Treatment Options in Cancer Surgery
review by Irene Alleger
"Making The Right Choice" by Richard A.
Avery Publishing Group, Garden City Park, New York
1995, softcover, $14.95, 344 pp.
Although alternative cancer treatments are being
studied and are often effective, when it comes to malignant tumors,
it is thought to be imperative to remove the tumor surgically before
it begins to metastasize. In the past, surgeons have operated on the
premise that removing every last tumor cell, usually involving the lymph
nodes and healthy tissue, referred to as radical surgery, was the most
effective way to prevent recurrence. Cancer surgeon Richard Evans, MD
began to question this rationale early in his career and published,
in 1980, an article questioning the necessity of trying to remove all
cancer cells by radical removal of breasts, organs, and extremities.
In the late 1970's, a group called the National
Surgical Adjuvant Breast Project (NSABP) published results of studies
showing that the microscopic cancer cells left in lymph nodes could
remain for months until they became enlarged and had to be removed.
But the most important part of the study was the fact that delayed removal
of lymph nodes did not impair survival. What was changing was the emergence
of the new scientific findings in the field of immunology.
These new findings involved the immune system's
surveillance and ability to kill cancer cells circulating within the
bloodstream, proving the "tumor-host" conflict. The patient
may have lost the battle in the breast, for instance, but was still
capable of defending themselves against the spread of cancer to distant
organs. They did this by killing cancer cells circulating within the
Dr. Evans concluded that a patient who could kill
cancer cells circulating from a breast cancer could also kill cells
circulating from a cancer in the lymph nodes. Thus, the cancer cells
left behind in a lymph node were of no risk to the patient, if they
were removed in a timely fashion. Dr. Evans became an advocate of what
he calls "conservative" surgery, urging his colleagues to
use lumpectomy (in breast cancer) instead of mastectomy inasmuch as
studies had proven that lumpectomy was as effective as mastectomy in
the treatment of breast cancer. Patients who develop locally recurrent
breast cancer following a lumpectomy have a second chance to be cured.
A recurrent tumor can be promptly removed without any added risk to
the patient's continued survival. Not suprisingly, many of his colleagues
still ignore these newer findings, perpetrating unnecessary suffering
and disfigurement of their patients.
In writing Making The Right Choice, the author's
stated goal is to ensure that patients faced with cancer surgery be
aware of these newer studies, and have the option of discussing them
with their oncologist. The book covers conservative surgery in malignant
melanoma, the soft tissue sarcomas, rectal cancer, bladder and breast
cancer, cancer of the cervix and penis, and prostate cancer. Dr. Evans
gives the reader a thorough understanding of the history of cancer surgery,
current research in cancer, and in "Principles of Treatment,"
he discusses types of cancer, how they're graded, their routes of spread,
screening procedures for early detection, signs and symptoms, diagnosis
and follow-up. Radiation, chemotherapy, and bone marrow transplantation
are also discussed in detail. Dr. Evans uses lay language throughout
this book, and imparts important information for patients concerning
"disease-free survival," response rates," hormonal and
biological therapies, and much more.
Oncology surgeons are under some pressure to recommend
aggressive treatment. Making The Right Choice gives the cancer patient
a way to participate effectively in deciding treatment options. The
author has written a comprehensive book on conservative surgery for
cancer, and advises cancer patients to study and prepare until they
are confident that the understand the issues: "Don't be satisfied
with simple answers."