By the time cancer is detectable at all, much less someone notices and decides to get tested, the tumor likely has at the bare minimum hundreds of thousands of cells, if not millions or more. It might not grow as a nice confined lump either, it could be more vein-like, or cells have broken off to form new tumors elsewhere
Most of the time the main tumor is removed manually, but if the cancer has already spread, the tumor is growing a difficult spot, or a spot where a lot of cutting could kill you, alternative methods may be used.
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