Perspectives on the surgical treatment of cancer

The surgical treatment of carcinoma has been likened by some to "a macroscopic attack on a microscopic disease." Until better alternatives of treatment emerge, our best hopes for cure and significant palliation lie in early detection of disease, accurate staging, and appropriate surgical intervention, the last selectively supplemented with irradiation or chemotherapy or both. Oncologic surgery must be guided by accurate staging. Radical resection is appropriate when performed to eradicate malignancy discovered early and when the surgery neither unnecessarily sacrifices organ function nor interferes with an acceptable quality of life. Radical surgery in the presence of distant spread of disease is not always warranted. Other choices exist that may better serve the interests of such direly affected patients.