In early May, the Denver resident underwent
emergency surgery to remove the tumor, which was
obstructing her bowel, and part of her colon. After the
operation, Martin met with an oncologist, who told her
she wasn’t a candidate for surgery to remove the liver
metastases. Instead, he recommended chemotherapy,
starting immediately, to try to shrink the liver tumors.
Before Martin agreed to the treatment plan, her
husband did some research on her condition. The
couple learned that only about 10 percent of patients
with stage IV colorectal cancer live five years or
longer. They concluded that additional surgery
to remove the liver metastases, combined with
chemotherapy, offered the best chance for Martin to
be declared NED, meaning no evidence of disease.
Martin decided to seek a second opinion about
whether more surgery was a good option.
“I wasn’t ready to settle my affairs,” she says.
Surgery, alone or with other treatments, has long
played a central role in treating cancer. For many
patients with localized solid tumors, such as early-
stage cervical, skin or lung cancer, surgery may
mean they can live the rest of their lives cancer-free.
But once cancer has spread to other parts of the
body, the decision to operate becomes more compli-
cated. Some oncologists take a dim view of surgery
at this point because they believe the risk and nega-
tive impact outweigh the survival benefit.
“The most important thing is recognizing when
we should and shouldn’t be operating on patients,”
says surgical oncologist Jeffrey Drebin, chair of the
department of surgery at Memorial Sloan Kettering
Cancer Center in New York City.
An Effective Cancer Therapy
More than 2,000 years ago, Hippocrates wrote that
surgical treatment of cancer usually leads to a speedier
death and that avoiding surgery was the best way to
prolong life for people with cancer. Today, experts agree
that surgery can mean long-term survival for many
patients, especially in the early stages of their disease.
“Surgery is the most effective cancer therapy in
history,” says Kelly McMasters, a surgical oncologist at
the University of Louisville in Kentucky and president
of the Society of Surgical Oncology. “The majority of
patients with solid tumors who are cured of their cancer
are cured because a surgeon cuts the cancer out.”
For early-stage cancer, surgery entails removing as
much of the tumor as possible and often all or part of
the organ where the tumor originated. The surgeon
may also remove surrounding healthy tissue and nearby
lymph nodes to check whether the cancer has spread
through the lymphatic system.
“The goal is to get every last bit of cancer while doing
as little harm to normal tissue as possible,” says Drebin.
Although traditional open surgery is still widely
used, less invasive techniques are also available for
some cancer patients. For example, laparoscopic
surgery, which uses narrow tube-like instruments,
tiny cameras and other tools inserted through small
incisions, may be an option to find out the stage
of cancer or sometimes to remove masses, such as
gynecologic and gastrointestinal tumors. Some hospitals and cancer centers offer surgery performed by
a minimally invasive, human-guided robot that can
remove tumors from a variety of sites, including the
pancreas, gallbladder, liver and ovaries. Cryosurgery,
which may be an option for patients with some
precancerous conditions and cancers of the eyes,
skin or prostate, destroys abnormal cells by freezing
them. Laser surgery uses focused beams of light that
burn off localized gynecologic and colorectal tumor
“The most important
thing is recognizing
when we should and
shouldn’t be operating