Understanding Cancer Treatment Options: Surgery

Learn how your treatment plan is decided and terms you may see

We continue our series to help you understand cancer and its treatment. This week we focus on surgery, the oldest form of cancer treatment. Learn about surgery timing, types of cancer surgery, and how NCCN evidence-based guidelines provide a standard treatment path no matter where you are.

In this Episode:

• 02:58 - Wisconsin-Cheese, UFOs, and Booyah Stew
• 04:52 - Anna Quindlen: Get a Life Where You Are Generous"
• 08:06 - Medical Specialists Involved in Cancer Care
• 08:52 - Treatment Decisions, Tumor Board and NCCN Guidelines
• 12:03 - Adjuvant and Neoadjuvant Therapy
• 13:13 - Surgery Timing, Reasons and Types
• 18:00 - Discussion - NCCN and Role of Research
• 24:34 - Reeves Keyworth:“On Loved Ones Telling the Dying to ‘Let Go”
• 23:54 - Outro

Surgery, radiation therapy, and chemotherapy alone or in combination are the most-common methods used to treat cancer. Specific treatment varies depending on the kind of cancer, the extent of the disease, its rate of progression, and the condition of the person. Surgery alone may not result in a cure and often chemotherapy and/or radiation are needed after surgery. Learn all about surgery and the guidelines your doctor will be following for your treatment.

Chapters

• 0:00 Intro
• 4:52 Anna Quindlen: Get a Life Where You Are Generous”
• 8:06 Medical Specialists Involved in Cancer Care
• 8:52 Treatment Decisions, Tumor Board and NCCN Guidelines
• 12:03 Adjuvant and Neoadjuvant Therapy
• 13:13 Surgery Timing, Reasons and Types
• 18:00 Discussion – NCCN and Role of Research
• 21:34 Reeves Keyworth:“On Loved Ones Telling the Dying to ‘Let Go”
• 23:54 Outro

Transcript

Hello and welcome to Everyone Dies, the podcast where we talk about serious illness, dying, death and bereavement. I'm Marianne Matzo, I'm a nurse practitioner and I use my experience from working as a nurse for 47 years to help answer your questions about what happens at the end of life. And I'm Charlie Navarette, an actor in New York City and here to offer an every person viewpoint to our podcast.

We are both here because we believe that the more you know, the better prepared you are to make difficult end-of-life decisions. Also, this podcast does not provide medical nor legal advice. Please listen to the complete disclosure at the end of the recording.

Welcome to this week's show. We are so glad to have you join us. Thank you for spending the next hour with Charlie and me as we continue with our series titled, Everything You Always Wanted to Know About Cancer, but Didn't Have Anyone to Ask, with a conversation about how cancer is treated starting with surgery.

This podcast is a combination of education and entertainment, edutainment if you will, delivered in three halves. Our main topic is in the second half, so you can fast forward to that yak-free zone if you'd like. In the first half, Charlie has our recipe of the week and an excerpt from Anna Quinlan's A Short Guide to a Happy Life.

In the second half, I'm going to talk about the ways that cancer can be treated, focusing on surgery this week. In the third half, Charlie has a poem by Reeves Keyworth. So Charles.

Yes? I don't owe you money, do I? Oh, probably. Oh, dear. What's up? Uh, not much.

Not much. Since we don't talk politics, we have nothing to talk about. Yeah, that's true.

There's nothing else to discuss. Yeah. There was something.

What did I read? Some iceberg. Another one. This massive iceberg is stuck.

It hit like a small island off the very southern coast of Argentina. I mean, this thing is. Somebody crying for the iceberg in Argentina? I guess, you know, there's not enough either, you know, crying for icebergs in Argentina, or maybe they just need ice for their drink.

I don't know. This thing is approximately, if you could, folks, if you could imagine New York City, it's big. This thing is approximately three times the size of New York City.

And right now it's just stuck on this tiny little island. I don't know why that fascinates me, but there we are. I need to get out more.

Anything? For the first half, our travels this week take us to Wisconsin, the dairy capital of the United States. 90% of the milk produced there is made into cheese, which is 40% of the cheese eaten in the USA. If that weren't enough, Wisconsin is very attractive to UFOs, and there are eyewitnesses reports dating back nearly a century.

In 1961, Joe Simonton of Eagle River, Wisconsin, reported he saw a UFO, and then three small aliens exited from it. All they wanted was pancakes. Good to have a hobby.

According to Cult of Weird, they gave Simonton a large container, which he somehow interpreted needed to be filled with water. After he filled the container with water, the aliens proceeded to make pancakes with their concoction, which they left with Simonton before departing. While the story about not eating their own pancakes sounds unbelievable, it was credible enough to be investigated by the United States Air Force, there we go, our tax dollars at work, who concluded that the mysterious alien pancakes seemed to be buckwheat pancakes.

So, our recipe this week is, of course, Booyah Stew, which is believed to have its origins from the Walloon Belgians, who lived in northeastern Wisconsin during the mid-1800s. This stew has your beef, has your chicken, your vegetables, and mass quantities of V8 juice, and can be found wherever large groups of Wisconsinites are found. So you might have to look for them, but you can make it wherever you live for your next funeral lunch.

Bon Appetit! And now for something completely different. I have an excerpt from the book, A Short Guide to a Happy Life, by the best-selling novelist and columnist, Anna Quinlan. In it, she reflects on what it takes to get a life, to live deeply every day and from your own unique self, rather than to merely exist through your days.

Get a life in which you are generous. Look around at the azaleas making fuchsia starbursts in spring. Look at a full moon hanging silver in the black sky on a cold night, and realize that life is glorious and that you have no business taking it for granted.

Care so deeply about its goodness that you want to spread it around. Take the money you would have spent on beers in a bar and give it to charity. Work in a soup kitchen.

Tutor a seventh grader. All of us want to do well, but if we do not do good too, then doing well will never be enough. Live by the words of this poem by Gwendolyn Brooks.

Exhaust a little moment, soon it dies, and be it gash or gold, it will not come again in this identical disguise. Life is short, remember that too. I've always known this, or almost always.

I've been living with mortality for decades, since my mother died of ovarian cancer when she was 40 and I was 19. And this is what I learned from that experience, that knowledge of our own mortality is the greatest gift God ever gives us. It is so easy to waste our lives, our days, our hours, our minutes.

It is so easy to take for granted the pale new growth on an evergreen, the sheen of the limestone on Fifth Avenue, the color of our kids' eyes, the way the melody in a symphony rises and falls and disappears and rises again. It is so easy to exist instead of live, unless you know there is a clock ticking. So many of us changed our lives when we heard a biological clock and decided to have kids, but that sound is a murmur compared to the tolling of mortality.

Please go to our webpage for this week's recipe for Booyah Stew and additional resources for this program. Everyone Dies is offered at no cost, but is not free to produce. Can we count on you to contribute? Your tax-deductible gift will go directly to supporting our non-profit journalism so that we can remain accessible to everyone.

You can also donate at www.everyonedies.org. That's every, the number one, dies.org. Or at our site on Patreon and search for Everyone Dies. Marianne? Thank you, Charlie. During the last few weeks, we've explored how cancer grows, gets diagnosed, and is staged.

At this point, there's what's called a medical oncologist, who is a specialist in the type of cancer diagnosed, and they are the person who orders and monitors chemotherapy treatments. This is the person who will, once chemotherapy is completed, will do the cancer surveillance follow-up. If surgery is required, a surgical oncologist, the person who removes the cancerous tumors, will be involved, and or a radiation oncologist who specializes in radiation therapy.

The next step is to consider treatment options, but you're probably wondering, with all the types and stages of cancer, how does your oncologist decide what treatments should be considered? And you should ask your clinician how they came up with the recommendations that they are offering. Information about the person and the cancer, for example, from scans, blood works, biopsies, are presented to what is called a tumor board. The tumor board is made up of clinicians who treat the type of cancer discussed.

When I worked at the cancer center, I would go to the brain tumor board, and the gynecological tumor board, and any other tumor boards where the patients I was taking care of were being discussed. These tumor boards discuss individual cancer cases to determine treatment options and develop a plan of care. Now, I would want my oncology practitioner to follow NCCN guidelines for my treatment.

NCCN stands for the National Comprehensive Cancer Network, NCCN, and this is a non-profit alliance of 33 leading cancer centers devoted to patient care, research, and education. Anyone can have an account on the website, and there are really exceptional patient resources. When you log on, there's a tab at the top that'll say patient resources that gives easy to understand information about every type of cancer.

I put the link in the show notes so that you can go there if you want to. They also publish continually updated evidence-based clinical cancer guidelines by type and stage of cancer. Now, evidence-based means that the guidelines are built upon and updated according to the most recent research findings.

So, a note about clinical research. Each research study adds something to what we know about cancer and its treatment. It's like making booyah stew from this week's recipe.

Each research team, those with a large number of people in the study and the strictest of research protocols, adds something to the stew. Depending on what they add, the stew could be barely changed or significantly changed. The NCCN keeps track of all of these recipes, what they add, and whether it's a worthwhile addition so that the recipe is either changed or kept the same.

And with the published NCCN guidelines, the standard of care is established, and people can get the benefit of treatment based on the most current science. Surgery, radiation therapy, and chemotherapy alone or in combination are the most common methods used to treat cancer. Specific treatment varies depending on the kind of cancer, the extent of the disease, its rate of progression, and the condition of the patient and their response to therapy.

This week, we're going to talk about surgery. Cutting out the cancer is the oldest form of cancer treatment. Surgery alone may not result in a cure, and often chemotherapy and or radiation are needed after surgery.

So I have two new words for you today, adjuvant therapy and neoadjuvant therapy. Adjuvant means helper. So adjuvant therapy is a treatment that increases the effectiveness of a medical intervention.

In cancer, chemotherapy given after surgery is called adjuvant therapy. This sequent of surgery first and chemotherapy is a very common scenario. Neoadjuvant therapy is when chemotherapy or radiation is given first, and then surgery is performed.

So in this case, the therapy like radiation or chemotherapy is given to shrink the tumor because less extensive surgery is needed when you're taking out a smaller tumor. Therefore, the first decision is surgery first, and then other cancer treatments or other cancer treatments, and then surgery or surgery alone. Depending on the types of cancer and how advanced it is, surgery can be done for three reasons.

One, to remove the entire tumor, and this is done when the cancer is contained in one area. Second, debulk a tumor. Debulk, make it smaller.

So debulking a tumor is done to remove some but not all of the cancer tumor. Debulking is used when removing an entire tumor might damage an organ or the body. Removing part of a tumor can help other treatments work better.

And the third reason is to ease cancer symptoms. Surgery is used to remove tumors that are causing pain or pressure. Now surgery is either open or minimally invasive because minimally invasive surgery requires small cuts.

It takes less time to recover from that kind of surgery than from open surgery. In open surgery, the surgeon makes one large cut to remove the tumor, some healthy tissue, and perhaps some nearby lymph nodes. For minimally invasive surgery, the surgeon makes a few small cuts instead of one large one.

They insert a long thin tube with a tiny camera into one of the small cuts. This tube is called a laparoscope. The camera projects images from the inside of the body onto a monitor which allows the surgeon to see what they're doing.

They use special surgery tools that are inserted through the other small cuts to remove the tumor and some healthy tissue. Some surgery does not even use scalpels to remove the cancer. These are cryosurgery which is a type of treatment that uses extreme cold produced by liquid nitrogen or argon gas and it's used to destroy the abnormal tissue.

Cryosurgery may be used to treat early stage skin cancer, retinoblastoma, and pre-cancerous growths of the skin and cervix. Cryosurgery is also called cryotherapy. The second is laser surgery which uses powerful beams of light to cut through tissue.

Lasers can focus very accurately on tiny areas so they can be used for precise surgeries. Lasers can also be used to shrink or destroy tumors or growths that might turn into cancer. Lasers are most often used to treat tumors on the surface of the body or on the inside lining of internal organs.

Examples include basal cell carcinoma, cervical changes that might turn into cancer, and cervical vaginal esophageal and non-small cell lung cancer. The third type is hyperthermia which exposes tissues to high temperatures to damage and kill cancer cells and to make them less sensitive to radiation and certain chemotherapy drugs. Radiofrequency ablation is one type of hyperthermia that uses high energy radio waves to generate heat.

Hyperthermia is not widely available and is being studied in clinical trials. Lastly is photodynamic therapy which injects drugs that react to a certain type of light. When the tumor is exposed to this light, these drugs become active and kill nearby cancer cells.

Photodynamic therapy is used most often to treat or relieve symptoms caused by kids cancer and non-small cell lung cancer. I put links in the show notes if you want more detail about these different types of surgery. The blood test before and the follow-up afterwards are the same as what you would expect with any surgery.

Ask your surgeon for specific details and your oncologist for the big picture plan. Come back next week and we'll talk about using radiation as a way to treat cancer. Any questions Charles? Yeah, but before you said the different places around the country that have centers.

I think you said it was the NCCN and those are like you know different like cancer centers around America. The cancer centers around America contribute to the guidelines. The NCCN is a non-profit itself that looks at all of those research and maintains the guidelines.

So they're available to anybody with a computer. Okay. So most rural cancer treatment doctor could access those.

Yeah, so I understand what you were saying about it but you know with different budget cuts and everything. I mean those aren't going to be affected right? I mean there will still be around the country. They'll be affected but in a maybe in a different way than what you're thinking.

So the NCCN is its own non-profit organization that looks at all of the research and updates those guidelines and those guidelines are online. So anybody anywhere in the world can access those guidelines but they're updated based on the research. So if the research funding goes away then there's not going to be as many studies sort of feeding into the NCCN in order for any techniques or new information to update those.

Oh dear. So well okay then with well let me ask you can the guidelines be changed by political appointees? Only in the sense of what they would do to research funding because it's the cancer researchers are the ones who do the research and they need money to do the research and the money a lot comes from the National Institutes of Health NIH grants that provide the support for those for those research studies. So if you don't have the money to support those research labs I mean I've seen when I was at the university people's labs being closed down when they weren't being awarded research money and so you need money to do the research.

I mean you know scientists aren't going to go into the lab for free. Right. I mean we do we do a lot of extra work beyond what we're paid for in academia but that's stuff that people don't ever see and you know they just say oh you know your teachers you're off all summer and all those breaks and they don't realize that theoretically people are off then but very few people don't work or write.

Exactly over the summer. Get their research out all the time. Okay all right thanks.

Our third half features a poem by Reeves Keyworth titled On Loved Ones Telling the Dying to Let Go. Don't bother yourselves really we're not clinging as you put it with your gentle scorn for the inept clinging to life like a minnow too dumb to expire when a rain pool dries up and we're not sticking around because we fear to disappoint you we're scratching out a bit of life here here on our planet the bed yes it's dimmed stripped ugly and the pain is awful but we are sipping air we're blood and bone the pulse though thready still twitches you think our lack of vanity and ambition is a handicap to pleasure but we're mostly enthralled to an inward delirium of memory a forest stream flashing with sunlight mothers smoking and reading on the couch an iowa paper boy wading through snowdrifts in the winter dawn a vivid presence that mounted snow blue shadowed marred only by the boy's laboring passage and removed from the muffled room lights here going off and on the muffled anticipatory sadness meanwhile your whispered encouragement to get going stop hanging around inside the shell of a dead yesterday ascend to a higher plane etc it's scaring us you used to like us well enough and now you're unlatching the door to our soul and leaving it open like a cheerful volunteer summoning the rehabbed hawk to leave its cage next week you'll be having dinner and pulling closed the solid weft of curtains against the washed out twilight of your sorrow solid dinner solid you remember that the last sound we heard on earth was you we loved hissing in our ear it's time to go time to go and thus ends another episode of everyone dies thank you for listening and please stay tuned this is charlie navarette and from shakespeare's macbeth give sorrow words the grief that does not speak whispers the ore-fraught heart and bids it break and i'm arianne matzo and we'll see you next week remember every day is a gift this podcast does not provide medical advice all discussion on this podcast such as treatments dosages outcomes charts patient profiles advice messages and any other discussion are for informational purposes only and are not a substitute for professional medical advice or treatment always seek the advice of your primary care practitioner or other qualified health providers with any questions that you may have regarding your health never disregard professional medical advice or delay in seeking it because of something you have heard from this podcast if you think you may have a medical emergency call your doctor or 911 immediately everyone dies does not recommend or endorse any specific tests practitioners products procedures opinions or other information that may be mentioned in this podcast reliance on any information provided in this podcast by persons appearing on this podcast at the invitation of dies or by other members is solely at your own risk