Cancer Surgery - American Cancer Society

/Home/About Cancer/Cancer Treatment Overviews/Cancer Surgery

Surgery
Revised: 05/01/08
American Cancer Society, Inc.

Surgery is the oldest form of cancer treatment. It also has a key role in diagnosing cancer and finding out how far it has spread (staging). Advances in surgical techniques have allowed surgeons to successfully operate on a growing number of patients. Today, less invasive operations often can be done to remove tumors while saving as much normal tissue and function as possible.

Surgery offers the greatest chance for cure for many types of cancer, especially those that have not spread to other parts of the body. Most people with cancer will have some type of surgery.

Why is surgery used for cancer?

Surgery can be done for many reasons. Some types of surgery are very minor and may be called procedures, while others are much bigger operations. The more common types of cancer surgeries are reviewed here.

Preventive (prophylactic) surgery

Preventive surgery is done to remove body tissue that is likely to become cancerous (malignant), even though there are no signs of cancer at the time of the surgery. For example, pre-cancerous polyps may be removed from the colon.

Sometimes preventive surgery is used to remove an entire organ when a person has an inherited condition that puts them at a much higher risk for having cancer some day. For example, some women with a strong family history of breast cancer are found to have a change (mutation) in their DNA in a breast cancer gene (BRCA1 or BRCA2). Because their risk of getting breast cancer is high, these women may want to consider prophylactic mastectomy (the breasts are removed before cancer is found).

Diagnostic surgery

This type of surgery is used to get a tissue sample to tell whether or not cancer is present or to tell what type of cancer it is. The diagnosis of cancer is often made by looking at the cells under a microscope. Many methods are used to get a sample of cells from a suspicious-looking area. These are described in the section, "Surgery to diagnose and stage cancer."

Staging surgery

Staging surgery is done to find out how much cancer there is and how far it has spread. While the physical exam and the results of lab and imaging tests can help figure out the clinical stage of the cancer, the surgical stage (also called the pathologic stage) is usually a more exact measure of how far the cancer has spread. For more information, please see the American Cancer Society document called Staging.

Examples of surgical procedures commonly used to stage cancers, such as laparotomy and laparoscopy, are described in the section, "Surgery to diagnose and stage cancer."

Curative surgery

Curative surgery is done when a tumor appears to be confined to one area, and it is likely that all of the tumor can be removed. Curative surgery can be the main treatment for the cancer. It may be used alone or along with chemotherapy or radiation therapy, which can be given before or after the operation. Sometimes radiation therapy is actually used during an operation. This is called intraoperative radiation therapy.

Debulking (cytoreductive) surgery

Debulking surgery is done to remove some, but not all, of the tumor. It is done when removing all of the tumor would cause too much damage to an organ or near-by tissues. In these cases, the doctor may remove as much of the tumor as possible and then try to treat what's left with radiation therapy or chemotherapy. Debulking surgery is commonly used for advanced cancer of the ovary.

Palliative surgery

This type of surgery is used to treat complications of advanced cancer. It is not intended to cure the cancer. Palliative surgery can also be used to correct a problem that is causing discomfort or disability. For example, some cancers in the abdomen may grow large enough to block off (obstruct) the intestine. If this happens, surgery can be used to remove the blockage. Palliative surgery may also be used to treat pain when the pain is hard to control by other means.

Supportive surgery

Supportive surgery is used to help with other types of treatment. For example, a vascular access device such as a port-a-cath can be surgically placed into a large vein. The port can then be used to give treatments or draw blood for testing, instead of having needles put in the arms.

Restorative (reconstructive) surgery

This type of surgery is used to change the way a person looks after major cancer surgery or to restore the function of an organ or body part after surgery. Examples include breast reconstruction after mastectomy or the use of tissue flaps, bone grafts, or prosthetic (metal or plastic) materials after surgery for oral cavity cancers. For more information on these types of reconstructive surgery, please see the American Cancer Society documents Breast Reconstruction after Mastectomy and Oral Cavity and Oropharyngeal Cancer.

Surgery to diagnose and stage cancer

A biopsy is a procedure done to remove a tissue sample so that it can be looked at under a microscope. Some biopsies may need to be done in surgery, but many types of biopsies involve removing tumor samples through a thin needle or an endoscope (a flexible lighted tube). Biopsies are often done by surgeons, but they can be done by other doctors, too. Some of the more common ways to do a biopsy are reviewed here.

Fine needle aspiration biopsy

Fine needle aspiration (FNA) uses a very thin needle attached to a syringe to pull out a small amount of tissue from a tumor. If the tumor canít be felt near the surface of the body, the needle can be guided into the tumor by looking at it with an imaging method such as an ultrasound (US) or CT (computed tomography) scan.

The main advantage of FNA is that no surgical incision (cutting through the skin) is needed. A drawback is that in some cases the needle canít take out enough tissue for a definite diagnosis. A more invasive type of biopsy may then be needed.

Core needle biopsy

This type of biopsy uses a slightly larger needle to take out some of the tissue. A core biopsy can be aspirated (removed) with a needle if the tumor can be felt at the surface. Core biopsies can also be guided by imaging methods if the tumor is too deep to be felt.

The advantage of core biopsy is that it usually collects enough tissue to find out whether or not the tumor is cancer.

Excisional or incisional biopsy

For these biopsies a surgeon cuts through the skin to remove the entire tumor (excisional biopsy) or a small part of the tumor (incisional biopsy). They can often be done with local or regional anesthesia. This means numbing medicine is used just in the area where the biopsy will be done. If the tumor is inside the chest or abdomen, general anesthesia (drugs that put you into a deep sleep) may be needed.

Endoscopy

This procedure uses a thin, flexible tube with a viewing lens or a video camera and a fiber optic light on the end. If a video camera is used, it is connected to a television screen. This allows the doctor to clearly see any tumors in the area. Endoscopes can be passed through natural body openings to look at areas of concern in places such as the following:

* throat (pharyngoscopy)
* voice box (laryngoscopy)
* esophagus (esophagoscopy)
* stomach (gastroscopy)
* small intestine (duodenoscopy)
* colon (colonoscopy or sigmoidoscopy)
* bladder (cystoscopy)
* respiratory tract -- windpipe, bronchi, and lungs (bronchoscopy)

Some of the advantages of endoscopy are:

* The doctor can look right at the tumor and get a good idea of where it is and how big it is.

* A biopsy can be taken through the scope to find out if the tumor is cancer.

* An open surgical incision or general anesthesia is usually not needed.

Local numbing medicines are needed before some types of endoscopy. Medicines may also be given to make you sleepy.

Ultrasonography

Ultrasound devices can be attached to the end of some endoscopes. This allows doctors to look at the layers of the esophagus (swallowing tube), bronchus (main breathing tube), and parts of the large intestine (bowel). Nearby lymph nodes can be seen, too. Using the ultrasound pictures to guide it, a needle can be placed through the endoscope and cells can be collected from lymph nodes that do not look normal.

Laparoscopy, thoracoscopy, or mediastinoscopy

Laparoscopy is much like endoscopy, but a small incision is made in the skin of the abdomen (belly). A thin tube called a laparoscope is then put through the incision and into the abdomen to look for possible areas of cancer that can be biopsied. When this type of procedure is done to look inside the chest it is called a thoracoscopy or mediastinoscopy.

Open surgical exploration (laparotomy, thoracotomy, or mediastinotomy)

When less invasive tests do not give enough information about a suspicious area in the abdomen, a laparotomy may be needed. In this procedure, a surgeon makes an incision, usually from the bottom of the sternum (breastbone) down to the lower part of the abdomen (belly), which allows him to look directly at the area in question. The location and size of the tumor and the surrounding areas can be seen and biopsies can be taken, if needed. Because this is a major surgical procedure, general anesthesia (medicines that put you in a deep sleep) is needed. An operation much like this can be done to open and look inside the chest. It is called a thoracotomy.

If lymph nodes near the trachea are swollen, a mediastinotomy is done. General anesthesia (medicines that put you in a deep sleep) is used for this procedure. A special scope (mediastinoscope) is put in the body through a small incision above the top of the sternum (breastbone) and biopsies are collected from the areas of concern.

Special surgery techniques

When most people think of surgery, they picture a doctor using a scalpel and other surgical instruments to remove, repair, or replace parts of the body affected by disease. But newer techniques, using different types of instruments, have expanded the concept of what surgery is. Some of these newer techniques are described below.

Laser surgery

A laser is a highly focused and powerful beam of light energy which can be used for very precise surgical work, such as repairing a damaged retina in the eye. It can also be used to cut through tissue (instead of using a scalpel) or to vaporize (burn and destroy) cancers of the cervix, larynx (voice box), liver, rectum, or skin.

Some surgeries can be made less invasive by using laser light. For example, with fiber optics the light can be directed inside the body without having to make a large incision.

Lasers are also used in a type of surgery called photoablation or photocoagulation. This means lasers are used to destroy tissue or to seal tissues or vessels. This type of surgery is often used to relieve symptoms, such as when large tumors block the windpipe or esophagus, causing problems with breathing or eating.

Cryosurgery

Cryosurgery involves the use of a liquid nitrogen spray or a very cold probe to freeze and kill abnormal cells. This technique is sometimes used to treat pre-cancerous conditions, such as those affecting the cervix. Cryosurgery is also being studied as a treatment for some cancers, such as those of the prostate.

Electrosurgery

High-frequency electrical current can be used to destroy cells. It is used for some cancers of the skin and mouth.

Mohs surgery

Mohs micrographic surgery, also called microscopically controlled surgery, is a technique to remove certain skin cancers by shaving off one thin layer at a time. After each layer is removed, a specially trained dermatologist (skin doctor) or a pathologist (doctor who specializes in diagnosing and classifying diseases by lab tests) looks at the tissue layer under a microscope. When all the cells look normal under the microscope, the surgeon stops removing layers of tissue.

This technique is used when the extent of the cancer is not known or when as much healthy tissue as possible needs to be preserved (as in cancers around the eye). It is done under local anesthesia by a specially trained surgeon.

Chemosurgery is an older name for this surgery and refers to certain chemicals put on the tissue before it is removed. Mohs surgery does not involve use of cancer chemotherapy drugs.

Laparoscopic surgery

A laparoscope is a long, narrow, flexible tube placed through a small incision (cut) to look inside the body. It is sometimes used to take biopsy samples. In recent years, doctors have found that by creating some small holes and using special instruments, the laparoscope can be used to perform surgery without making a large incision. This can help reduce blood loss during surgery and pain afterwards. It can also shorten hospital stays. Laparoscopic surgery is commonly used today to remove gallbladders and to repair hernias.

The role of laparoscopic surgery in cancer treatment is not yet clear. Doctors are now studying whether it is safe and effective to use laparoscopic surgeries for many cancers of the bladder, colon, prostate, and kidney, among others. It may prove to be as safe and effective as standard surgery while being less invasive. Some studies have hinted at this being the case. But larger, long-term studies still need to be completed.

Thorascopic surgery

A thoracoscope is a narrow, rigid tube with a camera connected at one end that can be placed through a small incision (cut) into the chest after the lung is collapsed. This allows the doctor to see inside the entire chest. Any areas of concern on the lining of the chest wall can be biopsied, fluid can be drained, and small tumors on the surface of the lung can be removed with small stapling devices. This less-invasive approach has also been used to remove parts (lobes) of the lung that contain cancer. Studies have shown that for early stage lung cancer, results are much like removing part of the lung by doing an open thoracotomy (incision in the side of the chest).

Other forms of surgery

Newer ways to remove or destroy cancer tumors are always being explored. Some methods are beginning to blur the lines between what we commonly think of as "surgery" and other forms of treatment. Researchers are testing many new techniques, using things such as high intensity focused ultrasound (HIFU); microwaves or radio waves (radiofrequency ablation, or RFA); or even magnets in an attempt to get rid of unwanted tissue. While promising, these techniques are still largely experimental.

As doctors learn how to better control the energy waves used in radiation therapy, some newer radiation techniques that are almost as effective as surgery have been found. By using radiation sources from different angles, stereotactic radiation therapy delivers a large precise radiation dose to a small tumor area. The doses are so exact that the term stereotactic surgery is sometimes used, even though no incision (cut) is actually made. In fact, the machines used to deliver this treatment have names like Gamma Knife and CyberKnife, although no actual knife is involved. The most common site being treated with this technique is the brain, but it is also being used in head, neck, lung, and spine tumors. Researchers are looking for ways to use it to treat other types of cancer, too.

Questions to ask your doctor about surgery

Before having surgery, find out all you can about the benefits, risks, and side effects of the operation. Answers to the following questions will help you feel more comfortable with your decision.

* Why am I having this operation? What are the chances of its success?

* Is there any other way to treat this cancer?

* Other than my cancer, am I healthy enough to go through the stress of the surgery and the anesthesia?

* Are you certified by the American Board of Surgery and/or Specialty Surgery Board?

* How many operations like this have you done? What is your success rate? Are you experienced in operating on my kind of cancer?

* Exactly what will you be doing in this operation? What will you be taking out? Why?

* How long will the surgery take?

* Will I need blood transfusions?

* What can I expect after the operation? Will I be in a lot of pain? Will I have drains or catheters? How long will I be in the hospital after the surgery?

* How will my body be affected by the surgery? Will it work or look different? Will any of the effects be permanent?

* How long will it take for me to recover?

* What are the possible risks and side effects of this operation? What is the risk of death or disability with this surgery?

* What will happen if I choose not to have the operation?

* What are the chances that the surgery will cure my cancer?

* Do I have time to think about my options or get a second opinion?

Getting a second opinion

One of the ways to find out whether a suggested operation is the best choice for you may be to get the opinion of another surgeon. Your doctor should not mind this. In fact, some insurance companies require you to get a second opinion. You may not need to have tests done again because you can often bring the results of your original tests to the second doctor.

Check with your insurance company before planning surgery and before getting a second opinion. Get all of the information you need to feel sure you are making the right choice for your situation. Making an informed decision about your health is almost always better than making a quick one.

What will surgery be like?

Your experience with surgery can depend on many factors, including the disease being treated, the type of operation being done, and your overall health. There are probably as many different surgical techniques as there are diseases to treat, so each case is different.

It's not possible to get into the specifics of each type of operation here, but if you would like more detail it can be found in the treatment sections of the American Cancer Society documents on specific types of cancer.

Still, some parts of the surgical experience are common to most operations. They include pre-operative testing and preparation, the surgery itself (usually including some type of anesthesia), and a recovery period.

Planning and preparation

Both you and your doctor have things to do before surgery to make sure you have the best chance for a good outcome. As much as is possible, you need to know what to expect and be comfortable that the decision you've made is the best one for you. People differ about how involved they want to be in the decision-making process. But knowing as much as you can about what lies ahead can, at the very least, help reduce your stress level.

It is not unusual for patients to wait several weeks after learning they have cancer to have surgery. You have time--time to learn more about your cancer, time to talk to others who have been through it, time to explore your treatment options, time to organize your thoughts, and time to find the right health care team for you. You also may want a second opinion. Insurance pre-approval for the surgery may be needed and this, too, takes time. In almost all cases, the time needed to prepare for surgery should have no impact on the positive outcome of the surgery. If you do have some type of urgent medical symptom, surgery will be scheduled as soon as possible.

Informed consent

Informed consent is one of the most important parts of your preparation for surgery. It is a process during which you are told about all aspects of the treatment before you give your doctor written permission to do the surgery. Although the details may vary from state to state, the informed consent form usually states that your doctor has explained these things:

* your condition and why surgery is an option
* the goal of the surgery
* how the surgery is to be done
* how it may benefit you
* what your risks are
* what side effects to expect
* what other treatment options you have

When you sign the consent form you are saying that you have received this information and you are willing to have the surgery. It is important that you read the consent form and understand each of the above issues before signing it. Make sure your doctor answers all of your questions and that you understand the answers. Having a family member or friend go over it with you may also be helpful.

Pre-operative testing

Many tests are usually needed in the days or weeks before your surgery, especially if a major operation is planned. These tests are done to make sure your body is able to go through surgery and anesthesia. They may also be done to help doctors better understand your condition and to help them plan the surgery. Not all of the tests listed here may be needed (especially if you are having a minor procedure in a doctor's office). The tests most often used include:

* Blood tests to measure your blood counts, your risk of bleeding or infection, and how well your liver and kidneys are working. Your blood type may also be checked in case you need blood transfusions during the operation.

* Urine test (urinalysis) to look at kidney function and check for infections.

* Chest x-ray and EKG (electrocardiogram) to check how well your lungs and heart are working.

* Other tests as needed, such as CT scans to look at the size and location of tumors and see whether or not the cancer has spread to nearby tissues.

Your doctor will also ask you questions about high blood pressure, heart disease, diabetes, and other conditions that could affect surgery. It is important that you let your doctor know about any allergic reactions you've had in the past.

If you are going to have general anesthesia (be put into a deep sleep), you will probably also see an anesthesiologist (doctor who specializes in giving anesthesia). Other specialists may be consulted or other tests done if you have any other problems that could affect the surgery.

Your surgeon may also change some of the medicines you take and ask you to stop smoking, stop drinking alcohol, try to improve your diet, and actively exercise before surgery.

Preparing for surgery

Depending on the type of operation you have, there may be things you need to do to be ready for surgery.

Emptying your digestive tract (stomach and bowels) is important if you will be asleep during surgery. Vomiting while under anesthesia can be very dangerous because the vomit could get into the lungs and cause an infection. For this reason, you will be asked to not eat or drink anything starting the night before the surgery. You may also be asked to use a laxative or an enema to make sure your intestines are empty.

You may need to have an area of your body shaved to keep hair from getting into the incision. The area will be cleaned before the operation to reduce the risk of infection. Other special preparations may also be needed.

It is normal to be anxious about surgery and anesthesia. Let your doctors know about these fears. They may give you medicine to help you relax before surgery.

The operation

Again, although each type of surgical procedure is different, they usually have certain factors in common.

Anesthesia

Anesthesia is the use of drugs to make the body unable to feel pain for a period of time. Depending on the type and extent of the operation, you may or may not need drugs to make you sleep. In some cases, you may have an option as to which type of anesthesia you prefer.

* Local anesthesia is often used for minor surgeries, such as biopsies near the body surface. Medicine is injected into the site beforehand to numb the nerves that cause pain. You stay awake and usually feel only pressure during the procedure.

* Topical anesthesia is a type of local anesthesia that is rubbed or sprayed onto a body surface instead of being injected. It is sometimes used in the throat before endoscopy.

* Regional anesthesia (a "nerve block") affects a larger area of the body while still allowing you to stay awake. It usually involves injecting medicine into an area around the spinal cord, which affects certain nerves coming out of it. But it may also involve injecting medicine around nerves in the arms or legs. The location of the injection determines the area affected. Medicine may be given as a single injection or as a continuous infusion. While you do stay awake, you may be given something to help you relax.

* General anesthesia puts you into a deep sleep for the surgery. It is commonly started by having you breathe into a face mask or by injecting a drug into a vein in your arm. Once you are asleep, an endotracheal (ET) tube is placed in your throat to make it easy for you to breathe. Your vital signs (heart rate, breathing rate, and blood pressure) will be closely watched during the surgery. A doctor or nurse who specializes in giving anesthesia watches you throughout the procedure and until you wake up. They also take out the ET tube once the operation is over.

Recovery

If you had local anesthesia, you may be allowed to go home shortly after the surgery. People who get regional or general anesthesia are taken to the recovery room to be watched closely while the effects of the anesthesia wear off. This may take several hours. People waking up from general anesthesia often feel "out of it" for some time. Things may seem hazy or dream-like for a while, and you may not feel like you are fully awake until the next day.

Your recovery right after surgery depends on many factors, including your state of health before the operation and how extensive the operation was. You will get pain medicine while in the hospital, and will be given a prescription for pain medicine to take at home if you need it. Throughout your hospital stay, be aware that there are many different medicines available to help you control your pain. If you have pain that is holding up your recovery, be sure to let your health care team know.

Your throat may be sore for a while from the ET tube. You may also have a catheter (tube) draining urine from your bladder into a bag. This may be taken out soon after surgery, but may need to be put back in if you have trouble urinating on your own.

You may also have a tube or tubes (called "drains") coming out of the incision site. Drains allow the excess fluid that collects at the surgery site to leave the body. Your doctor will likely take them out once they stop collecting fluid, usually a few days after the operation. This may be done while you are still in the hospital or later at the doctor's office.

You may not feel much like eating or drinking, but this is an important part of the recovery process. Your health care team may start you out with ice chips or water at first. They will check that you are urinating normally at this time and may want to measure the amount of urine you make by having you go in a special container.

The digestive tract (stomach and intestines) is one of the last parts of the body to recover from the effects of anesthesia. Signs of stomach and bowel activity need to return before you will be allowed to eat. Along with checking your surgical scar and other parts of your body, your doctor will use a stethoscope to listen for bowel sounds in your abdomen and will ask if you have passed gas. You will likely be on a clear liquid diet until this happens. Once it does, you may be allowed to try solid foods.

Your health care team will probably try to have you moving as soon as possible after surgery. They may even have you out of bed and walking the next day. While this may be difficult at first, it helps speed your recovery by getting the digestive tract moving. It also helps get your circulation going and prevents blood clots from forming in your legs. Again, be sure to let your team know if you are having a lot of pain, so they can give you medicine to control it.

Your team may also encourage you to do deep breathing exercises. This helps fully inflate the lungs and reduces the risk of pneumonia.

Once you are eating and walking, you may start hearing about plans for going home. Of course, this will depend upon other factors too, such as the results of the surgery and tests done afterward. Your doctor will want to make sure you are well enough to be home. Before leaving, be sure that you understand the following:

* what kind of wound care you need to do at home

* what to look for that might need attention right away

* what your activity limits are (driving, working, lifting, etc.)

* other restrictions (diet, those related to pain medicine, etc.)

* what medicines to take and how often to take them, including pain medicines

* who to call with questions or problems that may come up

* whether you should be doing anything in terms of rehabilitation (exercises or physical therapy)

* when you are due to see your doctor again

You may need help at home for a while after surgery. If family members or friends are unable to do all that is needed, your team may be able to arrange to have a nurse or nurse's aide visit you at home for a short while.

Other parts of recovery may be more long-term in nature. Wounds heal at different rates in different people. Some operations, such as a mastectomy (breast removal), may result in permanent changes to your body. Others, such as a limb amputation or an ostomy (opening in the abdomen connected to the end of your intestine) affect how your body works, and you may need to learn new ways of doing things.

Fully understanding the result of the operation before it is done is an important part of helping you adjust to the changes that have been made to your body. Be sure that all of your questions are answered up front. Get as specific as you need to with your questions, and make sure your health care team gives specific answers, too.

What are the risks and side effects of surgery?

There are risks that go with any type of medical procedure and surgery is no exception. Of course, there are risks with almost everything we do in life. What is important is whether or not the benefits outweigh the possible risks.

Doctors have been performing surgeries for a very long time. Advances in surgical techniques and in our understanding of how to prevent infections have made modern surgery safer and less invasive than it has ever been. Still, there is always a degree of risk involved, no matter how small.

Before you decide to have any medical procedure done, it is important that you understand the risks. Different procedures have different kinds of risks and side effects. This section is not meant to provide a list of all of the possible complications of every type of surgery. Be sure to discuss the details of your case with your doctor, who can give you a better idea about what your actual risks are.

During surgery

Possible complications during surgery may be caused by the surgery itself, the anesthesia, or an underlying disease. Generally speaking, the more complex the surgery the greater the risk.

Minor operations and biopsies usually pose less risk than major surgery. Pain at the site of the incision is the most common problem. Infections at the site and reactions to local anesthesia are also possible.

Complications in major surgical procedures are not common, but can include:

* Bleeding during surgery that may cause you to need blood transfusions. Doctors try to minimize this risk by checking your blood counts beforehand and being careful when working near blood vessels. Still, some operations involve a certain amount of controlled blood loss. If you have concerns, you can to talk to your doctor about banking some of your own blood in the weeks before surgery so it can be given back to you during the operation if needed. (This is called autologous transfusion.) For more information, see the American Cancer Society document, Blood Product Donation and Transfusion.

* Damage to internal organs and blood vessels during surgery. Again, doctors are careful to allow as little damage as possible.

* Reactions to anesthesia or other medicines. Although rare, these can be serious because they can cause dangerously low blood pressures. Your doctors will watch your vital signs throughout the procedure to look for this.

* Problems with other organs, such as the lungs, heart, or kidneys. These are very rare but can happen and can be life-threatening. They are more likely to happen to people who already have problems with these organs. This is why doctors get a complete patient history to look at possible risks before an operation is done.

After surgery

Some problems after surgery are fairly common, but are not usually life-threatening.

* Pain is probably the most common side effect. Almost everyone has some level of pain after surgery. Some pain is normal, but it should not be allowed to delay your recovery. There are many ways of dealing with surgical pain. Medicines for pain range from aspirin and acetaminophen (TylenolÆ) to stronger drugs, such as opioids like codeine and morphine.

* Infection at the site of the wound is another possible problem. Although doctors take great care to reduce this risk by cleaning the area and keeping the area around it sterile, infections do happen. Antibiotics, either as a pill or given through a vein in your arm (IV), are able to treat most infections.

Other problems are rare, but may be more serious.

* Pneumonia can occur, especially in patients with reduced lung function, such as smokers. Doing deep breathing exercises as soon as possible after surgery helps lessen this risk.

* Other infections can develop within the body, especially if the digestive tract was opened during the operation. Doctors take great care to try to make sure this does not happen. But if it does, powerful antibiotics will be used to treat it.

* Bleeding can happen either internally (inside the body) or externally (outside the body). It can occur if a blood vessel was not sealed off during surgery or if a wound opens up. Serious bleeding may cause the person to need another operation to find the source of the bleeding and stop it.

* Blood clots can form in the deep veins of the legs after surgery, especially if a person stays in bed for a long time. Such a clot could become a serious problem if it were to break loose and travel to another part of the body, such as a lung. This is why you will be encouraged to get out of bed and sit, stand, and walk as soon as possible.

* Slow recovery of other body functions, such as movement in the intestines, can sometimes become serious problems, too. Getting out of bed and walking around as soon as possible after surgery can decrease this risk.

Other life-threatening complications are very rare and difficult to predict, but sometimes do happen. Your surgical team will take many steps to avoid possible complications. This includes things like shaving and cleaning the area before cutting the skin to avoid infection, use of special leg pumps and low-dose blood thinners to avoid clots, and respiratory therapy to prevent pneumonia.

Long-term side effects depend on the type of procedure done. For example, people who are having colorectal cancer surgery may need a colostomy (an opening in the abdomen to which the end of the colon is attached). Men undergoing radical prostatectomy (removal of the prostate) are at risk for losing control of urination or becoming impotent. Your doctor should talk to you about all of these long-term outcomes before surgery. You can get more information on any possible long-term effect by calling the American Cancer Society at 1-800-ACS-2345.

Does surgery cause cancer to spread?

In nearly all cases, surgery does not cause cancer to spread, but there are some important exceptions. Doctors who are experienced in taking biopsies of cancers and treating them with surgery are very careful to avoid these situations.

The chances of a needle biopsy causing a cancer to spread are very low. In the past, larger needles were used for biopsies, and the chance of spread was higher.

Most types of cancers can be safely sampled by an incisional biopsy, but there are a few exceptions, such as certain tumors in the eyes or in the testicles. For these types of cancer, doctors may treat without a biopsy or may recommend removing the entire tumor if it is likely to be cancerous. In some cases a needle biopsy can be safely used, and then if the tumor is found to be cancer, the whole tumor is removed by surgery.

One common myth about cancer is that it will spread if it is exposed to air during surgery. Some people may believe this because they often feel worse after the operation than they did before. It is normal to feel this way when beginning to recover from any surgery. Cancer does not spread because it has been exposed to air. If you delay or refuse surgery because of this myth, then you may be harming yourself by passing up effective treatment.

The best chance of a cure from most types of cancer is to remove all of the cancer as soon as possible after diagnosis. If you have a solid tumor, sometimes surgery alone will provide a cure, but often chemotherapy, radiation therapy, or biologic therapy is also needed. Your health care team will discuss your best treatment options with you.

If you have any concerns about surgery and cancer spread, discuss this issue with the people who know your situation best--your surgeon and other members of your cancer care team.

You can also call 1-800-ACS-2345 any time you have questions or need help. The American Cancer Society has information, resources, and support available on cancer-related topics.

Additional resources

More information from your American Cancer Society

The following related information may also be helpful to you. These materials may be ordered from our toll-free number, 1-800-ACS-2345.

* After Diagnosis: A Guide for Patients and Families (also available in Spanish)

* Blood Product Donation and Transfusion

* Choosing a Doctor and a Hospital (also available in Spanish)

* Health Professionals Associated With Cancer Care

* Informed Consent (also available in Spanish)

* Lasers in Cancer Treatment

* Questions That People Ask about Cancer (also available in Spanish)

* Staging

* Talking with Your Doctor (also available in Spanish)

* What Is Cancer? (also available in Spanish)

National organizations and Web sites*

In addition to the American Cancer Society, other sources of patient information and support include:

American College of Surgeons
Telephone: 1-312-202-5000 or 1-312-202-5085 (Cancer Programs)
Web site: www.facs.org

National Cancer Institute
Toll-free number: 1-800-4-CANCER (1-800-422-6237)
Web site: www.cancer.gov

*Inclusion on this list does not imply endorsement by the American Cancer Society.

No matter who you are, we can help. Contact us anytime, day or night, for cancer-related information and support. Call us at 1-800-ACS-2345 or visit www.cancer.org.

References

Eyre HJ, Lange D, Morris LB. Informed Decisions. 2nd Ed. Atlanta, GA: American Cancer Society, 2002:159-170.

Fleming, ID. Surgical therapy. In: Lenhard RE, Osteen RT, Gansler T, eds. Clinical Oncology. Atlanta, GA: American Cancer Society, 2001:160-165.

Pollock RE, Morton DL. Principles of surgical oncology. In: Kufe DW, Pollock RE, Weichselbaum RR, Bast RC, Gansler TS, Holland JF, Frei E III, eds. Cancer Medicine. 6th Ed. Hamilton, Ontario: BC Decker; 2003:569-583.

Revised: 05/01/08

Copyright 2009 © American Cancer Society, Inc.