Getting Ready for Cancer Surgery

It is normal to feel nervous or worried as you get closer to having surgery. Knowing what to expect before, during, and after your surgery can help you prepare and feel more at ease.

Your surgery experience will depend on many things, including the type of cancer you have, the type of surgery you are getting, and your overall health. Knowing what to expect and being prepared can help. It's important to:

• Learn as much as you can beforehand
• Ask questions so you know what to expect
• Know that each person's situation is different

How quickly will I need to have surgery?

If you need to have surgery for your cancer, you might wonder if you need to get it right away or if you can wait a bit.

How soon you need surgery after finding out you have cancer depends on your type of cancer and other factors. Sometimes, cancer surgery needs to happen as soon as possible. Other times, waiting a while is not a problem. And sometimes, you might need chemotherapy or radiation before having surgery.

Talk to your surgeon or others on your cancer care team about how quickly you need to have surgery. Don't be afraid to ask questions. You might want to ask if you have time to think about other options or get a second opinion.

Where will the surgery be done?

Where your surgery is done depends on the type of surgery you need, and how much time you will need to recover under the care of your surgical team. Surgery can be done in a doctor's office, clinic, surgery center, or hospital.

Outpatient or ambulatory surgery:  If you don’t need to be monitored for a long time after your surgery, you can go home the same day or the next day.

Inpatient surgery:  If you need to be watched by the surgical care team for more than one day, you might need to stay at the hospital.

Your surgeon will let you know where your surgery will be done and how long you’ll need to recover after the procedure. You will also know if you’ll need to stay in the hospital after surgery and for how long.

Who will do my surgery?

The type of surgeon who does your operation depends on the type of cancer you have and where it is in your body. Your choice of surgeon might also depend on the hospital or treatment center where you get your surgery.

Surgical oncologists perform many types of cancer surgery.  Some may specialize in certain types of cancers, such as breast or colorectal, but can often treat other types of cancer.

Some specialize in treating cancer in specific parts of the body such as:

• Breast surgeons focus on treating people with breast cancer.
• Dermatologists or dermatologic surgeons mainly treat people with skin cancer and other skin problems.
• Gastrointestinal (GI) surgeons treat cancers of the stomach, small intestine, large intestine (colon), and rectum. They may also treat other cancers in the abdomen (belly), such as pancreatic, liver, and gallbladder.
• Gynecologic oncologists treat cancers of the female reproductive system, such as cervical cancer, ovarian cancer, and uterine cancer. One common surgery done by this type of surgeon is a hysterectomy which removes the uterus and part of the cervix.
• Neurosurgeons are specially trained to treat cancers in the brain or spine.
• Oral and maxillofacial  surgeons treat people with cancers affecting their mouth, jaw, or face.
• Orthopedic surgeons focus on treating different types of cancer in the bones or repairing damage to the bones from cancer.
• Otolaryngology or ear, nose, and throat (ENT) surgeons treat people with cancers of the ear, nose, and throat.
• Plastic or reconstructive surgeons specialize in changing how a body part looks after cancer treatment. They may rebuild or replace removed or injured body parts.
• Thoracic surgeons focus on surgery for cancers in the chest, such as the lungs or esophagus.
• Urologists and urologic oncologists focus on treating cancer of the urinary tract. This includes bladder, kidney, prostate, and testicular cancers.

When you are choosing the doctor who will do your surgery, be sure to ask how much experience they have in treating your kind of cancer. You can ask for a second opinion if you wish to talk to another surgeon before deciding.

Who will take care of me during surgery?

Your surgeon will lead the team who take care or you before, during and after your surgery. You might not meet some of them, but they will be in the operating room during your surgery or in the recovery room after your surgery is finished. Besides your surgeon, other members of your surgical team might include:

Anesthesiologist.  This type of doctor cares for patients right before, during, and after surgery by giving anesthesia and monitoring their vital signs, such as breathing, heart rate, and blood pressure.

Certified registered nurse anesthetist (CRNA).  This specially trained nurse might give you anesthesia and monitor your vital signs. They might work with the anesthesiologist or on their own.

Oncology nurse practitioners (NPs) and oncology physician assistants (PAs).  These providers work alongside a surgical oncologist. They might:

• Do physical examinations before and after surgery
• Order and interpret laboratory and diagnostic test results
• Prescribe medicines
• Provide education to you, your caregiver, and loved ones
• Assist in surgery and with other procedures

Operating room nurses.  These nurses may assist the surgeon during surgery.

Surgical technologists.  These professionals might assist the surgeon during surgery. They often get the operating room ready and help get you ready for surgery.

Recovery room nurses and staff.  These nurses and other staff care for and monitor people who have just had surgery as they recover.

Other health care professionals.  Other team members such as physical therapists, pharmacists, social workers, and nutritionists may help you recover and get the care you need before and after surgery.

Meeting your surgical team

When you meet with your surgeon or surgical team, they will:

• Review your medical record
• Examine you
• Evaluate the need for surgery
• Order some tests to see if you're healthy enough for surgery
• Explain the risks, benefits, and other options (if any) than the surgery
• Consult with other specialists to collaborate in your care (e.g., plastic and reconstructive surgeon, medical oncologist, radiation oncologist, etc.)
• Give you hints, tips, and pointers to get you organized and ready for surgery and the recovery period
• Give instructions for your care after returning home, including what you will and won’t be able to do
• Answer any questions you have

Getting ready for surgery

The time before surgery is called the pre-operative phase. Although there are many kinds of surgical procedures, certain steps need to happen during the pre-operative phase for almost all of them. Your surgical team will manage this part of your care.

 Insurance pre-approval

Before agreeing to surgery, ask your surgeon or other member of your cancer care team whether you will need pre-approval (or prior authorization) for the surgery. They might suggest that you check with your insurance provider to see if this is needed.

The facility where you are getting surgery may have a billing department that can help you figure this out and prepare any needed paperwork. Your surgeon or other members of the surgical team can tell you if there is someone who can help you with this.

Give your permission (informed consent)

Before your surgery can be done, you and your surgeon must go through a process called informed consent. This means that your surgeon and other members of the surgical team must talk to you about what you can expect with your surgery and answer any questions you have. Your surgical team should talk to you about:

• Your treatment options, including surgery and other treatment types
• How long it will be before surgery can be done
• The operation, including the benefits, risks, and side effects
• What to expect before, during, and after surgery

Once you have gotten this information and had your questions answered, your surgeon will ask if you understand what to expect and agree to the surgery. You will then be asked to sign a consent form. Signing this form means:

• You give written permission for this surgery
• Your team gave you information on your surgery, its risks, and other treatment options
• All your questions have been fully answered (for the time being)
• You choose to have this surgery
• You understand that the surgeon can’t guarantee that the surgery will give the expected results

Other factors that could affect your surgery

Tobacco: If you smoke, your surgeon may ask you to stop before surgery. Using tobacco tightens (constricts) blood vessels and decreases the amount of oxygen that gets to your body tissues. Smoking can delay healing and recovery. It can also increase the risk of complications after surgery.

Diet and alcohol:  Excess weight or obesity may affect surgery and recovery. Your surgeon may ask you to improve your diet, lose weight, or exercise before surgery. You may be advised to stop drinking alcohol, too.

Ask your surgery team about any diet restrictions before surgery. You may be told not to eat or drink the day or days before your operation or you might need to avoid certain foods or fluids. Restrictions are common, especially 24 hours before surgery.

Physical activity: Being physically active can also help you build your strength and gain more energy before you have surgery. It can also help you deal better with stress and anxiety that surgery can cause.  Being more active before surgery might help you recover more easily and have fewer complications.

Medicines and drugs: Be sure to tell your surgeon and surgical team about any prescriptions, over-the-counter medicines, vitamins, supplements, and marijuana or street drugs you may take. Some of these might cause problems before, during, and after surgery.

You may need to stop taking certain medicines before surgery. Some medicines must be stopped a couple of weeks or days before surgery. Others can be stopped the day before surgery, or can be taken as usual. Often, the surgeon will ask you to stop taking certain medicines, such as anti-inflammatory pain medications and blood thinners. Those medicines can increase your risk of bleeding during the surgery.

Anesthesia history: You will probably be asked if you or any family members have had problems with anesthesia before. There are things that can be done to prevent certain problems, such as nausea, vomiting, and being overly sleepy after getting anesthesia.

Pre-operative testing

You'll have tests to check your overall health and see if you have any problems that need to be watched for during surgery. The tests you need will depend on your situation, but here are some standard tests that might be done:

• Blood tests to check your blood count, blood sugar, kidney and liver function, and your risk for bleeding
• Blood test to identify your blood type in case you need a blood transfusion
• Urine test to make sure your kidneys are working and to check for infection
• Chest x-ray to look at your lungs
• Electrocardiogram (ECG or EKG) to test your heart function

To help plan your surgery, you may need imaging tests, such as magnetic resonance imaging (MRI),  computerized tomography (CT) scan, positron-emission tomography (PET) scan, an ultrasound, or a bone scan.

Will I have to stay in the hospital after surgery?

Depending on the type of surgery and how well you do, you may be able to go home the same day or have to stay in the hospital overnight.

Outpatient surgery means you can go home the same day as your surgery. You will need someone to take you home so plan to bring a family member or friend. Your surgeon or surgical team will follow-up with them after surgery to let them know how the surgery went and what you will need when you get home.

Inpatient surgery means you must stay in the hospital for at least one night after surgery. Many people like to bring a family member or friend to wait during surgery. Your surgeon or surgical team will talk with them during or after surgery to let them know how it went.

Your surgical team will let you know what kind of aftercare and support you will need at home after surgery. Ask your surgical team when you should see the surgeon for a follow-up visit. Also ask how and who to call, in case you have a problem, or a question comes up after the surgery. Be sure to ask your team about these things before leaving the place you had surgery.

Prep before surgery

A "prep" may be needed before surgery if you are getting anesthesia. You will likely be told to stop eating and drinking for a certain time before surgery. Sometimes, you will be told when to stop eating solid foods, and then liquids will be stopped later.

For some surgery, you might have to take a laxative or enema to be sure your bowels are empty. Your skin will need to be cleaned well before the operation to reduce the risk of infection. You may be asked to shower or bathe the day before or morning of your surgery. Some people will be told to use a specific cleanser so check with your surgical team.

What should I wear to my surgery? What should I bring with me?

Your surgical team will let you know what to wear and bring with you to your surgery. You may be asked to remove and store all clothing and/or jewelry, including rings, before surgery. Think about leaving jewelry and other valuables at home or with a family member or friend in the waiting area.

If you wear contacts, be sure to wear eyeglasses on the morning of your surgery. It is easier to remove your glasses. You can bring your contact lenses, case, and solution to use after surgery.

You might be asked not to wear makeup, skin lotions, or creams on the day of your surgery. This will depend on the type of surgery you are having, so be sure to check your instructions and ask questions about anything unclear.

What happens during cancer surgery?

The day of your surgery, the surgical team will get you ready for surgery. Some of the surgical preparation happens before you receive anesthesia and some happens after. People having surgery often receive anesthesia. There are different types of anesthesia depending on the type of surgery.

Before surgery, the staff will help you change into a surgical gown and you may be given a cap to wear on your head and socks. The staff may also remove any hair from the surgical area and clean your skin. This helps reduce the  risk of infection, and is an important part of care after surgery.

You may also have a catheter placed. A catheter is a flexible tube that is inserted into the body to collect urine from the bladder.

During many surgical procedures, the surgeon will remove your cancer. The surgeon often also removes some healthy tissue around your cancer to improve the chances that all the cancer is removed. There are many types of cancer surgery, depending on where your cancer is and how big it is. For some types of cancer surgery, nearby lymph nodes may also be removed.

During surgery, your doctor may insert one or more drains to help keep fluid from building up at the incision site. These drains may be removed before surgery is complete or may be left in place after the procedure is completed.

If you will still have the drain when you leave the hospital or clinic, your surgical team will tell you how to care for it. Be sure to ask any questions about your drain or your care after surgery.

Once the cancer is removed and drains (if used) are placed, your doctor will close your incision with stitches, staples, surgical glue, or special bandages. A dressing is often then placed to cover your incision. Your surgical team will teach you how to care for your incision when you go home.