Surgery

Breast cancer surgery has a central role in the long history of cancer. The story of how operations became radical – with all that entailed in disfigurement and distress – and then conservative in line with new scientific understanding, is a mainly European one but with the insight too of one outstanding American.

How can breast tumours that have no ‘palpable’ lumps be located precisely during surgery? A radiotracer injected into the lesions guides the surgeon to the site and results in a higher rate of excision of all the cancer.

The idea that lymph nodes can be guarded by a single ‘sentinel’ node proved to be correct and in breast cancer the status of this key node has played a pivotal role in avoiding unnecessary lymph node surgery without compromising on further treatment decisions. But it’s an evolving story.

Stereotactic radiosurgery – using focused beams of radiation to treat tumours and other abnormalities – was the brainchild of Swedish neurosurgeon, Lars Leksell. It has become widely deployed to treat brain metastases with a machine that bears his name – the Leksell Gamma Knife.