Specialized surgical oncology covers cancers that do not sit neatly under one organ system. Most of the cases on this page involve collaboration with medical oncology, radiation oncology, or both, as part of a coordinated treatment plan. Dr. Jabbar handles the surgical portion of that plan.
This page describes the conditions he treats in this area and the operations he performs, written for patients and families who want to understand what their diagnosis means and what surgery actually involves.
The conditions below are the most common reasons patients are referred to Dr. Jabbar’s practice for specialized surgical oncology. Each is covered briefly, focusing on the patterns that come up most often in the clinic.
Soft tissue sarcoma is a rare cancer that starts in the body’s connective tissues — muscle, fat, blood vessels, nerves, tendons, and the lining of joints. There are dozens of subtypes (leiomyosarcoma, liposarcoma, undifferentiated pleomorphic sarcoma, and others), and treatment depends heavily on the subtype and the tumor’s location.
Retroperitoneal sarcoma is a particularly challenging subset. It develops behind the abdominal cavity, near the kidneys, the great vessels, and other deep abdominal structures. Because the retroperitoneum has so much room, these tumors often grow very large before they produce symptoms, and the surgery to remove them often requires removing one or more adjacent organs to clear a margin.
Symptoms depend on location. An extremity sarcoma usually presents as a painless lump or swelling that may be firm, warm, or growing quickly. Retroperitoneal sarcomas tend to present with vague abdominal fullness, back or flank pain, early fullness with meals, or unintended weight loss once the tumor has reached a substantial size.
Risk factors include inherited syndromes (Li-Fraumeni, neurofibromatosis type 1, hereditary retinoblastoma), prior radiation to the affected area, chronic lymphedema, and certain chemical exposures (vinyl chloride, dioxin). Many sarcomas occur without an identifiable risk factor.
Diagnosis combines imaging (MRI for extremity lesions, CT for retroperitoneal disease) with an image-guided core needle biopsy interpreted by a pathologist experienced in sarcoma. The biopsy determines the specific subtype and grade, which drive every subsequent treatment decision.
Surgery is the cornerstone of curative treatment. The goal is complete removal of the tumor with negative (cancer-free) margins, often requiring resection of adjacent structures or organs. Radiation therapy is commonly combined with surgery, given before or after the operation depending on the subtype and location. Chemotherapy and targeted therapy are used for selected subtypes and for metastatic disease.
Breast cancer is cancer that begins in the cells of the breast. The two most common invasive types are invasive ductal carcinoma (the most common, arising from the milk ducts) and invasive lobular carcinoma (arising from the milk-producing lobules). Ductal carcinoma in situ, or DCIS, is the earliest, noninvasive form: abnormal cells are confined inside a milk duct and have not yet broken through the duct wall. DCIS is treated to prevent it from progressing to invasive cancer.
Symptoms of invasive breast cancer can include a new lump or thickening in the breast or underarm, a change in the size or shape of the breast, skin changes (dimpling, puckering, an “orange peel” texture), a nipple turning inward or new nipple discharge, and redness, scaling, or pitting of the skin over the breast or areola. DCIS usually causes no symptoms and is most often detected on screening mammograms as suspicious microcalcifications.
Risk factors include older age, female sex (men can also develop breast cancer, though the risk is much lower), personal or family history of breast cancer, inherited gene mutations (BRCA1, BRCA2, and others), early menarche, late menopause, no pregnancies or a first pregnancy after age 30, dense breast tissue, prior chest radiation, hormone therapy, obesity, and alcohol use.
Workup includes a diagnostic mammogram, breast ultrasound, sometimes a breast MRI, and an image-guided core needle biopsy with hormone receptor testing (ER, PR, and HER2). These results drive both surgical and medical treatment decisions.
Surgery is the foundation of breast cancer treatment for most patients. Options include lumpectomy (breast-conserving surgery, usually followed by radiation) and mastectomy, both described in the procedures section below. Sentinel lymph node biopsy is added for invasive disease to check whether cancer has spread to the underarm lymph nodes. Systemic treatment may include chemotherapy, hormone (endocrine) therapy for receptor-positive disease, HER2-targeted therapy, and immunotherapy. DCIS may be treated with breast-conserving surgery, usually followed by radiation, or with mastectomy. Endocrine therapy may be considered after breast-conserving surgery for hormone-receptor-positive disease based on recurrence risk and patient preferences.
Male breast cancer is rare. It develops in the small amount of breast tissue men have behind the nipple. Nearly all cases are invasive ductal carcinoma, and the great majority are strongly hormone-receptor-positive.
The most common sign is a painless lump or thickening in the breast tissue. Other signs include skin changes over the breast (dimpling, puckering, redness, scaling), a nipple that turns inward (retraction), redness or scaling of the nipple or areola, and nipple discharge.
Risk factors include older age (most diagnoses occur in men in their 60s), family history of breast cancer, BRCA mutations (especially BRCA2), Klinefelter syndrome, elevated estrogen exposure (cirrhosis, obesity, certain hormone therapies), prior chest radiation, and testicular disease.
Diagnosis is made by clinical breast exam, diagnostic mammogram and ultrasound, and core needle biopsy with receptor testing.
Surgery is the primary treatment. Because men have limited breast tissue and tumors usually sit centrally near the nipple, mastectomy with sentinel lymph node biopsy is the most common operation. Lumpectomy is less often appropriate because of the limited tissue and the difficulty achieving a good cosmetic result. Radiation, chemotherapy, hormone therapy (typically tamoxifen), and HER2-targeted therapy are added based on tumor biology and stage.
The three major types of skin cancer are basal cell carcinoma, squamous cell carcinoma, and melanoma. They differ significantly in how they behave, how they are treated, and how often they require a surgeon.
Basal cell carcinoma is the most common skin cancer. It tends to appear on sun-exposed skin as a pearly or waxy bump, a flat flesh-colored or brown scar-like lesion, or a sore that bleeds, scabs over, and returns. It very rarely spreads to other parts of the body, and most cases are cured with surgical excision or Mohs surgery performed by a dermatologic surgeon.
Squamous cell carcinoma typically appears as a firm red nodule, a flat lesion with a scaly crust, or a sore that does not heal. It can spread to the lymph nodes if neglected. Treatment is also typically surgical excision or Mohs surgery.
Melanoma is the skin cancer most likely to involve a general or surgical oncologist, because it can spread to other parts of the body even when the original skin lesion is small. The warning signs are described by the ABCDE rule: Asymmetry (one half does not match the other), irregular Borders, multiple Colors within the lesion, Diameter may be larger than about 6 millimeters, although melanomas can be smaller, and Evolving (the lesion is changing in size, shape, color, or height, or is itching or bleeding).
Risk factors include cumulative ultraviolet exposure from the sun or tanning beds, a history of blistering sunburns, fair skin, light eyes, red or blond hair, many moles or atypical moles, a personal or family history of skin cancer, immunosuppression (organ transplant, long-term immunosuppressive medications), and older age.
Diagnosis starts with a careful skin exam followed by a biopsy of the suspicious lesion (shave, punch, or excisional). For melanoma, the pathology report includes a Breslow depth measurement that determines how much normal tissue needs to be removed at the second operation, and whether a sentinel lymph node biopsy is needed.
The surgical treatment for melanoma is a wide local excision, in which the area where the original lesion was removed is re-excised with a defined margin of normal skin (usually 1 to 2 centimeters, depending on Breslow depth). Sentinel lymph node biopsy is added for intermediate- and high-risk melanomas to check whether cancer has spread to the regional lymph nodes. Advanced melanoma is treated with immunotherapy and targeted therapy.
Primary tumors that start in the spleen are rare. Most splenic masses that require surgery are part of a larger systemic process. The most common reason a surgeon is asked to remove the spleen is lymphoma (Hodgkin, non-Hodgkin, and splenic marginal zone lymphoma in particular), followed by autoimmune blood disorders (immune thrombocytopenia, or ITP), hereditary blood disorders, large benign cysts or vascular tumors, and trauma.
Symptoms of a splenic process include pain or fullness in the left upper abdomen, feeling full quickly with meals (because an enlarged spleen presses on the stomach), fatigue or shortness of breath from anemia, easy bruising or bleeding from low platelets, and — when lymphoma is the cause — unexplained weight loss, drenching night sweats, or fevers. Many splenic masses are found incidentally on imaging.
Workup includes CT or MRI to characterize the splenic mass and check for enlarged lymph nodes elsewhere. A PET scan is used in the staging of lymphoma. Image-guided biopsy of a splenic mass is an accepted option in selected patients when the result will change management, with bleeding risk assessed beforehand. Splenectomy is sometimes needed for diagnosis or treatment.
Splenectomy is both diagnostic and therapeutic for several splenic conditions, including isolated splenic lymphoma (particularly splenic marginal zone lymphoma), large or symptomatic splenic masses, and ruptured spleens after trauma. Medical management is the primary treatment for most systemic lymphomas; splenectomy is reserved for cases in which the lymphoma is causing problems from splenic enlargement, blood cell counts are dropping because of an oversized spleen, or tissue is needed for diagnosis. ITP is managed medically first, with splenectomy reserved for cases that do not respond.
The adrenal glands are small, triangular, hormone-producing glands that sit atop each kidney. They produce several important hormones, including cortisol (the stress hormone), aldosterone (which regulates blood pressure and electrolyte balance), sex hormones, and catecholamines (adrenaline and noradrenaline). Adrenal tumors can be silent (nonfunctional) or can produce excess hormones (functional), and the clinical picture — and the urgency of treatment — depends heavily on which kind it is.
Pheochromocytoma is a rare tumor of the inner adrenal gland (the medulla) that produces catecholamines. It causes episodic spells of dangerously high blood pressure, pounding headache, heavy sweating, rapid heartbeat, tremor, pallor, and anxiety. Patients are sometimes worked up for years for unexplained “spells” before the diagnosis is finally made.
Other functional adrenal tumors include cortisol-producing adenomas (causing Cushing syndrome, with weight gain in the trunk and face, easy bruising, muscle weakness, diabetes, and mood changes), aldosterone-producing adenomas (causing difficult-to-control high blood pressure with low potassium), and sex-hormone-producing tumors (causing virilization in women or breast enlargement in men). Nonfunctional adrenal masses are usually silent and are most often found incidentally on a CT or MRI done for another reason.
Risk factors include genetic syndromes (MEN2, von Hippel-Lindau, neurofibromatosis type 1, hereditary paraganglioma syndromes), family history, and increasing age for incidental adrenal masses.
Workup combines biochemical testing (plasma or 24-hour urine metanephrines for pheochromocytoma, cortisol and ACTH studies for Cushing syndrome, aldosterone-to-renin ratio for primary aldosteronism) with a dedicated adrenal-protocol CT or MRI to assess the size of the mass and look for features suggesting malignancy.
Adrenal surgery is recommended for hormone-producing tumors and considered for lesions with suspicious imaging features, significant growth, or other malignancy risk. Size is one factor, but a 4-centimeter measurement alone does not determine treatment. Pheochromocytoma requires special preoperative preparation: patients are placed on alpha-blocker medication (typically phenoxybenzamine or doxazosin) for 10 to 14 days before surgery to prevent dangerous blood pressure swings during the operation. Small, nonfunctional, imaging-benign adenomas are usually monitored rather than removed.
The operations below are the most common procedures Dr. Jabbar performs for the conditions described above. Whenever the disease and anatomy allow, they are performed robotically or laparoscopically through small incisions. When the case requires it, the same operations are performed open.
Adrenalectomy is the surgical removal of one or both adrenal glands. The operation is performed for hormone-producing tumors that need to be removed to stop the hormone excess, for adrenal masses with suspicious imaging features, significant growth, or other malignancy risk, and for adrenal cortical cancer. The most common indications are pheochromocytoma, cortisol-producing adenomas, aldosterone-producing adenomas, suspicious adrenal incidentalomas that are growing or have concerning features, selected adrenal metastases from other cancers, and adrenal cortical carcinoma.
Minimally invasive adrenalectomy, performed laparoscopically or robotically, is the standard of care for most benign and small malignant adrenal tumors. The operation can be approached through the abdomen (transabdominal) or through the back (retroperitoneal), depending on the tumor and the patient. Open adrenalectomy is used for very large tumors (typically larger than 6 to 8 centimeters), for known or suspected adrenal cortical carcinoma, or when the tumor invades adjacent structures.
For pheochromocytoma, preoperative preparation is critical. Alpha-blocker medication is started before surgery. A beta blocker may be added for persistent tachycardia only after adequate alpha blockade has been established; fluid and medication plans are individualized to reduce perioperative risk.
Hospital stay is typically one to three days for minimally invasive adrenalectomy and four to seven days for open. Pheochromocytoma patients often spend the first night in a monitored setting, because catecholamine levels drop sharply after the tumor is removed.
Splenectomy is the surgical removal of the spleen. Indications include immune thrombocytopenia (ITP) that has not responded to medical therapy, hereditary spherocytosis, certain other anemias, splenic lymphoma (especially splenic marginal zone lymphoma), large or symptomatic splenic cysts or tumors, splenic abscess, hypersplenism causing severe drops in blood cell counts, and trauma with splenic rupture.
Laparoscopic splenectomy is the standard for elective cases with a normal or moderately enlarged spleen. Robotic splenectomy uses the same minimally invasive approach with the added benefit of three-dimensional visualization and wristed instruments. Open splenectomy is used for massively enlarged spleens, severe inflammation, dense adhesions from prior surgery, or unstable trauma patients.
Patients undergoing elective splenectomy need vaccinations against encapsulated bacteria (pneumococcus, meningococcus, Haemophilus influenzae), ideally two weeks before the operation, because the spleen plays an important role in fighting these infections. Without the spleen, the risk of overwhelming infection from these organisms is higher than in the general population.
Hospital stay is typically one to three days for laparoscopic or robotic splenectomy and four to seven days for open or trauma cases.
Lumpectomy — also called partial mastectomy or breast-conserving surgery — removes the cancer along with a rim of surrounding healthy tissue while leaving the rest of the breast intact. It is the standard surgical option for many early-stage breast cancers and for DCIS.
Lumpectomy is appropriate when the tumor is small relative to the breast and a clear margin can be achieved with an acceptable cosmetic result. It is generally not appropriate for multicentric disease (cancer in multiple quadrants of the same breast), for patients who cannot receive radiation, for patients with prior radiation to the same breast, or for patients whose margins remain positive after re-excision.
The operation is performed under general anesthesia and is usually outpatient. For non-palpable lesions (cancers detected only on imaging), the radiologist places a wire, radioactive seed, or magnetic marker before surgery so the surgeon can locate and remove the correct tissue. Sentinel lymph node biopsy is added for invasive disease. Oncoplastic techniques (reshaping the breast at the time of the lumpectomy) can improve the cosmetic result for larger tumors or when a significant amount of tissue is removed.
Lumpectomy is almost always followed by radiation therapy to the whole breast or part of the breast to reduce the risk of local recurrence. In appropriately selected patients, long-term cancer outcomes for lumpectomy plus radiation are equivalent to those for mastectomy in the published literature.
The procedure is outpatient; most patients go home the same day.
Mastectomy is the surgical removal of the entire breast. There are several variants, differing in which surrounding tissues are removed and which skin and nipple are preserved.
A simple (or total) mastectomy removes all breast tissue, the nipple, the areola, and the overlying skin, but does not remove the axillary lymph nodes (a sentinel lymph node biopsy can be added for invasive disease).
A modified radical mastectomy combines a simple mastectomy with a level I and II axillary lymph node dissection (removal of the underarm lymph nodes). Its use is individualized because many patients with limited nodal disease can avoid full axillary dissection depending on the breast operation, radiation plan, systemic therapy, and response to treatment.
A skin-sparing mastectomy removes all breast tissue, the nipple, and the areola but preserves the skin envelope. This makes immediate reconstruction technically easier and produces a better cosmetic result.
A nipple-sparing mastectomy preserves the entire skin envelope, including the nipple and areola. It is oncologically safe in appropriately selected patients and is increasingly used both for cancer treatment and for risk-reducing surgery in patients with BRCA mutations or other high-risk genetic profiles.
Indications for mastectomy include larger tumors, multicentric disease, inflammatory breast cancer, recurrence after prior lumpectomy and radiation, risk-reducing surgery chosen by carriers of BRCA or other high-risk mutations, patient preference, and cases where breast conservation cannot achieve negative margins or an acceptable cosmetic result.
Hospital stay ranges from outpatient to one or two days for simple or nipple-sparing mastectomy without reconstruction, one to three days with immediate implant reconstruction, and longer for autologous (tissue flap) reconstruction.
Both of these operations check whether cancer has spread from a breast tumor (or a melanoma) to the regional lymph nodes. They differ in the number of nodes removed.
Sentinel lymph node biopsy (SLNB) identifies and removes the first one to three lymph nodes that drain the tumor area. The principle is that if the cancer has spread to the regional lymph nodes, the first nodes it reaches are the sentinel nodes. If the sentinel nodes are clean, the remaining regional lymph nodes are very likely to be clean as well, and a more extensive dissection is not needed.
SLNB is the standard staging approach for clinically node-negative invasive breast cancer and for intermediate- to high-risk melanoma. It is done at the same time as the cancer resection (lumpectomy, mastectomy, or melanoma wide excision). A radioactive tracer, blue dye, or both is injected near the tumor (or near the areola for breast cases), and the surgeon uses a gamma probe and visual inspection to locate the sentinel node or nodes through a small incision.
Axillary lymph node dissection (ALND) removes most of the level I and II underarm lymph nodes. It is used when the sentinel nodes contain significant cancer, when axillary nodes are known to be involved at the time of diagnosis, or when bulky residual nodal disease remains after neoadjuvant therapy. ALND is performed through a larger axillary incision.
SLNB alone is typically outpatient. ALND is performed as an outpatient procedure or with an overnight stay, and a surgical drain is usually placed and left for one to two weeks. ALND carries a meaningfully higher long-term risk of lymphedema (arm swelling), numbness, and shoulder stiffness than SLNB does.
An excisional breast biopsy is a surgical operation to remove a suspicious breast lesion (or a representative portion of it) for pathologic diagnosis. It is a diagnostic operation, not a cancer-removing operation. Most breast biopsies today are done by interventional radiology using image guidance and a core needle, but there are specific situations where a surgical biopsy is the right answer.
Excisional biopsy is used when an image-guided core needle biopsy is not technically possible (because of lesion location, very thin breast tissue, or calcifications that cannot be reached with stereotactic biopsy), when a core biopsy returned an inadequate or non-diagnostic sample, when there is a mismatch between what the imaging shows and what the pathology returned, or when a core biopsy identified a “high-risk” lesion that needs full excision to make sure there is no cancer next to it. High-risk lesions that typically warrant excisional biopsy include atypical ductal hyperplasia (ADH), atypical lobular hyperplasia, lobular carcinoma in situ (LCIS), papillary lesions, radial scar, and phyllodes tumor.
The operation is outpatient, done under local anesthesia with sedation or under general anesthesia. For non-palpable lesions, the radiologist places a wire, seed, or magnetic marker before surgery so the surgeon can locate and remove the correct tissue. The specimen is X-rayed in the operating room to confirm that the target area has been removed before closure.
Cytoreductive surgery (CRS) is a major abdominal operation that removes all visible cancer from the inside of the abdominal cavity. It often combines peritonectomy (stripping the lining of the abdomen) with resection of involved organs (the omentum, segments of bowel, the spleen, the gallbladder, or pelvic structures), all in the same operation. The goal is to leave no visible tumor behind.
Surgical debulking is a related, broader concept. It refers to operations that reduce tumor burden when complete removal is not achievable, in order to relieve symptoms (obstruction, ascites, pain, bleeding) or to improve the effectiveness of other treatments.
CRS is performed for advanced abdominal malignancies with peritoneal spread, including ovarian cancer (where surgical debulking is standard), appendiceal cancer with pseudomyxoma peritonei, peritoneal mesothelioma, selected cases of colorectal peritoneal carcinomatosis, and certain gastric or recurrent abdominal tumors. CRS can be done with curative intent when complete cytoreduction is achievable, or with palliative intent when the goal is symptom relief rather than cure.
A note on HIPEC: at specialized peritoneal-surface malignancy centers, complete cytoreduction is followed in the same operation by hyperthermic intraperitoneal chemotherapy (HIPEC) — heated chemotherapy circulated through the abdomen. CRS combined with HIPEC is the curative-intent standard of care for appendiceal cancer with pseudomyxoma peritonei, for peritoneal mesothelioma, and for selected colorectal carcinomatosis.
Dr. Jabbar does not perform HIPEC. He performs CRS as part of patient evaluation and surgical care, handles cases where HIPEC is not indicated or where the goal is palliative, and coordinates referrals to a HIPEC center for patients who are candidates for the combined CRS-plus-HIPEC approach.
The operation is performed open, through a long midline incision. It is often lengthy (six hours or more in extensive cases) and may involve multiple organ resections and bowel reconstruction. Hospital stay is generally 7 to 14 days for major cytoreduction, and longer if complications occur. Full recovery typically takes several weeks.
