Understanding Surgical Treatment of Cancer
by Dr. C.H. Weaver M.D. updated 10/2019
Nearly all patients with cancer will have some kind of surgery.
FAQ's About Cancer Surgery, Preparation for Surgery, and What you need to Know About Post-Surgical Care
Surgery may be used to perform a biopsy in order to obtain a specimen for determining an accurate diagnosis, provide local treatment of the cancer, and obtain other information to help determine whether additional treatment is necessary. Surgical techniques continue to improve, and surgeries are now less invasive and often performed on an outpatient basis. Discussed below...
- Answers to Frequently Asked Questions About Surgery for Cancer
- Preparing for Cancer Surgery
- Post Surgical Care for Surgery
In order to diagnose a cancer, a physician will typically perform a biopsy of a suspicious area, lump or mass suspected of being cancer. A biopsy can be performed on an outpatient basis. During a biopsy, part or all of the suspected cancer is removed and cells contained in the sample are sent to a pathology laboratory to determine whether cancer is present. Other information including genomic testing is obtained from the biopsy sample and can play an important role in treatment decisions.
Patients should discuss the role of genomic testing with their doctor to make sure the tissue removed during surgery is available to evaluate whether precision cancer medicines might be a treatment option. If the biopsy indicates that cancer is present, additional tests to determine the stage of cancer will be performed. Surgery may be performed as part of the staging evaluation and/or as part of treatment after the patient and doctor determine the overall treatment plan.
The successful treatment of cancer often requires the involvement and coordination of several different treatment approaches. This is referred to as multi-modality treatment and may consist of surgery, radiation therapy, systemic treatment with precision cancer medicines or chemotherapy and/or hormonal therapy. It is important to understand that surgery is a local treatment and is only capable of treating the cancer cells removed during surgery. By the time a cancer is diagnosed, many patients will already have experienced spread of cancer cells through the blood and lymph system to other locations in the body. These cancer cells are referred to as micrometastases.
Information obtained during surgery and from other tests determines the likelihood of the cancer having spread and whether additional systemic treatment with precision cancer chemotherapy, hormonal therapy or radiation is necessary to kill the cancer micrometastases responsible for a cancer recurrence. The following sections may answer additional questions that you have about undergoing surgery.
Answers to Frequently Asked Questions About Cancer Surgery
Will I need to have surgery?
Although most patients will have a biopsy performed, however, not all cancers require surgical treatment. Some cancers are best treated with radiation therapy or chemotherapy. In some instances, the cancer may be too big or difficult to remove with surgery. Your healthcare team will work with you to determine whether surgery is part of your overall treatment plan. If surgery is necessary, you will undergo a number of tests to determine whether you are an appropriate candidate for surgery.
What is the operation (procedure) that is recommended?
Ask your surgeon for a simplified explanation of the type of operation, technique used, and why it should be performed. (Pictures and drawings tell patients and family a great deal.)
What is the surgeon’s experience with this procedure?
Ask the surgeon about his experience with this procedure, its outcome, and the hospital or setting in which the operation will be performed.
What is the reason that this procedure is necessary at this time?
Is the procedure being done to relieve pain, diagnose a condition, correct deformity, for cosmetic reasons, or what exact purposes?
What are the options if this procedure is not done?
What are the non-surgical or medical treatments available? What will/might happen if the operation is not done at this time? If the operation is not done at this time, can it be done later? What are the advantages and disadvantages?
Are there alternatives to surgery?
Surgery may be the only treatment available or one of several choices or part of an overall treatment strategy that includes other treatments, such as radiation or chemotherapy. Ask your doctor how the recommended surgical treatment compares to other non-surgical treatment options and why surgery is best for you.
What is the goal of surgery?
What exactly are the expected or possible benefits of doing the procedure? Is the goal of surgery to cure the cancer, prolong life, or relieve symptoms and improve quality of life?
What should I know about the risks of surgery?
Surgery does involve risks and side effects, depending on the type of surgery you have, and the expertise and experience of the surgeon and hospital. Generally, the more invasive or complicated the surgery, the greater the risk of side effects. Additionally, research has indicated that hospitals and surgeons that perform more surgeries like yours have better outcomes. Before you have your surgery, you may want to get a second opinion from another surgeon and inquire as to the track record of his/her hospital.
Should I get a second opinion?
It is very common and appropriate to seek out a second opinion. This will not be a problem with the first surgeon who will recognize this as commonplace. If you choose to have surgery, the surgeon will tell you about all of the risks, side effects and benefits associated with your specific surgical procedure. Second opinions can reassure anxious patients (and family members) to make the whole process easier for all involved.
Where should I get surgery?
Several prior publications have indicated that outcomes of patients undergoing surgery may be significantly improved if they are treated in a hospital that has performed a large volume of such procedures. These results are presumed to be due to a more skilled and dedicated healthcare team that has experience with high-risk situations, as well as the attendance of skilled surgeons in such hospitals. However, the role of an individual surgeon in terms of surgical volume and patient outcome has been less well-defined in medical literature.
Patients undergoing complex surgical procedures have a significantly reduced risk of operative mortality if their surgeon has performed a large volume of the specific procedure compared to patients whose surgeon has performed a low volume of the procedure. Patients who are to undergo a complex surgical procedure should speak with their surgeon about their particular risks or ask their physician to refer them to a surgeon who performs a large number of the surgical procedure in which they are to undergo for treatment of their disease.
What are the specific risks of anesthesia?
What are the risks of the type of anesthesia to be used? What are the possibilities for anesthesia methods (local, regional, general, etc.)?
What is the recovery process after this procedure?
Procedures each vary in terms of wound recovery and rehabilitation programs. It is very important for patients to know the long-term program ahead of time for the best planning.
Should I have surgery before or after chemotherapy?
Chemotherapy that is administered before surgery is referred to as neoadjuvant therapy and chemotherapy that is administered after surgery is referred to as adjuvant therapy. Patients should ask their doctor if the treatment of their disease typically involves neoadjuvant or adjuvant chemotherapy.
Preparing for Cancer Surgery
You can help ensure that your cancer surgery and recovery go smoothly and that you have the best outcome possible by preparing yourself ahead of time. Here are a few tips to prepare you for cancer surgery, and help you recover more quickly:
Educate yourself. Learn as much as you can about your scheduled surgery ahead of time. Ask your medical team to explain your surgery and ask them to refer you to additional resources (such as journal articles and online material). Make sure all your questions are answered.
Ask about your choices for anesthesia. Options for anesthesia include local, regional, and general and, depending on the type, can be administered through IV or injection or can be inhaled. Find out which options are appropriated for your surgery and how anesthesia may affect you.
Be prepared to manage pain after surgery. You may experience discomfort after surgery, but there are ways to manage the pain. Ask your doctor about pain medications as well as other methods to ease discomfort; relaxation techniques, heat or cold therapy, and message are a few examples.
Reduce risk of infection. There is a risk of infection in hospitals (MRSA, a form of staph, for example). You can lower your risk by making sure you healthcare team washes and sanitizes their hands before treating you and by watching for signs of infection such as fever, chills, and weakness. Ask your doctor about other symptoms of infection.
Learn about your risk for blood clots. Surgery may put you at a higher risk of potentially life-threatening blood clots such as deep vein thrombosis and pulmonary embolism. Risk increase with age, smoking, being overweight, and a history of blood clots or cancer. Some medication also increases risk of clotting, so be sure to tell your doctor about all medications you are taking.
Tell your doctor about all your medical conditions. It’s important that your healthcare team is aware of any health issues, such as diabetes, high blood pressure, heart or lung conditions, as well as food and drug allergies.
Discuss all medications you are currently taking. Some medications, both prescription and over the counter, can put you at risk for complications during surgery. Your doctor can tell you which drugs you may need to stop taking before surgery.
Tell your doctor if you take supplements. Even natural supplements (such as vitamins and herbs) can be associated with a risk of surgical complications. Discuss all supplement use with your doctor before surgery. He or she can advise you on supplements to avoid around the time of surgery.
Find out if you need to donate blood. If there’s chance that you’ll need a transfusion during surgery, your doctor may suggest that you donate blood prior to the procedure. Blood must be donated at least four weeks before surgery.
Plan care after surgery. You may need assistance once you return home. Ask family and friends to help and prepare your home by stocking up on groceries and necessary personal items. Have bandages and other supplies on hand to care for surgical wounds.
Arrive for surgery with an empty stomach. Anesthesia can cause vomiting and interfere with normal reflexes that keep you from inhaling stomach contents, which creates a risk of choking and other complications. You doctor will tell you when before surgery you should stop eating and drinking.
Cut back on alcohol. Alcohol can cause serious complications during surgery, including increased bleeding and damage to the liver. Avoid alcohol before surgery or ask your doctor what amount you can safely consume.
Stop smoking. People who smoke have an increased risk of infection and other surgical complications. If you smoke and are planning to have surgery, it’s a good time to quit.
Post-Surgical Care for Cancer Surgery
Following any surgery, the wound must be kept clean to avoid infection.
Patients will typically have a sterile bandage placed on the wound and may have a drain inserted to prevent body fluid from collecting at the surgical site. This should help minimize swelling and pain, and also allow for quicker healing. Patients may have more than one drain. Each drain consists of a collection tube that is stitched to your skin so that it does not fall out. A small plastic plug at the end of the tube allows the fluid to be emptied. The color of the fluid may be dark red at first because of the large amount of blood cells in the area. Gradually, the color should change to pink-tinged and then finally a yellow straw color. The amount of drainage may vary. The more active you are, the more fluid will be produced. Gradually, the fluid will decrease.
Notify your surgeon if the following occurs
- 100.5 F. fever or chills
- Increased areas of redness around the insertion site
- Increased swelling around the insertion site
- Drainage from the wound itself – that is the incision site and not the tubing
- Cloudy fluid that has a bad odor
- Your drain is collecting thick yellowish or green fluid
- Drainage bulb does not stay flat after being emptied
- Wound edges begin to separate
- Pain is not relieved by your pain medication
- Your drainage is increasing instead of decreasing, or if you have a sudden increase in drainage
The surgeon will remove your drain(s) during a follow-up office visit. This usually occurs when the drainage is reduced to between 20 to 50 cc (1 to 3 tablespoons) per a 24 hour period OR four weeks after surgery, whichever comes first. You may feel a pulling sensation with moderate amount of pain only lasting a few seconds when the drain is removed. A small bandage will be placed over the drain site. This will need to be watched for infection for the next several days.
Do not swim or soak in a tub for two days but you may shower. The site should close within 3 to 4 days. You may notice some fluid oozing from the site until healing occurs.