What is surgery?

Surgery is one of the main treatments for many cancers and involves cutting body tissue. The type of surgery you have will depend on the type of cancer you have. The preparation, side effects and possible complications will also depend on the type of surgery you have.

For more information about the type of surgery you will have, you can ask your cancer doctor or specialist nurse.

Why am I having surgery?

There are different reasons why your cancer doctor may suggest you have surgery.

You may have surgery for one of the following reasons:

  • Surgery to diagnose cancer

    To help diagnose some cancers, the surgeon may remove a small piece of tissue. This is called a biopsy. The tissue is examined in a laboratory to confirm a diagnosis of cancer and to find out about the type. It may take a few days to get results but sometimes it can take longer.

  • Surgery to treat cancer

    Where possible, surgeons aim to remove the tumour and any surrounding tissues that could contain cancer cells. This may sometimes still be done even if the cancer has spread to another part of the body. Occasionally, surgery can be used to remove cancer cells that have spread from the original tumour into another part of the body, such as the lung or liver. Sometimes you can have other treatments, such as chemotherapy or radiotherapy before surgery. These treatments can reduce the size of a cancer, make surgery possible or mean that less surgery is needed.

  • Surgery to find out the stage of the cancer

    The stage of a cancer describes its size and if it has spread from where it started. Usually, doctors can stage the cancer using tests and scans. Sometimes doctors need to do a small operation to find out the stage of the cancer. This might be because the tumour cannot be seen on a scan. An example of surgery used in staging is a laparoscopy. During a laparoscopy, a surgeon will make a small cut in your tummy (abdomen). They will use an instrument called a laparoscope (a thin tube with a light and camera) to look around and assess the size of the tumour and whether it has spread. Some people may have similar operations on other parts of the body.

  • Reconstruction surgery

    Surgery can be used to restore a part of the body. For example, you may have reconstruction surgery to create a new bladder if it has been removed. Or you may have reconstruction surgery to restore the appearance of a part of the body. For example, breast reconstruction to create a new breast shape after a mastectomy (an operation to remove the breast).

  • Surgery to control the symptoms of cancer

    If a cancer cannot be completely removed or cured, surgery can sometimes help control symptoms. For example, surgeons can remove or bypass a tumour, if it is causing a blockage. If the cancer has spread by the time you are diagnosed you may not be offered surgery. This is because surgery alone will not cure the cancer. Depending on the type of cancer, your doctor may offer you other treatments, including chemotherapy, radiotherapy or hormonal therapy

Surgery to the lymph nodes

Your surgeon will often remove some of the lymph nodes (lymph glands) that are close to the tumour. This is because the lymph nodes are a common place for cancer cells to spread to. The number of lymph nodes removed varies with the type of cancer.

A doctor who specialises in diagnosing disease by examining tissues under a microscope (a pathologist) will test the lymph nodes for cancer cells. If the nodes contain cancer cells, there may be a bigger risk of the cancer coming back in the future. In this case, you may need to have treatment such as radiotherapy, chemotherapy or hormonal therapy after your operation.

Can surgery cure the cancer?

Many cancers can be cured with surgery. However, it is not always possible to know at the time of the surgery whether any cancer cells have broken away and spread to tissues around the main tumour. To try and make sure all the cancer cells are removed, the surgeon will remove the tumour and surrounding area (margin) of normal tissue. A pathologist will examine this tissue and check the margin to see if it is clear of cancer cells. A pathologist is a doctor who specialises in diagnosing disease by examining tissues under a microscope.

Removing all the cancer cells helps reduce the risk of the cancer coming back. If the margin of tissue is not clear, your cancer specialist may suggest you have a further operation to take more tissue from the surrounding area.

For some people, there is a risk that cancer cells may have spread from the main tumour to another part of the body. These are known as micrometastases. Micrometastases are too small to be seen on scans. If there is a risk of micrometastases, your cancer specialists may recommend that you have other treatments, such as chemotherapy and radiotherapy as part of your treatment.

Occasionally, scans taken before surgery do not show the true extent of the cancer. During the operation, the surgeon may find that it is not possible to remove the cancer completely. If this is the case, your cancer specialists will discuss with you the best treatment possible for your situation.

Types of surgery

There are different types of surgery that can be used to treat cancer.

Open surgery

Open surgery means the surgeon makes one large cut (incision).

Keyhole surgery

Some people may be able to have keyhole surgery (sometimes called laparoscopic surgery) to remove some or all of a tumour.

In this type of surgery, several small cuts are made instead of one large cut (incision). The surgeon uses a laparoscope to work inside the body and remove the tumour through a small cut in the skin.

The main advantage of keyhole surgery is that it leaves a much smaller wound in the chest or tummy wall. This means that recovery time is shorter. Sometimes people who are not fit enough to have an open operation may be able to have keyhole surgery.

The results from keyhole surgery can be as good as conventional surgery. However, it needs to be done by surgeons with specialist training and experience in using laparoscopic techniques. If it is suitable for you and you choose to have this type of surgery, you may need to travel to another hospital to have it.

Having your operation

Your operation will be carefully planned. You can read more specific information in the treating section of the cancer type you have.

Your surgeon and anaesthetist are responsible for your well-being during and after your surgery. They must be sure that you are fit enough to have the operation. You will probably have a hospital appointment before your operation, usually with a nurse and sometimes an anaesthetist. This is known as a pre-assessment clinic. It is important that you bring any medicines you are taking, including herbal medicines or supplements. The nurse will ask you about your medical history and if you have any allergies.

You may have some tests done, which usually include the following:

Some people may have other tests as well, depending on the type of operation or other health conditions.

If you are not able to have a general anaesthetic, you may still be able to have surgery. Some operations can be done under local anaesthetic or regional anaesthetic (such as an epidural or spinal anaesthetic). With these types of anaesthetic, you will be awake during the operation but will not feel any pain.

It is important that you understand everything about the operation you are having. You should be given an opportunity to talk about the operation with your surgeon. This might happen at the pre-assessment clinic. You will need to sign a consent form to say that you agree to the operation. No operation will be done without your consent.

Preparing for an operation

Before any operation, you will be asked not to eat or drink anything for a few hours. This is known as being ’nil-by-mouth’.

You may also need to bathe and shave body hair from the area of the operation. The nurse looking after you will give you more details about this. Body hair is only shaved if it is essential. It is done using a disposable razor and the hair will begin to grow back after the operation.

Having an operation can put you at risk of getting a blood clot in the leg. Compression stockings (also known as anti-embolic stockings) help to reduce this risk. Your doctors and nurses may ask you to wear a pair of compression stockings during your operation and for a short time afterwards. A nurse will assess your individual risk and take your measurements. They will show you how to put the stockings on properly.

Who might I meet?

In most hospitals, a team of specialists will meet to discuss and plan your treatment. This team is known as a multidisciplinary team (MDT).

There are a number of healthcare staff who are likely to be involved in your surgery:

  • Surgeon

    Different surgeons specialise in different types of surgery, for example you will see a breast surgeon for suspected breast cancer. With some cancers, you may need to see a more specialised surgeon who is skilled at particular surgical techniques. This may mean that you will be referred to a specialist cancer hospital, possibly quite far from where you live. If you want to know about the referral process planned for you, talk to your GP. They can explain the procedure and, if necessary, refer you for another surgical opinion.

  • Nurses

    Some outpatient clinics have nurses who give information about the treatment and side effects. They may also give advice on skin care and medicines to manage side effects. Many cancer centres have specialist cancer nurses, often called clinical nurse specialists (CNSs), who have expert knowledge about the type of cancer you have. They are a good source of support and information during your treatment.

  • Key worker or contact person

    Usually one of the nurses who looks after you will be named as your key worker. This is the person to contact if you need more information or support. If you are not sure who your key worker is, ask someone at your next appointment.

After surgery

Waking up after surgery

Knowing what will happen when you wake up after your operation can help you feel less anxious.

You will probably feel quite drowsy and may not remember much about the first few hours after you wake up.

A nurse will take your blood pressure regularly. Depending on the operation, you may have some tubes attached to you. If the operation was small, you may not have any tubes at all. Below is a list of the most common tubes you might have following an operation:

  • A drip (intravenous infusion) into a vein in your arm or hand to give you fluids until you can eat and drink normally. This may be for a few hours or a few days, depending on the operation you have had.
  • A tube (drain) in your wound to drain excess fluid into a small bottle. This is usually removed after a few days.
  • A small tube (catheter) may be put into your bladder so that urine is drained into a collection bag. The catheter is usually removed when you start walking.

You can read about what to expect in the surgery section of the type of cancer you have.

After surgery you may experience:

  • Pain

    You may have some pain after surgery, but this will be controlled with painkillers. The painkillers you have will depend on the type of operation you had. You can have painkillers as tablets or as injections, or through a tube into a vein in your hand or arm (cannula) connected to a pump. Some people have a continuous dose of painkiller into the spinal fluid through a fine tube and a pump. This is called an epidural. Always let the nurses know if you are still in pain. When you leave the hospital, you will get painkillers to take at home. Your healthcare team will tell you how often you should take them.

  • Feeling sick (nausea) and being sick (vomiting)

    Your nurse will give you anti-sickness (anti-emetic) injections or tablets to help control any sickness. If you still feel sick, tell the nurse looking after you.

Moving around after surgery

You will be encouraged to get up fairly soon after your operation. The ward staff will help you with washing and going to the toilet. Once you are moving about more freely, you will probably be able to manage this for yourself.

Moving around will help you recover more quickly and help reduce the risk of complications.

Breathing and leg exercises can also help reduce the risk of problems that can happen after surgery, such as chest infections and blood clots. Your nurse or physiotherapist will teach you these exercises.

You may also get medication to help prevent blood clots forming in the first few days after your operation. This is called an anti-coagulant. It is given as an injection just under the skin, usually in your tummy.

Complications of surgery

Complications will depend on the type of operation you have. The most common complications after surgery are a wound infection, bleeding from the wound, a chest infection or developing a blood clot. The nurses will monitor you for these. Let them know straight away if you have any bleeding, feel unwell, have symptoms of an infection, such as a cough or discharge from your wound, or swelling and redness in a limb.

Wound care

The wound is closed using clips or stitches. These are usually removed after you go home by a practice nurse at your GP surgery. Some surgeons use dissolving stitches that do not need to be removed. These will dissolve completely when the area is healed. You may be given antibiotics to help prevent wound infection. It is important to let your nurse or doctor know straight away if your wound becomes hot, painful or begins to bleed or leak any fluids, even after you go home.

Scarring

Your scar may feel itchy at first. It will look like a red line, which may feel a bit lumpy. This will gradually fade over time.

Your follow-up

You usually see your surgeon and a specialist nurse for a follow-up appointment a couple of weeks after your operation.

The rest of your follow-up will depend on the type of cancer and your situation. You usually have regular check-ups every few months at first, and eventually they may be yearly. Some people have follow-up appointments at a nurse-led clinic or by telephone. They see their specialist if anything needs to be checked further.

At your appointments, your doctor may examine you and explain any tests you need to help them monitor your recovery. You can also talk to them about any concerns you have, symptoms to look out for or help with your recovery.

If you notice any new symptoms between appointments, contact your doctor or nurse for advice.

Beginning to recover

The time it takes you to recover depends on the operation you had, your general health and whether you need any further treatment.

You may have mixed emotions when you get to the end of your treatment and begin to recover. You will probably feel relieved, but you may also feel anxious and uncertain.

You may feel ready to get on with your life after surgery, but sometimes you may feel less positive.

It is important to accept that it will take you time to recover and you may feel tired for a while. You may also have new challenges to cope with, such as physical effects caused by the cancer or its treatment. It usually takes time to adjust to these and find out what is now normal for you. Complementary therapies may help you feel better and reduce any stress and anxiety.

When your treatment is over, you may want to think about making some positive changes to your lifestyle. Many people find that over time they settle back into their usual routines. But it is important to remember that support is available to help you with any physical or emotional problems you have.

Possible long-term effects of surgery

Some people may have long-term effects after cancer surgery. Before your operation, your surgeon or specialist nurse will explain these to you and the risk of them happening.

There are different long-term effects depending on the operation you have. There is more information on long-term effects after surgery in our information about type of cancer you have. Some examples of long term effects are listed below:

  • Lymphoedema

    Removing the lymph nodes in some areas of the body, such as the armpit or groin may cause swelling called lymphoedema. This is not a common problem and is more likely if you have had radiotherapy to the area too.

  • Infertility

    Some operations may cause problems with fertility. We have more information about fertility after treatment for men and fertility after treatment for women.

  • Erectile dysfunction

    Surgery to the prostate may cause difficulty getting an erection (erectile dysfunction).

  • Changes to how your body looks or works

    Some operations change the way your body looks or works. This can affect the way you feel about yourself physically and emotionally. There is a lot of support available. Talk to your nurse or doctor about your concerns. They should be able to help you or arrange for you to see a counsellor. You can also talk to our cancer support specialists on 0808 808 00 00.