12 Years after Inoperable Cancer
Inoperable Cancers
The role of preoperative therapy is to shrink locally advanced cancers in order to make them more easily removed at surgery. But not all such cancers are amenable to this approach. Some have grown to such a degree that their removal may not be feasible despite the many advances in surgical techniques; an example would be a large brain tumor.
Some cancers, therefore, are better off being treated only with chemotherapy and radiation. Surgery is best avoided in these situations because it would not lead to cure or the best outcome.Surgeons and other cancer experts have established specific criteria for each cancer to determine its operability.
These criteria focus on determining if cancer has spread to particular lymph node regions or if the cancer encroaches on nearby blood vessels or other organs. This determination often requires additional testing, such as MRI, PET scan, or endoscopy with ultrasound (for gastrointestinal cancers) and biopsies of suspect lymph nodes. Sometimes even a minioperation such as laparoscopy will be performed so that the surgeon can visually inspect the extent of disease before deciding to proceed with a large operation (this is most commonly performed for pancreatic cancer).
If the above tests show that the cancer is limited in its extent and can be surgically removed with a chance for cure, then the surgeon will recommend an operation. If the tests reveal that the cancer has spread too far to be removed for cure, then it is deemed inoperable or “unresectable.”
The terms “inoperable” and “unresectable” do not always mean that a surgeon could not remove a locally advanced cancer; certainly, in the days before modern chemotherapy and radiation, surgeons tried to curebulky cancers with heroic surgery (such as the disfiguring operation for breast cancer called the radical mastectomy, which removed chest wall muscles as well as the overlying breast). Rather, these terms mean that other approaches have been shown to be superior to surgery in terms of improving a patient’s quality of life and extending survival.
For example, if a pancreatic cancer is growing into nearby major blood vessels or if a lung cancer has spread to lymph nodes on both sides of the mediastinum (stage IIIB), then extensive surgery to clear out all the cancer will not be performed. Instead, in these and similar situations affecting the esophagus, cervix, throat, and others, chemoradiation will be recommended as the “definitive” treatment; the radiation will encompass the entire extent of the cancer while the chemotherapy helps the radiation beams kill cancer cells more effectively.
Still, there are nuances here as well, and surgery may ultimately be helpful in certain initially unresectable cancers. For example, pancreatic cancer that appears to be pressing against local blood vessels rather than extensively wrapping around them may become surgically removable after a course of chemoradiation. As always, the specific details of each case determine the range of treatment options.
New research protocols aim to integrate targeted therapies into traditional chemoradiation protocols in order to improve survivals across the spectrum of cancers too advanced to be surgically removed.
The Cancer has Metastasized
Metastases can be present when a cancer is diagnosed or manifest at some time after the cancer has been treated, constituting a cancer relapse.
Regardless of when they are detected, being informed that one’s cancer has metastasized is devastating news, rivaled only by cancer’s first declaration. BUT it is essential to take stock of the situation, understand the diagnosis, extent of metastases (many or a few), treatment options, and possible outcomes.
Some stage IV cancers are curable, although most have a low chance of complete eradication and cure. If cure is not a likely outcome, prolonged survival may be attainable through control of the cancer with treatments administered over months or years. If the patient chooses no treatment, most commonly because the outlook is poor and he or she does not feel that the possible benefits of therapy outweigh the risks, then good supportive care (as provided by hospice) should be sought out to maximize the patient’s comfort and quality of life.
Yet today many people are living full and active lives while under treatment for metastatic cancer. Treatments may be given intermittently whenever the cancer flares or on a continuous basis. Furthermore, new hope springs yearly as novel weapons to fight cancer are introduced. As always, remember that every patient and every cancer is unique.
To maximize survival in the case of a metastatic cancer, it is important to consider all the treatment options available and to exercise each option at the right time.
