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Surgery is the oldest form of cancer treatment. It also plays
a key role in the process of diagnosing cancer and finding out how far
it has spread. This process is called staging. Advances
in surgical techniques have allowed surgeons to operate on a growing
number of patients and have good outcomes. When a surgeon has to cut
into the body to operate, it is called invasive surgery.
Today, operations that involve less cutting and damage to nearby organs
and tissues (less invasive surgery) often can be done to remove tumors
while saving as much normal tissue and function as possible.
Surgery offers the greatest chance for cure for many types of
cancer, especially those that have not spread to other parts of the
body. Most people with cancer will have some type of surgery.
How is surgery used for cancer?
Surgery can be done for many reasons. Some types of surgery
are very minor and may be called procedures, while others are much
bigger operations. The more common types of cancer surgeries are listed
here.
Preventive (prophylactic) surgery
Preventive surgery is done to remove body tissue that is
likely to become cancer (malignant), even though there are no signs of
cancer at the time of the surgery. For example, pre-cancerous polyps
may be removed from the colon.
Sometimes preventive surgery is used to remove an entire organ
when a person has an inherited condition that puts them at a much
higher risk for having cancer some day. For example, some women with a
strong family history of breast cancer are found to have a change
(mutation) in the DNA of a breast cancer gene (BRCA1 or BRCA2). Because
their risk of getting breast cancer is high, these women may want to
consider prophylactic mastectomy. This means the breasts are removed
before cancer is found.
Diagnostic surgery
This type of surgery is used to get a tissue sample to tell if
cancer is present or to tell what type of cancer it is. The diagnosis
of cancer is often made by looking at the cells under a microscope.
There are many ways to get a sample of cells from an area that looks
like it may be cancer. These are described in the section, "Surgery to
diagnose and stage cancer."
Staging surgery
Staging surgery is done to find out how much cancer there is
and how far it has spread. The physical exam and the results of lab and
imaging tests are used to figure out the clinical stage of
the cancer. But the surgical
stage (also called the pathologic stage)
is usually a more exact measure of how far the cancer has spread. To
learn more about this, please see our information on Staging.
Examples of surgical procedures commonly used to stage
cancers, such as laparotomy and laparoscopy, are described in the
section, "Surgery
to diagnose and stage cancer."
Curative surgery
Curative surgery is done when a tumor is found in only one
area, and it is likely that all of the tumor can be removed. Curative
surgery can be the main treatment for the cancer. It may be used alone
or along with chemotherapy or radiation therapy, which can be given
before or after the operation. Sometimes radiation therapy is actually
used during an operation. This is called intraoperative
radiation therapy.
Debulking (cytoreductive) surgery
Debulking surgery is done to remove some, but not all, of the
tumor. It is done when removing all of the tumor would cause too much
damage to an organ or near-by tissues. In these cases, the doctor may
take out as much of the tumor as possible and then try to treat what's
left with radiation therapy or chemotherapy. Debulking surgery is
commonly used for advanced cancer of the ovary.
Palliative surgery
This type of surgery is used to treat problems caused by
advanced cancer. It is not done to cure the cancer. Palliative surgery
can also be used to correct a problem that is causing discomfort or
disability. For example, some cancers in the belly (abdomen) may grow
large enough to block off (obstruct) the intestine. If this happens,
surgery can be used to remove the blockage. Palliative surgery may also
be used to treat pain when the pain is hard to control by other means.
Supportive surgery
Supportive surgery is done to help with other types of
treatment. For example, a vascular access device such as a port-a-cath
can be surgically placed into a large vein. The port can then be used
to give treatments or draw blood for testing, instead of putting
needles in the arms.
Restorative (reconstructive) surgery
This type of surgery is used to improve the way a person looks
after major cancer surgery, or to restore the function of an organ or
body part after surgery. Examples include breast reconstruction after
mastectomy or the use of tissue flaps, bone grafts, or prosthetic
(metal or plastic) materials after surgery for head and neck cancers.
For more information on these types of reconstructive surgeries, you
can read Breast Reconstruction after
Mastectomy and Oral Cavity and Oropharyngeal
Cancer. They can be read online or you can get a
copy by calling our toll-free number.
Surgery
to diagnose and stage cancer
A biopsy
is a procedure done to remove a tissue sample so that it can be looked
at under a microscope. Some biopsies may need to be done during
surgery. But many types of biopsies are done by removing small pieces
of tumor through a thin needle or through a flexible lighted tube
called an endoscope. Biopsies are often done by surgeons, but they can
be done by other doctors, too. Some of the more common ways to do a
biopsy are described here.
Fine needle aspiration biopsy
Fine needle aspiration (FNA) uses a very thin needle attached
to a syringe to pull out a small amount of tissue. If the tumor
can’t be felt near the surface of the body, the needle can be
guided into the tumor by looking at it using an imaging test, like an
ultrasound (US) or CT (computed tomography) scan.
The main advantage of FNA is that there is no need to cut
through the skin (surgical incision). A drawback is that in some cases
the needle can't take out enough tissue for an exact diagnosis. A more
invasive type of biopsy (one that involves larger needles or cutting
the skin) may then be needed.
Core needle biopsy
This type of biopsy uses a slightly larger needle to take out
some tissue. A core biopsy sample can be removed (aspirated) with a
needle if the tumor can be felt at the surface. Core biopsies can also
be guided by imaging methods if the tumor is too deep to be felt.
The advantage of core biopsy is that it usually collects
enough tissue to find out whether or not the tumor is cancer.
Excisional or incisional biopsy
For these biopsies a surgeon cuts through the skin to remove
the entire tumor (excisional
biopsy) or a small part of the tumor (incisional biopsy).
They can often be done with local or regional anesthesia. This means
numbing drugs are used just in the area where the biopsy will be done.
If the tumor is inside the chest or belly (abdomen), drugs that put you
into a deep sleep (general anesthesia) may be needed.
Endoscopy
This procedure uses a thin, flexible tube with a viewing lens
or a video camera and a fiber optic light on the end. If a video camera
is used, it is connected to a TV screen. This allows the doctor to
clearly see any tumors in the area. Endoscopes can be passed through
natural body openings to look at areas of concern in places such as
those listed below. Any of these procedures can be called an endoscopy,
but the more specific name is given as well:
- throat (pharyngoscopy)
- voice box (laryngoscopy)
- esophagus (esophagoscopy)
- stomach (gastroscopy)
- small intestine (duodenoscopy)
- colon (colonoscopy or sigmoidoscopy)
- bladder (cystoscopy)
- respiratory tract -- windpipe, smaller breathing tubes, and
lungs (bronchoscopy)
Some of the advantages of endoscopy are:
- The doctor can look right at the tumor and get a good idea
of where it is and how big it is.
- A biopsy can be taken through the scope to find out if the
tumor is cancer.
- An open surgical cut (incision) or drugs to make you sleep
(general anesthesia) is usually not needed.
Local numbing medicines are needed before some types of
endoscopy. Medicines may also be given to make you relax or go to
sleep.
Ultrasonography
Ultrasound devices can be attached to the end of some
endoscopes. This allows doctors to look at the layers of the swallowing
tube (esophagus), main breathing tubes (trachea and bronchi), and parts
of the bowel (large intestine). Nearby lymph nodes can be seen, too.
Using the ultrasound pictures to guide it, a needle can be put through
the endoscope and cells can be taken from lymph nodes that do not look
normal.
Laparoscopy, thoracoscopy, or
mediastinoscopy
Laparoscopy is much like endoscopy, but a small cut (incision)
is made in the skin of the belly (abdomen). A thin tube called a
laparoscope is then put through the incision and into the abdomen to
look for possible areas of cancer that can be biopsied.
When this type of procedure is done to look inside the chest
it is called a thoracoscopy or mediastinoscopy.
Open surgical exploration (laparotomy,
thoracotomy, or mediastinotomy)
When easier, less invasive explorations do not give enough
information about an area of concern in the belly (abdomen), a
laparotomy may be needed. In this procedure, a surgeon makes a cut
(incision), usually from the bottom of the breastbone (sternum) down to
the lower part of the abdomen, which allows him to look directly at the
area in question. The location and size of the tumor and the nearby
areas can be seen and biopsies can be taken, if needed. Because this is
a major surgical procedure, the patient is given medicines that put him
in a deep sleep (general anesthesia).
An operation much like this can be done to open and look
inside the chest. It is called a thoracotomy.
If lymph nodes near the trachea are swollen, a mediastinotomy
is done. General anesthesia is also used for this procedure. A special
scope (mediastinoscope) is put in the body through a small incision
above the top of the breastbone (sternum) and biopsies are collected
from the enlarged nodes.
Special surgery techniques
When most people think of surgery, they picture a doctor using
a scalpel and other surgical instruments to remove, repair, or replace
parts of the body affected by disease. But newer techniques, using
different types of instruments, have expanded the concept of what
surgery is. Some of these newer techniques are described here.
Laser surgery
A laser is a highly focused and powerful beam of light energy
which can be used for very precise surgical work, such as repairing a
damaged retina in the eye. It can also be used to cut through tissue
(instead of using a blade or scalpel) or to vaporize (burn and destroy)
some cancers of the cervix, voice box (larynx), liver, lung, rectum, or
skin.
Some surgeries can lead to less cutting and damage (be made
less invasive) by using laser light. For example, with fiber optics and
special scopes the laser can be directed inside a natural body opening
without having to make a large cut (incision). The laser is then
precisely aimed to destroy the tumor. See "Endoscopy" in the section
"Surgery to diagnose and stage cancer."
Lasers are also used in a type of surgery called photoablation or photocoagulation.
This means lasers are used to destroy tissue or to seal tissues or
vessels. This type of surgery is often used to relieve symptoms, such
as when large tumors block the windpipe (trachea) or swallowing tube
(esophagus), causing problems with breathing or eating.
Cryosurgery
Cryosurgery uses a liquid nitrogen spray or a very cold probe
to freeze and kill abnormal cells. This technique is sometimes used to
treat pre-cancerous conditions, such as those affecting the skin,
cervix, and penis. Cryosurgery is also used to treat some cancers, such
as those of the liver and prostate. A scan (like an ultrasound or CT
scan) is used to guide the probe into the cancer and watch the freezing
of the cells. This limits damage to nearby healthy tissue.
Electrosurgery
High-frequency electrical current can be used to destroy
cells. It is used for some cancers of the skin and mouth.
Mohs surgery
Mohs micrographic surgery, also called microscopically
controlled surgery, is used to remove certain skin cancers by shaving
off one thin layer at a time. After each layer is removed, a specially
trained skin doctor (called a dermatologist) or a doctor who
specializes in diagnosing and classifying diseases by lab tests (a
pathologist) looks at the tissue layer under a microscope. When all the
cells look normal under the microscope, the surgeon stops removing
layers of tissue.
Mohs surgery is used when the extent of the cancer is not
known or when as much healthy tissue as possible needs to be saved, as
in cancers around the eye. It is done by a specially trained surgeon
after the skin to be treated is numbed (under local anesthesia).
Chemosurgery is an older name for this type of surgery and
refers to certain drugs that may be put on the tissue before it is
removed. Mohs surgery does not involve use of cancer chemotherapy
drugs.
Laparoscopic surgery
A laparoscope is a long, narrow, flexible tube that can be
placed through a small cut (incision) to look inside the body. It is
sometimes used to take pieces of tissue to check for cancer (biopsy
samples). In recent years, doctors have found that by creating some
small holes and using special instruments, the laparoscope can be used
to perform surgery without making a large incision. This can help
reduce blood loss during surgery and pain afterward. It can also
shorten hospital stays and allow people to heal faster. Laparoscopic
surgery is used commonly today to remove gallbladders and to repair
hernias.
The role of laparoscopic surgery in cancer treatment is not
yet clear. Doctors are now studying whether it is safe and effective to
use laparoscopic surgeries for many cancers of the bladder, colon,
prostate, and kidney, among others. It may prove to be as safe and work
as well as standard surgery while cutting less and causing less damage
to healthy tissues (being less invasive). Some studies have hinted at
this being the case. But larger, long-term studies still need to be
done.
Thorascopic surgery
A thoracoscope is a narrow, rigid tube with a camera connected
at one end that can be put through a small cut (incision) into the
chest after the lung is collapsed. This allows the doctor to see inside
the chest. Tissue samples of any areas of concern on the lining of the
chest wall can be taken out (biopsied), fluid can be drained, and small
tumors on the surface of the lung can be removed with small stapling
devices. This approach leads to less cutting and has even been used to
remove parts (lobes) of the lung that contain cancer. Studies have
shown that for early stage lung cancer, results using this approach are
much the same as removing part of the lung through a cut (incision) in
the side of the chest (this surgery is called a thoracotomy).
Other forms of surgery
Doctors are always looking for new ways to remove or destroy
cancer tumors. Some of these methods are blurring the line between what
we commonly think of as surgery and other forms of treatment.
Researchers are testing many new techniques, using things such as high
intensity focused ultrasound; microwaves or radio waves (radiofrequency
ablation, or RFA); or even high-powered magnets to try and get rid of
unwanted tissue. Although promising, these techniques are still largely
experimental.
As doctors learn how to better control the energy waves used
in radiation therapy, some newer radiation techniques that work almost
as well as surgery have been found. By using radiation sources from
different angles, stereotactic radiation therapy delivers a large
precise radiation dose to a small tumor area. The process is so exact
that this is sometimes called stereotactic
surgery, even though no cut is actually made. In fact, the
machines used to deliver this treatment have names like Gamma Knife and
CyberKnife, although no knife is involved. The brain is the most common
site being treated using this technique, but it is also being used on
head, neck, lung, and spine tumors. Researchers are looking for ways to
use it to treat other types of cancer, too.
Questions to ask your doctor about surgery
Before having surgery, find out all you can about the
benefits, risks, and side effects of the operation. Answers to the
following questions will help you feel more comfortable with your
decision.
- Why am I having this operation? What are the chances of its
success?
- Is there any other way to treat this cancer?
- Other than my cancer, am I healthy enough to go through the
stress of the surgery and the drugs used to do it (anesthesia)?
- Are you certified by the American Board of Surgery and/or
Specialty Surgery Board?
- How many operations like this have you done? What is your
success rate? Are you experienced in operating on my kind of cancer?
- Exactly what will you be doing in this operation? What will
you be taking out? Why?
- How long will the surgery take?
- Will I need blood transfusions?
- What can I expect after the operation? Will I be in a lot
of pain? Will I have drains or catheters? How long will I be in the
hospital after the surgery?
- How will my body be affected by the surgery? Will it work
or look different? Will any of the effects be permanent?
- How long will it take for me to recover enough to go back
to my usual activities?
- What are the possible risks and side effects of this
operation? What is the risk of death or disability with this surgery?
- What will happen if I choose not to have the operation?
- What are the chances that the surgery will cure my cancer?
- Do I have time to think about my options or get a second
opinion?
Getting a second opinion
One of the ways to find out whether a suggested operation is
the best choice for you may be to get the opinion of another surgeon.
Your doctor should not mind this. In fact, some health insurance
companies make you get a second opinion. You may not need to have tests
done again because you can often bring the results of your original
tests to the second doctor.
Check with your insurance company before planning surgery and
before getting a second opinion. Get all of the information you need to
feel sure you are making the right choice for your situation. Making an
informed decision about your health is almost always better than making
a quick one.
What will surgery be like?
Your surgery experience depends on many things, including the
disease being treated, the type of operation being done, and your
overall health. There are probably as many different surgical
techniques as there are diseases to treat, so each case is different.
It's not possible to get into the specifics of each type of
operation here, but if you would like more detail you can find it in
the treatment sections of our documents on specific types of cancer.
You can get this information online, or call us at 1-800-227-2345.
Still, some parts of the surgical experience happen in almost
all types of operations. They include pre-operative testing and
preparation, the surgery itself (usually including some type of drugs
to get you through the surgery), and a recovery period.
Planning and preparation
Both you and your doctor have things to do before surgery to
make sure you have the best chance for a good outcome. As much as is
possible, you need to know what to expect and to be comfortable that
the decision you've made is the best one for you. People differ about
how involved they want to be in the decision-making process. But
knowing as much as you can about what lies ahead can, at the very
least, help reduce your stress level.
It is not unusual for patients to wait a few weeks after
learning they have cancer to have surgery. You have time—time
to learn more about your cancer, time to talk to others who have been
through it, time to explore your treatment options, time to organize
your thoughts, and time to find the right health care team for you. You
also may want a second opinion. Insurance pre-approval for the surgery
may be needed and this, too, takes time. In almost all cases, the time
needed to prepare for surgery should have no impact on the positive
outcome of the surgery. But if you do have some type of urgent medical
problem, surgery will be done as soon as possible.
Informed consent
Informed consent is one of the most important parts of getting
ready for surgery. It is a process during which you are told about all
aspects of the treatment before you give your doctor written permission
to do the surgery. Although the details may vary from state to state,
the informed consent form usually says that your doctor has explained
these things:
- your condition and why surgery is an option
- the goal of the surgery
- how the surgery is to be done
- how it may benefit you
- what your risks are
- what side effects to expect
- what other treatment options you have
When you sign the consent form you are saying that you have
received this information and you are willing to have the surgery. It
is important that you read the consent form and understand each of the
above issues before signing it. Make sure your doctor answers all of
your questions and that you understand the answers. Having a family
member or friend go over it with you may also be helpful.
Pre-operative testing
In most cases, you will need many tests in the days or weeks
before your surgery, especially if a major operation is planned. These
tests are done to make sure your body is able to go through surgery and
the drugs that will be used. They may also be done to help doctors
better understand your condition and to help them plan the surgery. You
may not need all of the tests listed here (especially if you are having
a minor procedure in a doctor's office). But the tests most often used
include:
- Blood tests
to measure your blood counts, your risk of bleeding or infection, and
how well your liver and kidneys are working. Your blood type may also
be checked in case you need blood transfusions during the operation.
- Urine test (urinalysis)
to look at kidney function and check for infections.
- Chest x-ray
and EKG
(electrocardiogram) to check how well your lungs and heart are working.
- Other tests as needed, such as CT scans to look at the size
and location of tumors and see if the cancer looks like it has spread
to nearby tissues.
Your doctor will also ask you questions about high blood
pressure, heart disease, diabetes, and other conditions that could
affect surgery. It is important that you let your doctor know about any
allergic reactions you've had in the past, including reactions to foods
or other substances.
If you are going to be given drugs to put you into a deep
sleep (have general anesthesia), you will probably also see a doctor
who specializes in giving anesthesia, called an anesthesiologist. Other
specialists may be consulted or other tests done if you have any other
problems that could affect the surgery.
Your surgeon may also change some of the medicines you take
and ask you to stop smoking, stop drinking alcohol, try to improve your
diet, and actively exercise before surgery.
Preparing for surgery
Depending on the type of operation you have, there may be
things you need to do to be ready for surgery.
Emptying your stomach and bowels (digestive tract) is
important if you will be given drugs to make you sleep during surgery
(anesthesia). Vomiting while under anesthesia can be very dangerous
because the vomit could get into your lungs and cause an infection. For
this reason, you will be asked to not eat or drink anything starting
the night before the surgery. You may also be asked to use a laxative
or an enema to make sure your intestines are empty.
You may need to have an area of your body shaved to keep hair
from getting into the surgical cut (incision). The area will be cleaned
before the operation to reduce the risk of infection. Other special
preparations may be needed, too.
It is normal to be anxious about surgery and anesthesia. Let
your doctors know about these fears. They may give you medicine to help
you relax before surgery.
The operation
Again, although each type of surgical procedure is different,
they usually have certain things in common.
Anesthesia
Anesthesia is the use of drugs to make the body unable to feel
pain for a period of time. Depending on the type and extent of the
operation, you may or may not need drugs to make you sleep. In some
cases, you may have an option as to which type of anesthesia you
prefer.
- Local
anesthesia is often used for minor surgeries, such as
biopsies near the body surface. A needle is used to put medicine into
the site beforehand. This numbs the nerves that cause pain. You stay
awake and usually feel only pressure during the procedure.
- Topical
anesthesia is a type of local anesthesia that is rubbed or
sprayed onto a body surface instead of being put in with a needle
(injected). It is sometimes used to numb the throat before a scope is
passed down to the stomach or lungs (endoscopy).
- Regional
anesthesia (a nerve
block) numbs a larger area of the body while still
allowing you to stay awake. A needle is used to put medicine into an
area around the spinal cord, which affects certain nerves coming out of
it. But it may also mean injecting medicine around nerves in the arms
or legs. The location of the injection determines the area affected.
Medicine may be given as a single injection or as an ongoing infusion.
Although you do stay awake, you may be given something to help you
relax.
- General
anesthesia puts you into a deep sleep for the surgery. It
is often started by having you breathe into a face mask or by putting a
drug into a vein in your arm. Once you are asleep, an endotracheal (ET)
tube is put in your throat to make it easy for you to breathe. Your
heart rate, breathing rate, and blood pressure (vital signs) will be
closely watched during the surgery. A doctor or nurse who specializes
in giving anesthesia watches you throughout the procedure and until you
wake up. They also take out the ET tube when the operation is over.
Recovery
From anesthesia
If you had local anesthesia, you may be allowed to go home
shortly after the surgery. People who get regional or general
anesthesia are taken to the recovery room to be watched closely while
the effects of the drugs wear off. This may take hours. People waking
up from general anesthesia often feel "out of it" for some time. Things
may seem hazy or dream-like for a while, and you may not feel like you
are fully awake until the next day.
Your recovery right after surgery depends on many factors,
including your state of health before the operation and how extensive
the operation was. You will get pain medicine while in the hospital,
and will be given a prescription for pain medicine to take at home if
you need it. Throughout your hospital stay, be aware that there are
many different medicines available to help you control your pain. If
you are in pain and it is holding up your recovery, be sure to let your
health care team know.
Your throat may be sore for a while from the ET tube. You may
also have a tube draining urine from your bladder into a bag (called a
Foley catheter). This may be taken out soon after surgery, but may need
to be put back in if you have trouble passing urine on your own.
Drains
You may also have a tube or tubes (called drains) coming out
of the surgical opening in your skin (incision site). Drains allow the
excess fluid that collects at the surgery site to leave the body. Your
doctor will probably take them out once they stop collecting fluid,
usually a few days after the operation. This may be done while you are
still in the hospital or later at the doctor's office.
Eating and drinking
You may not feel much like eating or drinking, but this is an
important part of the recovery process. Your health care team may start
you out with ice chips or clear liquids at first. They will check that
you are urinating normally at this time and may want to measure the
amount of urine you make by having you go in a special container.
The stomach and intestines (digestive tract) is one of the
last parts of the body to recover from the drugs used during surgery.
Signs of stomach and bowel activity need to return before you will be
allowed to eat. Along with checking your surgical wound and other parts
of your body, your doctor will listen for bowel sounds in your belly
and will ask if you have passed gas. These are signs that your
intestine is starting to function normally again. You will likely be on
a clear liquid diet until this happens. Once it does, you may get to
try solid foods.
Activity
Your health care team will probably try to have you move
around as soon as possible after surgery. They may even have you out of
bed and walking the next day. While this may be hard at first, it helps
speed your recovery by getting the digestive tract moving. It also
helps get your circulation going and prevents blood clots from forming
in your legs. Again, be sure to let your team know if you are having a
lot of pain, so they can give you medicine to control it.
Your team may also encourage you to do deep breathing
exercises. This helps fully inflate the lungs and reduces the risk of
pneumonia.
Going home
Once you are eating and walking, you may start hearing about
plans for going home. Of course, this will depend upon other factors
too, such as the results of the surgery and tests done afterward. Your
doctor will want to make sure you are well enough to be home. Before
leaving, be sure that you understand the following:
- how you will care for your wound at home
- what to look for that might need attention right away
- what your activity limits are (driving, working, lifting,
etc.)
- other restrictions (diet, those related to pain medicine,
etc.)
- what medicines to take and how often to take them,
including pain medicines
- who to call with questions or problems that may come up
- whether you should be doing anything in terms of
rehabilitation (exercises or physical therapy)
- when you are supposed to see your doctor again
You may need help at home for a while after surgery. If family
members or friends are unable to do all that is needed, your health
care team may be able to arrange to have a nurse or nurse's aide visit
you at home for a short while.
Other parts of recovery may be more long-term in nature.
Wounds heal at different rates in different people. Some operations,
such as a breast removal (mastectomy), may lead to permanent changes in
your body. Others, such as a having an arm or leg removed (limb
amputation) or an opening in your belly connected to the end of your
intestine (an ostomy) might affect how your body works, and you may
need to learn new ways of doing things.
Fully understanding the result of the operation before it is
done is an important part of helping you adjust to the changes that
have been made to your body. Be sure that all of your questions are
answered up front. Get as specific as you need to with your questions,
and make sure your health care team gives specific answers, too.
What are the risks and side effects of
surgery?
There are risks that go with any type of medical procedure and
surgery is no exception. Of course, there are risks with almost
everything we do in life. What is important is whether or not the
expected benefits outweigh the possible risks.
Doctors have been performing surgeries for a very long time.
Advances in surgical techniques and in our understanding of how to
prevent infections have made modern surgery safer and less likely to
damage healthy tissues than it has ever been. Still, there is always a
degree of risk involved, no matter how small.
Before you decide to have any medical procedure done, it is
important that you understand the risks. Different procedures have
different kinds of risks and side effects. This section cannot list all
of the possible problems (complications) of every type of surgery. Be
sure to discuss the details of your case with your doctor, who can give
you a better idea about what your actual risks are.
During surgery
Possible complications during surgery may be caused by the
surgery itself, the drugs used (anesthesia), or an underlying disease.
Generally speaking, the more complex the surgery the greater the risk.
Minor operations and tissue samples (biopsies) usually pose
less risk than major surgery. Pain at the site of the cut (incision) is
the most common problem. Infections at the site and reactions to the
drugs used to numb the area being treated (local anesthesia) are also
possible.
Complications in major surgical procedures are not common, but
can include:
- Bleeding during surgery that may cause you to need blood
transfusions. Doctors try to minimize this risk by checking your blood
counts beforehand and being careful when working near blood vessels.
Still, some operations involve a certain amount of controlled blood
loss. If you have concerns about needing a blood transfusion, talk to
your doctor before surgery. You may be able to save (bank) some of your
own blood in the weeks before surgery so it can be given back to you
during the operation if needed. (This is called autologous
transfusion.) For more information, see Blood Product Donation and
Transfusion, which you can read online or get by
calling our toll-free number.
- Damage to internal organs and blood vessels during surgery.
Again, doctors are careful to allow as little damage as possible.
- Reactions to drugs used (anesthesia) or other medicines.
Although rare, these can be serious because they can cause dangerously
low blood pressures. Your doctors will watch your heart rate, breathing
rate, blood pressure, and other signs throughout the procedure to look
for this.
- Problems with other organs, such as the lungs, heart, or
kidneys. These problems are very rare but can happen and can be
life-threatening. They are more likely to happen to people who already
have problems with these organs. This is why doctors get a complete
patient history to look at possible risks before an operation is done.
After surgery
Some problems after surgery are fairly common, but are not
usually life-threatening.
- Pain is probably the most common side effect.
Almost everyone has some level of pain after surgery. Some pain is
normal, but it should not be allowed to slow down your recovery. There
are many ways to deal with surgical pain. Medicines for pain range from
aspirin and acetaminophen (Tylenol®) to
stronger drugs, such as
opioids like codeine and morphine.
- Infection at the site of the wound is another
possible problem. Although doctors take great care to reduce this risk
by cleaning the area and keeping the area around it sterile, infections
do happen. Antibiotics, either as a pill or given through a vein in
your arm (IV), are able to treat most infections.
Other problems are rare, but may be more serious.
- A lung infection (pneumonia) can occur,
especially in patients with reduced lung function, such as smokers.
Doing deep breathing exercises as soon as possible after surgery helps
lessen this risk.
- Other infections can develop within the body,
especially if the stomach or intestines were opened during the
operation. Doctors take great care to try to make sure this does not
happen. But if it does, powerful antibiotics will be used to treat it.
- Bleeding can happen either inside the body
(internally) or outside the body (externally). It can occur if a blood
vessel was not sealed off during surgery or if a wound opens up.
Serious bleeding may cause the person to need another operation to find
the source of the bleeding and stop it.
- Blood clots can form in the deep veins of the
legs after surgery, especially if a person stays in bed for a long
time. Such a clot can become a serious problem if it breaks loose and
travels to another part of the body, such as a lung. This is why you
will be encouraged to get out of bed and sit, stand, and walk as soon
as possible.
- Slow recovery of other body functions, such as
movement in the intestines, can sometimes become serious problems, too.
Getting out of bed and walking around as soon as possible after surgery
can decrease this risk.
Other life-threatening complications are very rare and hard to
predict, but sometimes do happen. Your surgical team will take many
steps to avoid possible complications. This includes things like
shaving and cleaning the area before cutting the skin to avoid
infection, use of special leg pumps and low-dose blood thinners to
avoid clots, and breathing treatments (respiratory therapy) to prevent
pneumonia.
Long-term side effects depend on the type of surgery done. For
example, people who have colorectal cancer surgery may need an opening
in the belly to which the end of the colon is attached (a colostomy).
Men having their prostate removed (radical prostatectomy) are at risk
for losing control of their urine (incontinence) or becoming unable to
get or keep an erection (impotent). Your doctor should talk to you
about all of these long-term outcomes before surgery. You can get more
information on any possible long-term effect by calling the American
Cancer Society at 1-800-227-2345.
Does surgery cause cancer to spread?
In nearly all cases, surgery does not cause cancer to spread,
but there are some important exceptions. Doctors who have a lot of
experience in taking biopsies of cancers and treating them with surgery
are very careful to avoid these situations.
The chances that using a needle to remove a piece of the
tissue (needle biopsy) may cause a cancer to spread are very low. In
the past, larger needles were used for biopsies, and the chance of
spread was higher.
Most types of cancers can be safely sampled by an incisional
biopsy, where the surgeon cuts through the skin to remove a small part
of the tumor. But there are a few exceptions, such as certain tumors in
the eyes or in the testicles. For these types of cancer, doctors may
treat without looking at a piece of the tumor (biopsy) or may recommend
removing the entire tumor if it is likely to be cancer. In some cases a
needle biopsy can be safely used, and then if the tumor is found to be
cancer, the whole tumor is removed by surgery.
One common myth about cancer is that it will spread if it is
exposed to air during surgery. Some people may believe this because
they often feel worse after surgery than they did before. But it is
normal to feel this way when beginning to recover from any surgery.
Another reason people may believe this is because during surgery the
doctor may find more cancer than was expected from scans and x-rays.
Although this can happen, it is not because of the
surgery—the cancer was already there—it just did
not show up on the tests that were done. Cancer does not spread because
it has been exposed to air. If you delay or refuse surgery because of
this myth, then you may be harming yourself by passing up effective
treatment.
Some thoughts to remember
The best chance of a cure from most types of cancer is to
remove all of the cancer as soon as possible after diagnosis. If you
have a solid tumor, sometimes surgery alone will cure the cancer, but
often you might need chemotherapy, radiation therapy, or treatment,
too. Your health care team will discuss your best treatment options
with you.
If you have any concerns about surgery or cancer spread,
discuss this issue with the people who know your situation
best—your surgeon and other members of your cancer care team.
You can also call 1-800-227-2345 any time you have questions
or need help. The American Cancer Society has information, resources,
and support available on cancer-related topics.
Additional resources
More information from your American Cancer
Society
The following related information may also be helpful to you.
These materials may be ordered from our toll-free number,
1-800-227-2345.
National organizations and Web sites*
Along with the American Cancer Society, other sources of
information and support include:
American College
of Surgeons
Toll-free number: 1-800-621-4111
Web site: www.facs.org
Has a patient education Web site, "Patients as Partners in Surgical
Care," to help surgical patients and their families become informed
about their operation and surgical care, which can be found at:
www.facs.org/patienteducation
National Cancer
Institute
Toll-free number: 1-800-4-CANCER (1-800-422-6237)
Web site: www.cancer.gov
Provides accurate, up-to-date information on many cancer-related topics
to patients, their families, and the general public
*Inclusion on
this list does not imply endorsement by the
American Cancer Society.
No matter who you are, we can help. Contact us anytime, day or
night, for cancer-related information and support. Call us at
1-800-227-2345
or visit www.cancer.org.
References
Eyre HJ, Lange D, Morris LB. Informed Decisions.
2nd Ed.
Atlanta, GA: American Cancer Society, 2002:159–70.
Fleming, ID. Surgical therapy. In: Lenhard RE, Osteen RT,
Gansler T, eds. Clinical
Oncology. Atlanta, GA: American Cancer
Society, 2001:160–165.
National Cancer Institute. Cryosurgery in Cancer Treatment:
Questions and Answers. Accessed at:
www.cancer.gov/cancertopics/factsheet/Therapy/cryosurgery on June 3,
2009.
National Cancer Institute. Lasers in Cancer Treatment:
Questions and Answers. Accessed at:
www.cancer.gov/cancertopics/factsheet/Therapy/lasers on June 3, 2009.
Pollock RE, Morton DL. Principles of surgical oncology. In:
Kufe DW, Pollock RE, Weichselbaum RR, Bast RC, Gansler TS, Holland JF,
Frei E III, eds. Cancer
Medicine. 6th Ed. Hamilton, Ontario: BC Decker;
2003:569–583.
Last Medical Review: 06/19/2009
Last Revised: 06/19/2009
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