The role of surgery in cancer prevention

Oxford American handbook of oncology. Second Edition. Oxford University Press (2015)

Prophylactic surgery to prevent cancer in selected patients is of benefit in the following diseases.

  • Multiple endocrine neoplasia (MEN) type II and familial medullary cell thyroid carcinoma, in particular the relatives of patients who have the MEN 2B and 2A syndrome. Prophylactic thyroidectomy is recommended under the age of five years.
  • In patients with Barrett’s esophagus, especially with high-grade dysplasia, there may be a role for prophylactic esophageal resection.
  • Hereditary diffuse gastic cancer—there may be a role for preventative total gastrectomy.
  • Ulcerative colitis of over 10 years in the patient with total colitis and who has dysplasia may warrant a total colectomy, although this is now less popular with the advent of regular surveillance colonosocopy.
  • Hereditary colorectal cancer
  • Familial adenomatous polyposis (FAP) coli. After the diagnosis of this condition (with over .00 adenomas), total colectomy with a pouch procedure is now accepted practice to prevent the inevitable development of colorectal carcinoma.
  • Hereditary non-polyposis colorectal cancer (HNPCC) accounts for 5% of all colorectal cancers. There is currently no consensus regarding prophylactic subtotal colectomy in patients with HNPCC.

The 5%–10% of patients with hereditary breast carcinoma and who carry the BRCA1 gene have a lifetime risk of 60%–85% of getting breast cancer.

  • Some of these patients may opt for bilateral mastectomy and breast reconstruction.
  • Women who carry a mutation in BRCA1 and BRCA2 genes are at a high risk of developing ovarian cancer.
  • The lifetime risk lies between 60% and 85%, and after counseling, some of these women will opt for laparoscopic prophylactic oophorectomy.

Patients with an undescended testis have a higher chance of developing testicular cancer—more than 20 times that of the general population.

  • 10% of testicular tumors arise from undescended testes.
  • Orchidopexy is generally recommended within the first year or two of life; however, this does not abolish the risk of developing future testicular cancer.
  • It is generally agreed that in the postpubertal boy, a nonpalpable undescended testicle should be excised.

The role of surgery in cancer prevention

Removal of preinvasive lesions

In addition to surgical removal of whole organs in high-risk individuals, a strategy to remove cancer precursor lesions has been widely adopted for two cancer types.

  • A denomatous colon polyps are now accepted as the morphological precursor of colorectal cancer. Colonoscopic removal of polyps reduces the incidence of invasive colorectal cancer.
  • Women identified to have carcinoma in situ of the cervix (usually by biopsy prompted by an abnormal Paponicolou smear) can be prevented from developing invasive cervical cancer by surgical removal of part or all of the cervix.

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