While it is standard surgical practice to submit all surgically removed organs and tissue for pathological examination, some surgeons occasionally deem this unnecessary for common surgical conditions such as acute appendicitis, cholecystitis or thrombosed haemorrhoids. We report three cases in which a clinically unsuspected malignant tumour was diagnosed by histopathological examination in this setting. Even an experienced surgeon may miss diagnosing such a tumour if using naked‐eye examination alone. Failure to make the diagnosis of cancer may deny the patient proper radical resection of a potentially curable tumour. Surgically removed organs and tissue should be scrutinized by the surgeon and, with few exceptions, submitted for histopathological examination.
Radical resection of cancer, such as radical mastectomy and abdominoperineal rectal resection, was developed in the last century. Wide-field resection and lymph node dissection formed the basic tenets of these operations. Oesophagectomy, hepatectomy, pancreatectomy and other major resections followed. These surgical endeavours led to some spectacular cures, but also frequent postoperative deaths and complications. Advances in surgical technique and medical science have reduced the risk of surgery to an acceptable level. The last two decades have seen patients presenting with earlier and smaller cancers, prompting reexamination of the basic tenets of oncological resection. Radiotherapy as an adjunct to surgery has reduced the need for wide radical resection of cancer of the breast, rectum and many other sites. Prospective randomized clinical trials have validated the safety of lesser scopes of surgical resection for breast cancer and cutaneous melanoma. The classical radical mastectomy is now seldom carried out. Simple wedge excision (so-called 'lumpectomy') is now the most common operation for breast cancer. Wide radical resection continues to be advocated for cancer of the lung, oesophagus, stomach, and pancreas, but its benefit needs to be confirmed by similar controlled trials. Adjuvant chemotherapy given after resection of breast and colon cancer has proven survival benefit. Chemotherapy can also shrink some bulky, unresectable cancers, making them resectable. Advances in molecular biology have recently allowed the introduction of novel therapeutic agents which can abrogate the growth and progression of some cancers at the molecular level. Technological advances have enabled the development of minimally invasive cancer treatment techniques. Procedures such as radiosurgery, radiofrequency ablation, and video-assisted endoscopic resections can achieve cancer control with minimized risk and morbidity. The new millennium will see continued evolution in the role of surgery in the treatment of cancer.
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