Segmentectomy is the excision (removal) of a portion of any organ or gland. The procedure has several variations and many names, including segmental resection, wide excision, lumpectomy, tumorectomy, quadrantectomy, and partial mastectomy. Segmentectomy is the surgical removal of a defined segment or portion of an organ or gland performed as a treatment. In this case, the purpose is the removal of a cancerous tumor. Common organs that have segments are the breasts, lungs, and liver.
Segmentectomies are usually performed on patients with lung, liver, or breast cancer. Lung cancer is the second most common cancer among both men and women, and is the leading cause of cancer death for both genders. Lung cancer kills more people (approximately 157,000 per year) than cancers of the breast, prostate, colon, and pancreas combined. Almost 90% of all lung cancers are caused by cigarette smoking. Other causes include secondhand smoke and exposure to asbestos and other occupation-related substances.
In each of the racial and ethnic groups, the rates among men are about two to three times greater than the rates among women. Among men, age-adjusted lung cancer incidence rates (per 100,000) range from a low of about 14 among American Indians to a high of 117 among African Americans, an eight-fold difference. For women, the rates range from approximately 15 per 100,000 among Japanese to nearly 51 among Alaska Natives, approximately a three-fold difference.
Excluding cancers of the skin, breast cancer is the most common form of cancer among women in the United States. The increase in incidence is primarily due to increased screening by physical examination and mammography. Although breast cancer occurs among both women and men, it is quite rare among men. White non- Hispanic women have the highest rates of breast cancer, over twice the rate for Hispanic women. There are a low number of cases for Alaska Native, American Indian, Korean, and Vietnamese women.
Primary cancers of the liver account for approximately 1.5% of all cancer cases in the United States. About two-thirds of liver cancers are most clearly associated with hepatitis B and hepatitis C viral infections and cirrhosis. This type of liver cancer occurs more frequently in men than in women by a ratio of two to one.
Description
When cancer is confined to a segment of an organ, removal of that portion may offer cancer-control results equivalent to those of more extensive operations. This is especially true for breast and liver cancers. For breast and lung cancers, a segmentectomy is often combined with removal of some or all regional lymph nodes.
Treatment options for lung cancer depend on the stage of the cancer (whether it is in the lung only or has spread to other places in the body); tumor size; the type of lung cancer; presence (or lack) of symptoms; and the patient’s general health.
A disease in which malignant (cancer) cells form in the tissues of the lung is called non-small cell lung cancer (NSCLC). There are five types of NSCLC; each consists of different types of cancer cells, which grow and spread in different ways. The types of NSCLC are named for the kinds of cells found in the cancer, and how the cells appear when viewed under a microscope.
Segmentectomy may be the treatment of choice for cancerous tumors in the occult, or hidden stage, as well as in stage 0, stage I, or stage II NSCLC. When the site and nature of the primary tumor is defined in occult stage lung cancer, it is generally removed by segmentectomy. Segmentectomy is the usual treatment for stage 0 cancers of the lung, as they are limited to the layer of tissue that lines air passages, and have not invaded the nearby lung tissue. Chemotherapy or radiation therapy is not normally required.
Segmentectomy is recommended only for treating the smallest stage I cancers and for patients with other medical conditions that make removing part or the entire lobe of the lung (lobectomy) dangerous. If the patient does not have sufficient pulmonary function to tolerate this more extensive operation, a segmentectomy will be performed. Additional chemotherapy after surgery for stage I NSCLC is not routinely recommended. If a patient has serious medical problems, radiation therapy may be the primary treatment.
A cancerous tumor will be surgically removed by segmentectomy or lobectomy in cases of stage II NSCLC. A wedge resection might be done if the patient cannot withstand lobectomy. Sometimes pneumonectomy (removal of the entire lung) is needed. Radiation therapy may be used to destroy cancer cells left behind after surgery, especially if malignant cells are present at the edge of the tissue removed by surgery. Some doctors may recommend additional radiation therapy even if the edges of the sample have no detectable cancer cells. Segmentectomy is under investigation for the treatment of small-cell lung cancers.
Because of the need for radiotherapy after segmentectomy, some patients, such as pregnant women and those with syndromes not compatible with radiation treatment, may not be candidates for segmentectomy. As in any surgery, patients should alert their physician about all allergies and any medications they are taking.
Diagnosis / Preparation
The following methods may be used to help diagnose breast cancer:
• complete physical exam and family medical history
• clinical breast exam
• mammography
• biopsy (incisional, excisional, or needle)
• ultrasonography
• fine-needle aspiration
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