Surgical Onocology FAQs
Surgical Oncology is a sub-specialty of General Surgery, and is a specialty that focuses on the surgical treatment of cancer. As it is a sub-specialty of Surgery, which focuses on the diagnosis, surgical treatment and follow-up care of patients with cancer. Surgical Oncologists complete a 5-6 year General Surgery Residency, and then continue on to an Surgical Oncology Fellowship for 2-4 additional years of training at an Accredited Cancer Training Hospital.
Dr. Cuenca did a 6 year General Surgery residency at UNC- Chapel Hill, and an additional 4 years of Oncology Training at Roswell Park Cancer Institute in Buffalo, NY, where she did an NIH-T32 Research Fellowship doing Molecular Immunology Research for 2 years, then a 2 year Clinical Surgical Oncology Fellowship.
A patient may be referred to a Surgical Oncologist if there is concern for cancer or surgery is required to remove cancerous cells, tissues or tumors. An abnormal mammogram, an abnormal mole, a thyroid mass or abnormal calcium level are common reasons to see a Surgical Oncologist.
Recurrence of a cancer can also be assessed by a caner surgeon.
Strong Family History of cancer may be an indication that you should be checked by a Cancer specialist.
If cancer runs in your family, Genetic screening for Cancer Risk Assessment and Genetic Counseling can be addressed as a component of a Surgical Oncologist’s visit. Up to date recommendations for screening and assessment of High Risk will be discussed with you and your family.
Managing the whole plan of treatment, which may include a biopsy, surgery, or Genetic testing, and building an Oncology Team of Specialists: Medical or Radiation Oncologist, is an important role a Surgical Oncologist. This team approach is maintained for best outcomes.
Cancer is a mutation of cells that form in any area of the human body. While some cancerous cells manifest in the form of tumors, others appear as abnormalities in blood cell types. Cancer can form in any area of the internal or external body, including bone, blood, organs and tissue. If left untreated or not treated in time, certain cancers can spread, or metastasize, to other areas of the body.
The severity of cancer is described as Stage 0, Stage I, Stage II, Stage III, or Stage IV, but exact staging varies by type of cancer.
According to the National Cancer Institute, an estimated one in two women will be diagnosed with a form of cancer in her lifetime.
Chemotherapy is the use of oral or intravenous drugs to kill cancerous cells in the body. Commonly referred to as “chemo,” chemotherapy can be used at any time during the treatment course in an attempt to destroy cancer cells. It may also be used to shrink a tumor before surgery or destroy any cancerous cells remaining after surgery. A chemo cycle typically takes 3-4 weeks of regular treatments. Several of these cycles complete a course, which may last three months or longer. Palliative is defined as treating painful conditions. Palliative measures may be employed before, during, or after the treatment course to treat pain. For patients who choose to forgo any therapies because of poor prognosis or personal choice, palliative care and hospice can be employed. This type of care may be used to slow cancer growth, reduce symptoms and increase comfort.
Common side effects of chemotherapy treatment include hair loss, infections, fatigue, nausea and vomiting, diarrhea, pain and constipation. More serious side effects include permanent organ damage, loss of memory and ability to concentrate, nerve damage and changes to the nervous system.
Radiation therapy is the use of high-energy X-rays or other radioactive particles to kill cancer cells. Radiation may complement another treatment or be used on its own to treat various cancers. In certain patients, radiation therapy may be used as a palliative measure in an attempt to relieve symptoms and make the patient more comfortable. According to the American Society of Clinical Oncology, more than half of all people with cancer receive some type of radiation therapy.
The side effects of radiation treatment are well tolerated, can vary from no side effects, to damage to tissues surrounding the treated area, fatigue, skin reactions, upset stomach and loose stool. Radiation is added local therapy to tumor sites and can be done before, after, or instead of surgery.
Melanoma is a cancer that begins in the melanocytes- cells that provide pigment to our skin. Because most of these cells still make melanin -the pigment, melanoma tumors are often brown or black. But this is not always the case, and melanomas can also have no color. Melanoma most often starts on the trunk of fair-skinned men and on the lower legs of fair-skinned women, but it can start in other places, too. Having dark skin lowers the risk of melanoma, But it does develop in dark skinned people, as well. Melanoma can almost always be cured in its early stages. But it is likely to spread to other parts of the body if it is not caught early. Melanoma is much less common than basal cell and squamous cell skin cancers, but it is far more serious.
Skin cancer is the most common of all cancers. Melanoma accounts for less than 5% of skin cancer cases, but it causes most skin cancer deaths. The number of new cases of melanoma in the United States has increased drastically over the past 25 years. Overall, the lifetime risk of getting melanoma is about 1 in 50 for whites, 1 in 1,000 for blacks, 1 in 200 for Hispanics.
The following are risk factors associated with Melanoma:
UV (ultraviolet) light, Moles, Fair Skin, Family history of melanoma, Past history of melanoma, Weakened immune systems, Age, Gender, Xeroderma pigmentosum (XP).
Most skin cancer can be prevented especially by preventative measures such as:
Limit UV exposure- try to avoid the most sun intense times of the day to be outside (10 am-3 pm)
Protect your skin with clothing- especially sun protective UV blocking clothing , especially if your job is outdoors
Wear a hat
Use sunscreen/ block & wear sunglasses
Stay in the shade when you are outside
Protect children form too much sun
Avoid other sources of UV light: Tanning beds are extremely dangerous
Check for abnormal moles and have them removed
Genetic counseling and testing if you have a strong family history
The ABCDE rule can help you tell a normal mole from an abnormal mole. Moles that have any of these signs should be checked by your doctor. ABCDE stands for the following:
Asymmetry: One half of the mole does not match the other half.
Border irregularity: The edges of the mole are irregular or not smooth. They may look ragged, blurred, or notched.
Color: The color over the mole is not the same all over. There may be shades of tan, brown, or black, and sometimes patches of pink, red, blue, or white.
Diameter: The mole is larger than about ¼ inch– about the size of a pencil eraser– although sometimes melanomas can be smaller.
Evolution/Elevation: A mole that is changing or raising up, bleeding, itching
Staging is the process of finding out how widespread the cancer is. This includes finding out how big it is and whether it has spread to the lymph nodes or any other organs. The results of the biopsy of the mole will tell the Surgical Oncologist how deep the melanoma has grown into the layers of the skin, and a recommendation for Sentinel Lymph Node Biopsy may be given if the melanoma is deep, or has other suspicious features such as ulceration, or may mitoses (Cells in the process of dividing). The node biopsy is done at the time of wide excision of the melanoma, done in the operating room. The depth of the melanoma and the status of the node biopsy will determine the stage of the melanoma. Staging is very important because the treatment and the outlook (prognosis) for your recovery depend on the stage of the cancer.
Stages are labeled using Roman numerals I through IV (1-4). In general, the lower the number, the less the cancer has spread. A higher number, such as stage IV (4), means a more serious cancer.
There are really 2 types of staging for melanoma. The clinical stage is based on what is found in the physical exam, biopsy, x-rays, CT scans -if indicated. The pathological stage uses all of this information plus what is found during biopsies of lymph nodes or other organs. So the clinical stage (which is done first) may be lower than the pathologic stage, which is found after the biopsy.
After looking at your test results, the Surgeon will tell you the stage of your cancer. Be sure to ask your doctor to explain your stage in a way you understand. This will help you both decide on the best treatment for you.
The thickness of the melanoma as seen in the skin biopsy is called the “T category.” The thinner the melanoma, the better the outlook. For the most part, melanomas less than about 1/25 of an inch deep (about the size of a period or a comma) have a very small chance of spreading. Thicker melanomas have a greater chance of spreading. The thickness of the melanoma also guides the choice of treatment.
In one method of measuring the thickness of the melanoma, the pathologist measures under the microscope. This is called the Breslow measurement. Another system describes the thickness of a melanoma in relation to layers of the skin instead of actually measuring it. The Clark level of a melanoma uses a scale of I to V (1-5) to describe which layers of the skin are involved. Higher numbers mean a deeper melanoma.
Most often, the Breslow measurement of thickness is used in staging the cancer. Sometimes, though, the Clark level shows that a melanoma is more advanced than it appears from the Breslow measurement. Because of this, both systems may be used to describe a melanoma.
In either system, the melanoma is said to have a worse prognosis if it is ulcerated; this means that there is no covering layer of skin.
Clinical trials are carefully controlled research studies that are done with patients. These studies test whether a new treatment is safe and how well it works. Clinical trials may also test new ways to find or prevent a disease. These studies have led to many new ways to prevent, diagnose, and treat cancer. Clinical trials are done to get a closer look at new treatments or procedures. A clinical trial is only done when there is good reason to believe that the treatment, test, or procedure being studied may be better than the one used now. Treatments used in clinical trials are often found to have real benefits. If that happens, they may go on to become tomorrow’s standard treatment.
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