Curative cancer surgery demands special considerations. There is a danger of spreading or seeding the cancer during the process of removing it. Presuming the cancer cells can grow almost anywhere in the body they end up, the surgeon must not "spill" cells into the operating field or "knock them loose" into the blood stream. Special techniques called "block resection" and "no touch" are used. Block resection means taking the entire specimen out as a single piece. "No touch" means that only the normal tissue removed with specimen is handled; the cancer itself is never touched. This prevents "squeezing" cancer cells out into the circulation. Further, in this technique pains are taken to clamp off the blood supply first, preventing cells from leaving by that route later in the surgery.
There are four types of biopsy techniques:
Aspiration biopsy. A needle is inserted into the tumor and a sample is withdrawn.
Needle biopsy. A special cutting needle is inserted into the core of the tumor and a core sample is cut out.
Incisional biopsy. A portion of a large tumor is removed, usually before complete tumor removal.
Excisional biopsy. A whole lesion is removed along with surrounding normal tissue.
Complete tumor removal
Once surgical removal has been decided, an oncologic surgeon will remove the tumor whole, taking with it a large section of the surrounding normal tissue. The healthy tissue is removed to minimize the risk of possible seeding.
When surgical removal of a tumor is unacceptable as a sole treatment, a portion of the tumor is removed to "debulk" the mass. Debulking aids radiation and chemotherapy treatments.
Retesting and periodical examinations are necessary to ensure that a tumor has not reformed after total removal.
J. Ricker Polsdorfer MD, The Gale Group Inc., Gale, Detroit,