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Cancer Surgeon

Surgery is the removal of the tumor and surrounding tissue during an operation. A doctor who specializes in treating cancer using surgery is called a surgical oncologist. Surgery is the oldest type of cancer therapy and remains an effective treatment for many types of cancer today.

The goals of surgery vary. However, it is used for the following reasons:

  • To diagnose cancer
  • To remove all or some of a cancer or tumor
  • Find out where the cancer is located
  • Find out if the cancer has spread or is affecting the functions of other organs in the body
  • To restore the body's appearance or function
  • To relieve side effects

The location where you have surgery depends on the extent of the surgery and how much recovery you need. You may have surgery in a doctor's office, clinic, surgery center, or hospital. Outpatient surgery means that you do not need to stay overnight in the hospital before or after surgery. Inpatient surgery means that you do need to stay in the hospital overnight or longer to recover after the surgery.

Types of conventional surgery

Diagnostic. For most types of cancer, a biopsy is the only way to make a definitive diagnosis. During a surgical biopsy, the surgeon makes a cut called an incision in the skin. Then, he or she removes some or all of the suspicious tissue.

There are 2 main types of surgical biopsies:

  • An incisional biopsy is the removal of a piece of the suspicious area for examination.
  • An excisional biopsy is the removal of the entire suspicious area, such as an unusual mole or a lump.

After a biopsy, a pathologist uses a microscope to examine the tissue removed. A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease. The pathologist provides a pathology report to the surgeon or oncologist, who makes the diagnosis.

Staging. Staging surgery is performed to find out the size of the tumor and if or where it has spread. During this surgery, the doctor often removes some lymph nodes near the cancer to find out if it has spread. Lymph nodes are tiny, bean-shaped organs that help fight infection.

Your health care team uses the results from this surgery along with the results of other tests to guide the treatment options. These tests can also help predict a patient's prognosis, which is the chance of recovery. The stage of cancer may also be included on the pathology report (see above).

Tumor removal, also called curative or primary surgery. Surgery is most commonly used to remove the tumor and some of the surrounding healthy tissue. The tissue surrounding the tumor is called the margin.

Tumor removal may be the only treatment, or it may be combined with:

  • Chemotherapy
  • Radiation therapy
  • Other treatments, which may be given before or after surgery

With conventional surgery, the surgeon makes large incisions through skin, muscle, and sometimes bone. In some situations, surgeons can use surgical techniques that are less invasive. These less-invasive techniques may speed recovery and reduce pain afterwards. Learn more about types of minimally invasive surgery below.

Debulking. Sometimes, the surgeon cannot remove the entire tumor or removing it might cause too much damage to the body. In these situations, surgery is used to remove as much of the tumor as possible. Other treatments, such as radiation therapy or chemotherapy, may also be used to shrink the remaining cancer. These treatments may also be given before surgery to help shrink the tumor so it can be removed.

Palliation. Palliative surgery is used to relieve side effects caused by a tumor. It plays an important role in improving quality of life for patients with advanced cancer or widespread disease. For example, surgery may be used to:

Relieve pain or restore physical function when a tumor causes the following complications:

  • Pressure on a nerve or the spinal cord
  • Blockage of the bowel or intestines
  • Pressure or blockage elsewhere in the body.

Stop bleeding. Certain cancers are more likely to cause bleeding, including:

  • Cancers in areas with a high concentration of blood vessels, such as the uterus,
  • Cancers in organs that are fragile and can easily bleed when food and waste products pass through, such as the esophagus, stomach, and bowel.

Bleeding may also be a side effect of some drugs used to treat cancer. When surgery is needed to stop bleeding, a common technique is suture ligation. This surgery involves tying blood vessels using surgical thread.

  • Insert a feeding tube or tubes that deliver medications if the cancer or treatment has made it difficult to eat. A feeding tube is inserted directly into the stomach or intestine through the abdominal wall. Or, a tube may be inserted into a vein to deliver pain medication or chemotherapy.
  • Prevent broken bones. Bones weakened by cancer or cancer treatment can break easily and often heal slowly. Inserting a metal rod may help prevent fractures of weak bones and relieve pain during healing.

Reconstruction. After primary cancer surgery, surgery may be an option to restore the body's appearance or function. This is called reconstructive or plastic surgery. Reconstructive surgery may be done at the same time as surgery to remove the tumor. Or, it may be done later after a person has healed or received additional treatment. Examples of reconstructive surgery include breast reconstruction after a mastectomy and surgery to restore a person's appearance and function after surgery to the head and neck area.

Prevention. Some surgery is performed to reduce the risk of developing cancer. For example, doctors often recommend the removal of precancerous polyps in the colon to prevent colon cancer. In addition, women with a strong family history of breast or ovarian cancers or known mutations to the BRCA1 and BRCA2 breast and ovarian cancer genes may decide to have a mastectomy or oophorectomy to lower the risk of developing breast or ovarian cancer. A mastectomy is the removal of a breast. An oophorectomy is the removal of the ovaries.

Types of minimally invasive surgery

As mentioned above, conventional surgery often requires large incisions. In some situations, a surgeon can use one or more small incisions. These surgeries typically result in shorter recovery times and less pain afterwards. Below are some examples of minimally invasive procedures and surgeries:

Laparoscopic surgery. The doctor performs surgery through small incisions in the skin using a thin, lighted tube with a camera. The term laparoscopy refers to a minimally invasive surgery of the abdomen. The terms, mediastinoscopy and thoracoscopy are used when the same type of procedure is performed in the chest. Laparoscopic surgery may also be done with robotic assistance for some surgeries.During this type of surgery, the surgeon directs robotic instruments to perform the surgery. This surgical procedure may be used for the kidneys, a man’s prostate, or a woman’s uterus or ovaries.

Laser surgery. The doctor uses a narrow beam of high-intensity light to remove cancerous tissue.

Cryosurgery. The doctor uses liquid nitrogen to freeze and kill abnormal cells.

Mohs micrographic surgery, also called microscopically controlled surgery. The dermatologist shaves off a skin cancer, one layer at a time, until all cells in a layer appear to be normal cells when viewed under a microscope.

Endoscopy. The doctor inserts a thin, flexible tube with a light and camera on the tip into the body. This device is called an endoscope. It may be inserted into the mouth, rectum, or vagina to examine the internal organs. During an endoscopic procedure, it is possible to remove samples of potentially abnormal tissue for further examination. Learn more about types of endoscopy.

Your surgical team

If you need surgery, a team of highly trained medical professionals will work together to give you the best possible care. Your team may include the following people:

Surgeon or surgical oncologist. This is the doctor who will lead your surgical team. The type of surgeon you see is based on the type and stage of cancer. Below are some examples of different types of surgeons. However, there are other types of surgeons that are not listed here. In addition, general surgeons also perform a variety of cancer surgeries.

  • Urologists and urologic oncologists. These professionals specialize in treating urologic cancers with surgery. Urologic cancers include prostate, testicular, bladder, and kidney cancers.
  • Neurosurgeons. This type of surgeon treats brain cancers with surgery.
  • Thoracic surgeons. These are the doctors who treat lung and esophageal cancers with surgery.
  • Dermatologic surgeons. This type of surgeon treats some types of skin cancer.

Anesthesiologist. An anesthesiologist is a doctor who cares for patients immediately before, during, and after surgery by giving anesthesia. Anesthesia is medication that blocks your awareness of pain during surgery and may make you unconscious. An anesthesiologist also monitors your vital signs, such as breathing, heart rate, and blood pressure. And, he or she identifies and treats any problems related to anesthesia that may happen during surgery and recovery.

Certified registered nurse anesthetist (also called a CRNA). A nurse anesthetist may monitor your vital signs and modify the anesthesia as needed with the direction of the anesthesiologist.

Operating room nurse (also called an OR nurse). OR nurses assist the surgeon during surgery.

Recovery room nurses and staff. Recovery room nurses care for and monitor patients who have had major or minor surgery.

Other health care professionals. Other team members include pharmacists, social workers, nutritionists or dietitians, and physical therapists. Learn more about the oncology team.

Before you have surgery

Meeting your surgical team. Before surgery, you will meet with the surgeon or surgical team. They will review your medical record, do a physical examination, and evaluate the need for surgery.

Giving permission for surgery. Your surgeon or surgical team will talk with you about the risks and benefits of the surgery. They will also discuss possible alternatives to surgery. If you choose to have the surgery, your team will ask you to sign an informed consent form. Signing means: You give written permission for treatment.

  • Your team gave you information on your surgery and other options.
  • You choose to have surgery.
  • You understand that the surgery is not guaranteed to give the intended results.

Testing before surgery. Before surgery, you may need certain tests. Talk with your doctor to learn which tests you will need. Some examples are listed below.

  • A blood test to identify your blood type in case a blood transfusion is needed
  • Other blood and urine tests to assess your risk of bleeding or infection and check liver and kidney function
  • An electrocardiogram (EKG)
  • A computerized tomography (CT) scan
  • Magnetic resonance imaging (MRI)
  • An ultrasound
  • A bone scan
  • A positron-emission tomography (PET) scan

Quitting smoking. If you smoke, you are encouraged to quit smoking at least 2 weeks before surgery. Quitting smoking can help your body recover more quickly after surgery.

Avoiding certain foods and drinks. Talk with your doctor to learn what you should or should not eat or drink during the 24 hours before surgery.

Taking medications. Tell your surgical team about any medications and dietary or herbal supplements you are taking. This includes any prescription drugs and over-the-counter drugs. Your doctor and anesthesiologist will tell you whether to continue taking those medications before surgery and when to stop taking them.

What to wear and bring. When you arrive at the hospital, you may need to remove clothing or jewelry that could interfere with the surgery. Then, change into a hospital gown. Leave jewelry and other valuables at home or with a family member in the waiting area. Also, wear your eyeglasses on the morning of your surgery, rather than contact lenses. It is easier to remove your glasses before surgery. You may choose to bring your contact lenses, case, and solution to use once you are recovering from surgery. Usually, you will also be asked not to wear makeup on the day of the surgical procedure.

Other considerations.

  • Check with your insurance provider to learn whether you need to get preapproval of insurance coverage before the surgery.
  • If there is a risk of blood loss during surgery and your procedure is more than 4 weeks away, ask your surgical team if you should have your blood drawn and stored in case it is needed during surgery.
  • Consider bringing a family member or friend on the day of surgery. After the surgery, your doctor will provide him or her with an update about how it went.
  • Arrange for care during your recovery phase, including transportation home from the hospital.
  • If you have any questions, clarify instructions with the surgical care team. Also, make sure you receive instructions for your care after returning home.
  • Consider making your follow-up care appointments before surgery.
  • Ask about when after surgery you may begin to resume usually physical activity.
  • During surgery

    You will likely receive some type of anesthesia during surgery. There are different types of anesthesia depending on the type surgery.

    • Local anesthesia is an injection that numbs the area that needs surgery. Local anesthesia is used for procedures done in a doctor's office, such as the removal of a mole.
    • Regional anesthesia blocks pain in one larger part of the body. Usually, this is done by numbing the nerves in and around the area where surgery is needed. Patients who have regional anesthesia may receive conscious sedation, also called monitored anesthesia care. This helps the patient relax and sometimes sleep during the procedure.
    • General anesthesia makes a person unconscious during a major procedure. General anesthesia is given through a face mask, an intravenous (IV) needle placed in a vein in your arm, or a combination of both. The anesthesiologist then usually places a tube in your throat to help with breathing, provide oxygen, and sometimes deliver anesthesia. The anesthesiologist carefully monitors your heart rate, blood pressure, and oxygen during the operation. Generally, you are not aware of anything until the anesthesia wears off after the operation.

    After you receive anesthesia , your surgical team will clean and shave the area of your body where surgery is needed. This helps reduce the risk of infection.

    Once surgery is finished, you will be moved to the recovery area.

    After surgery

    Recovery time usually depends on the type of surgery and the type of anesthesia given during surgery.

    After local anesthesia . If you had local anesthesia, you may be able to go home shortly after the procedure.

    After regional anesthesia. If you had regional anesthesia with conscious sedation, you will need to be monitored carefully in a recovery room until the anesthesia wears off. It usually takes about 1 to 2 hours for the anesthesia to wear off. You may feel groggy for some time after surgery.

    After general anesthesia . You will need to be monitored carefully in a recovery room until the anesthesia wears off in 1 to 2 hours. In addition to feeling groggy, you may have soreness in your throat from the anesthesiatube. You may also feel soreness if there are tubes at the site of surgery for draining excess fluid or if you had a catheter. A catheter is a tube placed in the bladder to allow urine to exit your body. You may also become aware of pain as you awaken. Your health care team will give you medicine to relieve the pain. When your condition is stable, you will be taken to your hospital room or allowed to return home.

    Before you leave the hospital, schedule follow-up appointments so that your doctor can monitor your ongoing recovery. It is also important to follow recovery instructions from your doctor or nurse.

    Tips for recovering from surgery

    The following suggestions may help speed recovery:

    • Ask your doctor about physical activity after your surgery. It is important to walk as soon as you can to circulate blood and prevent clots.
    • Ask for a referral to a physical therapist, if needed. Physical therapy may be an important part of your recovery. It can help build strength and flexibility, and some patients can begin as early as the day after surgery. You may receive a home exercise program, but it is important to follow the specific directions given by your doctor and physical therapist.
    • Perform deep breathing exercises to help re-expand your lungs and lower the risk of pneumonia if your doctor recommends it.
    • Do not smoke during recovery. If you do smoke, talk with your health care team about resources to help you quit smoking.
    • Talk with your nurse or hospital dietitian about getting the right nutrition and returning to your regular foods.
    • Let your doctor and nurse know if you are in pain so they can help you to manage it.
    • Watch for unusual bleeding, infections, and allergic reactions to anesthesia or drugs, including nausea, shortness of breath , and dizziness. Your health care team will explain the signs and symptoms to watch for and when to contact your health care team about them.
    • If you develop a fever, excessive drainage from your surgical incision, redness or excessive swelling at your incision site, or persistent nausea and vomiting, contact your health care team.
    • Ask your doctor or nurse when and how to change your bandage, also called the dressing. Although a bandage is used to help a surgical incision heal and guard against infection, leaving it on too long may delay healing or lead to infection.

    https://www.cancer.net/navigating-cancer-care/how-cancer-treated/surgery/what-expect-when-having-surgery

    Side Effects of Surgery

    Cancer surgery, like all cancer treatments, has its benefits, risks, and side effects. The types and intensity of side effects vary from person to person based on several factors:

    • The type and location of the cancer
    • The type of surgery
    • Other treatments received before surgery, such as chemotherapy
    • The person's overall health

    Before you agree to have surgery, you will be given information about the risks and benefits of surgery. You will also learn about the possible side effects.

    Today, many patients are able to have less invasive surgery than in the past. This means that the side effects of surgery are often milder and patients often recover sooner. Also, doctors are now better able to reduce pain and other physical side effects from surgery.

    Relieving side effects is an important part of cancer care and treatment. This is called symptom management, palliative care, or supportive care. Talk with your health care team about any side effects from surgery you may experience. This includes any new side effects or a change in side effects.

    Common side effects of cancer surgery

    Side effects of cancer surgery may include the following:

    Pain. It is common to have some pain after any surgery. The amount and location of the pain depends on many factors, including:

    • Where on the body you had surgery.
    • How large the incision was.
    • How much tissue was removed.
    • If you had pain before surgery.

    Pain after surgery lessens gradually as the body heals. In the meantime, your doctor may give you pain medications to decrease your discomfort.

    Fatigue. Many patients feel very tired after major surgery, especially when if surgery involved the abdomen or chest. The causes of fatigue from surgery include:

    • Anesthesia.
    • The body using energy to help with the healing process.
    • How well-nourished a person is.
    • Loss of appetite after the surgery.
    • The stress of the surgery

    Fatigue usually goes away gradually, within 2 to 4 weeks after surgery.

    Appetite loss. Poor appetite after surgery is very common, especially when general anesthesia was used. It may be associated with temporary weight loss. Most patients regain their appetite and return to their normal weight as the effects of the surgery wear off.

    Swelling around the site of surgery. It is natural to experience some swelling after any surgical procedure. A surgical cut in the skin, also called an incision, is a form of injury to the body. The body's natural response to injury is the inflammatory process, which causes swelling. As the healing occurs after the surgical procedure, the swelling usually goes away.

    Drainage from the site of surgery. Sometimes the fluid that builds up at the surgery site drains through the surgical wound. Drainage that smells bad along with a fever and redness around the wound are signs of infection. If you develop signs of an infection, you should contact your surgeon's office.

    Bruising around the site of surgery. After any surgical incision, some blood may leak from small blood vessels under the skin. This can cause bruising, which is a common occurrence after a surgical procedure. However, if you have significant swelling along with bruising, contact your surgeon's office.

    Numbness. It is common to experience some numbness in the incision site since skin nerves are cut during surgery. Though it usually does not cause patients any problems, it often lasts a long time

    Bleeding. Patients usually lose some blood during surgery. But, it is usually very little and does not affect the normal functions of the body. Sometimes, patients can lose a larger amount of blood depending on the surgery. In these situations, the surgical team will have blood available for a transfusion if it is needed. After surgery, you may experience some bleeding from the wound. If this occurs, cover it with a clean, dry bandage, and contact your surgeon's office. If there is a lot of blood, apply pressure until you can get to your surgeon's office or the local emergency room.

    Infection. An infection may occur at the site of the incision, but it can also occur elsewhere in the body. Surgeons take great care to lower the risk of infection during the operation. After surgery, your health care team will teach you how to prevent infection during recovery. Signs of infection in a surgical incision include redness, warmth, increased pain, and sometimes, drainage from the wound. If you have any of these signs, contact your surgical care team. Antibiotics generally work well to treat most infections. However, some infections form an abscess. This is a closed skin cavity filled with fluid and/or pus. This usually needs to be drained in a doctor's office. Antibiotics do not work as well for an abscess because they may not be able to reach the infection.

    Lymphedema. Lymphedema is a common side effect that may occur after lymph nodes are removed. This type of surgery is called a lymph node dissection. Lymph nodes are tiny, bean-shaped organs that help fight infection. They filter bacteria and other harmful substances from the lymphatic fluid. Lymphatic fluid is a colorless fluid containing white blood cells that travels through most tissues of the body. Sometimes, when the lymph nodes are removed, lymphatic fluid collects in the surrounding tissues and cannot drain back out. This causes the swelling known as lymphedema. Lymphedema causes discomfort and tightness in the swollen area. It can also limit the movement and function of that area, such as an arm or leg. You may need specific therapy to manage this side effect. Talk with your surgical care team about the risk of lymphedema before having any lymph nodes removed. If it is a possible side effect, you may want to ask your doctor to recommend a certified lymphedema therapist (CLT). A CLT is a health professional who specializes in managing lymphedema.

    Organ dysfunction. Surgery in certain areas of the body, such as the abdomen or chest, may cause temporary problems with the surrounding organs. For example, when surgery is performed in the abdomen, the intestine may become paralyzed for a short time. This means that it won't allow food, fluid, and gas to pass through the bowels. This is called an ileus or bowel obstruction. It can cause nausea and vomiting, stomach cramps, and bloating until the bowels begin to function again. Organ dysfunction after surgery generally goes away as you heal.

    Other concerns after cancer surgery

    Dietary concerns. During recovery, the body needs extra calories and protein for healing. Some patients may have difficulty eating regular food. This often depends on the location where the surgery was performed. For example, the removal of any part of the mouth, throat, stomach , small intestine, colon, or rectum can cause the following problems.

    • A lowered appetite.
    • A reduction in the body's ability to absorb nutrients.
    • Problems after eating, such as gas, cramping, or constipation.
    • Difficulty chewing or swallowing food.

    Lowered ability to absorb certain vitamins, particularly after stomach surgery. Doctors usually prescribe vitamin supplements to help. Some vitamin supplements can be given only by injection.

    Body image. Cancer surgery may change the way your body looks and feels and how it functions. Any surgery that changes how your body looks and functions can affect your body image. Body image can also be affected if a patient did not receive the outcome he or she expected after surgery. For example, during surgery, the surgeon may find that a more extensive surgery is needed. Patients may have trouble coping with this change afterwards.

    Some people may feel insecure about these changes and struggle with their self-image. The emotional side effects of cancer surgery are as important to treat as the physical side effects. Before cancer surgery, talk with your doctor about how it will affect your appearance and abilities. Ask about options for reconstructive surgery or prostheses. And, ask about situations that might come up during surgery that would cause a different outcome. Learn more about surgery for specific types of cancer.

    You may also want to consider talking with a counselor who can help you cope with these changes to your body. In addition, some patients find it helpful to join a support group of other patients in similar situations.

    Sexuality and Reproduction

    Certain types of surgery may affect patients’ sexual and reproductive health. In particular, talk with your doctor before your surgery about how it may affect your fertility. Fertility is a woman's ability to conceive a child or maintain a pregnancy and a man's ability to father a child. Learn more about fertility concerns and fertility preservation options for women and for men.

    Depending on the location of the surgery, both men and women may experience sexual side effects . For example, surgery for prostate, bladder, colorectal, or other types of cancer may cause changes in sexual desire, semen production, or the ability to have an erection or ejaculate. Some gynecologic surgical procedures may cause vaginal pain or dryness.

    Many men and women experience a range of feelings after such surgeries that can affect sexual desire and intimacy. It is important to discuss the symptoms you experience with your doctor, nurse, or social worker. Various options are available to help men and women manage the sexual problems from cancer and its treatment.

    Source: https://www.cancer.net/navigating-cancer-care/how-cancer-treated/surgery/side-effects-surgery

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