Principles of surgical therapy in oncology

Abstract

The role of surgery in the treatment of cancer has seen a dramatic change over the past century, from that of the only chance for cure to becoming one weapon in an armamentarium of oncologic therapies. As the role of surgery changes, so has the role of the surgeon, evolving from cancer surgeon to surgical oncologist. This role continues to evolve, as the management of cancer is altered by increased knowledge of genetics, molecular biology, and tumor immunology. Although surgery has historically been the first line of defense against a tumor, the escalating use of neoadjuvant therapies often shifts surgery to the second or third line. The role of surgery has expanded from that of purely therapeutic to include both palliation and prophylaxis. Inasmuch as surgeons are the ones with direct access to tumors, they have cemented their role as physician-scientists, investigating novel molecular and immunologic therapies. As new discoveries continue to transform our approach to cancer, the field of surgical oncology will continue to evolve (Table 4.1). © 2006 Springer Science+Business Media, Inc.