Tumor Biology and Oncology

Abstract

The role of surgery in the management of human neoplasias is constantly undergoing reevaluation. Less surgical radicality reduces mutilating side-effects without a decrease in long-term survival if adjuvant chemotherapy is given. On the other hand, the surgical excision of isolated metastases helps to maintain curative intent even in the presence of residual disease after chemotherapy. Many experimental and clinical observations point to a predilection of circulating tumor cells for certain organs. Thus, the metastatic process is not simply a series of random events but rather governed by anatomical determinants such as venous and lymphatic drainage of the primary tumor and also by the intrinsic metastatic potential of the tumor cells themselves. The complex biology of metastasis is discussed with special reference to the surgical removal of isolated metastases.