Why Are Late Stage Cancers Rarely Operable?
Often the term “inoperable” is used not to indicate that it is physically impossible to operate on someone but that it’s no use. In other words: the risks and the disadvantages outweigh the benefits.
Some late stage cases will get the approach you are referring to — remove as much as you can and, if possible and useful, give chemo afterward. This is called debulking surgery:
- Sometimes, there is still hope for curative treatment, and this will actually be done in an attempt to remove as much as possible (potentially curative).
- In other cases, this is a palliative resection, which is meant to buy time. If these are done, it is because there is a belief that it actually buys more time than it will cost to recover.
However, in many cases when disease has spread to other organs, an important concept to understand is that the problem isn’t really what you see (macroscopic disease), but rather what has happened on a cellular level (microscopic disease and dedifferentiation). The problem in late-stage disease is that cancer cells in their very core have actually devolved to become so aggressive that they can enter the blood stream without any trouble and seed anew in their preferred locations pretty much as soon you remove the bulk of the tumor.
Also, they will be so aggressive that the rate of growth means they will be back at the same size in days or weeks at best. That means that operating will only put the patient through unnecessary risks and the burden of an admission and rehabilitation when time already isn’t likely to be on their side.
In those cases, either chemo or operations will be palliative and will only happen for two reasons:
- Extend the comfortable life of a patient as much as possible.
- To thwart life-threatening or debilitating consequences of local tumor growth. (i.e. if it threatens a big vessel, an organ, the spine, the brain etc.)
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