Cancer is an abnormal unregulated growth of cells in any part of the body. Solid organ tumors present as lumps such as lumps in the breast or soft tissue tumors while tumors in the alimentary canal or airway present as ulcers/ tumors that might bleed or cause pain. Depending on their location, they produce symptoms. In early stages, it remains localized to the organ of origin while as the disease progresses it may infiltrate surrounding organs and then spread to other parts of the body.

To establish a diagnosis of Cancer, a Biopsy from the primary tumor is essential. No imaging alone without the assessment of tissue samples can establish the diagnosis. It is a crucial pre-requisite not only to establish the diagnosis but also to type the tumor. Certain types of tumors will need chemotherapy, to begin with for example Triple-negative Breast cancer or Her 2 positive Breast Cancer. While for some other types of cancers, surgery might not be the choice of treatment. A biopsy thus helps to plan the treatment modality to be selected for a particular type of tumor. So, a biopsy is the initial investigation to be done when a patient is suspected or known to have Cancer.

While a few cancers might be treated with chemotherapy alone like Blood Cancers, a majority of solid cancers will need a multi-modality approach for curative treatment. Usually, surgery is done with curative or palliative intent.

Curative – When patients are diagnosed with non-metastatic disease, a curative intent surgery is planned either with chemotherapy/radiotherapy/chemoradiation before or after surgery ( neo-adjuvant or adjuvant chemotherapy/radiotherapy/chemoradiation). So, if a patient is offered surgery, it indirectly implies a chance at cure. So, in a way, it is good news for the patient and family.

Palliative- In case of metastatic disease, the usual therapeutic option left is chemotherapy or radiation therapy in some instances. Occasionally the patient will need surgery to palliate the symptoms; eg: bleeding, intestinal/gastric outlet obstruction. In such cases, the patient will still need surgery to relieve symptoms which cannot be done by chemotherapy alone.

To understand the need for so many tests, we need to understand cancer first. To start with, Cancer might seem to be confined to a single organ. However, it is established that even in the presence of a small tumor at a single site which is picked up in imaging, it is possible to have microscopic disease in the blood and small tumor deposits in other parts of body. To define the intent of treatment and thus plan the treatment options, multiple tests are needed. While some of the tests are done for diagnosis, some for staging, and few others are for planning the treatment.

To give a particular percentage and thus call it a successful surgery is not something that can be done easily. While many surgeons do define themselves with 98-99% success rates, these figures make no sense in actuality. A successful surgery is not merely one, from which the patient comes out smoothly and goes home, but also one that has less number of complications and a higher disease-free interval. So, a safe surgery with acceptable complication rate as per worldwide standards and a comparable disease-free survival actually means a successful surgery. The right balance of radicality of surgery and safety is essential to deliver the best for the patient. And so it is not a one-day result. It is something that needs long term follow-up to be called successful.

The rate of disease recurrence depends on a number of factors. The most important ones being the type of cancer, the biology of disease, the stage of disease at detection and the compliance to standard treatment guidelines. While it is possible to do the deliver the best service to patient in terms of the needed treatment, the rest of the factors remain un- modifiable. Thus it is essential to be treated by a team of specialised doctors who are abreast with the latest guidelines and are equally competent in the usage of latest technologies. With the best of multi-disciplinary team work, it is possible to achieve best oncological and supportive results for the patient.