, part of the small intestine, and the bile duct are
removed. Enough of the pancreas is left to make digestive juices and insulin.

37. PALLIATIVE SURGERY
The following types of may be done to relieve symptoms caused by a blocked bile duct and
improve quality of life:
 Biliary bypass: If cancer is blocking the bile duct and bile is building up in the gallbladder, a
biliary bypass may be done. During this operation, the doctor will cut the gallbladder or
bile duct in the area before the blockage and sew it to the part of the bile duct that is past
the blockage or to the small intestine. This type of surgery creates a new pathway around
the blocked area.
 Endoscopic stent placement: If the tumor is blocking the bile duct, surgery may be done to
put in a stent (a thin, flexible tube) to drain bile that has built up in the area. The doctor
may place the stent through a catheter that drains the bile into a bag on the outside of the
body or the stent may go around the blocked area and drain the bile into the small
intestine.

38. colorectal cancer
Surgery is the most common treatment
for colorectal cancer and may range
from minimally invasive, such as
removing a polyp during
a colonoscopy, to, in rare cases,
removing the entire colon. Many
surgeries for colorectal cancer involve
removing tumors, the section of the
colon in which the tumor was found,
surrounding normal tissue and nearby
lymph nodes.
Patients may
receive chemotherapy and/or radiation
therapy before and/or after surgery for
colorectal cancer. These adjuvant
therapies may help shrink tumors
before they are surgically removed and
are intended to target cancer cells that
may remain after surgery.

39. Local excision, polypectomy and endoscopic mucosal
resection: If colorectal cancer is found early—at stage 0 or 1—
the care team may be able to remove the cancer through
procedures used during a colonoscopy.
Polypectomy: If the excision involves the removal of a polyp,
the procedure is called a polypectomy.
Local excision: If the excision involves removing cancerous
cells and some surrounding tissue through a colonoscope, it’s
called a local excision. This surgery is a bit more complex
than a polypectomy, and it may require more time to recover.
Endoscopic mucosal resection: The removal of a stage 1 or
stage 2 colorectal cancer with a colonoscope is called
endoscopic mucosal resection (EMR).

40. Colectomy
A colectomy is surgery to remove all or part of
the colon. Nearby lymph nodes3 are also
removed.
If only part of the colon is removed, it's called a
hemicolectomy, partial
colectomy, or segmental resection. The
remaining sections of colon are then
reattached.

41. If all of the colon is removed, it's called a total colectomy. Total colectomy isn’t often
needed to remove colon cancer. It's mostly used only if there's another
problem in the part of the colon without cancer, such as hundreds of polyps (in someone
with familial adenomatous polyposis4) or, sometimes, inflammatory bowel disease.

42. CANCER RECTUM
Proctectomy: A proctectomy is performed to remove all or part of the rectum.
A low-anterior resection (LAR) involves the surgical removal of cancer located in the upper part of the
rectum, which is closest to the S-shaped sigmoid colon. Some adjacent healthy rectal tissue may also be
removed, along with nearby lymph nodes and fatty tissue.
Abdominoperineal resection is used to treat cancer in the lower rectum. Because this procedure requires
surgical removal of the cancerous portion of the lower rectum nearest the anus, some or all of the anal
sphincter is also removed.
 The sphincter is a muscle that keeps the anus closed and prevents stool leakage. Because the sphincter is
responsible for bowel control, the surgical oncologist also performs a colostomy to enable the body to
excrete waste.
 Pelvic exenteration is a complex operation to remove the rectum and other organs that the cancer has
spread to, such as the bladder. Recovering from this surgery can take months and depends on which
organs are removed.the patient typically need a colostomy after this surgery.

43. If the colon is blocked
When cancer blocks the colon, it usually happens slowly and the person can become
very sick over time. In cases like these, a stent may be placed before surgery is done through the
small opening using a colonoscope. This tube keeps the colon open and
relieves the blockage to help you prepare for surgery.

44. • If a stent can’t be placed in a blocked colon or if the tumor has caused a hole in the
• 6colon, surgery may be needed right away.
• This usually is the same type of colectomy that’s done to remove the cancer, but instead of
reconnecting the ends of the colon, the top end of the colon is attached to an opening (called
a stoma) made in the skin of the abdomen.
• Stool then comes out of this opening. This is called a colostomyand is usually only needed
for a short time. Sometimes the end of the small intestine (the ileum) instead of the colon is
connected to a stoma in the skin.
• This is called an ileostomy.
• Either way, a bag sticks to the skin around the stoma to hold the stool.

45. Colostomy: A colostomy may be necessary, depending on the type and extent of the colorectal
surgery performed. During this procedure, the colon is connected to a hole in the abdomen
(called a stoma) to divert stool away from a damaged or surgically repaired part of the
colon or rectum. Some colostomies may be reversed once the repaired tissue heals. Other
colostomies are permanent, and the stoma is attached to a colostomy bag that collects
waste.

46. • Once the patient is healthier, another operation (known as a colostomy reversal or ileostomy reversal)
can be done to put the ends of the colon back together or to attach the ileum to the colon. I t might
take anywhere from 2 to 6 months after the ostomy was first made for this reversal surgery to be done
due to healing times or even the need to treat with chemotherapy.
• Sometimes, if a tumor can’t be removed or a stent placed, the colostomy or ileostomy may need to
be permanent.
• Sometimes after colon surgery, the bowel takes longer than normal to “wake up” and start working
again after the surgery. This is called an ileus.
• It might be caused by the anesthesia or the actual handling of the bowel during the operation.
Sometimes, too much pain medicine after the surgery can slow down the bowel function.

47. HIPEC: Hyperthermic intraperitoneal chemotherapy (HIPEC) is a highly concentrated, heated
chemotherapy treatment that is delivered directly to the abdomen during surgery.
Unlike systemic chemotherapy delivery, which circulates throughout the body, HIPEC may
deliver chemotherapy directly to cancer cells in the abdomen. This allows for higher doses
of chemotherapy treatment.
HIPEC may be particularly helpful for colorectal cancer patients with abdominal tumors that
have spread to the inside of the abdomen but have not spread to organs such as the liver
or lungs, or to lymph nodes outside the abdominal cavity

48. Learn more about what to eat after colorectal surgery
Following surgery, it’s important to consume the right nutrients and give the body time to recover. The care
team typically provides clear liquids when the patient ready after surgery. The patient may be eating and
drinking normally within a couple weeks.
In the weeks following surgery, eat several small meals a day, avoiding high-fiber foods and hard-to-digest
foods such as:
 Nuts
 Seeds
 Corn
In general, aim to stay hydrated by drinking enough water each day. Ifthe patient have other health issues,
be sure to ask the doctor how much liquid the patient should be aiming for—some people with kidney
or heart issues may need to limit their fluids.

49. HEAD AND NECK CANCER
TREATMENT
 Hypopharyngeal Cancer
 Laryngeal Cancer
 Lip and Oral Cavity Cancer
 Metastatic Squamous Neck Cancer with Occult Primary
 Nasopharyngeal Cancer
 Oropharyngeal Cancer
 Paranasal Sinus and Nasal Cavity Cancer
 Salivary Gland Cancer

50. NUTRITIONAL ASPECT
What are the side effects of head and neck cancer treatment?
• Surgery for head and neck cancers may affect the patient’s ability to chew, swallow, or talk.
• The patient may look different after surgery, and the face and neck may be swollen.
• The swelling usually improves with time.
• However, if lymph nodes are removed,
• the flow of lymph in the area where they were removed may be slower and lymph could collect in the
tissues (a condition called lymphedema), causing additional swelling that may last for a long time.
• Patients with untreated lymphedema may be more at risk of complications such as cellulitis, or an
infection of the tissues. Untreated cellulitis, if severe, can be dangerous and could lead to further swallowing
or breathing difficulties.

51. CANCER LARYNX
Surgery (removing the cancer in an operation) is a common treatment for all stages of
laryngeal cancer. The following surgical procedures may be used:
 Cordectomy: Surgery to remove the vocal cords only.
 Supraglottic laryngectomy: Surgery to remove the supraglottis only.
 Hemilaryngectomy: Surgery to remove half of the larynx (voice box). A hemilaryngectomy
saves the voice.

52. After a laryngectomy (surgery to remove the voice box) or other
surgery in the neck, parts of the neck and throat may feel numb
because nerves have been cut. If lymph nodes in the neck were
removed, the shoulder and neck may become weak and stiff.

53.  Partial laryngectomy: Surgery to remove part of the larynx (voice
box). A partial laryngectomy helps keep the patient's ability to talk.
 Total laryngectomy: Surgery to remove the whole larynx. During
this operation, a hole is made in the front of the neck to allow the
patient to breathe. This is called a tracheostomy.
 Thyroidectomy: The removal of all or part of the thyroid gland.
 Laser surgery: A surgical procedure that uses a laser beam (a
narrow beam of intense light) as a knife to make bloodless cuts
in tissue or to remove a surface lesion such as a tumor in the
larynx.

54. LIP CANCER
Surgery (removing the cancer in an operation) is a common treatment for all stages of lip and
oral cavity cancer. Surgery may include the following:
 Wide local excision: Removal of the cancer and some of the healthy tissue around it. If
cancer has spread into bone, surgery may include removal of the involved bone tissue.
 Neck dissection: Removal of lymph nodes and other tissues in the neck. This is done when
cancer may have spread from the lip and oral cavity.
 Plastic surgery: An operation that restores or improves the appearance of parts of the
body. Dental implants, a skin graft, or other plastic surgery may be needed to repair parts
of the mouth, throat, or neck after removal of large tumors.

55. BLADDER CANCER TREATMENT
Surgery is the main treatment for bladder cancer.
The type of surgery depends on where the cancer is located.
Treatment given before surgery is called preoperative therapy or neoadjuvant therapy.
 Chemotherapy may be given before surgery to shrink the tumor and reduce the amount of
tissue that needs to be removed during surgery.
 Treatment given after surgery, to lower the risk that the cancer will come back, is called
adjuvant therapy.

56. BLADDER CANCER
a radical cystectomy?
A radical cystectomy is surgery to remove the bladder to prevent further cancer spread. It may
also involve removing lymph nodes and some, or all, of the urethra.
. The procedure can be performed on both men and women. In men, organs near the bladder
that are often removed include the prostate and the seminal vesicles.
In women, a radical cystectomy may also include the removal of the uterus, ovaries, and
fallopian tubes. In some cases, parts of the vagina may also be removed.

57. POST TURBT SURGERY,

58. Transurethral resection (TUR) with fulguration
During TUR with fulguration, the doctor inserts a cystoscope (a thin lighted tube) into
the bladder through the urethra. A tool with a small wire loop on the end is then used to
remove the cancer or to burn the tumor away with high-energy electricity. This is known as
fulguration.
Partial cystectomy
Partial cystectomy is surgery to remove part of the bladder. This may be done for patients who
have a low-grade tumor that has invaded the wall of the bladder but is limited to one area of
the bladder. Because only a part of the bladder is removed, patients are able to urinate
normally after recovering from this surgery. This is also called segmental cystectomy.

59. urinary diversion
A radical cystectomy also involves creating a urinary diversion since the bladder is removed
during the procedure.
This urinary diversion involves using parts of the intestines to allow urine to pass from the
kidneys to either an ileal conduit, urinary reservoir pouch called an Indiana Pouch, or a
neobladder.
Alternatives to a Radical Cystectomy
There are various alternatives to a radical cystectomy. These include:
 A partial cystectomy, where only part of the bladder is removed
 Radiotherapy
 Chemotherapy
 A combination of radiotherapy and chemotherapy
 Bladder preservation

61. ILEAL CONDUIT
• An ileal conduit is the easiest and most common
reconstruction performed by the urologist.
• A small portion of the ileum or small intestine is
disconnected.
• One side of the piece of ileum is attached to a skin
opening on the right side of the abdomen and a
small stoma or mouth is created.
• A plastic appliance or ostomy bag is placed over
the stoma to collect the urine.
• The ureters are sewn or re-implanted near the other
end of the ileum. Because the nerves and the blood
supply are preserved, the conduit is able to propel
the urine into the appliance.

62. continent cutaneous pouch
An internal storage “container” for urine.
Using a combination of small and large intestine,
the urologist reconstructs the tubular shape of the
intestine and creates a sphere or pouch.
This pouch is connected to the skin on the abdomen by
a small stoma creating a type of continent urinary
reservoir; no external bag is necessary.
The patient drains the pouch periodically by inserting
a catheter (a thin tube) through the small stoma and
then removing the catheter and, in some cases,
covering the stoma with a bandage.

63. A neobladder is type of internal reservoir for
storing urine.
Using a portion of small intestine,
the urologist reconstructs the tubular shape of the
intestine and creates a sphere. The surgeon then
connects the pouch to the urethra, creating
a neobladder, in which case the patient can void
(pass urine out of the body) normally.
By tensing the abdominal muscles and relaxing
certain pelvic muscles, the patient is able to push
the urine through the urethra.
neobladder

64. CANCER UTERUS
Surgery (removing the cancer in an operation) is the most
common treatment for endometrial cancer. The following
surgical procedures may be used:
Total hysterectomy: Surgery to remove the uterus, including
the cervix. If the uterus and cervix are taken out through
the vagina, the operation is called
a vaginal hysterectomy. If the uterus and cervix are taken
out through a large incision (cut) in the abdomen, the
operation is called a total abdominal hysterectomy. If the
uterus and cervix are taken out through a small incision
(cut) in the abdomen using a laparoscope, the operation
is called a total laparoscopic hysterectomy.ENLARGE

65. Pelvic exenteration
Pelvic exenteration is performed as a palliative
or curative option for patients with recurrent or
locally invasive pelvic cancer.
Most cases are performed via laparotomy.
However, laparoscopic and robotic approaches
are becoming more common. The main
indication is for en bloc removal of recurrent or
locally invasive pelvic cancer.

66. Pelvic exenteration (PE) refers to an extended en bloc multi-visceral resection of pelvic structures.
A complete PE involves resection of the distal sigmoid colon, rectum, and anus along with the bladder,
seminal vesicles, prostate, and urethra in males or the uterus, ovaries, vagina, bladder, and urethra in
females.
In females, partial pelvic exenterations can be performed as indicated: anterior- resection of the gynecologic
and urologic structures with preservation of the rectum and anus;
or posterior- resection of the gastrointestinal and gynecologic structures with preservation of the bladder and
urethra.

67. RENAL CANCER
Treatment of stage I renal cell cancer may include the following:
 Surgery (radical nephrectomy, simple nephrectomy, or partial nephrectomy).
 Radiation therapy as palliative therapy to relieve symptoms in patients who cannot have
surgery.
 Arterial embolization as palliative therapy.
 U.S. Department of Health and Human ServicesNational Institutes of HealthNational Cancer Institute1-800-4-CANCERUpdated: May 5, 2023

68. CHILDHOOD KIDNEY TUMORS.
Two types of surgery are used to treat kidney tumors:
 Nephrectomy: Wilms tumor and other childhood kidney tumors are usually treated with
nephrectomy (surgery to remove the whole kidney). Nearby lymph nodes may also be
removed and checked for signs of cancer. Sometimes a kidney transplant (surgery to
remove the kidney and replace it with a kidney from a donor) is done when the cancer is in
both kidneys and the kidneys are not working well.
 Partial nephrectomy: If cancer is found in both kidneys or is likely to spread to both
kidneys, surgery may include a partial nephrectomy (removal of the cancer in the kidney
and a small amount of normal tissue around it). Partial nephrectomy is done to keep as
much of the kidney working as possible. A partial nephrectomy is also called renal-sparing
surgery.

69. Cancert prostate
Surgery
Patients in good health whose tumor is in the prostate gland only may
be treated with surgery to remove the tumor. The following types
of surgery are used:
 Radical prostatectomy: A surgical procedure to remove the
prostate, surrounding tissue, and seminal vesicles. Removal of
nearby lymph nodes may be done at the same time. The main
types of radical prostatectomy include:

70. o Open radical prostatectomy.
o Radical laparoscopic prostatectomy.
o Robot-assisted laparoscopic radical
prostatectomy.
o Transurethral resection of the prostate (TURP

71. lung cancer:
Four types of surgery are used to treat lung cancer:
Wedge resection: Surgery to remove a tumor and some of the normal tissue around it. When a
slightly larger amount of tissue is taken, it is called a segmental resection.ENLARGE
https://www.cancer.gov/types/lung/patient/small-cell-lung-treatment-pdq. Accessed <MM/DD/YYYY>. [PMID: 26389478]

72. PNEUMONECTOMY. THE WHOLE LUNG IS
REMOVED.
 Sleeve resection: Surgery to remove part of the bronchus.
Treatment of occult non-small cell lung cancer depends on
the stage of the disease. Occult tumors are often found at an
early stage (the tumor is in the lung only) and sometimes can
be cured by surgery.
 Surgery (wedge resection, segmental resection, sleeve
resection, or lobectomy).
 Cancer Instituteat the National Institutes of HealthUpdated: February 16, 2023
 National

73. PAPILLARY AND FOLLICULAR THYROID
CANCER

74. THYROID CANCER.
Surgery is the most common treatment for One of the following procedures may be used:
 Lobectomy: Removal of the lobe in which thyroid cancer is found. Lymph nodes near the cancer may
also be removed and checked under a microscope for signs of cancer.
 Near-total thyroidectomy: Removal of all but a very small part of the thyroid. Lymph nodes near the
cancer may also be removed and checked under a microscope for signs of cancer.
 Total thyroidectomy: Removal of the whole thyroid. Lymph nodes near the cancer may also be removed
and checked under a microscope for signs of cancer.
 Tracheostomy: Surgery to create an opening (stoma) into the windpipe to help you breathe. The
opening itself may also be called a tracheostomy.

75. GENERAL INFORMATION ABOUT CHILDHOOD
BRAIN AND SPINAL CORD TUMORS
Most childhood brain tumors are diagnosed and removed in surgery.
ere isn't a specific diet that the patient should follow during or after treatment for a brain
tumour. However, the brain tumour, its treatment and other medication can all cause
symptoms that make eating and drinking challenging.

76. BREAST CANCER.
Types of surgery include the following:
Breast-conserving surgery is an operation to remove the cancer and some normal tissue
around it, but not the breast itself. Part of the chest wall lining may also be removed if the
cancer is near it. This type of surgery may also be called lumpectomy, partial mastectomy,
segmental mastectomy, quadrantectomy, or breast-sparing surgery.ENLARGE
Total mastectomy is surgery to remove the whole breast that has cancer. This procedure is also
called a simple mastectomy. Some of the lymph nodes under the arm may be removed and
checked for cancer. This may be done at the same time as the breast surgery or after. This is
done through a separate incision.ENLARGE

77. Surgery
 Total mastectomy for women with open or painful breast lesions. Radiation therapy may be
given after surgery.
 Surgery to remove cancer that has spread to the brain or spine. Radiation therapy may be
given after surgery.
 Surgery to remove cancer that has spread to the lung.
 Surgery to repair or help support weak or broken bones. Radiation therapy may be given
after surgery.

78. Dorshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 6th ed.
Philadelphia, Pa. Elsevier: 2020.
Libutti SK, Saltz LB, Willett CG, and Levine RA. Ch 62 - Cancer of the Colon. In: DeVita
VT, Hellman S, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer:
Principles and Practice of Oncology. 11th ed. Philadelphia, Pa: Lippincott-Williams &
Wilkins; 2019.
National Cancer Institute. (2020). Colon Cancer Treatment (PDQ®)–Patient Version.
[online] Available at: https://www.cancer.gov/types/colorectal/patient/colon-
treatmentpdq#_
93 [Accessed 12 Feb. 2020].
National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines
in Oncology: Colon Cancer. V.1.2020. Accessed at
https://www.nccn.org/professionals/physician_gls/pdf/colon.pdf on Jan 23, 2020.

79. Thank you