Cancer Surgery

Laura Lambert, MDLaura Lambert, MD, is a surgical oncologist in the UMass Memorial Health Care Cancer Center of ExcellenceDr. Lambert is director of the Peritoneal Carcinomatosis Center and a national leader in hyperthermic intraperitoneal chemotherapy, also known as HIPEC. This procedure involves heating chemotherapy during surgery and placing it directly into the abdominal area to kill any microscopic tumor cells that could not be seen at the time of surgery. Learn more about Dr. Lambert in, “Five Questions With...A Surgical Oncologist.”

Our cancer surgeons have expertise and training in many different kinds of tumors, including some types of rare cancers that may be difficult to treat. Our Medical Center surgeons are leaders in minimally invasive laparoscopic and robotic surgery for cancer treatment.

Physician

Laura Lambert, MD

Q:

What is the genetic risk for endometrial cancer, having a direct relative affected? Maternal relative, diagnosed in her 70s.

A:

There is no known genetic risk for endometrial cancer in this setting. The known risk factors for endometrial cancer are increasing age, estrogen therapy without progesterone therapy, late menopause (after age 55), nulliparity (no history of childbearing), polycystic ovary syndrome, obesity, diabetes and Tamoxifen.

There is an increased risk in women with an inherited cancer syndrome known as Lynch syndrome, also called hereditary nonpolyposis colorectal cancer or HNPCC.

Q:

How common is cancer of the appendix and what are the signs and symptoms to look for with this type of cancer?

A:

Appendiceal cancer is very rare. It is reported that there are approximately 1,500 to 2,000 new cases per year in the United States. However, most surgical oncologists who specialize in this disease feel that the incidence is underestimated. The most common presentation is right lower quadrant abdominal pain or discomfort.

Many people present with acute appendicitis. People can also present at much later stages with increasing abdominal girth or new hernias that are filled with the fluid that is often produced by these tumors. Women are often initially diagnosed with ovarian cancer as they frequently present with a large pelvic mass or abnormal vaginal bleeding.

Q:

I know that PMP is a rare cancer but am wondering if this type of cancer spreads through the body the way that other cancers do.

A:

PMP stands for pseudomyxoma peritonei, which is a rare, slow-growing cancer of the appendix. PMP is very rare and usually results from a tumor of the appendix. Although these tumors can spread to other parts of the body, it is extremely rare that they do so. They tend to be a local issue within the abdominal cavity.

Q:

For tumors, is cancer surgery the best form of treatment or is chemo or radiation more effective?

A:

It all depends. In general, for most solid tumors, if the primary tumor has not metastasized (spread to other parts of the body) and can be completely removed by surgery, then surgery is usually consider the best initial treatment. If the cancer has spread to other parts of the body, surgery may still be considered, and it will usually be part of a combined treatment approach (i.e. surgery, plus chemotherapy and/or radiation).

Q:

Can you explain the difference between a lobectomy and a pneumonectomy surgery in terms of the effectiveness and overall outcomes?

A:

The answer to this question depends largely on the individual circumstances of the cancer being treated. If the cancer is localized to one area (lobe) and does not appear to have spread to lymph nodes outside the immediate vicinity, and the tumor and draining regional lymph nodes can be removed with a lobectomy (just removing a portion of the lung), then a lobectomy will be equally as effective as a pneumonectomy, which is removing the whole lung. A lobectomy will leave the person with significantly more lung to use after the surgery.

Q:

Is it more common for a man with colon cancer to experience sexual side affects after surgery than with other cancers? Are these side affects temporary?

A:

If a man has had surgery to remove the lowest portion of his colon called the rectum, he can experience sexual dysfunction as the nerves that are responsible for an erection run very close to or through the area where the surgeon has to operate to remove the cancer. Sometimes it is temporary but other times it may be permanent. If you are concerned, you should speak with your surgeon.

Q:

How common is hormone therapy as a treatment over surgery for prostate cancer?

A:

The primary treatment for most patients with newly diagnosed prostate cancer (Stages 1-3) is either surgery (prostatectomy) or radiation therapy to the prostate. Hormone therapy is used as an additional treatment if the cancer is found to have spread to the lymph nodes at the time of surgery, or it may be used prior to surgery in combination with radiation therapy in people with more advanced or high-risk disease.

Hormone therapy alone as the initial treatment is used only for people diagnosed with metastatic disease (Stage 4) (cancer that has spread to other parts of the body). They can receive several different types of hormone therapy over the course of their treatment.

Q:

What is the treatment called where the chemotherapy is poured into the abdomen and mixed up? Does your hospital do this? Does it work?

A:

This treatment is referred to as Hyperthermic Intraperitoneal Chemoperfusion (HIPEC) if it is performed at the time of surgery and is combined with heat. It is referred to as Early Perioperative Intraperitoneal Chemoperfusion (EPIC) if it is given immediately after surgery, without heat. Our hospital performs HIPEC routinely.

It has been shown to work for cancers of the appendix, peritoneal mesothelioma (cancer of the abdominal lining), selected cases of colon cancer and pediatric sarcomas. There is data accumulating to suggest that it works in gynecologic cancers as well. The efficacy of the HIPEC is heavily dependent on removal of all the visible cancer at the time of the surgery.

Please note: Latex Balloons No Longer Allowed at Medical Center

Due to allergic reactions to latex and the possible choking hazard for our pediatric patients, these balloons are no longer allowed. Mylar balloons are acceptable to bring into the hospital.