For example a risk from melanoma is that it could grow to reach blood vessels, providing a highway to spread to other parts of the body – how then during the process of the excision of a melanoma (pre wider local excision) where doctors cut around the mole but may cut into parts of the skin that have melanoma cells in it, does this not result in cancer cells seeping into the wound and spreading to other parts of the body?
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The answer part 1 is “carefully”.
The answer part 2 is “all cancer treatments have risks”.
They only remove a tumor if they can cleanly remove the entire tumor and a sufficient margin of non-cancerous cells around it. Otherwise yeah, they risk spreading cancer further.
And also, they usually recommend further treatment like chemotherapy or radiation afterwards to help ensure they got everything.
Blood vessels are closed off from their surroundings. Things like cancer cells outside them won’t just end up inside easily. The tumor is carefully dissected away from the surrounding tissue. Blood vessels are cauterized. Also, most cancers spread through the lymph system, not blood. There is a risk of some cancers “seeding” tissue by shedding some cells that can then start new tumors. This sometimes happens when doing a biopsy with a needle. Luckily, this doesn’t happen with most types of cancer.
This is why cancer treatment is a whole plan. Surgery might be one part, but it’s almost always connected with other types of therapy, like chemo as well.
This way you can remove the major tumors and hopefully reduce the amount of chemotherapy that needs to happen. A hard chemo regimen is extremely hard on the body, and if you can reduce it with surgery then the prognosis may improve.
They will take out healthy tissue around the tumor to make sure they get it all.
They will also potentially take out vessels around the tumor like lymph nodes to limit the chance of metastasis.
They will also do chemo which should kill any rogue cells that get out.
It’s not necessarily an issue if a few cells get into the bloodstream since not all cancers metastasize easily.
Cancer treatment is a multi front assault.
Surgery to remove tumors is the “basic” attack. A surgeon will do a lot of imaging to see where the tumor is and how big it is. They’ll determine how much healthy tissue around the tumor they can cut because if they leave any bit, the tumor can grow back and they’ll be back at square one (if not worse due to having to recover from surgery).
On top of that, many different types of medication are prescribed to poison the cancer. Things like chemotherapy. Cancer is a very “hungry” type of cell. It will consume lots and lots of nutrients from the blood to fuel its rapid division. This is partly what ends up killing people. The organs around the tumor basically starve and begin to shut down (there’s still a lot of mechanisms that lead to death when it comes to cancer).
Chemotherapy drugs are incredibly toxic to tissue. But, because cancer absorbs so much more nutrients than typical cells, it will absorb more poison than the cells around it. Chemotherapy is basically poisoning yourself as much as you can handle with the hopes that the cancer dies first. This will help to ensure that any cancerous cells that did escape have less success reproducing and forming more tumors.
There’s also radiation. Basically, beams of highly energetic light are blasted in such a way that they will enter your body and destroy the DNA within the cancerous cells. Much like surgical removal, blasting healthy cells around the cancer to ensure the entire tumor is hit is also part of this process.
Combinations of these procedures are used for cancer treatments as well as managing the symptoms from these treatments (surgery obviously has its side effects, chemo is poison so it makes you sicker than hell, and radiation destroys tissue that your body has to work to get rid of and heal from).
There’s also immunotherapy where they basically engineer your own cells to fight the cancer. It’s super cool. They basically take your own immune cells out and teach them to hunt specifically for the cancerous cells and then put them back in your body. It’s sort of a systemic protection from cancer spreading but it’s still pretty new.
Most cancer surgery is completed via WIDE AREA EXTRACTION. The idea is that you remove the cancer AND an area around the cancer to guarantee its removal. If the cancer is next to the blood vessels or lymph system there is a good chance it has already spread. This is why early detection is critical.
There are some cancers, like thyroid, where all of the gland/tissue cannot be excised. We have thyroid cells all over our bodies. Suppression therapy is used afterward to be sure the body doesn’t activate those leftover cells. For others, chemo &/or radiation are used to get everything (for some kinds of T-cancer, too).
One consideration is that when cancer has spread, the main tumor actually sends out suppressing chemicals to the others. If you remove the big one, the others all start to grow which is why they do the chemo and aggressive treatments.
Since it’s just cells in the blood, your body can destroy them, but they do get through, which is why you have follow ups
It’s easiest to think of cancer cells not as good/bad, but more like Pokémon accumulating different abilities over time.
One cell may develop a “grow” mutation andand multiply. One of those subsequent cells may add a “break through blood vessels” mutation. Yet another one may add a “seed in different organ” mutation. Without all of those, the cancer may just be a growing lump that never becomes deadly. The body is always looking for early mutated cells to destroy them.
So if you cut out a tumor before it gains an aggressive mutation, it may be cured before it has a chance to spread.
It literally can, you try to not cut directly into tumors, good technique involves removing tissue widely depending on the type of cancer and avoiding violating capsules if present, not cutting into lymph nodes, etc. but risk of seeding is less than risk of having cancer so you still do surgery. 100 cancer cells is better to have than 1 billion cancer cells. Chemo/Radiation target “leftover”cells when surgery is initial treatment. Source: am surgeon.
It can, though they try to make a clean removal, sometimes removing a bunch of surrounding healthy tissue to be sure they got it all, since the edges are not necessarily obvious by looking.
But even then, some cancers will have tiny pieces break off into the bloodstream normally, “seeding” your body with cancerous cell clusters – but also releasing hormones that suppress other tumors from forming. But remove the main tumor, you remove the suppression, and all the “seeds” start growing.
That’s why surgery is often combined with chemotherapy. Beforehand to shrink the tumor and make it easier to remove cleanly, and afterwards to hopefully kill any remaining cells.
You say, “may cut into the skin that have melanoma cells in it”. That is exactly what they must NOT do! Because yes, that would indeed spread cancer.
That is the reason why they need to cut around it, with a margin of safety.