Cancer Prevention

With the exponential increase in our understanding of inherited genetic mutations and the identification of patients who are predisposed to malignant transformation, surgical therapy has expanded beyond the therapy of established tumors and into the prevention of cancer. Prophylaxis is not a new concept in surgical oncology. Patients with chronic inflammatory diseases are known to be at high risk of subsequent malignant transformation. This realization typically prompts close surveillance and surgical resection at the first identification of premalignant changes. However, with the ability to perform genetic screening for relevant mutations, cancer prevention can be implemented before the onset of symptoms or histologic changes. With the decoding of the entire human genome, it is likely that more genes responsible for specific cancers will be identified, and the potential role for prevention will expand. Although many interventions may ultimately be nonsurgical (such as tamoxifen for the chemoprevention of breast cancer), the role of surgical therapy remains a primary option in the prevention of cancer. It is for this reason that all surgical oncologists must be aware of those high-risk situations that require surgery to prevent subsequent malignant disease (Table 4.3).

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