There are specific goals of cancer surgery that need to be defined by the cancer surgeon prior to surgery.

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For cure:  This generally requires the complete removal of all cancer. The completeness of the cancer surgery can be defined by several terms:

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• RO Resection:  complete resection with no microscopic residual tumor (margins are microscopically negative according to the pathologist).

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• R1 Resection:  complete resection with no grossly visible tumor as defined by the surgeon, but microscopic cancer may be left behind (margins are microscopically positive according to the pathologist).  This may need additional surgery, such as with breast cancer, rectal/colon cancer or certain skin cancers.  Other options are to treat the affected margin with radiation and possibly chemotherapy, often seen with pancreatic, biliary malignancies, or certain sarcomas.

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• R2 Resection:  partial resection, with grossly visible tumor left behind.  Sadly, this provides similar survival benefits to simply doing the biopsy alone.  If this seems likely pre-operatively, then discussions need to be undertaken about pre-operative chemotherapy or radiation, palliative surgery (see below), or no surgery at all.  Exceptions to this include certain rare peritoneal malignancies, such as pseudomyxoma peritonei.

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For palliation:  This goal is to relieve suffering, but to not necessarily prolong survival. Frequently, surgery is initially undertaken for cure, but it becomes apparent only an R2 resection can be done.  While the patient is “open”, surgeries are done to relieve pain, bypass obstructions, or provide access for nutrition and electrolytes.

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For diagnosis:  The only way to know for certain that one has cancer and the specific type of cancer is to obtain apiece for the pathologist to analyze.  Hopefully, this can be done non-invasively without surgery, such as with a needle biopsy or endoscopically.  Occasionally, however surgery must be done for diagnosis.