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Know Your Cancer

What is Surgery in cancer, and why is it important?

Surgery is a standard method of treating cancer. Cancer Surgery means removing the tumour and adjacent tissue during an operation. A doctor who performs Surgery to treat cancer is called an onco-surgeon. Surgery is one of the oldest types of Cancer Treatment. And today, it is still beneficial in the treatment of many types of cancer. It is the most accurate in removing most types of cancer before it had even spread to (metastasized) lymph nodes or distant sites.

Surgery in cancer is not only a treatment method. It is also used extensively for the diagnosis of cancer. It is also used by doctors to locate if the cancer has spread to nearby lymph nodes and tissues. However, Surgery is not a solution for certain cancers like blood cancer, which does not form a solid tumour.

Surgery is not usually the recommended treatment across early-stage cancers. Some cancers grow rapidly or are in inaccessible locations. In other cases, removing the cancer may require the removal of an entire organ, or Surgery may impair the function of the organ. In such cases, it may be beneficial to treat with radiation or Chemotherapy first.

If the cancer has not metastasised, the patient may be cured by Surgery. Before surgery, though, it is not always possible to be sure, whether the cancer has spread or has not. Doctors also remove lymph nodes near the tumour (sentinel nodes) during Surgery to see if the cancer is spreading in them. If so, the person may be at a high risk of recurrence of the cancer and may require post-surgery radiation or Chemotherapy to prevent recurrence.

When a cancer has metastasised, Surgery is not the primary treatment. Sometimes, however, Surgery is done to decrease primary tumour size (a procedure called debulking), so Radiation therapy and Chemotherapy may be more effective. Surgery may be performed to improve symptoms such as extreme Pain and Nausea or vomiting, when a tumour blocks the intestine. Surgically extracting metastases rarely results in a cure because it is difficult to locate all the tumours. However, under certain types of cancer (such as renal cell cancer) that have quite a small number of metastases, especially to the liver, brain, or lungs, surgical removal of the metastases can be helpful. Surgery may be used on its own or together with other therapies, such as Radiation therapy and Chemotherapy.

When a tumour has been removed, additional Surgery may be required to enhance the comfort or quality of life of the person (for example, after mastectomy, reconstruction of a breast).

The effectiveness of Surgery to treat cancer and its positive result varies depending on the form, stage, size, spread, and location of the cancer. Surgery in the initial stages of cancer results in fairly good outcomes for treatment.

Surgery may be your only way of treatment, but often radiotherapy, drug therapy, such as cytotoxic drugs, or both combined. Combination therapy is used as cancer cells can detach themselves from the tumour and move through the body elsewhere, often even at a very early stage, which Surgery can not avoid. Additional treatment, or adjuvant, is used to destroy detached cancer cells.

When is Surgery required in cancer?

Surgery is the earliest treatment for cancer, and is also an outstanding choice for cancer care. In addition to removing the cancerous tumour, Surgery can also help confirm a diagnosis and classify the stage of cancer. While Surgery is an efficient treatment for several forms of cancer, the cancer's site and growth behaviour will determine if the most efficient response would be Surgery.

Surgery may be required at different stages of cancer development:

  • During cancer diagnosis
  • For eliminating all or part of a cancer
  • For determining where the cancer lies
  • For assessing whether the cancer has spread or has an effect on other organ functions in the body
  • For restoring the appearance or feature of the body
  • For treating the side effects of cancer

You may have Surgery in the doctor's clinic, operating centre, or hospital. It depends on the type of operation and how long you need to recover from it. There is inpatient operation where you need to stay in hospital overnight or longer to recover from the Surgery. Outpatient Surgery means you do not need to stay overnight in hospital before or after the procedure.

Who needs cancer surgery?

Whether Surgery is an efficient method of treatment, depends on factors such as the tumour's type, location, size, stage of cancer and grade. The patient's health issues including physical fitness, age, and other medical conditions are also considered. Many patients may undergo cancer Surgery in combination with other treatments like radiation therapy, chemotherapy, and/or Hormone therapy.

Depending on the cancer type, tumour size and location, Surgery may take place using minimally invasive techniques such as laparoscopy or Robotic Surgery. Certain conditions may require more invasive open surgery, with larger incisions. A surgical oncologist may collaborate with other doctors and healthcare professionals to help reduce Pain and other adverse effects from surgery, and to speed recovery.

Surgery works best for single area containing solid tumours. It is a local treatment, meaning it is treating the cancer only to the part of your body. It is not used for the spread of leukaemia (a type of blood cancer) or cancers.

How Surgery works against cancer?

Common reasons that Surgery is used against cancer include:

  • Preventing cancer: If you have a high chance of contracting cancer in other tissues or organs, it may be recommended that the doctor remove certain tissues or organs before cancer. For example, if you are born with a genetic disorder called family adenomatous polyposis, the doctor may use cancer surgeries to correct the colon and rectum, since you have a high chance of contracting Colon Cancer.
  • Diagnosis: Your doctor can use a type of cancer Surgery to remove all or part of the tumour С allowing the tumour to be analyzed under a microscope С to decide whether the tumour is cancerous (malignant) or non-cancerous (benign).
  • Staging: Cancer Surgery lets the doctor decide how advanced the cancer is. This is called its stage. Surgery helps the doctor to measure the extent of the tumour and to assess if it has spread to your lymph nodes. Additional testing can be required to determine the stage of the cancer.
  • Treatment: Cancer Surgery is one of the primary treatments and is the best hope of a cure for many cancers, particularly if the cancer is small and has not spread.
  • Debulking: If it is not possible to remove all cancerous tumours, as this may cause significant organ damage, the doctor can remove as much tumour (debulking) as possible to make Chemotherapy or radiation more successful.
  • Relieving symptoms: Surgery is occasionally used to improve quality of life rather than to treat the cancer itself, to relieve Pain caused by a nerve or bone tumour, or to remove a tumour that blocks your intestine.

How is cancer Surgery done?

Often, surgeons use small, thin knives, called scalpels, and other sharp tools to cut through the part of the body during operations. Sometimes, Surgery involves cutting through the skin, muscles and even bones. These cuts may be painful, and take some time for recovery.

During surgery, anaesthesia prevents you from feeling Pain. Anaesthesia refers to drugs or other substances that cause you to lose sensation or sensitivity. Anaesthesia are of three types:

  • Local anaesthesia causes loss of sensation in one specific small area of the body.
  • Regional anaesthesia induces a lack of feeling in a portion of the body, like an arm or a leg.
  • General anaesthesia causes a complete loss of awareness that appears to be in a very deep sleep.

The primary purpose of cancer Surgery is to cure your cancer by removing it all or in part, from your body. This is usually done by the onco-surgeon cutting into your body and removing the cancer along with some healthy tissue in the neighbouring area to ensure all cancer is eliminated.

Also, your surgeon may remove certain lymph nodes in the area and determine if the cancer has spread. This allows your doctor to assess both your chance of being cured and the need for further treatment.

In the case of Breast Cancer surgery, the doctor may remove the cancer by detaching the whole breast (mastectomy) or by removing just the substantial part of your breast that encompasses the cancer and even some of the adjacent tissue (lumpectomy).

In Lung Cancer surgery, the surgeon may remove part of the lung (lobectomy) or the one entire lung (pneumonectomy) to extract all of the cancer.

In both of these examples, at the time of the procedure, the surgeon may also detach certain lymph nodes in the area to see if the cancer is spreading.

Before, during and after Surgery

Before your surgery

Several steps may need to happen before a cancer Surgery to ensure that you can undergo Surgery.

  1. Consultation with your Surgery team: You must consult the onco-surgeon or medical team before the Surgery. Your Surgery team will perform the following:
    • Check your medical records.
    • Perform a physical assessment.
    • Assess the need of Surgery.
    • Explore the risks, benefits and possible options for you.
    • Give you post-surgery instructions.
  2. Informed consent: You will be explained about the risks, benefits and process of the Surgery. You will be asked to sign an informed consent form, which means:
    • You have given written permission for Surgery.
    • You were given information about your Surgery and other available options.
    • You have chosen to undergo Surgery.
    • You may need to apprehend that the Surgery is not guaranteed to give the projected results.
  3. Medical Examinations: You might need to undergo certain medical examinations before the Surgery. Some blood and urine tests will be performed to determine the risk of injury or infection and to monitor kidney and liver functions. Some other medical examinations that may have to undergo are:
    • ECG
    • CT Scan
    • MRI Scan
    • Ultrasound
    • Bone Scan
    • Positron Emission Tomography (PET)
  4. Blood Transfusion: In some situations, blood transfusions may be required. A Blood Test to identify your blood group will be required. You might also have to arrange for blood.
  5. Quitting smoking: You are recommended to avoid smoking at least 2 weeks before your Surgery. This will help in a quicker recovery.
  6. Foods and drinks: Consult your health care team about eating and drinking before the Surgery. In some cases, you might not be allowed to eat or drink for up to 24 hours before Surgery.
  7. Medications: Inform your doctors about any medications you are taking. This includes all dietary or herbal supplements you are taking. Your doctor might recommend you to either stop or continue taking them before Surgery.

During surgery

Based on the type of surgery, different forms of anaesthesia used. Local anaesthesia is administered through an injection, that stuns a small area in your body. This is used in a doctor's clinic for treatments like mole removal. A large portion of the body is numbed using regional anaesthesia. It is achieved by engulfing the nerves around the surgical area. Regional anaesthesia can achieve deliberate sedation. It lets the patients relax and sometimes sleep during the treatment

General anaesthesia is used in major surgeries. It makes a person unconscious during the Surgery. It is administered through a face mask, intravenously, or a combination of both. An anesthesiologist will place a tube in your throat during this procedure. It helps you to breathe, gives you oxygen and sometimes delivers anaesthesia. Your heart rate, blood pressure, and oxygen during the operation will be monitored.

After surgery

You will be transferred into the recovery area after Surgery. The time of recovery depends on the type of operation and anaesthesia employed. You will be able to return home immediately after the operation using local anaesthesia. If regional or general anaesthesia are used, your team will carefully monitor you in a recovery room, until the anaesthesia is worn off. It takes normally 1-2 hours. After surgery, you may feel groggy for a while.

You may feel:

  • Weak
  • Sore in your throat
  • Sore at the site of Surgery or if you have a catheter.
  • Pain when you wake up. You will receive medicine from your healthcare team for Pain relief.

Contact your health team if you develop:

  • Fever
  • Excessive drainage from place of surgery
  • Persistent Nausea and vomiting

What are the Side Effects of surgery?

Potential complications during Surgery may be due to Surgery itself, the drugs used, and your general health. Broadly speaking, the more complicated the surgery, the higher the chance of side effects.

Minor Surgery and taking tissue samples (biopsies) are usually less risky than major Surgery. The most common issue is Pain at the Surgery site. Site infections and reaction due to opioid use, to calm the region (local anaesthesia) are also likely.

Some side effects may occur during and after Surgery. Usually, these side effects are not expected to be life-threatening. You may have:

  • Bleeding
  • Blood clots
  • Damage to nearby tissues
  • Drug reactions
  • Damage to other organs
  • Pain
  • Infections
  • Slow recovery of other body functions

Bleeding:

Bleeding is part of any kind of Surgery and can be, usually, controlled. Bleeding may happen either within the body (internal) or outside the body (external). Bleeding may occur if a blood vessel has not been sealed during Surgery or if a wound is left open.

Doctors try to reduce the risk of bleeding by being very careful when working near blood vessels. They do look for other factors such as laboratory tests to make sure that a person's blood will clot naturally. Serious bleeding may require another Surgery to find the source of the bleeding and stop it. This form of bleeding will also involve a blood transfusion to restore the blood that has been lost.

Blood clots:

Blood clots may form in the deep veins in the legs after surgery, especially if the patient stays in bed for a long time. Such a clot can become a major problem if it gets free and moves to another part of the body, such as the lungs. This is a big reason why you will be encouraged to get out of bed to sit, stand and walk as quickly as possible.

Damage to nearby tissues:

Internal organs and blood vessels may be damaged during Surgery. The doctors are extremely cautious to do as little damage as possible.

Damage to other organs:

Surgery may contribute to trouble with other organs, such as the lungs, heart, or kidneys. Such problems are very rare, but they can be life-threatening. People who already have problems with these organs are more likely to suffer. That's why doctors get a complete medical history and do assessments to look for potential risks before Surgery is performed.

Drug reactions:

Some people have reactions to anaesthesia or other medicines that are used during Surgery. Although rare, they can be severe as they can cause dangerously low blood pressure. Your respiratory rate, heart rate, blood pressure, and other vitals will be closely monitored throughout the Surgery to prevent, detect, or correct this.

Pain:

After surgery, nearly everybody has some suffering. Pain is normal, but you should not allow Pain to slow down your recovery. There are a variety of ways to cope with and overcome and manage surgical Pain. Medicines for Pain may range from acetaminophen (Tylenol) to anti-inflammatory drugs or more potent drugs such as morphine.

Infections:

A few days before surgery, you may be advised to help avoid infection by using a special soap. This soap is especially good for destroying bacteria and can help prepare the skin for Surgery. This is one way you can help prevent the infection from occurring. Even though you do things like this before surgery, and the surgical team takes great precautions to minimize infection, infection at the location of the incision (cut) is a potential problem. Antibiotics, either as a pill or via a vein in your arm (IV), can treat most of the infections.

In patients with a decreased lung function, such as those who have chronic lung disease or those who smoke, lung infection (pneumonia) is particularly common. Deep breathing exercises after Surgery helps reduce this risk as soon as possible.

Other infections within the body could develop, in particular when the stomach, intestines or catheter were kept open during Surgery and while draining the urine. Surgeons and nurses monitor for infection and test for any temperature, skin or wound changes and try to stop it. But, antibiotics are required if this happens.

Slow recovery of other body functions:

Some body activities, such as bowel activity, can be slow to recover. Your level of energy can also decrease. After surgery, leaving bed as soon as possible can help reduce this risk.

Possible long-term side effects of cancer surgery

Long-term adverse reactions depend on the type of operation performed. You may want to ask if you are having Surgery on or around your reproductive organs about the effects on your ability to have a baby or father a child (fertility). Colorectal Cancer surgeries may require an aperture in the abdomen to which the colon end is attached (colostomy). A man with the removal of his prostate (radical prostatectomy) may lose control of the urine or become unable to obtain an erection or maintain it (impotence). The potential long-term impacts of Surgery should be discussed with the doctor before the procedure.

Can Surgery cause cancer to spread?

You might have heard that cancer Surgery can spread the cancer. It is very seldom that cancer spreads through Surgery. Progress in Surgery equipment and more detailed imagery tests contribute to a low risk. However, there are some crucial situations when this can occur. Physicians with considerable experience of cancer diagnosis and procedures are particularly vigilant to prevent these conditions.

In the past, bigger needles were used to grab a piece of the tumour (biopsy) to look at under a microscope. In those days, there was a likelihood of Biopsy spread or "seeding." Nowadays, a tiny needle is used to remove a piece of the tissue (called a needle biopsy). The risk of a Biopsy that causes cancer to spread is very low with the smaller needles. However, a slight chance of this happening during a Biopsy is posed by some liver (hepatic), kidney(renal) and other tumours.

The so-called incisional biopsy, where a surgeon cuts the skin to remove a small portion of the tumour, can safely test many types of cancers. However, there are some exceptions, like some eyes or testicular tumours. Doctors can first treat these cancers without Biopsy or can advise that the whole tumour should be removed (resected), if the tumour is likely to be cancer. A needle Biopsy may also be used and the entire tumour is removed if it is shown to be cancer.

For some tumours, no needle biopsies can be used. The tumour may have to be removed partially or fully in these cases. Any types of tumours are at low risk of spreading cancer from the resection process. Parathyroid and gallbladder tumours, and some sarcomas are examples. Though, this only rarely happens, thanks to rapid advances in equipment and imaging techniques.

A common myth about cancer is that it spreads through Surgery when exposed to air. Some people may think so because after an operation they often feel worse than ever. But when you heal from surgery, it is common to feel this way. Another reason people may think this is true, because the doctor may find more cancer during Surgery than anticipated in scans and X-rays. This can occur, but it is not due to the Surgery - the cancer had already occurred - the tests that were carried out did not identify the tumours. The exposure of cancer to air has not spread it. You may harm yourself if you delay or refuse surgical procedure because of this myth.

What are the Risks of cancer surgery

Risk is part of any kind of Surgery. While science and medical technology have made Surgery a safe and effective treatment choice, there is still a chance of possible complications and side effects. However, in many cases, the benefits of Surgery outweigh the threats. This is one of the justifications of why learning about cancer and Cancer Treatment is essential. The more you know about cancer surgery, the more informed your choices will be. Until you seek surgery, make sure to address the following possible problems with your cancer care team:

Some of the risks of cancer Surgery are:

  • Pain: Pain is a common side effect of almost all surgeries. Some people experience more Pain than others do. Your doctor will tell you how to minimize your Pain and provide medication to eliminate or reduce your Pain.
  • Infection: The site of your Surgery may become infected. Your doctor will advise you how to take care of your wound following Surgery. You will have to practice this regimen closely to prevent infection. This will add to faster recovery. In certain cases, if an infection occurs, the doctor may treat it with antibiotics.
  • Loss of organ function: The surgeon may need to remove the whole organ to treat the cancer. If you have kidney cancer, a kidney (nephrectomy) may be performed. For some of these surgeries, the remaining organ may function adequately to cover the loss, but you may be left with disabilities. For e.g, removal of the lung (pneumonectomy) can cause trouble breathing.
  • Bleeding: All patients undergoing surgeries are at risk of bleeding. Your surgeon is going to try to minimize this risk. You might require blood transfusion either during the Surgery or after it.
  • Blood clots: When you are healing from surgery, you are at an elevated risk of building up a blood clot. Although the risk is small, its consequences may be serious. Blood clots most often occur in the legs and can cause some swelling and discomfort. A blood clot that breaks down and travels to the lung (pulmonary embolism) is harmful and sometimes deadly. Your surgeon will take measures to prevent blood clots from forming, such as getting you up and out of bed as quickly as possible. following Surgery or administering a blood-thinning drug to minimize the chance of clots.
  • Altered feature of the stomach and bladder: Right after surgery, you may have difficulty having a bowel movement or urinating. This normally settles within a few days, depending on the particular procedure.
  • Whatever medical care your doctor may recommend, you are likely to feel some Anxiety about your condition and the treatment process. Knowing what to expect can help you. Use this material to help you ask knowledgeable questions while you have a consultation with your doctor.