Common questions about surgery
Many people with cancer have surgery. Although many people want to have surgery to ‘cut the cancer out’, it isn’t a suitable treatment for all cancers.
Learn more about:
- How is surgery used for cancer?
- How is surgery done?
- Will I stay in hospital?
- What questions should I ask?
- What is a surgical margin?
- Can surgery spread the cancer?
- Will I have other treatments?
There are several reasons why surgery is used for cancer:
Prevention – Preventive or prophylactic surgery removes healthy tissue that doctors believe will probably become cancerous. It will reduce a person’s risk of developing cancer. For example, a woman with a strong family history of ovarian cancer, but no actual signs of cancer, may have surgery to remove her healthy ovaries. The decision to have preventive surgery should 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 to other tissues or lymph nodes. This is called staging. The results of the surgery, imaging scans and other tests will help the doctor work out the stage and decide on appropriate treatment.
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.
Debulking (cytoreductive) – If it is not possible to remove all the cancer without damaging nearby healthy organs, debulking surgery is done. The aim is to remove as much of the tumour as possible to help make other cancer treatments more effective.
Reconstructing a part of the body – Reconstructive or plastic surgery can be done for many different reasons, such as to take control of your appearance, restore self-esteem, and help improve 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 aid another cancer treatment. For example, you may have day surgery to insert a tube (catheter) into a large vein in your chest to make it easier to receive chemotherapy.
Palliative treatment – Surgery can be used to improve quality of life by easing cancer symptoms and treatment side effects. 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.
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 approaches, and not all involve making cuts. Each method has advantages in particular situations – your doctor will advise which approach is most suitable for you.
Open surgery – During open surgery, the surgeon makes one or more cuts (incisions) into the body to see and operate on the organs and remove cancerous tissue. The size of the cut can vary from small to quite large. An open approach might also be used for staging surgery.
Open surgery is a well-established technique and widely available. It is often used for cancers in the abdomen or the pelvic area, when it 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.
The surgeon will insert a tiny instrument with a light and camera into one of the cuts. The camera projects images onto a TV screen so the surgeon can see the inside of your body. The surgeon inserts tools into the other cuts and removes the cancerous tissue, using the images on the screen for guidance.
Keyhole surgery in the abdomen or pelvic area is called a laparoscopy. When keyhole surgery is done on the chest it is called a thoracoscopy or video-assisted thoracoscopic surgery.
In many cases, keyhole surgery can lead to a shorter stay in hospital and reduce pain and recovery time. Some people have keyhole surgery followed by open surgery.
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.
Cryotherapy – Also called cryosurgery, this is often used to treat skin cancers. Liquid nitrogen is sprayed onto the skin to freeze and kill the cancerous tissue.
Waiting for surgery
It’s common to have to wait for surgery. How long you have to wait depends on the type of cancer you have, its stage, the surgery you are having, and the hospital’s schedule. The waiting list is organised by how urgently people need surgery. This ensures that people are treated in turn but without waiting for periods of time that would be harmful.
Waiting for surgery to begin can be a stressful time – if you are anxious or concerned speak to your surgeon or call Cancer Council 13 11 20.
Will I stay in hospital?
Often you will 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.
What questions should I ask?
It’s important to ask questions about the type of surgery recommended to you, including the risks, possible complications and how long it will take to recover. Also remember to ask your surgeon about their training and experience. Here are some suggested questions to ask your doctor.
What is a surgical margin
The surrounding tissue that is removed with the cancer is known as the surgical margin. A pathologist checks the margin under a microscope to make sure the cancer has been completely removed. 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 further treatment.
Before I had surgery, 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?
In some rare cases it is possible for surgery to spread the cancer. In this situation, surgeons take precautions and will still operate if the benefits of the surgery outweigh the risk of not having it.
For example, most men with testicular cancer have the entire affected testicle removed. This is because removing only part of the testicle can cause cancer cells to spread during surgery.
Some people think cancer can spread if it’s exposed to air during surgery. This is incorrect. One reason people may believe this myth 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 spread it.
If you are concerned about the cancer spreading during surgery, talk to your surgeon.
Will I have other treatments?
For some types of cancer, you may be given other treatments before, during or after surgery.
Timing of other cancer treatments
|neoadjuvant therapy||Drug therapies or radiation therapy may be given before surgery to try to shrink the tumour and make it easier to remove.|
|simultaneous therapy||Two types of treatment are sometimes given at the same time – for example, radiation therapy or heated chemotherapy may be given during surgery.|
|adjuvant therapy||Drug therapies or radiation therapy may be given once you have recovered from surgery, often when:the tumour hasn’t been completely removedcancer has spread to other parts of the body, such as the lymph nodesthere is a chance there may be hidden cancer cellsthere is a significant risk that the cancer could come back.|
Prof Andrew Spillane, Surgical Oncologist, Melanoma Institute of Australia, and Professor of Surgical Oncology, The University of Sydney Northern Clinical School, NSW; Lynne Hendrick, Consumer; Judy Holland, Physiotherapist, Calvary Mater Newcastle, NSW; Kara Hutchinson, Cancer Nurse Coordinator, St Vincent’s Hospital Melbourne, VIC; A/Prof Declan Murphy, Urologist and Director of Genitourinary Oncology, Peter MacCallum Cancer Centre, VIC; Caitriona Nienaber, 13 11 20 Consultant, Cancer Council WA; Prof Stephan Schug, Director of Pain Medicine, Royal Perth Hospital, and Chair of Anaesthesiology and Pain Medicine, The University of Western Australia Medical School, WA; Dr Emma Secomb, Specialist Surgeon, Hinterland Surgical Centre, QLD. We would like to thank the health professionals, consumers and editorial teams who have worked on previous editions of this title.
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