Based on descriptions of discovered Egyptian papyri, surgeries were performed by the ancient Egyptians. The tools they used for surgery included knives, drills, saws, hooks, forceps, and pinchers. Some of these tools, somewhat modified, are still used for surgical purposes today. In contrast with the role played by surgery in the past, surgery is more important now than ever. Surgical technology and techniques are so advanced that surgery is able to accomplish what ancient surgeons never dreamed of. Surgery is used for a great variety of diseases, including cancer treatment. In fact, it is the oldest form of treatment for cancer and until the mid 20th century, surgery was considered the only treatment modality that could cure patients with cancer.

Cancer surgery attempts to completely remove localized tumors or reduce the size of large tumors so that follow-up treatment by radiation or chemotherapy will be more effective.

Other than its curative purpose, cancer surgery may be done as a diagnostic (staging) process or a preventive measure. Surgeries are also performed to relieve pain or repair deformities and abnormalities caused by surgical treatment for cancer.

Sometimes, surgeries for different purposes may take place simultaneously. For example, curative surgery may be performed right after a diagnostic surgery or a curative surgery may be followed by a reconstructive surgery.

Generally surgery involves cutting into the body (incision) to explore or remove tissue while the patient is under anesthesia.

Surgical techniques used for surgery include cryosurgery, electrocauterization surgery, laser surgery, gamma knife, and en bloc resection. These techniques will be discussed in detail later.

Surgeons often use small, thin knives, called scalpels, and other sharp tools to cut your body during surgery. Surgery often requires cuts through skin, muscles, and sometimes bone. After surgery, these cuts can be painful and take some time to heal.

Anesthesia keeps you from feeling pain during surgery. Anesthesia refers to drugs or other substances that cause you to lose feeling or awareness. There are three types of anesthesia:

• Local anesthesia causes loss of feeling in one small area of the body.
• Regional anesthesia causes loss of feeling in a part of the body, such as an arm or leg.
• General anesthesia causes loss of feeling and a complete loss of awareness that seems like a very deep sleep.

There are other ways of performing surgery that do not involve cuts with scalpels. Some of these include:

Cryosurgery

Cryosurgery is a type of treatment in which extreme cold produced by liquid nitrogen or argon gas is used to destroy abnormal tissue. Cryosurgery may be used to treat early-stage skin cancer, retinoblastoma, and precancerous growths on the skin and cervix. Cryosurgery is also called cryotherapy.

Lasers

This is a type of treatment in which powerful beams of light are used to cut through tissue. Lasers can focus very accurately on tiny areas, so they can be used for precise surgeries. Lasers can also be used to shrink or destroy tumors or growths that might turn into cancer.

Lasers are most often used to treat tumors on the surface of the body or on the inside lining of internal organs. Examples include basal cell carcinoma, cervical changes that might turn into cancer, and cervical, vaginal, esophageal, and non-small cell lung cancer.

Hyperthermia

Hyperthermia is a type of treatment in which small areas of body tissue are exposed to high temperatures. The high heat can damage and kill cancer cells or make them more sensitive to radiation and certain chemotherapy drugs. Radiofrequency ablation is one type of hyperthermia that uses high-energy radio waves to generate heat. Hyperthermia is not widely available and is being studied in clinical trials.

Photodynamic Therapy

Photodynamic therapy is a type of treatment that uses drugs which react to a certain type of light. When the tumor is exposed to this light, these drugs become active and kill nearby cancer cells. Photodynamic therapy is used most often to treat or relieve symptoms caused by skin cancer, mycosis fungoides, and non-small cell lung cancer.

The scalpel is the traditional cancer surgery tool. Other tools such as needles, forceps, or scissors are involved in cancer diagnostic surgeries. However, these traditional cancer surgery tools are being replaced by new and more effective cancer surgical tools such as laser and radiation. These new surgical tools often result in less operative time, cause less pain to cancer patients, and reduce complications, such as scarring that sometimes occur with surgeries performed with traditional surgical tools.

A recent innovative cancer surgery tool, "Smart Scalpel," still in development, can even detect cancer cells. "Smart Scalpel," a dime-sized biological laser, can quickly identify a cell population that has abnormal protein content (as cancer cells usually do). This device should assist surgeons in cutting away malignant tissue while minimizing the amount of healthy tissue removed.

Cryosurgery (also called cryotherapy) is the use of extreme cold to destroy cancer cells. Traditionally, it has been used to treat external tumors, such as those on the skin, but recently some physicians have begun using it as a treatment for tumors that occur inside the body. Cryosurgery for internal tumors is increasing in popularity as a result of developments in technology over the past several years.

For external tumors, liquid nitrogen (-196 degrees Celsius, -320.8 degrees Fahrenheit) is applied directly to the cancer cells or tissue with a cotton swab or spraying device. For internal tumors, liquid nitrogen is circulated through an instrument called a cryoprobe, which is placed in contact with the tumor. To guide the cryoprobe and to monitor the freezing of the cells, the physician uses ultrasound (computerized moving pictures of the body generated by high-frequency sound waves). By using ultrasound, physicians hope to spare nearby healthy tissue.

Cryosurgery often involves a cycle of treatments in which the tumor is frozen, allowed to thaw, and then refrozen.

Advantages of Cryosurgery:

1. Minimally invasive--no blood loss, no surgical incision, and can be done as an outpatient.
2. Favorable success rates and less complications--less complications than open surgery.
3. Short recuperation period.
4. Procedure can be repeated if the first cryosurgery has failed.
5. Radiation therapy or radical surgery is still an option if the cryosurgery fails.
6. Cost is less than traditional treatment.

Cauterization is the process of destroying tissue by using chemical corrosion, electricity, or heat. Electrocautery is done using a small probe, which has an electric current running through it, to cauterize (burn or destroy) the tissue.

Electrocautery is a safe procedure and is routinely used in surgery to burn unwanted or harmful tissue. It is also effectively used to reduce or stop hemorrhaging by "burning" the bleeding blood vessels (seals them off). Various types, shapes, and sizes of tips (probes) are available for specific treatments.

A specific type of electrocautery is fulguration, sometimes called electrodesiccation. Electrodesiccation is the destruction of tissue with a diathermy instrument. Electrodesiccation is particularly useful inside the bladder. Bladder electrodesiccation is performed via the urethra and viewed through a cystoscope.

L-A-S-E-R stands for Light Amplification by Stimulated Emission of Radiation. Through a complicated electronic process, a beam of light is produced which has special properties. This light is all one wavelength; that is, it is all one color of the spectrum. The light is focused so that all of its rays are traveling in the same direction. In a similar fashion, you might use the lens of a magnifying glass to focus rays of sunlight to a point.

Lasers are used for many reasons. In many instances, lasers can improve the precision of the surgeon with finely focused beams of light. Some lasers can reduce bleeding by coagulating blood vessels as they cut tissue. Others can be aimed down narrow passages or sent down fiber-optic channels in endoscopes to reach areas that are otherwise inaccessible.

A new trend in laser surgery is to use the special properties of different wavelengths of laser light to selectively treat different problems. For instance, a yellow laser light absorbed by the red blood cells of a birthmark called a "portwine stain" can result in the selective destruction of the birthmark without affecting the skin cells around it. The result is that scarring of the remaining normal skin is lessened or avoided. In another instance of selective laser treatment, drugs that are retained by tumors are infused into the body and activated by lasers to destroy only the tumor, preserving normal structures.

In many instances, the cost of medical care can be reduced by lasers. Through their use, many procedures that previously required hospital admission can be done on an outpatient basis.

PDT is a revolutionary medical technology that uses lasers to activate light-sensitive pharmaceuticals to treat cancer (and other diseases) in a minimally-invasive manner.

PDT is considered to be cancer-directed surgery, and there are specific codes in the surgery data fields for PDT of various primary sites.

PDT works as follows:

1. The patient is injected intravenously with a light-sensitive drug (most often, "photofrin").
2. The drug is retained by malignant tissue, remaining inactive until exposed to a specific wavelength of laser light.
3. Laser energy is directed to the site through a flexible fiberoptic device that allows the laser to be targeted precisely at the site.
4. When activated by the lasers' light energy, the drug creates a toxic form of oxygen that destroys the cancerous cells with minimal damage to surrounding healthy cells.

An en bloc resection is a surgical procedure in which a lesion and surrounding tissues are removed. "En bloc" or "in continuity with" means that all of the tissues were removed during the same procedure, but not necessarily in a single specimen.

There are many types of surgery. The types differ based on the purpose of the surgery, the part of the body that requires surgery, the amount of tissue to be removed, and, in some cases, what the patient prefers.

Surgery may be open or minimally invasive.

• In open surgery, the surgeon makes one large cut to remove the tumor, some healthy tissue, and maybe some nearby lymph nodes.
• In minimally invasive surgery, the surgeon makes a few small cuts instead of one large one. She inserts a long, thin tube with a tiny camera into one of the small cuts. This tube is called a laparoscope. The camera projects images from the inside of the body onto a monitor, which allows the surgeon to see what she is doing. She uses special surgery tools that are inserted through the other small cuts to remove the tumor and some healthy tissue.

Because minimally invasive surgery requires smaller cuts, it takes less time to recover from than open surgery.

There are many ways to detect or confirm a suspicion of the presence of a cancer. Microscopic examination of biopsy samples is the ideal way that a positive diagnosis of cancer can be made. This procedure involves physically removing all or part (tissue, cells, or fluid) of a suspected tumor and examining this material under a microscope. The purpose of a biopsy is to identify the histologic type of cancer and possibly stage of disease.

Any organ in the body can be biopsied utilizing a variety of techniques. Some may require major surgery, while others may not even require local anesthesia. Types of biopsies include incisional biopsy, excisional biopsy, endoscopic biopsy, colposcopic biopsy, bone marrow biopsy, fine needle aspiration biopsy, stereotactic biopsy, and core biopsy, to name a few. Biopsies typically leave gross tumor in the body.

A pathologist performs the microscopic examination of the biopsied material. After careful evaluation, a benign or malignant diagnosis can usually be established. A written report prepared by the pathologist is sent to the doctor who treats the cancer patient. This doctor will then make decisions regarding treatment based on the information found in this report.

Take breast cancer for example: If a breast abnormality is detected with mammography or physical exam, the patient will typically be referred for additional breast imaging with diagnostic mammography, ultrasound, or other imaging tests. While all of these methods of diagnosis can help detect a breast abnormality, biopsy followed by pathological (microscopic) analysis is really the only definitive way to determine if cancer is present.

The method of biopsy chosen will depend on,

• How suspicious the abnormality appears
• The size, shape, and location of the abnormality
• The number of abnormalities present
• The patient's medical history
• The patient's preference
• The training of the physician who is performing the biopsy
• The breast imaging center or surgical center where the biopsy is performed.

Side effects and risks of biopsy do exist, depending on the type of biopsy performed and certain biopsy techniques. Cytology procedures, needle biopsies, and core biopsies, sometimes may not even come up with a positive cancer diagnosis due to inadequate quantities of cells or tissue removed from the patient. In rare cases, an incorrect diagnosis could be made in the situation where the needle misses the tumor and removes only healthy or non-cancerous tissue. As with the case of preventive surgery, patients are strongly encouraged to discuss the advantages and disadvantages of the different biopsy methods with their physician(s) prior to undergoing the procedure(s).

A biopsy that removes only a fragment or portion of the tumor, primary or metastatic, is recorded in the abstract as non-cancer-directed treatment.

In a preventive surgery, the surgeon removes tissue that does not yet contain cancer cells, but has the probability of becoming cancerous in the future. This may also be referred to as prophylactic surgery. For example, with the consent of the patient, the surgeon sometimes removes the ovaries of a woman to avoid the risk of ovarian cancer if the person has a very strong family history of ovarian cancer. Based on studies, a woman whose mother or sister had ovarian cancer has a higher than average risk of developing ovarian cancer. The procedure is called prophylactic oophorectomy (removal of both ovaries).

Preventive mastectomy is another example of a surgery with a preventive purpose. In the past, the surgeon may have removed the breast tissue but spared the nipple (subcutaneous mastectomy). Total mastectomy (removal of the entire breast and nipple) is considered in an effort to prevent or reduce the risk of breast cancer. In addition to women who have already had one breast removed due to cancer, preventive mastectomy may also be an option for women with a strong family history of breast cancer, especially if several close relatives developed the disease before age 50. Women in families with hereditary breast cancer who test positive for a known cancer-causing gene alteration (for example, BRCA1 and BRCA2) may also consider prophylactic mastectomy surgery, as may women who have had lobular carcinoma in situ, a condition that increases their risk of developing breast cancer in the same breast and/or in the opposite breast.

Those patients who have a congenital or genetic trait that creates a high risk of developing cancer may benefit from preventive surgery. For example, studies have shown that half of the patients with familial polyposis of the colon, without a preventive colectomy, would develop cancer of the colon by age 40, and all would develop the disease by age 70.

Pros and cons exist for preventive surgeries. Some patients may not choose preventive mastectomy or oopherectomy due to their concerns about with sexual and reproductive function and self-image, even if the procedure may add years to their life expectancy. Due to unique risk factors for cancer of each individual patient, a preventive surgery does not guarantee the patient will never develop cancer. Therefore, the decision of a preventive surgery should only be considered after a careful discussion between the surgeon and the patient.

Surgery plays a vital role in the cancer treatment plan, especially in patients with solid tumors. Surgery is often used to attempt to cure patients whose tumors are localized at the time of the diagnosis. After definite cancer diagnosis, curative surgical operations are conducted to remove or destroy cancerous tissue. Unlike diagnostic surgeries which may remove a small amount of tissue to confirm the existence and the stage of the disease, curative surgeries take a much more radical surgical approach, typically resulting in partial or total removal of the organ of origin.

In a curative procedure, a certain amount of normal tissue as well as cancerous tissue may be removed to obtain adequate margins. The purpose is to minimize the risk of any cancer cells being left behind, which may result in a recurrence of the cancer. For the same purpose, the surgeon may also remove the lymph nodes that are adjacent to the tumor.

Resection of isolated metastases (removal of solitary metastases) may be performed in some cases, especially if there has been a disease-free interval of more than one year after the surgery. Second-look operations are sometimes performed following adjuvant therapies, but they have little effect on the final outcome in the great majority of cancer patients.

Scalpels or other instruments are used in excisional surgeries to eradicate the malignant tumor. Many types of excisional surgeries exist, each named for the particular area of the body in which they are performed. For example, laryngectomy involves removal of a large tumor of the larynx which may include removing part of the tongue or oropharynx. Similarly, parathyroidectomy refers to a surgery to remove parathyroid glands or tumors.

In addition to the more traditional surgical instruments such as scalpels, new technologies are employed in cancer curative surgeries depending on such factors as the patient's age and general health condition, location of tumor, and so on.

Laser surgery uses a powerful beam of light, which can be directed to specific parts of the body, without making a large incision, to destroy cancer cells. Laser also can be used in cancer treatment as well as preventive surgeries. For example, in the digestive system, laser is often used to remove colon polyps, which may later become cancerous. Laser has been used to treat abnormal tissue, carcinoma in situ, and early cancer of the cervix, vagina, and vulva, to name a few. Many woman with breast cancer choose laser as the surgical tool because it is less painful and requires a shorter stay in the hospital.

Laser, as a tumor removal tool, has several advantages over scalpels. It is more precise and takes less operating time. Healing time is often shortened because laser heat seals blood vessels so there is less bleeding, swelling, and scarring involved in the surgical procedure. The downside of laser surgery is its cost and proper training of the cancer surgeons. The equipment can be bulky and technologically complicated compared with the more traditional surgical tools such as scalpels.

Working on a similar biological principle, electrosurgery uses high-frequency electrical currents to cut and destroy cancer cells. In electrosurgery, the high density of the radio-frequency current applied by the active electrosurgical electrode causes a cutting action, which can act like a fine micro-needle, a lancet, a knife, a snare, or even an energized scalpel or scissors.

Another innovative surgical technique to remove cancer is cryosurgery. Liquid nitrogen, or a probe that is very cold, is used to freeze and kill cancer cells. Traditionally, it has been used to treat external tumors, but now the technique is being employed as a treatment for tumors that occur internally.

Similar to laser, cryosurgery, incurs minimal blood loss, little discomfort, and shorter recovery time and shorter hospital stays. While researchers are still studying the effectiveness of cryosurgery as a treatment for other types of cancer, the technique has been used successfully in treating prostate cancer. Just as with the laser techniques, cryosurgery has proven to be effective in preventive surgeries. For example, pre-cancerous skin growths known as actinic keratosis and cervical intraepithelial neoplasia can be treated succesfully with cryosurgery.

According to cancer specialists, the stage of the cancer plays an important role in opting for cryosurgery as a cancer surgical tool. Cryosurgery is most effective for younger patients whose disease is contained entirely within the prostate.

One frequently asked question is: "Can the surgeon cure the cancer after the surgery?" Unfortunately, there is not a definite answer to this question. In many cases, cancer cells can break away from the primary tumor site and spread (metastasize) to other parts of the body by the time of the diagnosis. These patients may not only receive surgery, but may also receive adjuvant treatment such as chemotherapy to destroy the metastases.

The decision of a curative surgery is often made based on such factors as the patient's age and general health condition, location of tumor, stage of tumor, presence or absence of enlarged nodes, and the patient's desire for preservation.

Each of the surgical procedures described above is recorded in the abstract as cancer-directed treatment.

In addition to diagnostic, curative, and preventive surgeries, surgical procedures are also performed to improve the patient's quality of life. They can restore the function or appearance of organs or tissues that were either removed or changed by cancer treatment.

Palliative Surgery

Cancer causes pain to most cancer patients as does the treatment. It is estimated that 80% of cancer patients have two or more episodes of pain. More patients experience pain with advanced disease. The quality of life of those patients in great pain, resulting from either the disease or the treatment, is greatly compromised. Under such circumstances, palliative surgery may be performed. For example, the procedure may involve the removal of a painful primary or metastatic tumor mass such as a solitary spinal metastasis.

The purpose of palliative surgery is mainly to reduce pain for the patient. The surgery may not necessarily aim to eradicate cancer tissue in the patient. In fact, palliative surgery is often deemed as worthwhile and feasible by cancer specialists when the disease is not responsive to any type of curative treatment. A successful palliative surgery may not only make the patient's life more comfortable, but it may also prolong the cancer patient's life in some cases. Palliative surgery which removes cancer tissue is recorded as cancer-directed surgery. Palliative surgery such as a nerve block procedure to interrupt pain signals in the nervous system, or a stent placement to alleviate obstruction, etc., which does not remove cancer tissue is not recorded as cancer-directed surgery. Palliative procedures are recorded as non-cancer directed surgery.

Reconstructive Surgery

Reconstructive surgeries are performed on patients with physical deformities and abnormalities caused by traumatic injuries, birth defects, developmental abnormalities, or disease.

The goals of reconstructive surgery differ from those of cosmetic surgery; while cosmetic surgery is performed to reshape normal structures of the body to improve the patient's appearance and self-esteem, reconstructive surgery is performed on abnormal or damaged structures of the body. In many cases, the reason for the surgery is to repair the damage caused by the curative surgery, as well as to improve functions of certain anatomic parts of the body. In cancer treatment, if curative surgical procedures cause any disfigurement, dysfunction, or deformity, reconstructive surgery may be necessary. Breast reconstruction following surgical treatment for breast cancer is perhaps the most common example of reconstructive surgery.

For many simple or modified radical mastectomy patients, breast reconstruction may be possible during the same surgical procedure. In this type of reconstructive surgery, additional surgery is avoided and patients do not wake up to the "shock" of losing a breast. While a mastectomy is performed by the cancer surgeon, reconstructive surgery is usually performed by the plastic surgeon. Breast reconstruction may interfere with adjuvant treatment such as chemotherapy or radiation therapy. In these cases, reconstructive surgery may be delayed.

Sometimes, a one-stage reconstruction may not be enough; multiple stages may be necessary for optimal results when delayed tissue transfer is required. As with all other types of surgeries in cancer treatment, careful discussions between cancer patients and their doctors and plastic surgeons are encouraged so that the decisions regarding cancer surgery and reconstructive surgery can be made in the best interest of the patient.

An "open" surgery is one in which the patient is cut open. A typical open surgery involves the use of a scalpel (see scalpel) to make an incision into the skin and cut through the various layers of the dermis and sub-dermal layers and tissues to get to the desired tissue or organ. Some open surgeries use a laser to make the incision.

Endoscopy is a surgical technique that involves the use of an endoscope, a special viewing instrument that allows a surgeon to see images of the body's internal structures through very small incisions.

Endoscopic surgery has been used for decades in a number of different procedures, including gallbladder removal, tubal ligation, and knee surgery.

The endoscope

An endoscope consists of two basic parts: A tubular probe fitted with a tiny camera and bright light, which is inserted through a small incision; and a viewing screen, which magnifies the transmitted images of the body's internal structures. During surgery, the surgeon watches the screen while moving the tube of the endoscope through the surgical area.

It's important to understand that the endoscope functions as a viewing device only. To perform the surgery, a separate surgical instrument--such as a scalpel, scissors, or forceps--must be inserted through a different point of entry and manipulated within the tissue.

Advantages of endoscopy

All surgery carries risks and every incision leaves a scar. However, with endoscopic surgery, scars are likely to be much smaller and some of the after effects of surgery may be minimized.

In a typical endoscopic procedure, only a few small incisions, each less than one inch long, are needed to insert the endoscope probe and other instruments. For some procedures, such as breast augmentation, only two incisions may be necessary. For others, such as a forehead lift, three or more short incisions may be needed. The tiny "eye" of the endoscope's camera allows a surgeon to view the surgical site almost as clearly as if the skin were opened from a long incision.

Because the incisions are shorter with endoscopy, the risk of sensory loss from nerve damage is decreased. Also, bleeding, bruising and swelling may be significantly reduced. With the endoscopic approach, recovery may be quicker than that of an open surgery.

Endoscopic surgery may also allow you to avoid an overnight hospital stay. Many endoscopic procedures can be performed on an outpatient basis under local anesthesia with sedation. Patients should discuss this possibility with their doctor.

Many types of cancer are treated with surgery. Surgery works best for solid tumors that are contained in one area. It is a local treatment, meaning that it treats only the part of your body with the cancer. It is not used for leukemia (a type of blood cancer) or for cancers that have spread.

Sometimes surgery will be the only treatment you need. But most often, you will also have other cancer treatments.

Depending on your type of cancer and how advanced it is, surgery can be used to:

• Remove the entire tumor
  Surgery removes cancer that is contained in one area.
• Debulk a tumor
  Surgery removes some, but not all, of a cancer tumor. Debulking is used when removing an entire tumor might damage an organ or the body. Removing part of a tumor can help other treatments work better.
• Ease cancer symptoms
  Surgery is used to remove tumors that are causing pain or pressure.

Surgeons are highly trained and will do everything they can to prevent problems during surgery. Even so, sometimes problems do occur. Common problems are:

Pain

After surgery, most people will have pain in the part of the body that was operated on. How much pain you feel will depend on the extent of the surgery, the part of your body where you had surgery, and how you feel pain.

Your doctor or nurse can help you manage pain after surgery. Talk with your doctor or nurse before surgery about ways to control pain. After surgery, tell them if your pain is not controlled.

Infection

Infection is another problem that can happen after surgery. To help prevent infection, follow your nurse’s instructions about caring for the area where you had surgery. If you do develop an infection, your doctor can prescribe a medicine (called an antibiotic) to treat it.

Other risks of surgery include bleeding, damage to nearby tissues, and reactions to the anesthesia. Talk to your doctor about possible risks for the type of surgery you will have.

The cost of surgery depends on many factors, including:

• the type of surgery you have
• how many specialists are involved in your surgery
• if you need local, regional, or general anesthesia
• where you have surgery—at an outpatient clinic, a doctor’s office, or the hospital
• if you need to stay in the hospital, and for how long
• the part of the country where you live

Talk with your health insurance company about what services it will pay for. Most insurance plans pay for surgery to treat cancer. To learn more, talk with the business office of the clinic or hospital where you go for treatment. If you need financial assistance, there are organizations that may be able to help. To find such organizations, go to the NCI database, Organizations that Offer Support Services and search for "financial assistance." Or call toll-free 1-800-4-CANCER (1-800-422-6237) to ask for information on organizations that may help.

Where you have surgery depends on:

• the type of surgery
• how extensive it is
• where the surgeon practices
• the type of facility your insurance will cover

You can have outpatient surgery in a doctor’s office, surgery center, or hospital. Outpatient means that you do not spend the night. Or, you may have surgery in the hospital and stay the night. How many nights you stay will depend on the type of surgery you have and how quickly you recover.

Before surgery

Before surgery, a nurse may call you to tell you how to prepare. He or she may tell you about tests and exams you need to have before the surgery. Common tests that you may need, if you have not had them lately, are:

• blood tests
• chest x-ray
• electrocardiogram (ECG)

You may not be able to eat or drink for a certain period of time before the surgery. It is important to follow the instructions about eating and drinking. If you don’t, your surgery may need to be rescheduled.

You may also be asked to have supplies on hand for taking care of your wounds after surgery. Supplies might include antiseptic ointment and bandages.

During surgery

Once you are under anesthesia, the surgeon removes the cancer, usually along with some healthy tissue around it. Removing this healthy tissue helps improve the chances that all the cancer has been removed.

Sometimes, the surgeon might also remove lymph nodes or other tissues near the tumor. These tissues will be checked under a microscope to see if the cancer has spread. Knowing if the nearby tissue contains cancer will help your doctors suggest the best treatment plan for you after surgery.

After surgery

Once you are ready to go home after surgery, the nurse will tell you how to take care of yourself. He or she will explain:

• how to control pain
• activities you should and should not do
• how to take care of your wound
• how to spot signs of infection and steps to take if you do
• when you can return to work

You will have at least one more visit with the surgeon a week or two after you go home. For more complex surgeries, you may need to see the surgeon more often. You may have stitches removed, and the surgeon will check to make sure you are healing as you should.

Surgery increases your need for good nutrition. If you are weak or underweight, you may need to eat a high-protein, high-calorie diet before surgery.

Some types of surgery may change how your body uses food. Surgery can also affect eating if you have surgery of the mouth, stomach, intestines, or throat. If you have trouble eating after surgery, you may be given nutrients through a feeding tube or IV (through a needle directly into a vein).

Talk with a dietitian for help with eating problems caused by surgery. For more information about coping with eating problems see the booklet Eating Hints.

You will need to take time off from work to have and recover from surgery. You may need only 1 day or many weeks. How long you need to recover depends on many factors, such as:

• The type of anesthesia you have. If you have local or regional anesthesia, you will probably return to work more quickly than if you have general anesthesia.
• The type of surgery you have, and how extensive it is
• The type of work you do. If you have an active job, you may need to take off more time than if you sit at a desk. If your job allows, you may want to see if you can work at home, or start back part time, to help you ease back into a full work day.

Ask your doctor how long you will need to recover from your surgery. If you expect a longer recovery time, talk with your employer to find out if you can take medical leave. Check to make sure your health insurance will cover costs if you are on medical leave and not working for a time.