how can doctors be confident in saying "we got all of the cancer"?
how can doctors be confident in saying "we got all of the cancer"?
When I watch TV I often hear the doctors (actors) assure patients and their family that they got "all of the cancer" during removal surgeries.
In my mind.. I always thought that cancer was a lump of cells.. multiplying uncontrolled.. and at some point along its margins, it borders normal tissue.
How can you possibly cut perfectly between normal tissue and cancerous tissue?
That's what TV says. In reality, people get tested for years after it's in remission. https://xkcd.com/931/
Does anyone else feel like the first pane is upside down?
Many TV writers are ignorant dorks. Cancer is never "cured," it's "in remission." Cells at the margin that have been excised are biopsied, which can allow doctors to say "the margins are clear." That's what my doctor said to me, looking a little wary. "Why the long face?" I asked. "I don't trust squamous cells," he replied.
How can you possibly cut perfectly between normal tissue and cancerous tissue?
As you suspected, you can't. That's why a lot of cancer removal surgeries will remove a little potentially healthy tissue along the borders (if it's not important), and err on the safe side.
There's also some situations where the cancer may be benign, and you remove the entire body part it was attached to (like removing the relevant testicle in testicular cancer), which can give a greater likelihood of getting the whole tumour, but it's not a certainty, and you would still need monitoring/treatment, just to check that there's no relapse, or surprise cancer cells popping up elsewhere.
TV probably simplifies it for plot/drama reasons. Unless it's specifically relevant to the plot, it adds unnecessary complications for the character to spend the next several years going back to the doctor for monitoring, or leaving the audience wondering whether the cancer had been removed or not.
Cancer is never cured. Testing goes on your in remission. If your lucky it won't come back or go bad again.
I guess you use enough margin? I have a friend who had breast cancer but they found it at an early stage and by removing the whole breast, they were confident that cancerous cells were contained and hadn't spread to the rest of the body yet.
They examine the cut edges of the tissue removed and check whether there are any cancer cells on that cut surface. If there are, they know they left some behind. If there aren't, they can be reasonably sure that they got it all (assuming surgery was possible for all known cancer sites). Monitoring will remain fairly intensive following surgery to try to catch any recurrence early.
Adjuvant treatment, usually radiotherapy or chemotherapy, will often be used after surgery to try to mop up any remaining cancer cells which cannot be macroscopically detected, especially in cancers which are prone to spread beyond the original site of the cancer.