Pathological Aspects

Abstract

The surgeon of today is quickly coming to regard malignant diseases, and the role of surgery in treatment, very differently from his predecessor of even a decade ago. He no longer sees his work as the operative removal of every tumor cell, thereby producing a surgical cure of the disease. This reorientated approach has resulted not so much from the acquisition of new knowledge about cancer and its biology as from the reiteration of information which has long been available, but to varying degrees ignored, possibly because the implications were unpalatable. The cherished idea, as old as tumor surgery itself, that “early” excision of a malignant tumor, or sufficiently radical procedures in more advanced lesions, can in themselves offer cure to the patient, dies hard. With it there went an overreadiness to ascribe to surgical extirpation any long-term, symptom-free survival, further accorded the status of a “cure” at an interval as short as 5 years. It is many years since the tiny, elusive, or occasionally even undemonstrable bronchial carcinoma, with gross and widespread metastases, pointed clearly to the fact that hematogenous dissemination can occur when a primary neoplasm is very small, whether or not such dimension implies an “early” lesion in the biological or chronological sense. More recently it has become evident that this dissemination is not merely possible, but usual, and a surgical attack on these tumors is now much less common.