Surgery is the oldest form of cancer treatment. It also has an important role in diagnosing and staging (finding the extent) of cancer. Advances in surgical techniques have allowed surgeons to successfully operate on a growing number of patients. Today, less invasive operations 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.
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Why Is Surgery Used for Cancer?

Surgery can be done for any of several reasons. It is often done to reach more than one of these goals:

Preventive (prophylactic) Surgery

Preventive surgery is done to remove body tissue that is not malignant (cancerous) but is likely to become malignant. For example, this type of surgery may be used if you have a pre-cancerous condition such as polyps in 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 their DNA in a breast cancer gene (BRCA1 or BRCA2). Because their risk of getting breast cancer is high, these women may want to consider prophylactic mastectomy (breast removal before cancer is found).

Diagnostic Surgery

This type of surgery is used to get a tissue sample to tell whether or not 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. Several surgical techniques can be used to obtain a sample of cells from a suspicious looking area. These are described in the next 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. While the physical exam and the results of lab and imaging tests can help figure out the clinical stage of the cancer, the surgical stage is usually a more exact measure of how far the cancer has spread. For more information, please see the American Cancer Society document called Staging.

Examples of surgical procedures commonly used for staging cancers, such as laparotomy and laparoscopy, are described in the next section, "Surgery to Diagnose and Stage Cancer."

Curative Surgery

Curative surgery is done when a tumor appears to be confined to one area and it is likely that all of the tumor can be removed. Curative surgery can be the primary treatment of 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

Surgery is done to debulk a tumor when removing all of the tumor would cause too much damage to an organ or near-by tissues. In these cases, the doctor may remove 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 complications of advanced cancer. It is not intended 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 abdomen may grow large enough to obstruct (block off) the intestine. This may require surgery to remove the blockage. Palliative surgery may also be used to treat pain when it is hard to control it by other means.

Supportive Surgery

Supportive surgery is used to help with other types of treatment. For example, a vascular access device such as a catheter port can be surgically placed into a large vein. The port can then be used to give chemotherapy treatments or draw blood for testing, reducing the number of needle sticks needed.

Restorative (reconstructive) Surgery

This type of surgery is used to restore a person’s appearance or the function of an organ or body part after primary surgery. Examples include breast reconstruction after mastectomy or the use of tissue flaps, bone grafts, or prosthetic (metal or plastic) materials after surgery for oral cavity cancers. For more information on these types of reconstructive surgery, please see the American Cancer Society documents Breast Reconstruction After Mastectomy and Oral Cavity and Oropharyngeal Cancer.

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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 require surgery, but many types of biopsies can remove tumor samples through a thin needle or an endoscope (a flexible lighted tube). Biopsies are often done by surgeons, but they can be done by other doctors too.

Fine Needle Aspiration Biopsy

Fine needle aspiration (FNA) uses a very thin needle attached to a syringe to withdraw a small amount of tissue from a tumor. If the tumor can’t be felt near the surface of the body, the needle can be guided into the tumor by viewing it with an imaging technique such as an ultrasound (US) or CT (computed tomography) scan. The main advantage of FNA is that it does not require a surgical incision (cutting through the skin). A drawback is that in some cases the needle can’t remove enough tissue for a definite diagnosis. A more invasive type of biopsy may then be needed.

Core Needle Biopsy

This type of biopsy uses a slightly larger needle. The advantage of core biopsy is that it usually collects enough of a sample to find out whether or not the tumor is cancer. A core biopsy can be aspirated (removed) with a needle if the tumor can be felt at the surface. Core biopsies can also be guided by imaging techniques if the tumor is too deep to be felt.

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 a large tumor (incisional biopsy). They can often be done with local or regional anesthesia (numbing medicine used just in the area of the biopsy). If the tumor is inside the chest or abdomen, general anesthesia (putting you into a deep sleep) may be needed.

Endoscopy

This procedure uses a 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 television screen, allowing the doctor to clearly see any masses in the area. Endoscopes can be passed through natural body openings to view suspicious areas in places such as the:

• throat (pharyngoscopy)
• voice box (laryngoscopy)
• esophagus (esophagoscopy)
• stomach (gastroscopy)
• small intestine (duodenoscopy)
• colon (colonoscopy or sigmoidoscopy)
• bladder (cystoscopy)
• respiratory tract (windpipe, bronchi, and lungs) (bronchoscopy)

Endoscopy has several advantages:

• The doctor can see the cancer mass directly and can get a good idea of its size and location.
• A biopsy can be taken through the scope to determine if the mass is cancer.
• It usually does not require an open surgical incision or general anesthesia.

Some types of endoscopy require the use of local numbing medicines before the procedure. Medicines may also be given to make you sleepy but do not put you to sleep.

Ultrasonography

Ultrasound devices can be attached to the end of some endoscopes. This allows doctors to look at the layers of the esophagus, bronchus, and parts of the large intestine. Close by lymph nodes also can be seen. Using the ultrasound pictures to guide it, a needle can be placed through the biopsy channel of the scope and cells can be collected from abnormal looking lymph nodes.

Laparoscopy, Thoracoscopy, or Mediastinoscopy

Laparoscopy is similar to endoscopy, but requires a small incision to be made in the skin of the abdomen (belly). A thin tube called a laparoscope is then inserted through the incision 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, Mediastinotomy)

When less intrusive tests can’t provide enough information about a suspicious area in the abdomen, a laparotomy may provide an answer. In this procedure, a surgeon makes an incision, usually from the bottom of the sternum (breastbone) down to the lower part of the abdomen (belly), allowing him or her to look directly at the area in question. The location and size of the tumor and the surrounding areas can be seen and a biopsy can be taken, if needed. Because this is a major surgical procedure, it requires general anesthesia (medicine is used to put you in a deep sleep). A similar operation to open and look inside the chest is called a thoracotomy.

If lymph nodes are enlarged near the trachea, a mediastinotomy is done. This procedure also requires general anesthesia (medicine is used to put you in a deep sleep). Then a special scope (mediastinoscope) is inserted through a small incision above the top of the sternum (breastbone) and biopsies are collected from the areas of concern.

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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 below.

Laser Surgery

A laser is a highly focused and powerful beam of light energy, which can be used in medicine 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 scalpel) or to vaporize cancers of the cervix, larynx (voice box), liver, rectum, or skin.

Some surgeries can be made less invasive by using laser light. For example, with fiber optics the light can be directed to parts of the body without having to make a large incision.

Lasers are also used in a type of surgery called photoablation or photocoagulation. This type of surgery is often used to relieve symptoms, such as when large tumors block the windpipe or esophagus, causing problems with breathing or eating.

Cryosurgery

Cryosurgery involves the use of a liquid nitrogen spray or a very cold probe to freeze and kill abnormal cells. This technique is sometimes used to treat precancerous conditions such as those affecting the cervix. Cryosurgery is also being studied as a treatment of some cancers, such as those of the prostate.

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 a technique to remove certain skin cancers by shaving off one layer at a time. After each layer is removed, a specially trained dermatologist (skin doctor) or a pathologist (doctor who specializes in diagnosing and classifying diseases by lab tests) looks at the tissue layer under a microscope. When all the cells look normal under the microscope, the surgeon stops removing layers of tissue.

This technique is used when the extent of the cancer is not known or when as much healthy tissue as possible needs to be preserved (as in cancers around the eye). It is performed under local anesthesia by a specially trained surgeon.

Chemosurgery is an older name for this surgery and refers to certain chemicals applied to the tissue before it is removed. Mohs surgery does not involve use of cancer chemotherapy drugs.

Laparoscopic Surgery

A laparoscope is a long, flexible tube placed through a small incision to look inside the body. It is sometimes used to take biopsy samples. In recent years, doctors have found that by creating several small holes and using special instruments, the laparoscopic technique can be used to perform surgery without the need for a large incision. This can help reduce blood loss during surgery and pain afterwards. It can also shorten hospital stays. Laparoscopic surgery is commonly used today to remove gallbladders and to repair hernias.

Its role in cancer, however, remains less clear. Doctors are now studying whether it is safe and effective to use laparoscopic surgeries for cancers of the colon, prostate, and kidney, among others. It may prove to be as safe and effective as conventional surgery while being less invasive. Some studies have hinted at this being the case. But until larger, long-term studies are completed, laparoscopic surgery for most forms of cancer is still considered investigational.

Thorascopic Surgery

A thoracoscope is a rigid tube with a camera connected at one end that can be placed through a small incision into the chest after the lung is collapsed. This allows the doctor to see inside the entire chest cavity. Any areas of concern on the lining of the chest wall can be biopsied, fluid can be drained, and small tumors seen on the surface of the lung can be removed with small stapling devices. This less invasive approach has also been used to remove parts (lobes) of the lung that contain cancer. Studies have shown that for early stage lung cancer, results are similar to removing a portion of the lung by doing an open thoracotomy (incision in the side of the chest).

Other Forms of Surgery

Newer ways to remove or destroy cancer tumors are always being explored. Some methods are beginning to blur the lines between what we commonly think of as "surgery" and other forms of therapy. Researchers are testing many new techniques, using things such as high intensity focused ultrasound (HIFU); microwaves or radio waves (radiofrequency ablation, or RFA); or even magnets in an attempt to get rid of unwanted tissue. While 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 are almost as effective 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 doses are so exact that the term stereotactic surgery is sometimes used, even though no incision is actually made. In fact, the machines used to deliver this treatment have names like Gamma Knife and CyberKnife, although no actual knife is involved. The most common site being treated with this technique is the brain, but it is also being used in head, neck, lung, and spine tumors. Researchers are looking for ways to use it with other types of cancer as well.

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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 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 and removing in this operation? Why?

• How long will the surgery take?

• Will I need blood transfusions?

• What can I expect after the operation? Will I be in a great deal 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 any of the effects be permanent?

• How long will it take for me to recover?

• What are the possible risks and side effects of this operation? What is the risk of death or disability as a result of 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?

One of the ways to find out if 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 insurance companies require you to 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.

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The Surgery Experience

A person’s experience with surgery can depend on many factors, including the disease being treated, the type of operation being done, and the person’s 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 it can be found in the treatment sections of the American Cancer Society documents on specific types of cancer.

Still, some parts of the surgical experience are common to most operations. They include pre-operative testing and preparation, the surgery itself (usually including some type of anesthesia), 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. For your part, this involves knowing what to expect (as much as possible) and being comfortable that the decision you’ve made is the best one for you. People differ as far as 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 level of stress.

It is not unusual for patients to learn that they have cancer and then wait several weeks 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 medical team for you. You also may want a second opinion. Pre-approval for the procedure by your insurance provider may be required and this, too, takes time. In almost all cases, a slight delay in surgery should have no impact on the positive outcome of the surgery. If you do have some type of urgent medical symptom, surgery will be scheduled as soon as possible.

Informed consent: Informed consent is one of the most important parts of your preparation for surgery. It is a process during which you are told about all aspects of the treatment and then give your doctor written permission to perform the surgery. Although the specifics may vary from state to state, the informed consent form usually states that your doctor has explained these items:

• 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 to expect in terms of side effects
• what other options are available to you

Your signature means that you have received this information and that 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. 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.

Preoperative testing: Several tests are usually needed 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 anesthesia. They may also be done to better understand your condition and help plan the surgery. Not all of these may be needed (especially if you are having a minor procedure in a doctor’s office). The tests most often used include:

• Blood tests to measure your blood counts, the risk of bleeding or infection, and functioning of your liver and kidneys. Your blood type may also be determined in case you need blood transfusions during the operation.

• Urine test (urinalysis) to look at kidney function and possible infections.

• Chest x-ray and EKG (electrocardiogram) to check your lung and heart function.

• Other tests as needed, such as CT scans to look at the size and location of tumors and see whether or not they are involved with near-by structures in the body.

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. If you are going to have general anesthesia (be put into a deep sleep), you will probably also see an anesthesiologist (doctor who specializes in giving anesthesia). Other specialists may be consulted or other tests performed if you have any other conditions that could affect the surgery. Your surgeon may also ask you to stop smoking and drinking alcohol and 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 digestive tract is important if you will be asleep during surgery. Vomiting while under anesthesia can be very dangerous because the material could enter the lungs and cause an infection. For this reason, you will be asked not to 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 incision site. The area will be cleaned before the operation to reduce the risk of infection. Other, special preparations may also be needed.

It is normal to be anxious about surgery and going to sleep. Let your surgeon know about these fears because often a medication to calm you may be helpful.

The Operation

Again, although each type of surgical procedure is different, they usually have certain factors 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, it may or may not involve having you asleep. 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. Medicine is injected into the site beforehand to numb the nerves that cause pain. You remain awake and usually feel only slight pressure during the procedure.

• Topical anesthesia is a type of local anesthesia that is rubbed or sprayed onto a body surface instead of being injected. It is sometimes used in the throat before endoscopy.

• Regional anesthesia (a "nerve block") affects a larger area of the body while still allowing you to remain awake. It usually involves injecting medicine into an area around the spinal cord, which affects certain nerves coming out of it. But it may also involve 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 a continuous infusion. While you remain awake, you may be given something to help you relax.

• General anesthesia puts you into a deep sleep for the surgery. It is commonly started by having you breathe into a facemask or by injecting a drug into a vein in your arm. Once you are asleep an endotracheal (ET) tube is placed in your throat to make it easy for you to breathe. Your vital signs (heart rate, breathing rate, and blood pressure) will be closely monitored during the surgery. A doctor or nurse who specializes in giving anesthesia watches you throughout the procedure and until you wake up. They also remove the ET tube once the operation is over.

Recovery

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 monitored while the effects of the anesthesia wear off. This may take several 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 following 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 receive 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 continue to have pain that is interfering with 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 notice that you have a catheter (tube) draining urine from your bladder into a bag. This may be removed soon after surgery, but may need to be put back in if you have trouble urinating on your own.

You may also have a tube or tubes (called "drains") coming out of the incision site. Drains allow the excess fluid that collects at the surgery site to leave the body. Your doctor will likely remove them once they stop collecting fluid, usually a few days after the operation. This may be done while still in the hospital or at the doctor’s office after you have been sent home.

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 water 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 digestive tract (stomach and intestines) is one of the last parts of the body to recover from the effects of anesthesia. Signs of stomach and bowel activity need to be present before you will be allowed to eat. In addition to checking your surgical scar and other parts of your body, your doctor will use a stethoscope to listen for bowel sounds in your abdomen and will ask if you have passed gas. You will likely be on a clear liquid diet until this happens. Once it does, you may be allowed to try solid foods.

Your health care team will probably try to have you moving as soon as possible after surgery. They may even have you out of bed and walking the next day. While this may be difficult 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 experiencing a lot of pain, as this can be controlled with medicine.

Your team may also encourage you to do deep breathing exercises. This helps fully inflate the lungs and reduces the risk of pneumonia.

Once you are eating and walking, you may start hearing about plans for going home. Of course, this will depend upon other factors as well, 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:

• what is expected of you in terms of caring for the wound
• what to look for that might require attention right away
• what your physical limitations 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 arise
• whether you should be doing anything in terms of rehabilitation (exercises or physical therapy)
• when you are due 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 team may be able to arrange to have a nurse or nurse's aide visit you at home for a short while.

Other aspects of recovery may be more long term in nature. Wounds heal at different rates in different people. Some operations, such as a mastectomy (breast removal), may result in permanent changes to your body. Others, such as a limb amputation or an ostomy (opening in the abdomen connected to the end of your intestine) affect how your body functions and may require that you learn new ways of doing things.

Understanding beforehand what the result of the operation will be 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, as well.

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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 risk is outweighed by the possible benefits.

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 invasive than it has ever been. But 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 is not meant to provide a list of all of the possible complications of every type of surgery. Be sure to discuss your particular case with your doctor. He or she 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 anesthesia, or an underlying disease. Generally speaking, the more complex the surgery the greater the risk.

Minor operations and biopsies usually pose less risk than major surgery. Pain at the site of the incision is the most common problem. Infections at the site and reactions to local anesthesia are also possible.

Complications in major surgical procedures are not common, but can include:

• Bleeding during surgery that may require blood transfusions. Doctors try to minimize this risk by checking your blood counts beforehand and being careful near close-by blood vessels. Still, some operations involve a certain amount of controlled blood loss. For certain procedures, you may want to consider banking some of your own blood in the weeks before surgery so you can get it during the operation (autologous transfusion) if needed.

• Damage to internal organs and blood vessels during surgery. Again, doctors are careful to allow as little damage as possible.

• Reactions to anesthesia or other medicines. Although rare, these can be serious because they can cause dangerously low blood pressures. Your doctors will monitor your vital signs throughout the procedure to look for this.

• Problems with other organs, such as the lungs, heart, or kidneys. These 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, which 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 experiences some level of pain after surgery. Some pain is normal, but it should not be allowed to interfere with your recovery. There are many ways of dealing with surgical pain. Medications for pain range from aspirin and acetaminophen (Tylenol®) to stronger agents such as opioids (like codeine and morphine).

• Infection at the site of the wound is another possible problem. Although doctors take great care to minimize this risk by cleaning the area and keeping the area around it sterile, infections do occur. Antibiotics, either as a pill or given through a vein in your arm, are able to treat most infections.

Other problems are rare, but may be more serious.

• Pneumonia can occur, especially among 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 digestive tract was 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 internally (inside the body) or externally (outside the body). It can occur if a blood vessel was not sealed off during surgery or if a wound reopens. 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 remains in bed for a long time. Such a clot could become a serious problem if it were to break loose and travel 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 occasionally become serious problems as well. 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 difficult to predict, but sometimes do happen. Your surgical team will take many steps to avoid potential complications, including such things as antibiotics before cutting the skin to avoid infection, use of special leg devices and low-dose blood thinners to avoid clots, and respiratory therapy to prevent pneumonia.

Long-term side effects depend on the type of procedure used. For example, people undergoing colorectal cancer surgery may need a colostomy (an opening in the abdomen to which the end of the colon is attached), while men undergoing radical prostatectomy (removal of the prostate) are at risk for losing control of urination or becoming impotent. All of these long-term outcomes should be discussed before surgery. You can get more information on any possible long-term effect by calling the American Cancer Society at 1-800-ACS-2345.

Does Surgery Cause Cancer to Spread?

In nearly all situations, surgery does not cause cancer to spread, but there are some important exceptions. Doctors who are experienced in taking biopsies of cancers and treating them with surgery are very careful to avoid these situations.

The chances of a needle biopsy causing a cancer to spread are extremely 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, 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 a biopsy or may recommend removing the entire tumor if it is likely to be cancerous. In some cases a needle biopsy can be safely used and if the tumor is found to be cancer it can be 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 the operation than they did before. It is normal to feel this way when beginning to recover from any surgery. 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.

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 provide a cure, but often chemotherapy, radiation therapy, or biologic therapy is also needed. Your health care team will discuss your best treatment options with you.

If you have any concerns about surgery and 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-ACS-2345 any time any day you have questions or need help. The American Cancer Society has information, resources, and support available on any cancer-related topic.

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Additional Resources

More Information From Your American Cancer Society

We have selected some related information that may also be helpful to you. These materials may be ordered from our toll-free number, 1-800-ACS-2345.

• After Diagnosis: A Guide for Patients and Families (also available in Spanish)

• Blood Product Donation And Transfusion

• Choosing A Doctor And A Hospital (also available in Spanish only through our toll-free number)

• Health Professionals Associated With Cancer Care

• Informed Consent (also available in Spanish only through our toll-free number)

• Lasers In Cancer Treatment

• Questions That People Ask About Cancer (also available in Spanish)

• Staging

• Talking With Your Doctor (also available in Spanish only through our toll-free number)

• What Is Cancer?

National Organizations and Web Sites*

In addition to the American Cancer Society, other sources of patient information and support include:

American College of Surgeons
Telephone: 1-312-202-5000 or 1-312-202-5085 (Cancer Programs)
Internet Address: www.facs.org

National Cancer Institute
Telephone: 1-800-4-CANCER (1-800-422-6237)
Internet Address: www.cancer.gov

*Inclusion on this list does not imply endorsement by the American Cancer Society.

The American Cancer Society is happy to address almost any cancer-related topic. If you have any more questions, please call us at 1-800-ACS-2345 at any time, 24 hours a day.


References

Eyre HJ, Lange D, Morris LB. Informed Decisions. 2nd Ed. Atlanta, GA: American Cancer Society, 2002:159-170.

Fleming, ID. Surgical therapy. In: Lenhard RE, Osteen RT, Gansler T, eds. Clinical Oncology. Atlanta, GA: American Cancer Society, 2001:160-165.

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.

Revised: 03/20/2007