Fighting cancer with surgery is what Cancer Care Northwest’s fellowship-trained surgical oncologists know and do best. Cancer Care Northwest’s surgical oncology team is highly trained in the most advanced surgical treatments for the diagnosis, staging and treatment of cancer. Their surgical expertise includes:
Using innovative surgical techniques, Cancer Care Northwest’s surgical oncologists are among the most skilled and experienced in the region:
Dr. Rebecca Kirschner is a surgical oncologist with fellowship training in Heated Intraperitoneal Chemotherapy (HIPEC) to treat patients with abdominal cancers.
Our breast surgeons have a widespread reputation for being among the best in the Inland Northwest, with expertise in cutting-edge surgical procedures such as oncoplastic breast surgery, skin and nipple sparing mastectomy in collaboration with plastic surgery, and sentinel node biopsy.
Cancer Care Northwest also specializes in robotic-assisted surgical oncology procedures to treat certain forms of cancers. Using the da Vinci® Surgical System, surgical oncologist Dr. Maryam Parviz performs these minimally invasive surgical procedures, which are an alternative option to both conventional open surgery and laparoscopy.
Surgery is a primary treatment method used to treat most types of cancer. Surgery alone may successfully remove cancers that have not yet spread to other parts of the body (localized cancer). Or, it is often paired with other treatments, such as chemotherapy and radiation therapy.
Surgery is also instrumental in cancer diagnosis. A biopsy is a surgical procedure to remove and examine suspicious tissue. Surgery is helpful in staging the cancer, which tells you if and where cancer has spread.
Treatment of breast cancer often begins with surgery. Cancer Care Northwest's surgical oncology team includes fellowship-trained surgeons who specialize in treating breast cancer.
Types of Breast Surgery
At Cancer Care Northwest, we are committed to providing you with the most suitable treatment for your breast cancer care. The type and extent of surgery depends on several factors, including; tumor size, breast size, cancer location, and your ability to receive radiation therapy.
Lumpectomy
Also known as a partial mastectomy or breast conservation surgery, lumpectomy is a surgical procedure that removes all the breast cancer along with a small margin of healthy tissue surrounding it to ensure all affected areas are removed. When cancer is removed via lumpectomy, radiation therapy typically follows to lower the risk of recurrence. A lumpectomy may not be an option in cases where negative margins cannot be achieved, or the patient underwent prior radiation to the chest wall.
Mastectomy
A mastectomy is a surgical procedure used to treat breast cancer by removing all the breast tissue in one breast (unilateral mastectomy) or both breasts (bilateral mastectomy or double mastectomy). There are various types of mastectomy options tailored to each patient's specific breast-health needs.
When cancer is removed via a mastectomy, the need for post-surgical radiation therapy will depend on a patient's pathology report and will be determined by your CCNW care team.
Reconstructive Surgery
A mastectomy can be done with or without breast reconstruction, which can be done at the same time, shortly after, or several months to a year later, depending on the plastic surgeon's plan. The two main reconstruction methods are using tissue from another part of the body, such as DIEP Flap reconstruction, or an implant. This process adds time to surgery and recovery, and patients must meet specific criteria to qualify for breast reconstruction.
Lymph Node Surgery
When breast cancer spreads, it often reaches the underarm lymph nodes, or axilla, first. Surgery may be needed to check if the cancer has spread beyond the breast, though in some early cases, this is unnecessary. The breast surgeon will recommend underarm surgery based on the individual case, and the type of breast surgery chosen usually doesn't affect this decision. Here are the common axillary surgeries:
Surgery in the axilla can cause scarring and damage to the arm's lymphatic system, as arm and breast lymph nodes intersect in this area. Damage to arm lymph nodes may lead to fluid buildup and swelling, known as lymphedema. At CCNW, our goal is to fully remove and cure breast cancer without compromising the lymphatic system. Whenever possible, we take extra precautions to reduce the risk of lymphedema.
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To better prepare yourself for breast surgery, we invite you to discuss any concerns with your Cancer Care Northwest physician. Our surgeons are available to see you within 72 hours of your diagnosis. To schedule an appointment with a CCNW breast surgical oncologist, please call (509) 228-1000.
Surgery is a common treatment for cancers of the gastrointestinal (GI) system, the group of organs that ingest and digest food and eliminate waste. The GI system includes the esophagus, stomach, intestines, liver, gallbladder, pancreas, colon and rectum.
Types of Gastrointestinal Surgery
The type and extent of gastrointestinal surgery depends on the size and location of your cancer.
Surgery may be used as the only treatment or in combination with other treatments, such as chemotherapy and radiation therapy. Your surgical oncologist works closely with your medical oncologist and radiation oncologist to determine the best treatment protocol.
Your surgical oncologist may remove part of the organ or the entire organ. Sometimes it is necessary to also remove surrounding organs and tissue. After your cancer is removed, your surgeon reconstructs the healthy parts of the organs so that the gastrointestinal system functions as normally as possible. Depending on your specific cancer, your surgeon will decide which surgical procedure is more appropriate to treat your cancer:
Stomach Cancer
Stomach cancer is usually treated with a surgical procedure called a gastrectomy. If the lower part of the stomach is removed (partial gastrectomy), your surgeon connects the remaining part of stomach to the small intestine. If the entire stomach is removed (total gastrectomy), your surgeon connects the esophagus to the small intestine. These procedures can sometimes be done with robotic assistance.
This disease often requires a multi-disciplinary approach where your surgeon and medical oncologist collaborate to provide the best standard of care. Supportive services such as dietician and counseling are also provided to promote full recovery.
Pancreatic Cancer
Pancreatic cancer may be treated with a Whipple procedure to remove the head of the pancreas, the first part of the small intestine (duodenum), gallbladder and bile duct and sometimes part of the stomach. In certain cases, a portion of your portal vein may also need to be removed and then reconstructed.
A distal pancreatectomy removes the body and tail of the pancreas and with or without the spleen. Patients often require chemotherapy to shrink their tumors in order to successfully undergo pancreatic surgery.
In rare cases, your surgeon may need to remove the entire pancreas along with the attached small intestine (called duodenum), the lower bile duct and the gallbladder along with surrounding lymph nodes. This is called a total pancreatectomy. In these instances, your surgeon will work with other physicians such as endocrinologist and dietician to manage the side effects and metabolic changes associated with this surgery.
Gallbladder Cancer
Early stages of gallbladder cancer and/or cancers of the bile ducts are often treated surgically. The surgeon will remove the gallbladder and the adjacent liver as well as the attached bile ducts and reconstruct the biliary tree using parts of the small intestine (extended cholecystectomy).
Colorectal Cancer
Treatment of colorectal cancer often requires removal of a segment of the colon or rectum and reconnection of the two remaining ends (colectomy). On occasion, a colostomy may be required to create a new path for waste products to leave the body. In this procedure, your surgeon makes an opening (stoma) in the abdomen, connects the intestine to the opening, and fits a bag over the opening to collect waste. A colostomy may be temporary or permanent.
Esophageal Cancer
These cancers often require a multi-disciplinary approach with collaboration between surgical oncology, medical oncology and radiation oncology. An esophagectomy may be used to remove all or part of the esophagus to treat esophageal cancer. Most often, the stomach is used to replace the esophagus. In rare situations, the small intestine or colon may be used as an alternative to the stomach. These surgeries can be performed with robotic assistance or conventional open technique depending on many factors such as the size and location of the tumor and the patient’s medical condition.
In order to promote a full recovery, your surgeon will work with dietician and other supportive services to ensure adequate nutrition and hydration throughout this process.
Liver Cancer
Surgery to remove parts of the liver is called a hepatectomy. As much as 80 percent of the liver may be removed if the remaining liver tissue is healthy. The remaining healthy tissue keeps the liver functioning normally. The size and location of tumors as well as the number of tumors in the liver will help your doctor determine the appropriate treatment.
Radiofrequency ablation and/or microwave ablation are treatment options if and when hepatectomy is not appropriate. Your surgical oncologist inserts a small probe through an incision in your abdomen into the liver tumors under ultrasound guidance. The probe delivers high temperatures to the tumor, killing cancer cells with extensive heat. Cancer Care Northwest has special expertise in this area. These procedures can also be done either laparoscopically or conventional open technique.
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To better prepare yourself for gastrointestinal surgery, we invite you to discuss any concerns with your Cancer Care Northwest physician.
Surgery is the standard treatment for melanoma, a common type of skin cancer. If performed early enough, surgery for melanoma is often completely curative.
Types of Melanoma Surgery
The extent of surgery depends on if the cancer has spread and how deeply the cancer has invaded the skin.
Wide Local Excision
Malignant melanoma of the skin requires removal by a procedure called Wide Local Excision (WLE). In this procedure, the surgeon removes the tumor with a margin of normal skin around it. The amount of margin required is based largely on the depth of the lesion (determined by biopsy beforehand). In general, the thicker the tumor, the larger the margin.
Sentinel Lymph Node Biopsy
Cancer Care Northwest’s surgical oncologists perform sentinel lymph node biopsy, a fairly new surgical procedure used to determine if melanoma has spread to the lymph nodes.
With sentinel lymph node biopsy, the surgeon uses a radioactive substance or dye to find the first (sentinel) lymph node that is most likely to be invaded by cancer. This lymph node is removed and checked for cancerous cells. The results help your doctors predict if cancer has spread to other lymph nodes.
Prior to sentinel lymph node biopsy, all of the lymph nodes in question had to be removed to determine if the cancer had spread. Because melanoma often does not involve the lymph nodes, many patients, prior to sentinel lymph node biopsy, had to undergo an operation that was ultimately found to be unnecessary.
Surgeons at Cancer Care Northwest have been actively involved in clinical research aimed at better defining which melanoma patients, particularly those with thinner lesions (< 1mm in depth), need to undergo this procedure as part of their surgical treatment. These findings have been presented at recent regional/national surgical meetings and published in peer-reviewed surgical journals.
Skin Graft
Occasionally, Wide Local Excision creates a defect in the skin that can only be closed with the use of a skin graft (transfer of skin from one area of the body to another). Most of the time, however, the skin can be closed without a skin graft.
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To better prepare yourself for malanoma surgery, we invite you to discuss any concerns with your Cancer Care Northwest physician.
Sarcoma is a type of cancerous tumor that develops in soft tissue such as the muscle, nerves, fat and blood vessels. Surgery to remove the tumor is a common treatment for sarcoma.
Types of Sarcoma Surgery
They type of surgery depends on where the tumor is located and if and where the cancer has spread.
Wide Local Excision
Your surgeon removes the tumor along with a large part (at least one to two cm) of the surrounding tissue, also called the margin. The goal of a wide local excision is to completely remove the tumor as much as possible of the potentially cancerous cells around the tumor. Radiation or chemotherapy may be used to kill any cancerous cells left behind.
Limb-sparing Surgery vs. Amputation
Most sarcomas occur in the arms or legs. In the past, these sarcomas were treated with amputation (removal of a limb).
But today, thanks to advanced surgical expertise and technology, most patients with sarcoma can be treated without amputation in a limb-sparing surgery. Cancer Care Northwest’s skilled surgical oncologists have successfully performed many complicated limb-sparing surgeries to remove sarcomas that would have once required amputation.
Heated Intraperitoneal Chemotherapy (HIPEC)
Cancer Care Northwest is the only treatment center in the multi-state Northwest that offers Heated Intraperitoneal Chemotherapy (HIPEC), an innovative chemotherapy procedure performed during surgery that can be used to treat sarcomas that have spread to the abdomen.
With HIPEC, a surgical oncologist removes all visible signs of the cancer. During the operation, heated chemotherapy drugs (heat makes the chemo more powerful) are circulated up to 90 minutes throughout the abdominal cavity to kill remaining cancerous cells.
Cancer Care Northwest’s Dr. Ryan Holbrook, surgical oncologist, is recognized throughout the nation for his expertise in HIPEC. He has used the procedure to treat more than 100 patients over the past 12 years.
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To better prepare yourself for sarcoma surgery, we invite you to discuss any concerns with your Cancer Care Northwest physician.
Surgical oncology is an innovative method of cancer treatment and is constantly changing. We invite you to learn more by visiting the following trusted sites:
