Surgery

Friday 1 April, 2016

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On this page: What is surgery? | How is surgery used for cancer? | 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 other treatments might I have? | Which health professionals will I see?


What is surgery?

Surgery is a medical treatment performed by a surgeon or a surgical oncologist to remove cancer from the body or repair a part of the body affected by cancer. It’s sometimes called an operation or surgical resection.

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 reasons why surgery is used for cancer:

Prevention

Preventive or prophylactic surgery aims to remove healthy tissue that doctors believe will probably become cancerous in the future. It 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 surgery should always be made after talking to qualified health professionals, including a genetic counsellor.

Diagnosis

Surgery may be done to confirm a cancer diagnosis. The doctor may remove all or part of a tumour in a procedure called a biopsy.

Staging

Surgery can help the doctor determine the size of the tumour and whether the cancer has spread. This is called staging. The results of the surgery and other tests will help the doctor work out the stage and decide on appropriate treatment. Call 13 11 20 for more information about staging.

Primary treatment

Small, early-stage cancers that haven’t spread are often successfully treated with surgery. If the cancer is confined to one part of the body, the surgeon will remove the cancerous tissue or a whole organ. This may be the only treatment, or it may be combined with other treatments.

Debulking

If it is not possible to remove all the cancer without damaging nearby healthy organs, a surgical procedure called debulking is done to remove as much of the tumour as possible and to make other cancer treatments more effective.

Reconstructing the body

Reconstructive or plastic surgery can be done for different reasons, such as to improve your appearance and self-image, and to help with mobility or function. Examples include breast reconstruction after a mastectomy, or a skin graft after surgery for skin cancer.

Supporting other treatments

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

Palliative treatment

Surgery can be used to improve quality of life by easing symptoms and side effects of cancer and treatment. For example, surgery may be done if the cancer grows very large and blocks the bowel (obstruction). Other surgical procedures can help to reduce pain.

See information about the types of surgery used for cancer.

How is surgery done?

The way the surgery is done (the approach or technique) depends on the type of cancer, its location, the surgeon’s training and the equipment in the hospital/operating theatre. There are many different techniques that surgeons can use.

Doctors are constantly developing new surgical techniques with the aim of improving recovery times and causing less pain.

Open surgery

During open surgery, the surgeon makes a single vertical cut (incision) into the body to see and operate on the organs and remove cancerous tissue. Sometimes the cut can be quite large. Open surgery might also be used to find out more information about the cancer and its stage.

For cancers in the abdomen or the pelvic area, open surgery is the most common approach and is known as a laparotomy. When open surgery is done on the chest area, it is called a thoracotomy.

Keyhole surgery

Also called minimally invasive surgery, this is when the surgeon makes a few small cuts in the body instead of the one large cut used in open surgery.

For abdominal surgery (laparoscopy), the surgeon makes about 3–5 small cuts and inserts an instrument called a laparoscope. This has a camera and a light attached to it, and the images are projected onto a TV screen. Other instruments are used to remove cancerous tissue.

Similar surgery can be performed on other parts of the body, such as the chest. This is sometimes called thoracoscopy or video-assisted thoracic surgery (VATS). Some people have keyhole surgery followed by open surgery.

In many cases, keyhole surgery can lead to a shorter stay in hospital and reduce bleeding, pain and recovery time.

Robotic surgery

This is a type of keyhole surgery where the surgical instruments are moved by robotic arms controlled by the surgeon, who sits at a console next to the operating table.

Laser surgery

A laser can be used to remove or destroy cancerous tissue. In some cases, laser surgery can be less invasive than other types of surgery.

Cryosurgery

Also called cryotherapy, this is often used to treat skin cancers. Liquid nitrogen is sprayed onto the skin to freeze and kill the cancerous tissue.

Will I stay in hospital?

Often 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 surgery you have, the speed of your recovery and whether you have support at home after you are discharged.

It may be possible to have surgery as an outpatient (day surgery). This means you can go home soon after the surgery – you don’t have to stay overnight in hospital, provided there are no complications. Your doctor will tell you whether you will have surgery as an inpatient or outpatient at one of your pre-surgery appointments.

What is a surgical margin?

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

"Before I had surgery for breast cancer, the doctor told me he didn’t know whether the cancer had spread. During surgery, he removed the tumour and an area around it. The pathology results showed there was cancer in the margin, and I had to have further surgery." – Page

Can surgery spread the cancer?

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

For example, most men with testicular cancer have the entire testicle removed. This is because removing only part of the testicle can increase the chance of the cancer cells spreading during surgery.

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

Some people think cancer can spread if it’s exposed to air during surgery. This is incorrect. This myth may exist because people who feel worse after surgery than they did before might believe this is due to the cancer spreading. However, it’s common to feel unwell after surgery.

Another reason people may believe that exposure to air can spread cancer is if the surgeon finds more cancer than expected. In this case, the diagnostic tests and scans may not have shown all of the cancer, but the cancer was already there – surgery didn’t cause it to spread.

If you are concerned about the cancer spreading during surgery, talk to your surgeon or call Cancer Council 13 11 20.

What questions should I ask?

It’s important to ask questions about the type of surgery recommended to you and the surgeon who will be operating, such as their training and experience. See a list of suggested questions.

What other treatments might I have?

Other treatments, such as chemotherapy or radiotherapy , can be given before, during or after surgery.

Other cancer treatments
Neo-adjuvant therapy

Given before surgery to try to shrink the tumour and make it easier to remove.

Adjuvant therapy

Given after surgery, often when:

  • the tumour 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 therapy

Two types of treatment are given at the same time. This is rare – an example is specialised chemotherapy called hyperthermic intraperitoneal chemotherapy, which is delivered directly to the abdomen during surgery.

Which health professionals will I see?

You will be cared for by a range of health professionals before, during and after surgery who will work as part of a multidisciplinary team (MDT). Read about the type of cancer you have for a list of the people who will make up your MDT.

Some of the health professionals you may see include:

  • surgeon/surgical oncologist – a doctor who specialises in the surgical treatment of cancer
  • anaesthetist – a doctor who administers anaesthetic before surgery and monitors patients during the operation
  • cancer care coordinator or clinical nurse consultant – coordinates your care, liaises with other members of the MDT and supports your family throughout treatment
  • nurses – administer drugs and provide care, information and support throughout your treatment
  • social worker, psychologist – link you to helpful services and provide emotional support to you and your family
  • dietitian – recommends an eating plan to follow when you’re in treatment and recovery
  • physiotherapist – helps you to move and exercise safely to regain strength, fitness and mobility
  • occupational therapist – offers equipment/aids and advice about getting back to your daily activities
  • general practitioner (GP) – provides follow-up care after surgery.

Other help is available in certain situations – for instance, if you will require a stoma, a stomal therapy nurse will give you specialised information and support.


Reviewed by: A/Prof Gavin Wright, Director, Surgical Oncology, St Vincent’s Hospital, VIC; Mr Chip Farmer, Colorectal Surgeon, The Alfred Hospital, Cabrini Hospital and The Avenue Hospital, VIC; Carmen Heathcote, Cancer Support Advisor, 13 11 20, Cancer Council Queensland, QLD; Anna Hrynko, Consumer; Georgie Palmer, Physiotherapist, Physiofit, TAS; Karen Redman, Breast Care Nurse Practitioner, Breast/Endocrine Surgical Oncology, The Queen Elizabeth Hospital, SA; Dr Shomik Sengupta, Urologist, Sengupta Urology, VIC; Dr Anica Vasic, Head, Pain Management Unit, St George Hospital, NSW.