For an overview of cancer surgery, including the different types of
surgery, read the PLWC Feature: Part I: Understanding Cancer Surgery.
This week's article discusses what to expect when you are scheduled for
surgery, including before surgery, during surgery, and recovery from
The surgical team
When a patient with cancer undergoes surgery, a team of highly trained
medical professionals works together to provide the best possible care during
surgery. This team is led by a surgeon. The type of surgeon who performs
the procedure will vary based on the type and extent of cancer (for
example, urologists [urologic cancers, including prostate, bladder,
kidney], neurosurgeons [brain cancers], thoracic surgeons [lung cancers],
and dermatologic surgeons [some types of skin cancer]. General surgeons
also perform cancer surgeries. Below you will find more information about
the surgeon and other members of the surgery team.
Surgeons. All surgeons have completed medical school and
undergo additional specialized training after medical school. Most
surgeons have also passed national level exams given by a board of
surgeons for "board certification." A surgical oncologist is a
doctor who specializes in surgery and other invasive procedures to
prevent, diagnose, and treat cancer.
Anesthesiologist. Modern anesthesiologists are doctors who
complete four years of anesthesiology residency after medical school.
These doctors ensure your comfort during surgery, but they also make
informed medical judgments to protect you. They monitor your breathing,
heart rate, and blood pressure. They will immediately diagnose and treat
any medical problems that may arise during your surgery or recovery
period. Anesthesiologists are also involved in pain management and give
the medicines that cause a loss of feeling to relieve pain during
surgery. The anesthesiologist gets involved before, during, and after
your surgery to ensure your surgery is managed in the best manner possible.
Certified registered nurse anesthetist (CRNA). A nurse
anesthetist may also take care of you before, during, and after surgery.
This nurse monitors every important function of your body and modifies
the anesthesia when necessary to ensure your safety and comfort. A nurse
anesthetist has a bachelor degree in nursing, as well as specialized
training in anesthesia. Nurse anesthetists are required to pass a
national certification exam to become CRNAs.
Operating room (OR) nurse/circulating nurse. OR nurses are
registered nurses that are licensed by the state to care for surgery
patients. The OR nurse assists the surgeon during surgery. Operating room
nurses are certified in various surgical areas.
Recovery room nurses and staff. Recovery room nurses care for and
monitor patients who have undergone major or minor surgery.
Reconstructive surgeon. A reconstructive surgeon specializes in
the reconstruction of removed or altered body parts. During
reconstruction, the reconstructive surgeon may use tissue from the patient
or special material manufactured to maintain a particular shape over
time. Sometimes the cancer surgery and the reconstructive surgery are
performed at the same time, especially if the reconstruction is needed to
close the wound, but frequently they will be separate procedures.
Generally, these two types of surgery are performed by two different
surgeons. The surgeon operating on the cancer must have the cancer and
the best chance of cure as his or her focus. The surgeon performing the
reconstruction generally has cosmetic outcome as his or her focus.
Questions to ask about your surgery
Consider asking the following questions if your doctor recommends
Is surgery the best
treatment for my type of cancer?
What other treatment
options are available?
What should I do to
prepare for the procedure?
How many operations like
this one have you done?
How long will the
Will you describe
exactly what you will be doing during this operation and why?
What type of anesthesia
will I need for this operation? (See below for more information.)
What are the potential
risks and side effects of this operation?
Should I get a second
What can I expect after
How long will I be in
How long will it take for
me to recover?
Will there be permanent
effects from the surgery?
Are there instructions
or post-operative care pamphlets I can take home with me?
What to expect when scheduled for surgery
The decision to treat your cancer with surgery should be made with
your doctor and with full understanding of the benefits, risks, and side
effects of the operation (read PLWC Feature: Part III: Side Effects
of Cancer Surgery). You will be asked to provide written permission for
your doctor to perform surgery after you have been informed of all
aspects of the treatment. This process is called informed consent, and it
gives you the opportunity to ask questions about the surgery.
Unless you need emergency surgery, your surgery may be scheduled
several weeks after your diagnosis. This gives you time to educate
yourself about your cancer; talk with others who have undergone the same
type of procedure; obtain a second opinion, if you choose or if required
by your insurance provider; secure pre-approval for the procedure by your
insurance provider, if needed; and arrange for care during the recovery
phase, if needed.
Before surgery, you may need preoperative tests. These tests include:
Determining your blood
type in case a blood transfusion becomes necessary
Assessing liver and
kidney function. These are referred to as "preoperative hepatic
function assessments" and "preoperative renal function
assessments," respectively. These assessments normally occur
through blood tests that measure circulating liver and kidney enzyme
Checking blood counts
and urine samples to see if there is a risk of bleeding or if there
is any on-going infection. This results from assessments of white
blood cell and platelet counts.
Taking chest x-rays and
an electrocardiogram (EKG) to determine lung and heart function
Using a variety of radiologic imaging scans to map the location and
extent of tumors (including computerized tomography [CT], magnetic
resonance imaging [MRI], ultrasound, bone scans, positron-emission
Smokers are encouraged to quit smoking at least two weeks before
surgery to enable their bodies to recovery more quickly after surgery.
You should not eat or drink anything after
the night before your surgery without talking with your doctor. This
includes chewing gum and candy. Drinking alcoholic beverages or smoking
within 24 hours before your surgery can increase the time it takes for
you to recover from anesthesia and may lengthen the healing process.
A possible exception to drinking anything is that you may be allowed
to have clear fluids a few hours prior to checking in at the hospital.
Clear fluids include water, clear juices, clear soft drinks, and
If you are currently taking daily medications for any condition,
including diabetes, high blood pressure, asthma, or others, you should
discuss this with your doctor and anesthesiologist, and follow their
If there is a risk of blood loss during the operation and your
procedure is more than four weeks away, you may want to consider banking
(storing) your own blood for use during your operation.
When you go to the hospital for your surgery, you should wear
comfortable, loose-fitting clothing. Also, instead of wearing your
contact lenses, wear your eyeglasses on the morning of your surgery, as
it is easier to remove your glasses prior to surgery. You may bring your
contact lenses, case, and solution to use once you are recovering from
surgery. You should leave all jewelry and other valuables at home or with
a family member in the surgical waiting area. Jewelry can be a source of
infection, or may interfere with anesthesia or the placement of
monitoring equipment. When the operation is over, your doctor will want
to speak with your family to give them an update on the outcome of your
operation, so please bring someone with you to the hospital on the day of
If you have not been contacted by
the day before your surgery is scheduled to set up a time for your
surgery, you should call to confirm your appointment. If you have any
questions, clarify instructions with the doctor or nurse.
Immediately before surgery, the area of your body to be operated on
will be thoroughly cleaned and shaved to reduce the risk of infection. You
will then be taken to the surgery holding area where a family member or
close friend can stay with you at your request. If the patient is a
child, a parent may even be allowed into the operating room (OR) where
the surgery is performed before the surgery begins.
Anesthesia may be started in the holding area or in the OR. Anesthesia
blocks awareness of pain, but with local and regional anesthesia, you
will remain awake during the procedure. General anesthesia puts you in a
deep sleep for surgery. You may be given medication to help you relax.
Initially, anesthesia is delivered through either a face mask or an
intravenous (IV) needle (a needle placed in a vein in your arm). The
anesthesiologist then places a tube in your throat to assist with
breathing, deliver oxygen, and sometimes anesthesia. The anesthesiologist
carefully monitors your heart rate, blood pressure, and oxygen during the
operation. Generally, you are not aware of anything until you wake up at
the end of the operation. The different types of anesthesia are described
in more detail below.
Local anesthesia. Local anesthesia involves injection of an
anesthetic (numbing agent) directly into the surgical area to block pain.
You may remain awake, but you will probably receive medicine to help you
relax or sleep during the surgery.
Regional anesthesia. Regional anesthesia involves injection of
local anesthetic around major nerves or the spinal cord to block pain
from a larger part of the body. Regional anesthesia types include:
Peripheral nerve blocks. In this
situation, a specific nerve (or group of nerves) is blocked by the direct
injection of a local anesthetic near the nerve. Nerve blocks are usually
reserved for surgery of the hands, arms, feet, legs, or face.
Epidural and spinal anesthesia. When
epidural and spinal anesthesia is used, the spinal cord and nerves that
connect to it are numbed by the nearby injection of local anesthetic to
block pain from an entire region of the body.
General anesthesia. General anesthesia involves inhalation or
injection into a vein of an anesthetic to affect the entire body. No pain
is felt during general anesthesia, and awareness is completely blocked.
Recovery time usually depends on the type of surgery performed and the
type of anesthesia given during surgery. For example, patients who
received local anesthesia may be permitted to go home shortly after the
procedure. Patients who have received regional or general anesthesia are
monitored carefully in a recovery room until the anesthesia wears off,
usually in one or two hours. You may feel groggy for some time after
surgery and gradually become aware of some soreness in your throat from
the anesthesia tube, the presence of tubes at the site of surgery for
draining excess fluid, and perhaps a catheter (tube) in your bladder
allowing urine to exit your body. You might also become aware of pain as
you awaken and may be given medication to relieve pain. When your
condition is stable you will be discharged either to home or your
It is important to follow recovery instructions from your doctor or
nurse. The following suggestions can help speed recovery:
Walk as soon as you can
to circulate blood and prevent clots.
Work with your doctor
and/or nurse to manage pain.
Perform deep breathing
exercises to prevent pneumonia if suggested by your doctor. Do not
smoke during recovery.
Talk with your nurse or
hospital dietitian about getting back to your regular diet.
Be alert for
complications, such as excessive bleeding, infections, and allergic
reactions to anesthesia or drugs (nausea, shortness of breath,
Ask your doctor about
engaging in physical activity after your surgery. Physical therapy
(PT) may be allowed, and it can begin as early as the day following
surgery. PT may become an important part of your recovery because it
can help build strength and flexibility. Some patients are given a
home exercise program to continue their progress, and increased
activity also can be associated with earlier discharge, but it is
important to follow the specific directions given by your doctor.
Although a dressing
(bandage) is used to help a surgical incision heal and to guard
against infection, leaving the dressing on may actually delay
healing or lead to infection. The amount of time that a dressing
should remain in place can vary, so talk with your doctor about how
to change your dressing.
Don't hesitate to ask your health-care providers if you have questions
regarding your recovery. Be sure to follow any specific discharge
instructions they provide and schedule follow-up appointments before you
leave the hospital.
American Cancer Society (ACS): Making Treatment Decisions, Surgery