Dr. Mark Gimbel

This is a complicated question with many layers to it.
To start, it depends on the type of tumor you have. If the tumor is malignant (or cancerous), then there is a much higher risk of it recurring compared to if the tumor is benign.
The size of the tumor may also predict a higher chance of a tumor coming back where large tumors are much more likely to recur - given the total surface area - versus small tumors.

The way the cells look under the microscope may also predispose someone to a higher risk of recurrence. If the cells are more orderly and look like normal tissue, then these tumors are less likely to come back, while tumors that are highly mutated and look nothing like that normal tissue, have a higher risk of recurrence.

After surgery for breast cancer, depending on the type of surgery and the location of the tumor, radiation may be recommended. This is to reduce the chance of the tumor coming back. So with some tumors where patients undergo breast conservation, radiation may be offered to reduce that risk.

The stage of the tumor will also affect the risk of recurrence. If the tumor has spread to lymph nodes (stage III), then the risk of cancer coming back is much higher.

There are many layers to this question, but a comprehensive treatment plan should be undertaken to get the best treatment and to reduce the chance that a tumor recurs.

Cancer can always spread, but this is not typically due to have surgery. The goal to surgery is to remove the cancer completely so that it won't spread. However, if the tumor cannot be completely removed or is growing into surrounding structures, the likelihood of the tumor coming back is increased. Similarly, if the tumor has spread to lymph nodes, then there is a much higher risk that it can recur or spread to other organs. There are many factors that cause a tumor to spread, but surgery is a tried and true treatment that allows for cure of many tumors. Once the tumor is removed, there is always a chance that it could come back and spread, but this is usually due to other factors - size of tumor, grade of the tumor cells (how aggressive the cells look under the microscope), Stage of the tumor, etc.
Working with you cancer team will allow a comprehensive plan to be put into place along with continued follow up after surgery.

All surgery is invasive to some extent. The deeper the tumor is in the tissues, the more invasive the surgery will be. A skin tumor requires minimal surgery, while a muscle or bone tumor could potentially require radical surgery and thus be more invasive. If the tumor is small, the surgery should be relatively small, but without knowing all the details, a full answer cannot be given. You will need to discuss your fears with your surgeon.

A pancreas cancer diagnosis does not have to be fatal. There are various types of pancreatic tumors so the biopsy results will be very important. For 'standard' pancreatic cancer (adenocarcinoma), the likelihood of cure is lower than compared to a neuroendocrine tumor of the pancreas.

However, a diagnosis of adenocarcinoma is not fatal. The size of the tumor, location, and spread to lymph nodes are very important features when discussing overall survival. Once a diagnosis of your husband's tumor is made, these other factors will need to be discussed with your cancer team.

Colon cancer is a very treatable cancer in the earlier stages. Surgery is usually recommended as surgery alone could lead to a cure. Surgery for colon cancer has advanced significantly - where minimally invasive techniques including robotics as well as enhanced recovery pathways allow for quick recovery with minimal discomfort.

Another important reason to have surgery is that many times, there is microscopic disease in the surrounding lymph nodes that cannot be seen on imaging. By removing the lymph nodes along with the colon and the cancer, a full cancer picture can now be obtained - dictating whether or not chemotherapy will be recommended.

There are critical structures in the human body that render a tumor unresectable (cannot remove the tumor). If the tumor involves these structures, it many not be able to be removed. However, there are other reasons why a tumor may not be removed at surgery. If there is more than one tumor seen at the time of surgery, then there may be no survival benefit to performing a surgery. Surgery to remove the tumor would only cause a longer recovery time delaying the time a patient can get to chemotherapy. In this scenario, chemotherapy would be the only life lengthening treatment.

In the liver, there are 2 distinct lobes or sides. If the tumor encroached upon the other side of the liver, there may not have been enough liver left after a resection. This could send a patient into liver failure and ultimately death.

Interesting question. The answer can be quite complex. In short, some tumors can be treated without surgery, but it depends on the type of cancer. Some cancers are very sensitive to chemotherapy and/or immunotherapy and others are sensitive to radiation therapy. If your friend has a tumor that can respond to these types of treatments then these might be good options. Remember that all treatments have some side effects. Many tumors may respond partially or not at all to chemotherapy and radiation and that is when surgery is required. The question that needs to be asked is: Does the risk of surgery outweigh the benefit of removing the tumor? If your friend becomes paralyzed after surgery, then this may not be a viable option.

As with all cancer diagnoses and treatment plans, I do recommend a second opinion from another specialist to corroborate or refute the plan that you were given.

Mark I. Gimbel, MD

Yes, cancer can come back after surgery. The goal of surgery is to remove the cancer completely (negative margins). If the cancer cannot be removed completely then it is at a much higher risk of coming back. However, if the cancer is completely removed, there is still a chance your cancer could recur. Some cancers are more aggressive and are more likely to come back than others even with it completely removed.

However, in your situation, you developed a lump a couple of months later. It would be unlikely for cancer to recur that quickly especially if you were told it was completely removed. After surgery, the body's natural response to filling in a defect (i.e. where your tumor was removed) is to fill it with fluid. Many times, this fluid can resemble another lump. Before you get too concerned, an ultrasound can usually be performed to see if it is a fluid filled space or if it looks like something has returned.

A quick answer to your question is... No, not all tumors need to be removed. If you have had something (like a mass) for a while and it does not bother you then it is unlikely cancer and does not need to be removed. If anything changes though, you may want to consider removal to verify that it is not a cancer.

That being said, there are some benign processes that can continue to grow and cause issues by the size alone. If you have it removed now, it may be much easier to perform the surgery and with less complications then if you need it removed in the future.

There are no specific surgical preparations for a lumpectomy. This is a relatively straight forward procedure. You will want to make certain to keep the area clean and dry after surgery (especially if you have pendulous breasts). You can expect a small incision on the breast (location of the incision is dependent on the location of the cancer). It is not uncommon to have bruising after this type of surgery.

If you have a cancer diagnosis and you choose lumpectomy, radiation therapy may be recommended after surgery depending on the size and type of tumor.

A double mastectomy is protective for breast cancer. If there is no breast tissue left then cancer cannot grow. However, even if you have a risk reducing double mastectomy, it is nearly impossible to remove every bit of breast cancer. You should always be aware of any changes to your breasts even after surgery. While the chance of developing a tumor in residual breast cells is quite low, it is not zero.

In short, benign tumors can grow back. One of the most common benign tumors is called a lipoma (an abnormal growth of fat). These commonly recur after they are removed. Just because they recur does not mean it is cancer though!

If you just had a tumor removed and you still feel a lump, this is most likely a fluid collection (or seroma). This should decrease over the next few weeks. If it does not go away, a simple Ultrasound can be used to evaluate it.

It depends on the type of cancer and where the cancer is located. Skin cancers are mainly diagnosed with excisions or superficial biopsies. Breast cancers are typically biopsied through radiology (although a surgeon could do this as well). Cancers in the gastrointestinal tract are usually diagnoses by the gastroenterologist when getting a colonoscopy or other type of scope. Cancers in deeper organs (lung, livers, bones, etc) are usually biopsied by the radiologist. If a radiologist cannot perform a biopsy safely, then perhaps a surgical biopsy will be recommended (this is seen with intra-abdominal cancers mostly).

If it has been growing, yes, it could be cancer. I would first get an MRI of the affected area and then you may require a biopsy to see what this may be. Make certain you see a cancer surgeon/surgical oncologist to appropriately work up this mass. A general surgeon may act too quickly when surgery may not be the appropriate first treatment.

This is a good question. While the tumor was cancerous, there are multiple types of cancerous tumors of the stomach. It could be that a simple removal could be curative. Other types of cancers require chemotherapy as part of the treatment. Depending on the type of cancer, lymph nodes may have been taken and if there is involvement of the lymph nodes, then cure rates decrease (although cure is still possible). This is a complex question, and a full answer cannot be given with just the information provided.

Removing fluid from the lungs is a straight forward procedure and usually uncomplicated. If she continues to re-accumulate fluid, there are certain types of tubes that can be left in place to help the fluid drain.

By not removing the tumor, the cancer can continue to grow. As it grows, it becomes more likely that it will spread via lymphatic or hematogenous routes (by the lymph glands or the blood vessels). To make certain removal is the appropriate treatment for you, you should have a multidisciplinary team consisting of surgical oncologists, medical oncologist, and radiation oncologists working together to develop the best plan for your type of tumor.

Depending on the stage of the cancer, surgery is most of the time offered as a curative approach. That means that if the cancer has not spread, the goal would be to cut the cancer out so it would not be able to spread. If the cancer has already spread then surgery is usually not offered as it will not impact the progression of the disease.

If it is a very treatable breast cancer, surgery will be a vital part of her plan of care. She may require chemotherapy before or after surgery, but will need to discuss the surgical options as well. This could be as simple as a lumpectomy to as complex as bilateral prophylactic mastectomies. So yes, I do recommend discussing the case with a breast surgeon.