Surgery is a major part of treatment for many cancers, especially when the cancer is localised (i.e. has not spread). You might have surgery for a range of reasons, including:
- diagnosis and staging: to help diagnose the type of tumour, or see how big it is and whether it has spread or changed
- first-line or primary treatment: which aims to remove as much of the tumour or tumours as possible
- combination treatment: to remove as much of the tumour as possible before starting another treatment such as chemotherapy or radiation therapy, or to remove any remaining cancer after these therapies
- palliative surgery: to relieve the symptoms of a tumour, especially if it is causing pain or obstructing other organs.
- Reconstructive surgery: to improve the appearance and function of a person after a major cancer surgery, such as breast reconstructive surgery or use of prosthetics for head and neck surgery.
- Preventive or Prophylactic surgery: to remove body tissue that is at high risk of developing into cancer.
Types of surgery
Surgery is most commonly done with the intent to completely remove a tumour. It involves making cuts through skin and muscle to reach the tumour. In general, the cancer along with some apparently normal tissue (a margin) is removed, to ensure that there are no microscopic traces of the tumour at the edge of the specimen. Depending on the situation, an entire organ may need to be removed to ensure removal of the cancer. You may need to stay in hospital for this surgery.
Minimally invasive surgery
Minimally invasive surgery (often called keyhole surgery) is often used to help make a diagnosis or to determine the extent of a tumour, as well as for treatment. It involves making small cuts in the body and inserting a tube that contains a video camera, which allows the surgeon to see the tumour and the surrounding tissue, and a special device that can take a sample (biopsy) or cut out the cancer. Recovery times are usually shorter than for surgery that requires large cuts, and there is often less pain.
Minimally invasive surgery may be given a specific name when it is done on certain parts of the body. It is called a laparoscopy when done on the abdomen (belly), and a mediastinoscopy or thoracoscopy when done on the chest.
Preventive (also known as risk-reducing or prophylactic) surgery is sometimes done to remove pre-cancerous tissue that is very likely to become cancer, or to remove apparently normal tissues or organs that are at increased risk of developing cancer. An example of preventive surgery is risk-reducing mastectomy (removal of the breasts) for women with a strong family history of breast cancer.
Another role of surgery may be to insert a central line (also called a venous access device, central venous catheter, portacath or port) into a large blood vessel. This line is usually inserted in your chest or upper arm, and is usually done in the radiology department of the hospital. It is a small plastic tube that either comes out of the body or sits just under the skin. It allows medicines, including chemotherapy, to be given intravenously, and can also be used to take blood samples for testing. Central lines are created for infusional treatments that need to be given over a longer period of time, and so that new lines do not have to be inserted with each treatment or test.
Potential side effects of surgery will depend on the type of surgery and which parts of your body were operated on. During surgery, potential complications can include bleeding, infection, damage to other organs or tissues, and reactions to anaesthetic medications. Doctors will always try to reduce the risks of these side effects, but it is never possible to eliminate them altogether.
Major surgery is usually done under general anaesthetic so that you sleep through the procedure without feeling pain. After surgery, you will probably feel tired and confused, and you may feel sick (nausea) or vomit, and have little appetite. These are normal reactions to anaesthetic. The doctors and nurses will monitor you closely as the anaesthetic medicines wear off in the hours after surgery.
After surgery, it is common to have some pain or discomfort. Pain can be managed, and pain relief might be provided in a number of ways.
People who have abdominal surgery requiring removal of the bowel or bladder may need an opening in the abdominal skin to allow emptying of bowel contents (colostomy) or urine (urostomy). People with head and neck cancers may need a breathing tube in the throat (tracheostomy) if the cancer is expected to cause breathing problems.
Minor surgeries, such as skin biopsies, do not usually require a general anaesthetic. Instead, your doctor may inject a local anaesthetic that blocks pain to that part of the body. You will stay awake and alert during this procedure. Recovery from local anaesthetic is quicker than general anaesthetic, with fewer side effects.
It is also normal to have some swelling and bruising around the site of the surgery. This is your body’s normal response to any cut, and is part of the healing process.
Recovery from surgery
Recovery time from surgery varies from person to person. It will depend on different factors, such as the type of cancer, the type of surgery, how much tissue was taken during surgery, the stage of your cancer and your general health. It will take time to get back to normal activities.
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