By Raj Mohan, MS, DNB, Mch
When cancer is diagnosed, people always talk about a patient’s journey—their anxieties, worries, fear of cancer coming back, and fear of dying one fine day. What many don’t talk about is the journey of a cancer surgeon while treating an individual patient. Our anxiety, worries, fear of recurrence, and fear of our operated patient dying is as real as that of the patient. We, patient and surgeon, go on the journey together.
From the time a lump appears malignant the journey of patient and the surgeon starts. First, the core biopsy for tissue diagnosis. If the biopsy report comes back normal or inconclusive, we constantly doubt our biopsy adequacy rather than the pathologist’s reporting.
Then we have to allay the anxiety of a tense patient and their relatives, stage the cancer, and work up the patient for surgery. We have to be considerate of the comorbidities the patient has, including poor nutrition, and talk to our other oncology colleagues as necessary.
We resect or remove the tumor and hope that we have done a complete oncologic resection with all tumor-free margins. The patient goes to recovery, and we wait. While the rest of surgical fraternity celebrates after a successful appendectomy or complex cardiac bypass, the cancer surgeon eagerly waits for their report card—the histopathology report!—before we can have even a small celebration of our small success.
Let’s look at a complex cancer operation like a Whipple’s or rectal cancer surgery. After a long and exhausting surgery and even after a good patient recovery, the report card can still tell me that I have left microscopic tumor cells behind. My other oncology colleagues and pathologists would call me a “margin-positive surgeon,” and of course bombard the patient (who has now recovered well) with more therapies, since I as the surgeon did a poor job. The other oncology colleagues may ask for feasibility for re-resection, which we surgeons know is not possible in a sizeable number of patients.
These things don’t happen routinely and most of the time we are able to achieve a margin-free resection, but the report card is still awaited eagerly. As the patient completes their treatment with the medical and radiation oncologists, the surgeon continues to interact with them and hopes the patient comes out of all this alive and ticking.
My anxiety of the tumor coming back or of my patient dying of their cancer nearly equals that of the patient. After all, I have interacted with the patient and their tumor at very close quarters! I know that once the tumor comes back, a realistic chance of cure diminishes.
So this journey that we are indeed blessed to share with our patients is a journey full of ups and downs, and even as we continue to try our best to achieve a margin-free resection we still wait for the final pathology report with the same anxiety as that of a school kid waiting for his report card!
Dr. Mohan is a surgical oncologist with the Indian Air Force in Bangalore, India. He is a 2017 recipient of ASCO and Conquer Cancer’s International Development and Education Award.