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Surgical Oncology

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. Ryan Holbrook is a premier surgical oncologist in the nation performing cytoreductive surgery and Heated Intraperitoneal Chemotherapy (HIPEC) to treat patients with abdominal cancers. Patients from across the country travel to Spokane for his expertise.

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
The type and extent of surgery depends on the size of the cancer and if and where it has spread.

Breast-conservation Surgery
Women with early stage breast cancer (the tumor is small and has not spread) are able to effectively treat their disease while also sparing their breasts. A breast-conservation surgery removes the tumor and surrounding tissue in a procedure called a lumpectomy. Lymph nodes under the arm may also be removed.

Research shows that breast-conservation surgery, when paired with radiation therapy to kill any remaining cancerous cells that are left behind after the operation, is as effective as a mastectomy (removal of breast) when treating small tumors.

Partial Breast Irradiation
Instead of the weeks of external beam radiation therapy that usually follows a breast-conservation surgery, partial breast irradiation allows you to complete your radiation treatment in as few as five days.

Partial breast irradiation is a form of brachytherapy (internal radiation therapy). Within weeks after your surgery to remove the cancer, your breast surgeon may place a balloon device into the empty space that was created after a lumpectomy. The balloon is filled with saline solution and remains inflated throughout treatment. A tiny radioactive seed inserted into the balloon delivers radiation to the surrounding the area. The balloon is removed after treatment. There are different products used to perform this procedure, including Mammosite and Contura.

Other techniques to deliver partial breast irradiation include interstitial catheters and modifications of the standard external beam radiation. Your surgical oncologist and radiation oncologist work together to determine which type is more suitable for your situation.

Cancer Care Northwest’s Dr. Stephanie Moline introduced partial breast irradiation to Spokane in 2004.

A mastectomy is the surgical removal of the entire breast and lymph nodes under the arm. A sentinel lymph node biopsy may be performed to help your doctors determine if and where the cancer has spread.

Reconstructive Surgery
Some women who have a mastectomy are candidates for breast reconstruction to rebuild the breast. This may be done at the time of the mastectomy or later. Our surgeons work with local plastic surgeons to coordinate the best outcome.

Learn More
To better prepare yourself for breast 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.

Learn More
To better prepare yourself for malanoma surgery, we invite you to discuss any concerns with your Cancer Care Northwest physician.

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:

  • Conventional open surgery
  • Minimally-invasive Laparoscopic surgery
  • Robotic-assisted Surgery

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. 

Colorectal Cancer
Treatment of colorectal cancer often requires removal of a segment of the colon or rectum and reconnection of the two remaining ends. 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.

Learn More
To better prepare yourself for gastrointestinal 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.

Learn More
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: