The act of cancer surgery starts from the belief that a cancerous process begins in a small area in an organ and then gradually becomes larger and spreads to the surrounding tissues and when the cancer cells shed by the main mass begin to migrate through the vessels draining that particular organ, the regional lymph nodes are the first sanctuaries to arrest and harbor them.
It also believes that most of the time there is a sufficient time lag between the clinical manifestation of a tumour and its spread beyond the regional nodes and if the disease bearing part with all round wide margins and regional nodes can be excised in that window of opportunity, there is a reasonable chance of curing the disease (fig 1). Slow growing cancers are thus more suitable for surgical treatment and that is why initial surgery for malignancy is more successful than operations for recurrence at a later stage.
Cancer surgery thus aims to remove the disease process along with its surrounding tissues and the known possible sites of regional spread i.e. the regional nodes before the disease has spread to the other parts of the body. An exercise that is indicated by adding the term ‘radical’ before the name of the operation. So removal of a diseased breast or stomach for cancer is not just mastectomy or gastrectomy, it is radical mastectomy or radical gastrectomy. See the nodal groups around the stomach (fig 2). In executing a radical gastrectomy, all these nodes are required to be removed.
But excision of a tumour is not the only goal of cancer surgery.