Surgery

Tuesday 1 April, 2014

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On this page: What is surgery? | How is surgery used for cancer? | What other treatments might I have? | How is surgery done? | Will I stay in hospital? | What is a surgical margin? | Can surgery spread the cancer? | What questions should I ask?


What is surgery?

Surgery is a medical technique that involves cutting into a person’s body. It’s sometimes called an operation.

Although many patients want to have surgery to ‘cut the cancer out’, it isn’t a suitable treatment for all cancers.

For many cancers, doctors follow medical standards called clinical practice guidelines, which outline treatments that have been verified by research. Sometimes surgery is the most effective approach for a particular type of cancer, which is why it is recommended. In other cases, non-surgical treatments have been proven to be more effective.

How is surgery used for cancer?

There are several types of surgery for cancer, which are used to achieve different outcomes:

Prophylactic

Preventive surgery to remove healthy tissue that doctors believe will probably become cancerous in the future. This may significantly reduce a person’s cancer risk.

For example, a woman with a strong family history of ovarian cancer may have prophylactic surgery to remove her healthy ovaries. The decision to have any type of prophylactic operation should always be made after talking to qualified health professionals, including a genetic counsellor.

Diagnostic, staging and exploratory

Surgery may be done to see how much cancer is in the body and to cut out a piece of tissue that may be looked at under a microscope. This is called a biopsy, and it can confirm the type of cancer present. Sometimes the only way to biopsy tissue inside the body is to operate. Based on the biopsy results, the doctor may give the cancer a stage (see below).

Curative

Sometimes the surgeon will remove the cancerous tissue to try to cure the disease. This is usually possible if the cancer is confined to one part of the body. Sometimes a whole organ is removed.

Debulking/cytoreductive

If it’s not possible to remove all the cancer without damaging adjacent healthy organs, debulking is done to remove as much of it as possible. After the operation, the doctor may treat the remaining cancer using radiotherapy or chemotherapy.

Reconstructive (plastic surgery)

This procedure can be done for different reasons, such as to improve your appearance, help with mobility, or improve the way you feel. Examples include breast reconstruction, a prosthestic limb or grafting tissue to repair the surgical site.

Supportive

Surgery done to help another treatment. For example, you may have day surgery to have a tube (catheter) inserted into a large vein in your chest (e.g. a central venous access device or port) so you can receive chemotherapy.

Palliative

Surgery can be used to ease symptoms and side effects, without trying to cure the cancer. For instance, surgery may be done if the cancer grows very large and blocks the bowel (obstruction). There are also procedures, such as a nerve resection, that are done to reduce pain.

For detailed information about how surgery is used, call the Cancer Council 13 11 20. 

What other treatments might I have?

Other treatments, such as chemotherapy or radiotherapy, can be used with surgery.

Neo-adjuvant therapy: Given before surgery, to try to shrink the tumour and ake it easier to remove. 

Adjuvant therapy: Given after surgery, often when:

  • the cancer hasn’t been completely removed
  • cancer has spread to other parts of the body, such as the lymph nodes
  • there is a chance there are hidden cancer cells
  • the cancer is likely to come back.

Simultaneous: Having two types of treatment at the same time. This is rare – an example is specialised, highlyconcentrated chemotherapy delivered directly to the abdomen during surgery (hyperthermic intraperitoneal chemotherapy). 

If you have adjuvant therapy, you will be given time to recover from surgery before receiving chemotherapy or radiotherapy. Many people wait about 6–8 weeks. 

Cancer Council has detailed information about other treatments, such as chemotherapy and radiotherapy. For more information call the Cancer Council 13 11 20. 

How is surgery done?

The way the surgery is done (the approach) depends on the type of operation you have, the surgeon’s training, and the equipment in the hospital/theatre.

Open surgery is the most traditional approach. The surgeon makes a single cut (incision) into the body to see and operate on the organs. Sometimes the cut can be quite large.

Minimally invasive surgery (MIS) is usually called keyhole or laparoscopic surgery. For an abdominal operation, the surgeon makes about 3–5 small cuts and inserts an instrument called a laparoscope. This has a camera and light attached to it and the images are projected onto a TV screen. Instruments are inserted to take a biopsy, cut out cancerous tissue or remove an organ. Similar procedures can be performed on other parts of the body, such as the chest. In some cases, you might have MIS followed by an open operation.

Some surgical procedures may be carried out through tubes (endoscopes) passed into the inside of an organ, such as the stomach, bowel, bladder or trachea.

There are also other surgical techniques, including laser surgery, cryosurgery, robotic surgery and microsurgery. A specialist surgeon may be required, and it may be expensive. For more information, speak to your surgeon or call Cancer Council 13 11 20. 

Will I stay in hospital?

Sometimes you will need to be admitted to hospital to have surgery. This is called inpatient care.

The length of your hospital stay depends on the type of operation you have, your recovery and if you have support at home.

It may be possible to have day surgery (outpatient surgery). This means you can go home on the same day of the operation – you don’t have to stay overnight in hospital, as long as complications don’t arise. 

What is a surgical margin?

The margin refers to the normal-looking, healthy tissue that is removed with the cancer. This extra tissue is removed to try to ensure that all of the cancer is taken out.

The margin is checked under a microscope in a laboratory. If there aren’t any cancer cells, it is called a clear, negative or clean margin. If there are cancer cells in the tissue, it is a positive or close margin, and you may require more treatment. 

"I went to a doctor who specialises in facial and cosmetic surgery. He said it was important to get the melanoma out straightaway. He cut out a larger piece – about the size of a 20-cent coin – and it had clear margins. The cuts from surgery were able to heal into the folds and wrinkles of my face, so the scar is not noticeable." – John

Can surgery spread the cancer?

There are some situations where it is possible for surgery to cause cancer to spread, but it is very rare. In these cases, surgeons are very cautious and will still operate if the benefits of surgery outweigh the risk of not having the operation.

For example, most men with testicular cancer have their entire testicle removed, rather than part of the testicle. This is to prevent cancer cells becoming dislodged.

If the surgeon must remove tissue from more than one part of the body, they will use different tools at each location to reduce the risk of cancer cells spreading.

Some people think that cancer can spread if it’s exposed to air during surgery. This is incorrect. This myth may exist because people feel unwell after an operation. However, it’s common to feel this way when your body has been put under stress and is recovering.

People may also incorrectly think that air spreads cancer, especially if, during the operation, the surgeon finds more cancer than expected. But this isn’t caused by air exposure or surgery. The extent of the cancer isn’t always obvious before surgery – diagnostic tests and scans can’t always show all of the cancer. For this reason, exploratory surgery can be helpful – it gives the surgeon an opportunity to look for abnormal tissue.

Talk to your surgeon or call Cancer Council 13 11 20 if you are concerned about the cancer spreading.

What questions should I ask?

It’s important to ask questions about the type of surgical procedure recommended to you and the surgeon who will be operating.

In particular, make sure you’re familiar with the surgeon’s training and experience. You should also know the likely costs, and the risks and complications of the procedure. See planning and preparation


Reviewed by: Dr Bronwyn Avard, Deputy Director, Intensive Care Unit, The Canberra Hospital and Senior Lecturer, ANU Medical School, ACT; Kylie Foley, Registered Nurse, Urological, Gynaecological and Vascular Surgery, Royal North Shore Hospital, and Practice Nurse, Hills Family General Practice, NSW; Di Holt, Consumer; Shelly Hunter, Physiotherapist, Brisbane Private Hospital Rehabilitation Unit, QLD; Lorraine Kealley, Registered Nurse, Medical Oncology Ward, Royal Perth Hospital, WA; Shomik Sengupta, Urologist, Sengupta Urology, VIC; Dr BP Wheatley, Retired Generalist Obstetrician and Gynaecologist, SA; Carmen Heathcote, Yvonne Howlett and Amy Parker, Helpline Operators, Cancer Council Queensland.

Updated: 01 Apr, 2014