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Part II: Cancer Surgery—Your Personal Experience

 

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 surgery.

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 surgery:

  • 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 surgery take?
  • 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 opinion?
  • What can I expect after the operation?
    • How long will I be in the hospital?
    • 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

Before 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 levels.
  • 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 tomography [PET])

Other considerations

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 midnight 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 popsicles.

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 recommendations carefully.

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 surgery.

If you have not been contacted by noon 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.

During surgery

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

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 hospital room.

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, dizziness).
  • 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.

Additional resources

American Cancer Society (ACS): Making Treatment Decisions, Surgery

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