Q. If I am referred to a surgical oncologist does that mean I have cancer?
A. No, many times surgical oncologists become involved with patient care because of the potential of a problem being cancer. Benign tumors are also best dealt with by surgical removal.

Q. What is cancer?
A. Cancer is normal body cells that have started to grow uncontrollably and usually form into a tumor.

Q. How can I have cancer if I feel fine?
A. Because the cells are normal body cells, it is hard for your body to tell that there is anything seriously wrong until the growth has been significant enough to be noticed as a lump or cause pain or blockage.

Q. How do you know if cancer has spread (metastasized)?
A. There are several tests that have been developed to identify spread of the tumor. These areas of spread are called metastases: 1) a CT scan is a special X-ray that cuts the body like a sausage and looks for tumors that may be spread, 2) MRI is a special scan similar to a CT, that gives different pictures of the area of concern and is able to show structures such as nerves a little better. It is not “better” than a CT scan just different, 3) PET scan is a test that lights up in areas of rapid growth. It cannot tell the difference between infection and healing or from cancer, but it is a good test. None of these tests are perfect.

Q. What kinds of tumors do surgical oncologists take care of?
A. Breast cancer, tumors of the gastrointestinal tract (esophagus, stomach, small intestine, and large intestine including the rectum), the hepatobiliary system (pancreas, gall bladder, liver and bile ducts), the skin and soft tissue (melanoma, sarcoma), and rare tumors such as neuroendocrine carcinomas, carcinomatosis (spread inside the abdomen), and pseudomyxoma (jelly belly).

Q. Why so many different areas and types?
A. These tumors have been found to require multi-disciplinary care. That is, they need to have other treatments involved including chemotherapy and radiation therapy. A surgical oncologist is involved in the decision that a tumor be removed first, or shrunk with chemotherapy and/or radiation therapy, then removed. Some patients with tumors in the abdomen that do not have a diagnosis are often seen by a surgical oncologist in order to decide the best way to find out what it is and how to treat it.

Q. It has been said that tumors spread once they are operated upon, is this true?
A. This is not true. The best evidence that this is not true is that the only patients cured with breast cancer, gastrointestinal cancer, melanoma, and sarcoma are those that the tumor has been surgically removed.

Q. What is minimally invasive surgery and how does it apply to surgical oncology?
A. Minimally invasive surgery is when a surgeon is performing an operation where there is only a small incision or there is a minimum amount of tissue damaged during the operation (usually the patient goes home the same day). Procedures such as laparoscopy (telescope in the belly button to look into the abdomen), and sentinel node biopsy (identify and remove the first draining lymph node or gland from a tumor) are examples.

Q. What is a sentinel node biopsy?
A. This is a surgical procedure that is done after technetium (a mildly radioactive substance) is injected into the skin around a tumor the morning of surgery. It involves removing the lymph node (gland) that lights up under the scanning screen. Removing this lymph gland is done in the operating room and allows the pathologist to look under the microscope and determine if there is any spread. Even if it is microscopic, this is a reliable test. Patients can go home the same day.

Q. When is sentinel node biopsy used?
A. Breast cancer is the most common use. This allows a minimally invasive procedure to be performed in order to identify spread of the cancer to lymph nodes. Melanoma is also managed based on results of sentinel node biopsy. Most centers perform this procedure on a regular basis.

Q. What is laparoscopy?
A. It is an operation in which a patient goes to sleep and a small incision is made in the belly button and a telescope is placed into the abdomen. The internal organs are examined and biopsies can be taken. If there is a question about the presence of spread of the tumor, then this technique is a good way to help determine this. Cancers of the gastrointestinal tract, hepatobiliary system, and sometime colon and rectum are treated using this technique.

Q. Once the tumor is removed how will you tell if the tumor is going to come back?
A. A combination of tests such as the CT scan, blood tests with tumor markers, physically examining the areas that were operated on can usually help. The only true test, however, is time.

Q. Could the cancer be back if the PET scan and CT scan are negative?
A. Yes, remember, all the tests to determine if a tumor has spread are good tests not perfect. The size of a metastasis may only be a few millimeters in size (less than an eighth of an inch) but be composed of millions of cells. The limits of detection of a CT scan or an MRI are 3-5 mm at best and a PET scan is slightly less than a centimeter (one quarter of an inch). That means there may be microscopic spread that is not detected by any test.