Cancer Treatment: Surgery

Surgery to treat cancer

Surgery plays an important role in treating most types of cancers. Surgery may be used to diagnose, treat or improve symptoms due to cancer. This section covers the following topics: 

What are the goals of surgery?

The goals of surgery include one or more of the following:

• Remove a sample of tissue for the purpose of diagnosing cancer or gathering more information about cancer type, subtype, stage and biomarkers to help guide treatment. In some cases, this may be performed by a need biopsy rather than surgery. 
• Remove the entire cancerous tissue or affected organ, often including some surrounding tissue to reduce the risk of spread or recurrence.
• Remove as much of the cancerous tissue as possible to improve symptoms or increase the effectiveness of therapy (sometimes called debulking).

What are lymph nodes? What is a lymph node dissection?

Lymph nodes are part of our immune system. Located throughout our body, they act like filters that protect tissue and organs from infections. Surgeons remove lymph nodes near the tumor to see how far the cancer has spread. Removal of lymph nodes can lead to a long-term health issue known as lymphedema. The more lymph nodes that are removed, the greater the chance for lymphedema. 

What is a sentinel node biopsy?

Sentinel node biopsies are a type of surgery that removes a limited number of lymph nodes to see the cancer has spread. Before surgery, the surgeon injects a dye or an agent known as a "tracer" into the tumor. This helps the surgeon find and remove one or a few lymph nodes that filter the cancer, known as sentinel nodes. The sentinel nodes are then checked for cancer. If no evidence of cancer is found, the surgeon can leave the other lymph nodes in place, lowering the risk for lymphedema. If the sentinel node shows evidence of cancer, the surgeon may remove other lymph nodes as well.

What is minimally-invasive surgery?

Minimally‑invasive surgery is a technique that uses small incisions and an instrument called a laparoscope to remove the cancer. It may be an option for certain cancers of the abdomen, pelvis or chest, especially small and early stage cancers. Compared with traditional surgery, minimally‑invasive surgery may lead to smaller scars, fewer risks for complications and a quicker recovery.

Tumor pathology

After a biopsy or surgery confirms cancer, pathologists look closely at the cells and perform additional tests. This may include tumor biomarker tests. Your pathology report contains important information about your cancer diagnosis, which may be used to guide the choice of treatment. Ask your doctor or nurse to explain any parts of your pathology report or medical record that you do not understand. Information that may be found in your pathology report includes:

• type of cancer
• subtype of cancer
• tumor grade
• results of special stains
• whether the tumor was completely removed
• results of biomarker tests

What are the possible side effects of surgery?

Every surgery has potential risks; some are more serious than others. Risks and complications of surgery may depend on several factors, including:

• the type of surgical procedure the size, stage and location of the cancer and how much it has spread
• removal of lymph nodes
• your overall health
• medications or treatments before or after surgery

Some general tips for reducing and managing surgical side effects include:

• Find a surgeon with expertise in the surgery. 
• Stay well hydrated and get the proper nutrition. Ask for a referral to a nutritionist if you need help. 
• Follow all your surgeon's orders. Take all medications as directed. Restrict activities as instructed. 
• Ask about referral for physical therapy before surgery (prehab) and after (rehab) to speed recovery. 

Recovery and short-term risks

Some of the more common short-term effects of surgery may include:

• anesthesia risks
• infection
• fluid build-up at the surgical site (seroma or hematoma)
• delayed healing
• blood loss
• blood clots
• injury to nearby organs
• pain (post-operative pain)

It's important to ask your surgeon what you should watch for after surgery to assure that your body is healing normally. Report any fever, worsening of pain, or discharge, swelling or redness at the incision site to your surgeon. 

Late-onset or long-term complications

Late-onset or long-term complications persist six months or longer after surgery. These may include: 

• numbness or unusual sensations (such as itching) at or near the surgical site
• hardening or scarring of tissue around the surgical site
• long-term pain syndromes 
• fluid buildup and swelling of extremities (lymphedema)
• long-term loss of mobility

Physical therapy, special massage, exercise programs and medications may help address some of the long-term complications of surgery. It's important that you report any symptoms or changes in your health to your doctor so that they can assess the cause of your symptoms and treat them.

Long-term pain syndromes

Post-surgical pain syndrome is a long-term complication of nerve damage during surgery, especially mastectomy. It can lead to persistent pain, tingling or phantom itching. It is more likely to happen after radiation or when lymph nodes are removed during surgery. Treatment may be available for this complication but might require referral to a specialist. Not all pain syndromes can be successfully treated.  

Loss of function or mobility

Surgery that involves muscle, tendon, nerve or bone may lead to changes in strength, mobility or function. Physical therapy before surgery (known as prehab) or after surgery (known as rehab) may improve mobility and function over time.

Lymphedema

Lymphedema is fluid buildup and swelling that can occur in the arms, legs or other part of the body as a result of surgery that removes or disrupts lymph nodes. Not everyone with lymph node removal will develop lymphedema. The swelling and fluid may be mild to severe and can cause pain, infection and loss of mobility. 

Although symptoms of lymphedema may not always be obvious, it is important for people who have had surgery, radiation or lymph nodes removed to report any persistent feeling of heaviness, pain or discomfort, muscle weakness, tightness or swelling to their doctor. 

Lymphedema is usually managed with special massage and compression garments. This is most effective when it is caught early. 

Questions for your doctor

Below are some questions to ask your doctor before and after surgery.

• What is the name of the surgery I am having?
• How many of these surgeries have you performed?
• What is your surgery complication rate? 
• What is your hospital's infection rate?
• Will I need to stay in the hospital after surgery? If so, for how long? 
• What are the possible complications and how common are each? Am I at increased risk for any of these complications?   
• Will you be removing lymph nodes? If so, is sentinel node biopsy an option? 
• Is minimally-invasive surgery an option? Is robotic surgery an option?
• Where will my scars be? What will they look like? 
• Am I likely to lose mobility, strength or function? If so, is prehab an option before surgery? Is rehab an option after surgery? Can you refer me to a physical therapist?
• How long will I need to stay inactive after surgery? 
• How will my pain be managed?