Surgery

Surgery is a way to remove cancer from the body or repair a part of the body affected by cancer. It usually involves cutting into the body. It may be called a procedure, operation or surgical resection. It is done by one or more surgeons and a team of other health professionals, including an anaesthetist, nurses and technicians

Many cancers that are found at an early stage can be removed with surgery, and this may be the only treatment needed. If cancer has already spread to a number of places in the body, surgery may not be the best treatment.

The Guides to Best Cancer Care set out the recommended treatment pathways in Australia for many types of cancer. For some cancers, surgery is recommended as the most effective approach, either on its own or in combination with other treatments. For other cancers, non-surgical treatments are more effective.

Surgery is an important part of treating cancer. It can be used:

To prevent cancer – Preventive or prophylactic surgery removes healthy tissue that doctors believe will probably become cancerous. It is done to reduce a person’s risk of developing cancer. The decision to have preventive surgery should be made after talking to qualified health professionals, including a genetic counsellor.

To diagnose or stage cancer – Surgery may be done to confirm a cancer diagnosis. The doctor may remove all or part of a tumour in a procedure called a biopsy. Surgery can also help the doctor determine the size of the tumour and whether the cancer has spread. This is called staging.

To achieve cure – Small, early-stage cancers that haven’t spread are often successfully treated with surgery. If the cancer is only in one part of the  body, the surgeon may remove the cancerous tissue or a whole organ.

To reduce the size of the cancer – If it is not possible to remove all the cancer without damaging nearby healthy organs, debulking (cytoreductive) surgery may be done. The aim of the surgery is to remove as much of the cancer as possible, to help make other treatments more effective.

To reconstruct a part of the body – Reconstructive or plastic surgery can be done for many different reasons, such as to take control of your  appearance, and help improve mobility or function. Examples include breast reconstruction after removal of a breast (mastectomy) or a skin graft after surgery for skin cancer.

To help other treatments – Some procedures are done to assist other cancer treatments. For example, you may have a procedure to insert a tube (catheter) into a large vein in your chest to make it easier to receive chemotherapy.

To relieve symptoms – Surgery can help to relieve cancer symptoms and treatment side effects. This is known as palliative treatment. For example, you may have surgery to treat a blockage in the bowel or to relieve discomfort caused by tumours pressing on nerves.

For some types of cancer, you may be given other treatments before, during or after surgery.

Timing of other cancer treatments with surgery

• Before (neoadjuvant) – Drug therapies or radiation therapy may be given before surgery to try to shrink the tumour and make it easier to remove.
• During (simultaneous) – Two types of treatment are sometimes given at the same time – for example, radiation therapy or heated chemotherapy may be given during surgery.
• After (adjuvant) – Drug therapies or radiation therapy may be given after you have recovered from surgery, often when:
  • the tumour hasn’t been completely removed
  • cancer has spread to other parts of the body, such as the lymph nodes
  • there is a chance there may be hidden cancer cells
  • there is a significant risk that the cancer could come back.

The way the surgery is done (the approach or technique) depends on the type of cancer, its location in the body, the surgeon’s training and the equipment in the hospital or operating theatre.

Each method has advantages in particular situations – your doctor will advise which approach is most suitable for you. Some people have a combination of approaches.

Open surgery – During open surgery, the surgeon makes one or more cuts (incisions) into the body to see and operate on the organs and remove cancerous tissue. The size of the cut can vary depending on the type of surgery. Your surgeon can talk with you about the size of the cut before surgery.

Open surgery is a well-established technique and widely available. It is often used for cancers in the abdomen (belly) or the pelvic area, when it is known as a laparotomy. When open surgery is done on the chest area, it is called a thoracotomy.

Keyhole surgery – Also called minimally invasive surgery, this is when the surgeon makes a few small cuts in the body instead of the large cuts used in open surgery. The surgeon will insert a thin instrument with a light and camera into one of the cuts. The camera projects images onto a TV screen so the surgeon can see the inside of your body. The surgeon inserts tools into the other cuts and removes the cancerous tissue, using the images on the screen as a guide.

Keyhole surgery in the abdomen or pelvic area is called a laparoscopy. When keyhole surgery is done on the chest, it is called a thoracoscopy or video-assisted thoracoscopic surgery.

In many cases, keyhole surgery can lead to a shorter stay in hospital and reduce pain and recovery time.

Robotic surgery – This is a type of keyhole surgery performed with help from a robotic system. The surgical instruments are moved by robotic arms controlled by the surgeon, who sits at a computer console next to the operating table. The console lets the surgeon see a three-dimensional view of the surgical site.

Laser surgery – This procedure uses a laser beam instead of a knife to vaporise or remove cancerous tissue. A laser beam is a strong, hot beam of light.

Cryotherapy – Also called cryosurgery, this is often used to treat skin cancers. Liquid nitrogen is sprayed onto the cancerous tissue to freeze and kill it.

To help stop the spread of COVID-19, your hospital may have put in place some extra procedures. You may need to have a negative rapid antigen test (RAT) before arriving at the hospital on the day of the surgery, hospitals may limit the number of people that visit, and you may have to wear a mask that covers your nose and mouth while you are in hospital.

If you have COVID-19 or are recovering from a recent COVID-19 infection, planned surgery may be delayed for a few weeks. This is to ensure you have recovered and the surgery can be carried out safely. Your hospital will let you know if there are any specific precautions you need to follow.

Often you will be admitted to hospital to have surgery. This is called inpatient care. The length of your hospital stay depends on the type of surgery you have, the speed of your recovery and whether you have support after you are discharged.

For many procedures, it is common to have surgery and go home on the same day, provided there are no complications. This is called day surgery or outpatient surgery. Your doctor will tell you whether you will have surgery as an inpatient or outpatient.

The cost of surgery varies, depending on the cancer type and stage, the operation you are having, the length of stay in hospital, and whether you have treatment as a public or private patient.

You have a right to know what you will have to pay for surgery and whether there will be any additional costs not covered by Medicare or your health fund. There may be fees you hadn’t expected (e.g. if you have surgery as a private patient, there will be separate fees for your surgeon, anaesthetist, operating room and hospital stay).

When you are booked in for surgery, ask your surgeon, anaesthetist and hospital for a written quote that shows what you will have to pay. Talk to your health insurer to see what is covered.

If you are concerned about the cost, you may want to ask your surgeon if there is any way to reduce the costs, get a second opinion from another specialist, or seek surgery as a public patient.

Download our booklet ‘Cancer Care and Your Rights’

In most cases, surgery does not cause cancer cells to spread to other places in the body. Surgeons take steps to prevent this. However, for a few cancers, there is a higher risk. For example, most men with testicular cancer have the entire affected testicle removed. This is because removing only part of the testicle can cause cancer cells to spread during surgery. Talk to your surgeon if you are concerned.

Surgery is a way to remove cancer from the body or repair a part of the body affected by cancer. It usually involves cutting into the body. It may be called a procedure, operation or surgical resection. It is done by one or more surgeons and a team of other health professionals, including an anaesthetist, nurses and technicians

Many cancers that are found at an early stage can be removed with surgery, and this may be the only treatment needed. If cancer has already spread to a number of places in the body, surgery may not be the best treatment.

The Guides to Best Cancer Care set out the recommended treatment pathways in Australia for many types of cancer. For some cancers, surgery is recommended as the most effective approach, either on its own or in combination with other treatments. For other cancers, non-surgical treatments are more effective.

Surgery is an important part of treating cancer. It can be used:

To prevent cancer – Preventive or prophylactic surgery removes healthy tissue that doctors believe will probably become cancerous. It is done to reduce a person’s risk of developing cancer. The decision to have preventive surgery should be made after talking to qualified health professionals, including a genetic counsellor.

To diagnose or stage cancer – Surgery may be done to confirm a cancer diagnosis. The doctor may remove all or part of a tumour in a procedure called a biopsy. Surgery can also help the doctor determine the size of the tumour and whether the cancer has spread. This is called staging.

To achieve cure – Small, early-stage cancers that haven’t spread are often successfully treated with surgery. If the cancer is only in one part of the  body, the surgeon may remove the cancerous tissue or a whole organ.

To reduce the size of the cancer – If it is not possible to remove all the cancer without damaging nearby healthy organs, debulking (cytoreductive) surgery may be done. The aim of the surgery is to remove as much of the cancer as possible, to help make other treatments more effective.

To reconstruct a part of the body – Reconstructive or plastic surgery can be done for many different reasons, such as to take control of your  appearance, and help improve mobility or function. Examples include breast reconstruction after removal of a breast (mastectomy) or a skin graft after surgery for skin cancer.

To help other treatments – Some procedures are done to assist other cancer treatments. For example, you may have a procedure to insert a tube (catheter) into a large vein in your chest to make it easier to receive chemotherapy.

To relieve symptoms – Surgery can help to relieve cancer symptoms and treatment side effects. This is known as palliative treatment. For example, you may have surgery to treat a blockage in the bowel or to relieve discomfort caused by tumours pressing on nerves.

For some types of cancer, you may be given other treatments before, during or after surgery.

Timing of other cancer treatments with surgery

• Before (neoadjuvant) – Drug therapies or radiation therapy may be given before surgery to try to shrink the tumour and make it easier to remove.
• During (simultaneous) – Two types of treatment are sometimes given at the same time – for example, radiation therapy or heated chemotherapy may be given during surgery.
• After (adjuvant) – Drug therapies or radiation therapy may be given after you have recovered from surgery, often when:
  • the tumour hasn’t been completely removed
  • cancer has spread to other parts of the body, such as the lymph nodes
  • there is a chance there may be hidden cancer cells
  • there is a significant risk that the cancer could come back.

The way the surgery is done (the approach or technique) depends on the type of cancer, its location in the body, the surgeon’s training and the equipment in the hospital or operating theatre.

Each method has advantages in particular situations – your doctor will advise which approach is most suitable for you. Some people have a combination of approaches.

Open surgery – During open surgery, the surgeon makes one or more cuts (incisions) into the body to see and operate on the organs and remove cancerous tissue. The size of the cut can vary depending on the type of surgery. Your surgeon can talk with you about the size of the cut before surgery.

Open surgery is a well-established technique and widely available. It is often used for cancers in the abdomen (belly) or the pelvic area, when it is known as a laparotomy. When open surgery is done on the chest area, it is called a thoracotomy.

Keyhole surgery – Also called minimally invasive surgery, this is when the surgeon makes a few small cuts in the body instead of the large cuts used in open surgery. The surgeon will insert a thin instrument with a light and camera into one of the cuts. The camera projects images onto a TV screen so the surgeon can see the inside of your body. The surgeon inserts tools into the other cuts and removes the cancerous tissue, using the images on the screen as a guide.

Keyhole surgery in the abdomen or pelvic area is called a laparoscopy. When keyhole surgery is done on the chest, it is called a thoracoscopy or video-assisted thoracoscopic surgery.

In many cases, keyhole surgery can lead to a shorter stay in hospital and reduce pain and recovery time.

Robotic surgery – This is a type of keyhole surgery performed with help from a robotic system. The surgical instruments are moved by robotic arms controlled by the surgeon, who sits at a computer console next to the operating table. The console lets the surgeon see a three-dimensional view of the surgical site.

Laser surgery – This procedure uses a laser beam instead of a knife to vaporise or remove cancerous tissue. A laser beam is a strong, hot beam of light.

Cryotherapy – Also called cryosurgery, this is often used to treat skin cancers. Liquid nitrogen is sprayed onto the cancerous tissue to freeze and kill it.

To help stop the spread of COVID-19, your hospital may have put in place some extra procedures. You may need to have a negative rapid antigen test (RAT) before arriving at the hospital on the day of the surgery, hospitals may limit the number of people that visit, and you may have to wear a mask that covers your nose and mouth while you are in hospital.

If you have COVID-19 or are recovering from a recent COVID-19 infection, planned surgery may be delayed for a few weeks. This is to ensure you have recovered and the surgery can be carried out safely. Your hospital will let you know if there are any specific precautions you need to follow.

Often you will be admitted to hospital to have surgery. This is called inpatient care. The length of your hospital stay depends on the type of surgery you have, the speed of your recovery and whether you have support after you are discharged.

For many procedures, it is common to have surgery and go home on the same day, provided there are no complications. This is called day surgery or outpatient surgery. Your doctor will tell you whether you will have surgery as an inpatient or outpatient.

The cost of surgery varies, depending on the cancer type and stage, the operation you are having, the length of stay in hospital, and whether you have treatment as a public or private patient.

You have a right to know what you will have to pay for surgery and whether there will be any additional costs not covered by Medicare or your health fund. There may be fees you hadn’t expected (e.g. if you have surgery as a private patient, there will be separate fees for your surgeon, anaesthetist, operating room and hospital stay).

When you are booked in for surgery, ask your surgeon, anaesthetist and hospital for a written quote that shows what you will have to pay. Talk to your health insurer to see what is covered.

If you are concerned about the cost, you may want to ask your surgeon if there is any way to reduce the costs, get a second opinion from another specialist, or seek surgery as a public patient.

Download our booklet ‘Cancer Care and Your Rights’

In most cases, surgery does not cause cancer cells to spread to other places in the body. Surgeons take steps to prevent this. However, for a few cancers, there is a higher risk. For example, most men with testicular cancer have the entire affected testicle removed. This is because removing only part of the testicle can cause cancer cells to spread during surgery. Talk to your surgeon if you are concerned.

The surrounding tissue that is removed with the cancer is known as the surgical margin. A specialist doctor called a pathologist checks the margin under a microscope to make sure the cancer has been completely removed. If there aren’t any cancer cells at the edge of the removed tissue, it is called a clear, negative or clean margin. If there are cancer cells, it is a positive or close margin, and you may need to have more surgery or other treatments.

Your general practitioner (GP) will arrange the first tests to assess your symptoms. If these tests do not rule out cancer, you will usually be referred to a specialist, for example, a surgeon. It is a good idea to build a relationship with a GP. They can assist you with treatment decisions and follow-up care after surgery. For example, GPs can help with pain control, prescriptions for medicines, or referrals for follow-up blood tests and scans.

The type of surgeon you see will depend on the location of the cancer. For example, your GP may refer you to a breast surgeon, gynaecological  oncologist (female reproductive system), urologist (urinary tract or kidneys; male reproductive system), thoracic surgeon (chest and lung), colorectal surgeon (bowel), or head and neck surgeon. Sometimes your main specialist will be a general surgeon.

Treatment options will often be discussed with other health professionals at what is known as a multidisciplinary team (MDT) meeting. This means health professionals work together to plan your treatment and manage care.

It is recommended that complex cancer surgeries are done by an experienced surgeon who works in an MDT in a specialist centre. Centres that do a high number of these procedures may have better outcomes.

Health professionals you may see

surgeon – surgically removes tumours and performs some biopsies; specialist cancer surgeons may be called surgical oncologists reconstructive  (plastic) surgeon performs surgery that restores, repairs or reconstructs the body’s appearance and function

anaesthetist – assesses your health before surgery; administers anaesthesia and looks after you during the surgery; commonly plans your pain relief after surgery

operating room staff – include anaesthetists, technicians and nurses who prepare you for surgery and care for you during the operation and recovery

junior medical staff – doctors at different levels of training, who look after patients under the supervision of a fully qualified surgeon or anaesthetist; includes registrars, fellows and resident medical officers

cancer care coordinator – coordinates your care, liaises with other members of the MDT and supports you and your family throughout treatment; may also be called a nurse consultant or cancer nurse specialist

nurse – administers drugs and provides care, information and support throughout your treatment

pathologist – examines cells and tissue samples to determine the type and extent of the cancer

pharmacist – dispenses medicines and gives advice about dosage and side effects

dietitian – helps with nutrition concerns and recommends changes to diet during treatment and recovery

psychiatrist, psychologist, counsellor – help you manage your emotional response to diagnosis and treatment; a psycho-oncologist specialises in the field of cancer care

rehabilitation specialist – recommends and oversees treatment to help you recover and return to your usual activities

physiotherapist, exercise physiologist – help restore movement and mobility, and improve fitness and wellbeing;  physiotherapists also help with breathing exercises and managing lymphoedema

occupational therapist – assists in adapting your living and working environment to help you resume usual activities after treatment

speech pathologist – helps with communication, voice and swallowing difficulties during and after treatment

social worker – links you to support services and helps you with emotional, practical and financial issues

A thin needle is used to remove a sample of fluid or cells from the tumour.

A special tool is used to remove a circle of tissue.

A hollow needle is inserted through the skin to remove a thin piece of tissue (a core).

The surgeon cuts into the body to remove all or part of a tumour. It may be called an excision biopsy (removes the whole tumour) or incision biopsy (removes part of the tumour).

A flexible tube with a light and camera (endoscope) is inserted into the body through a natural opening (such as the mouth) or a small cut. This lets the doctor see inside the body and take a tissue sample. Endoscopies are named after the part of the body affected, e.g. colonoscopy (colon), gastroscopy (stomach).

Your surgeon – Your surgeon will ask you to complete a questionnaire about your medical history, including any allergies and any medicines you take. Tell them if you are taking any over-the-counter medicines, vitamins, herbs or other supplements, as these could affect the surgery and your recovery. For example, they may increase the risk of bleeding during surgery or affect the way pain medicines work.

If you don’t need to attend a pre-admission clinic, your surgeon will talk to you at one of your usual appointments about the surgery and any  preparations you need to make. If you are having surgery privately, the anaesthetist may call you to discuss any issues noted on your pre-admission questionnaire.

Pre-admission clinic – Depending on the surgery you are having and your general health, you may need to attend a pre-admission clinic. This may be in person or over telehealth. Your medical team will check your fitness for surgery and recommend any tests or other things you need to do to prepare for surgery and ensure the best outcomes.

The health professionals you see at the clinic will vary depending on any other health conditions you have, the type of cancer and the surgery  planned, but they could include:

• the surgeon or a resident medical officer or registrar
• the anaesthetist or another member of the anaesthesia team, such as a specialist nurse or registrar
• a physiotherapist to show you exercises to do before surgery to improve the chances of a smooth recovery
• other specialists depending on your medical history and the type of surgery (e.g. you may see a heart specialist)
• specialist nurses such as a cancer care coordinator, breast care nurse or stomal therapy nurse.

You may also have blood tests (including compatibility testing in case you need a blood transfusion), urine tests, heart monitoring tests (ECG) and a chest x-ray, and imaging tests such as CT, MRI or PET–CT scans. You may not need to have all of these tests and scans.

Enhanced recovery after surgery programs

Some hospitals in Australia have programs to reduce the stress of surgery and improve recovery. These are called enhanced recovery after surgery (ERAS) or fast track surgical (FTS) programs.

These programs encourage you to play an active part in your care through pre-admission counselling and education about pain, diet and exercise, so you know what to expect before and after surgery.

Talk with your surgeon about ways you can look after your health before surgery. The suggestions below may improve your strength, help you cope with side effects and lead to a smoother recovery. For some people, improving their physical health means they become fit enough for surgery.

Stop smoking – If you smoke tobacco or vape, aim to quit as soon as possible. Continuing to smoke or vape can increase the risk of complications after surgery, and delay your healing and recovery time. Quitting smoking or vaping can be difficult – for support, talk to your doctor or call the Quitline on
13 7848.

Exercise – Surgery places a strain on the body, including the heart and lungs. Exercise will help build up your strength to cope with recovery and reduce the risk of complications after surgery. Talk to your doctor or physiotherapist about the amount and type of exercise that is right for you, and any precautions to take.

Improve nutrition – Healthy food can help your body cope with the stress of surgery, improve your strength, and assist with your recovery. A dietitian can suggest foods to eat to ensure you get enough energy and protein. They may also recommend you have special drinks (nutritional supplements).

Avoid alcohol – Talk to your doctor about your alcohol use. Alcohol can affect how the body works and increase the risk of complications after surgery, including bleeding and infections. Drinking even small amounts of alcohol increases the risk of developing some cancers, so it’s best to avoid alcohol after a cancer diagnosis.

Talk to someone – You may find it useful to talk to a counsellor about how you are feeling. This can help you deal with any anxiety you are feeling  about having surgery, and help you feel more in control.

Almost all medical procedures have risks. Factors to consider when weighing up the risks and benefits of surgery include:

• how long the operation will take
• the type of anaesthetic you will have
• the expected outcome
• what will happen if you don’t have the surgery
• your age and general health.

Although advances in surgical techniques have made surgery safer, there are still things that may be unknown or not go as planned. Complications may also occur during surgery and after surgery.

Some surgeries may cause permanent physical changes such as scarring or loss of a body part. Surgery may also affect your fertility (your ability to conceive a child). If you may be interested in having children in the future, talk to your surgeon about your options before the operation.

Overall, you and your surgeon should feel that the expected benefits are greater than the possible risks. For some cancers, there are few options other than surgery. For other cancers, there is more than one recommended treatment pathway. Talk to your surgeon about your options. If you are unsure, ask for a second opinion from another specialist.

A surgeon needs your agreement (consent) before performing any medical treatment. Adults can give their consent – or refuse it – if they have capacity (ability to make decisions). This means you can understand and remember information about the proposed choices; understand the possible outcomes of your decision; and communicate your decision.

Sometimes consent is not needed, such as in a medical emergency. However, if your surgery is planned, your surgeon will discuss why you need the surgery and its benefits; other treatment options; how they will perform the surgery; and possible side effects, risks and complications.

You will be asked to sign a document indicating that you understand this information and agree to treatment. This is known as giving informed consent. 

Download our booklet ‘Cancer Care and Your Rights’

You may be able to have some appointments with your surgeon and other health professionals at home by phone or video call. This is known as telehealth and it can reduce the number of times you need to travel to appointments. This may be particularly helpful if you have to travel a long way to see your doctors. Telehealth can also reduce the risk of catching an infection.

Although telehealth can’t replace all face-to-face appointments, you can use it to talk about a range of issues including test results, prescriptions, help with side effects, and nutrition and exercise advice.

For more information, talk to your treatment team, or call Cancer Council 13 11 20.

Download our fact sheet ‘Telehealth for Cancer Patients and Carers’

As part of the preoperative assessment, you will be given instructions about how to prepare for the surgery based on your health and medical history. 

The advice you receive will cover a range of issues. Let your treatment team know if you have any concerns about what you are asked to do.

Bathing and shaving – You will be told when to shower or bathe. This may be the night before and/or morning of the surgery. If you have been told that hair near the surgical site needs to be removed, you may be asked to do it yourself before you go to hospital, or it may be done when you are admitted. In cases where there is a lot of hair at the surgical site, you will be asked to avoid shaving the area yourself, as any cuts to the area can increase the risk of infection. You may also be asked not to wear any make-up, nail polish, moisturiser, perfume or deodorant; and to remove false nails and  piercings.

Eating and drinking – Most people are told not to eat (fast) for 6 hours before surgery. This ensures that your stomach is empty before having an anaesthetic, which reduces the risk of food getting into your lungs (aspiration). Depending on the type of operation, your surgeon may tell you to avoid having some types of food and drink. You should not drink alcohol or smoke for at least 24 hours before the operation, or chew gum while you
are fasting. In some cases, you can continue drinking clear fluids such as water or will be given supplements to drink up to 2 hours before surgery – your surgeon, anaesthetist or a hospital nurse will advise you about this.

What to take with you – The hospital will let you know what personal items to take with you and what to leave at home. For example, they may tell you to take all your current medicines with you, but suggest you leave valuables, such as jewellery, at home. You should also take your admission letter and any recent x-rays or scans with you. If you are staying in hospital after your operation, you might like to take some toiletries, nightclothes and non-slip, comfortable shoes.

Organise help – If you are having day surgery, you will need to arrange for someone to take you home when you are discharged and then stay with you for 24 hours after surgery. It’s not safe to travel alone or use public transport or a taxi, as you will still be under the effects of the anaesthetic.

If you are admitted to hospital, talk to your doctor about whether you will be able to go home when you are discharged or will need to go to a  rehabilitation unit. If you go home, you may need to organise for a relative or friend to stay with you for a few days in case you have any  complications. They can also help with washing, dressing and meals. You may also need to organise equipment to help your recovery.

Medicines – Your doctor will tell you whether to keep taking any medicine you are on or stop taking it in the days or weeks before surgery. If you are told to take medicine while fasting, swallow it with a small mouthful of water. If you are on blood thinners, including over-the-counter ones like aspirin and ibuprofen, talk to your surgeon about whether you need to stop taking them.

What time to arrive – You will be told what time to arrive at the hospital, either in the letter confirming the surgery or during a phone call from the hospital on the day before the surgery. You may have to wait for surgery, which can be stressful. It’s a good idea to take a quiet activity with you to keep you occupied and feeling calm (e.g. a book or magazine).

Arrival – The hospital will give you a time to arrive, called the admission time. When you’re admitted, you might not know the exact time of the surgery, but you’ll probably know if it will be in the morning or afternoon. Sometimes there are unexpected delays due to emergencies and the order of the operating list may change – the receptionists and nurses will keep you informed.

Getting ready – Before you go to the operating theatre, a nurse will:

• review your medical history and whether you have any allergies
• check you have had a recent negative rapid antigen test for COVID
• place an identification band around your wrist or ankle
• ask when and what you last ate and drank
• check your temperature, blood pressure, pulse, height, weight and blood oxygen levels
• confirm the procedure you are having.

You will be directed to a bed and asked to change into a surgical gown. If the surgery is to a part of your body with hair, it may be clipped.

Preventing blood clots – All surgery and some cancers increase the risk of developing blood clots in the deep veins of the legs or pelvis (deep vein thrombosis or DVT). You will usually be given compression stockings to wear on your legs during and after surgery to reduce the risk. Some people may have special cuffs placed around the legs to keep the calf muscles moving during, and sometimes after, surgery. You may also be given an injection of blood-thinning medicine.

Personal possessions – Your clothes and other possessions may be stored under the bed in a bag, in a locker or given to your support person. It’s best to leave valuables at home.

Fall prevention – You may be given non-slip socks to wear while you are in hospital to help prevent you falling over and hurting yourself.

Sometimes surgery is cancelled on the day. Whatever the reason, this can be very stressful. The hospital staff will talk to you about the next steps and your ongoing plan of care.

A specialist doctor called an anaesthetist will give you drugs to send you to sleep or to numb an area of the body. This is called anaesthesia and it will prevent you feeling pain or discomfort during surgery. The anaesthetist may also give you other drugs to manage pain and nausea.

When you meet your anaesthetist before surgery, it is important to tell them about any medical conditions or drug allergies you have, when you last ate or drank, and if you have had a previous reaction to an anaesthetic (including if you took a long time to wake up).

Different types of anaesthetic

There are different types of anaesthetic used for surgery. The type you have will depend on the procedure you are having and your overall health. You may have more than one type of anaesthetic during surgery.

Light or conscious sedation – You will be given drugs to relax you and make you sleepy. You will still be able to respond to directions from your surgeon but may not remember what happened during the procedure.

Local anaesthetic – This involves numbing the skin or part of the body being operated on. It is usually done as an injection, but drops, sprays or  ointments may be used instead. You may also be given a sedative to help you relax. You are still awake during surgery, but you won’t feel any pain or discomfort. The numbness typically lasts for several hours to a day.

Regional anaesthetic (nerve block) – A local anaesthetic is injected through a needle placed close to a nerve or nerves near the surgical site. This numbs the part of the body being operated on. You may be given a light sedative to help you relax, or stronger medicine to put you to sleep.

General anaesthetic – You will be given strong drugs to make you go to sleep (fall unconscious). Both injectable drugs and gases can be used. Some people say that having a general anaesthetic feels like a deep, dreamless sleep. You may experience some side effects, such as nausea and confusion, when you wake up from general anaesthetic. Most of these effects are temporary and are easily managed by your medical team.

You might walk into the operating theatre or lie on a bed that is wheeled into the operating theatre. This is a purpose-designed, very clean room where the surgery occurs. The surgical team will wear caps, masks and gowns to help prevent infection.

The anaesthetist will put a small tube (cannula) into a vein in the back of your hand or arm. The anaesthetic drugs will be injected into the cannula. You might feel a slight stinging sensation, but once the drugs start to work you won’t be aware of what’s happening.

During surgery under general anaesthetic, a machine called a ventilator helps you breathe or may breathe for you. The anaesthetist constantly checks your vital signs (heart rate, temperature, blood pressure and blood oxygen levels) to ensure they remain at normal levels. They also give you pain medicine so you are comfortable when you wake up.

When the surgery is finished, the anaesthetist will stop giving you the anaesthetic drugs and may give you other drugs to reverse the effects of  general anaesthesia. You’ll be taken to the recovery room, and your vital signs will be monitored until you are fully awake.

There are some things the medical team may not know until the surgery is in progress. The surgeon will discuss these with you beforehand.

Taking a different approach – The surgeon may start the operation as keyhole surgery but have to change to open surgery. This is usually so they can more easily reach the tumour or safely deal with any complications that may arise.

Adding another surgeon – Another surgeon may be in the theatre to assist your surgeon. This is standard practice, as the extra support can help achieve the best outcome for you. For example, a gynaecological surgeon may ask a colorectal surgeon to assist if they discover gynaecological cancer extending into the bowel.

Removing extra tissue – It may be difficult for your surgeon to tell you exactly what will be removed during the surgery, as scans don’t always detect all of the cancer. You may be asked to give consent to remove extra tissue if the cancer is found in places not shown on scans.

Creating a stoma – The medical team will talk to you before surgery if they might need to create an artificial opening in the body (stoma). An example of a stoma is a colostomy. This is when part of the large bowel is brought out to the surface of your abdomen through an opening created surgically, and a disposable bag is attached to collect waste matter. A stoma may be temporary or permanent.

Needing a blood transfusion – If you lose a lot of blood during surgery, some blood or blood products can be given to you through a vein (transfusion). Blood from a donor is usually used. There are strict screening and safety measures in place, so transfusion is generally very safe. Let your surgeon know beforehand if you refuse to have a transfusion or you are worried about needing a blood transfusion.

Your surgeon will close up the wound (incision) created during the surgery. Their approach will depend on the part of your body affected and the kind of surgery you had (e.g. open or keyhole surgery).

Common ways to close a surgical wound include:

• sutures or stitches – sewing the wound closed using a strong, threadlike material that can dissolve or will be removed at a later date
• staples – small metal clips that will be removed by your doctor once the wound has healed
• glue – clear liquid or paste that dissolves over time; used to seal minor wounds (up to 5 cm) or applied on top of sutures
• adhesive strips – pieces of tape placed across the wound to hold the edges together; may be used with sutures.

Wound coverings (dressings)

The wound will usually be covered with a surgical dressing to keep it dry and clean. This may be a waterproof adhesive dressing or a bandage. The dressing will be changed as needed. If you have surgery as an inpatient, the nurses will look at the wound to see if it’s healing and to check for bleeding or signs of infection. When you have a shower, if the dressing is not waterproof it may need to be covered or taken off and reapplied  afterwards.

The wound may feel itchy or irritated after surgery. Tell the nurses if this happens – it could be a sign it’s healing, but it may also be a problem, such as an allergic reaction to adhesive tape.

Before you leave hospital, the nurses will give you instructions about how to care for your wound and dressing.

Sometimes problems or complications occur during surgery. It’s very unlikely that all of the complications described here would apply to you. Your surgeon can give you a better idea of the risks of your operation. Generally, the more complex the surgery is, the higher the chance of problems.

Bleeding – You may lose blood during surgery. Your surgeon will usually manage and control bleeding. Sometimes, you may receive a blood transfusion during surgery to replace lost blood.

Damage to nearby tissue and organs – Most internal organs are packed tightly together, so operating on one part of the body can affect nearby tissue and organs. This may alter how other organs work after surgery – for example, the surgeon’s handling of the bowel during pelvic surgery may cause temporary constipation (difficulty passing a bowel motion) or a build-up of gas in the abdomen.

Drug reactions – In rare cases, some people have a bad reaction to anaesthetic or other drugs used during surgery. This can lead to changes in blood pressure, heart rate and breathing. Your anaesthetist will monitor these signs throughout the surgery and quickly treat any changes if they occur.

Tell your doctor if you’ve had any previous reactions to over-the-counter, prescription or herbal medicine, even if the reaction was small.

After the operation is over, you will be moved to a recovery room. This is an area near the operating theatre where there is monitoring equipment and specially trained staff. In some hospitals, it may be called a recovery ward or post-anaesthesia care unit. It might be a shared space or a private room.

People who need a high level of care will go into the high dependency unit (HDU) or intensive care unit (ICU) for the first night or for a few days. You will be moved out of the HDU or ICU as your condition improves. Your surgeon will tell you before surgery if it’s likely you will be moved to one of these  units.

While the anaesthetic wears off, a recovery nurse will check your wound, pain levels and vital signs. They will also give you medicine or fluids to help reduce side effects caused by the anaesthetic. You may have several tubes in place.

Tubes and drains you might have

Intravenous (IV) drip

• inserted into a vein in your arm or hand
• gives you fluids until you can eat and drink again
• also used to give pain relief and other medicines
• may be in place for a few hours or a few days, depending on the surgery

Breathing tube

• inserted down your throat to help you breathe during surgery
• usually removed while you are under anaesthetic, but may stay in if you go to ICU

Surgical drain

• a tube placed in the wound to drain fluid from the surgical site into a small bottle or bag
• may stay in for a few days or a few weeks, depending on how much fluid is being collected and the type of operation

Urinary catheter

• a thin tube that drains urine from your bladder into a bag
• may stay in for a few hours or a few days, depending on the type of operation
• usually removed when you start walking after surgery and can get to the toilet

Nasogastric (NG) tube

• a thin tube placed through your nose into the stomach
• used to remove fluid from the stomach until bowel function returns to normal or for feeding

Feeding tube

• may be needed if you are unable to eat and drink after surgery
• a tube is placed into your stomach or small bowel, either through your nostril (NG tube) or an opening on the outside of your abdomen (gastrostomy tube)
• usually temporary, but sometimes permanent

Leaving the recovery room

You will leave the recovery room when the nursing staff are satisfied that your vital signs are stable and that you are comfortable.

• Day surgery – You will be moved to the day surgery unit where you will get dressed and have something to eat and drink before going home. Your surgeon will often see you here to discuss the procedure.
• Inpatient surgery – If you are staying in hospital to recover, you will be moved from the recovery room to a ward.

General anaesthesia is very safe, but like any medical procedure, you may experience some side effects. Most side effects occur immediately after  surgery and don’t last long. Tell your medical team if any of these side effects get worse or worry you.

Nausea and vomiting – You may feel sick (nausea) or vomit after an anaesthetic, but this usually improves within a day or two. You may be given  medicine to control this. Sometimes vomiting makes you feel better.

Chills and dizziness – Your body temperature often drops in the operating theatre and you may wake up shivering or feeling cold. Some people feel dizzy from the anaesthetic or because they are dehydrated. These side effects will be monitored in the recovery room.

Agitation – You might cry or feel restless and anxious when you wake up. Some people feel like their arms or legs are twitchy. This is a normal reaction.

Sore throat or hoarseness – The tube placed down your throat to help you breathe while you are asleep can leave you with a sore throat or a hoarse voice after it is removed. This should get better in a few days.

Mental effects – You may feel confused, groggy or “fuzzy” in the minutes or hours after you wake up, and you may not remember why you had surgery.

Most people make a full recovery within a few hours. In some cases, this may take around 24 hours, particularly in elderly people and those who had memory problems before surgery.

Rarely, people have ongoing mental effects (such as fogginess or mild memory loss) for more than a week. This is called postoperative cognitive  dysfunction. There is no evidence that anaesthesia worsens how the brain works (cognitive function) in the longer term.

You should not drive, operate complex equipment or sign important documents for at least 24 hours after a general anaesthetic.

While you are recovering on the ward, nurses and doctors will check your progress regularly. They will usually take your blood pressure, pulse and temperature, look at your wound and change the dressing as needed. Your health care team will also help you with the following:

Pain control – It is common to have some pain and discomfort for several days after surgery, but this can be controlled with pain medicines. Pain usually improves as the wound heals. Let your doctor or nurse know if you are in pain so they can adjust your medicines to make you as comfortable as possible. Do not wait until the pain is severe. Pain relief options may include:

• an injection or ongoing infusion of local anaesthetic into the wound, near the spinal column (epidural), or near a nerve to block pain to a specific area of the body (nerve block)
• an injection of strong pain medicine into a muscle or under the skin
• a PCA (patient-controlled analgesia) device, which delivers a set dose of medicine through a plastic tube into a vein when you press a button
• tablets that can be immediate release (fast acting) or slow release (long acting); some tablets are taken regularly, others you can ask for if you still have pain.

Strong pain medicines can make bowel motions difficult to pass (constipation) so you may also be given laxatives.

See ‘Understanding Cancer Pain’ for more information.

Movement – Based on the surgeon’s recommendations, the nurses or a physiotherapist will encourage you to get out of bed and move around as soon as you feel up to it and it is safe to do so. Moving around as much as possible will speed up your recovery and reduce the chance of blood clots, chest infections and wound infections. A physiotherapist may teach you some breathing or coughing exercises to help keep your lungs clear.

Eating and drinking – Most people can start eating and drinking either the same day or the day after surgery. Some people begin by drinking clear fluids, moving onto other kinds of fluid, then plain foods and small meals. Other people receive nutrition through a drip or a feeding tube for a short while rather than eating. If you go home with a feeding tube, a dietitian will let you know the type and amount of feeding formula you need to take and how to care for the tube. If the cancer and surgery affect your digestive system (e.g. mouth, throat, oesophagus, stomach, bowel), you will need to follow the dietitian’s advice about eating and drinking.

See ‘Nutrition for People Living with Cancer’ for more information.

Bathing – The timing of your first shower depends on how you are feeling and the type of surgery that you have had. Some people shower the same day or the next day if they are up to it. The nurses will probably encourage you to shower as soon as possible because it is a good reason to get out of bed. They can help you if you need to remove dressings or cover them to keep them from getting wet. If you can’t get up and move, the nurses will help you bathe in bed.

Sometimes problems or complications occur after surgery. It’s very unlikely that all of the problems described here would apply to you. Your surgeon  can give you a better idea of the actual risks for your type of surgery. Generally, the more complex the surgery is, the higher the chance of problems.  Most complications are minor and can be treated easily, but some can have serious consequences.

Infection – The biggest risk of infection after surgery is at the wound site, but infection can also occur in the chest, in the urinary tract, and around the catheter site. Sometimes the doctor will prescribe medicine before surgery to prevent infection (prophylactic antibiotics). In hospital, you will be checked for signs of infection, such as tenderness, redness, swelling or a discharge around the wound; cloudy urine; cough; shortness of breath; and chest pain. After you go home, if the wound site is red, getting bigger, painful or oozing, have it checked by your GP, nurse or doctor. If you are given antibiotics, it is important to take the full course to completely kill bacteria and prevent infection.

Bleeding – Bleeding can happen inside the body (internally) or outside the body (externally). Internal bleeding can occur if a blood vessel breaks free after surgery, and external bleeding can occur if a wound opens up. Your medical team will manage any bleeding after surgery. This could include giving you a blood transfusion, further surgery to stop the bleeding, or an iron infusion to help restore haemoglobin levels in the blood.

Blood clots or DVT – To reduce the risk of developing blood clots in the deep veins of the legs or pelvis (deep vein thrombosis or DVT), you may have to wear compression stockings or have pills or injections of blood-thinning medicine for a couple of weeks after the surgery.

Lung problems – After surgery, it may be painful to breathe or cough for a period of time, particularly if you have had surgery to your chest or abdomen. A physiotherapist will teach you breathing or coughing exercises to help keep your lungs clear and reduce the risk of a chest infection. You will be encouraged to get out of bed and move around with help from the nurses and physiotherapists. Your medical team will observe your breathing and provide medicine to control any pain.

Weak muscles (atrophy) – Although you’ll need to rest after surgery, it’s important to get up and move around when it is safe to do so. Based on your surgeon’s recommendations, a physiotherapist or nurse may help you to get moving and give you advice about the best exercises to do. If you aren’t mobile, your muscles may get weak (atrophy). Generally, the sooner you are able to get up and move, the better your recovery will be.

Lymphoedema – If lymph nodes are removed, fluid can build up in the tissues under the skin and cause swelling. It’s common to have some swelling after surgery but this usually settles in the weeks afterwards. If this swelling builds up over weeks or months, it is known as lymphoedema. It is important to seek help as soon as possible because early diagnosis and treatment lead to better outcomes.

See ‘Understanding Lymphoedema’ for more information.

Day surgery – If you have day surgery, you will be discharged from hospital sometime after you leave the recovery room. It’s important to arrange ahead of time for someone to take you home after surgery. The nurses will contact this person to tell them when you’ll be ready to leave. If you live alone, you will need to organise another adult to stay with you the first night you are home, or arrange to stay with family or friends.

Inpatient – If you have surgery as an inpatient, you will be discharged when the medical team thinks you are healthy enough to leave. Some people stay in hospital for a day or two, but others stay for longer – in some cases several weeks or, rarely, months.

Paperwork – Along with discharge papers, the medical team may give you other information, such as:

• scan and test results
• instructions about recovering at home
• guidelines about when to contact your doctor
• the date for your follow-up appointment with your surgeon
• a medical certificate setting out how much time you will need off work
• insurance forms, bills or receipts
• a list of any medicines you are taking, prescriptions or a small supply of medicines (such as pain relief)
• referrals to support services such as a dietitian or social worker.

If you want specific paperwork (e.g. a letter for your employer) and it isn’t offered, you can ask for it from the doctor, nurses, receptionist or social worker. You may want to make a copy of your paperwork for your records. In most cases, a copy is automatically sent to your GP.

Where to recover – Most people go home after discharge, but some go to an inpatient rehabilitation centre (often called a rehab hospital) to help them get safely back on their feet before going home.

Your medical team will give you information so you can continue to recover safely at home. If you are given medicines to take, make sure you know when and how to take them.

Looking after yourself at home is one of the most important parts of your recovery. Your progress will depend on the type of surgery you have, what support you have at home, your overall fitness and health, and whether you are having other cancer treatments.

A community nurse may visit to check on you and change any dressings, or you might see your GP. You may need to organise some equipment to help you move safely, such as a walker or shower chair. Try to organise this before surgery so it is ready when you get home. A physiotherapist or occupational therapist can show you how to use this equipment.

Keep in mind that recovery will take time, and try not to expect too much of yourself. Although it’s a good idea to stay active and do gentle exercise while you are recovering, it’s also important to follow your surgeon’s advice about any restrictions.

When to call the doctor or go back to hospital

The wound, pain and scar will take time to settle. Your medical team will tell you what to look out for and when to seek help. As a general guide,  contact your doctor immediately or go to the nearest hospital emergency department if you have any of the following symptoms:

• increased bleeding, swelling, redness, pus or drainage, or an unusual smell from the wound or around any tubes, drains or stomas
• a fever of 38°C or higher
• chills or shivering
• swelling in your limbs
• sudden, severe pain
• pain or burning when urinating
• nausea or vomiting for 12 hours or more
• trouble breathing, walking or doing things you could do before surgery
• other symptoms or changes that the surgeon warned you to look out for.

What to expect when you return home

When you get home, be guided by your doctor’s instructions, but these general suggestions may help. If you don’t have support from family, friends or neighbours, ask your nurse or a social worker at the hospital whether it is possible to get help at home while you recover.

Pain relief

• Take pain medicine as prescribed by your health care team.
• Strong pain medicine is usually used for only a short time after surgery as it can make you feel confused, sick or constipated.
• If your pain isn’t controlled, becomes worse, or if the medicine causes side effects, talk to your surgeon, the nurse listed on your discharge paperwork, or your GP.
• If your pain is severe, consider going to the emergency department.

See ‘Understanding Cancer Pain’ for more information.

Wound care

• Follow any instructions you are given about how to care for the wound.
• If the wound is left open, clean it with mild soap and warm water and pat it dry. Avoid putting lotions or perfumes on the wound and the area around it.
• If you have dressings, you might need to keep them dry while you shower.
• Your doctor or nurse will remove any stitches or staples at a follow-up appointment.
• If adhesive strips have been used, they should fall off within a few weeks, or you will be told when to remove them. Removing the strips too soon might cause the wound to open.
• Any bruising around the surgical site will fade over a few weeks.
• Avoid touching the wound or picking at scabs.

Drains and stomas

• Some people go home with a temporary drain or tube near the surgical site to collect extra fluid leaving the body.
• Before you leave the hospital, nurses will show you how to look after the drains at home until they are ready to come out. You may need to record how much fluid collects in the bag attached to the drain.
• Some people go home with a stoma. A stomal therapy nurse will see you after the operation to teach you how to look after the stoma.

Eating and drinking

• Your health care team may instruct you to follow a special diet.
• Some people feel sick after surgery. When you feel like eating, try basic foods such as rice and toast before going back to your usual diet.
• Eat fibre and drink plenty of water to avoid constipation, and avoid alcohol, especially if you are taking pain medicine.
• To help your body recover from surgery, eat a well-balanced diet that includes a variety of foods.
• A dietitian can help with any eating issues.

See ‘Nutrition for People Living with Cancer‘ for more information.

Self-care

• Unless you’ve been told otherwise, you will be able to shower. Gently wash your body and pat yourself dry. Depending on the type of surgery you had, you may not be able to take a bath for a few weeks after surgery.
• Strong pain medicines and long periods in bed can make you constipated. Avoid straining when going to the toilet. Talk to your treatment team about taking laxatives if needed.
• Some people have trouble controlling their bowel or bladder after some types of surgery. Incontinence is usually temporary. For support, see a continence nurse or call the National Continence Helpline on 1800 33 00 66.

Daily activities

• You may find that you tire easily and need to rest during the day. Get plenty of sleep and take breaks if you feel tired.
• Ask family or friends to assist you with household tasks, such as cooking and laundry.
• Check with your surgeon when you can start doing your regular activities and what to avoid – such as heavy lifting, swimming, driving or sexual intercourse.
• Try to do some gentle exercise. This can help reduce tiredness, build up strength, lift mood and speed up a return to usual activities. Follow your doctor’s advice about any restrictions.

See ‘Exercise for People Living with Cancer’ for more information.

Surgery often leaves a scar. In most cases, your doctor will do everything they can to make the scar less noticeable. How your scar looks will change over many months. Most scars will improve and fade with time.

Reducing stiffness and pain – Once the wound is fully healed, you may find it helpful to:

• moisturise the scar to reduce any itching
• do stretching exercises to improve your range of motion
• massage the scar a few times a day
• apply silicone tape or gel strips that put gentle pressure on the scar.

Precautions – It’s important to avoid putting stress or strain on the wound until it is healed and there are no other medical issues such as blood clots, infections or trapped pockets of fluid under the skin (seroma). Ask your surgeon when you can start treating your scar. It’s also important to protect scars from the sun, as sunburn can worsen scarring.

Other treatments – Talk to your surgeon, a physiotherapist or occupational therapist about other ways to improve the appearance of scars. A  dermatologist may be able to treat problem scars with a laser.

Depending on the type of surgery you have, it may take many weeks or months to fully recover. A range of therapies can support you in your recovery and show you ways to manage any longer term changes. These therapies are known as rehabilitation. Hospital staff or your GP can organise referrals to any support services you need after surgery.

Rehabilitation may be available at your cancer treatment centre, through a rehabilitation specialist at a rehabilitation hospital, or at home. Your GP or specialist may also refer you to allied health professionals (e.g. physiotherapist, occupational therapist) in private practice. Ask to see a therapist experienced in working with people after cancer surgery.

Some common types of rehabilitation therapy

Physiotherapy – A physiotherapist can help you learn how to move more easily, improve your range of motion, develop muscle strength and improve balance. They can tailor a program to help you return to your usual activities. Visit the Australian Physiotherapy Association to find a physiotherapist near you.

Speech therapy – A speech pathologist can help restore speech if your ability to speak clearly has been affected by surgery. They also work with people who have difficulty swallowing food and drink after cancer treatment. Visit Speech Pathology Australia for more information.

Occupational therapy – An occupational therapist can help you manage everyday personal tasks (e.g. showering, dressing). They can also give you strategies and aids to help you manage fatigue and maintain your independence. Visit Occupational Therapy Australia to find an OT near you.

Exercise physiology – An exercise physiologist can help with increasing physical activity and exercising safely to improve circulation and mobility, increase your heart and lung fitness, and help you return to your usual activities. Visit Exercise and Sports Science Australia to find an exercise physiologist near you.

Nutritional support – A dietitian can explain how to manage any special dietary needs or any ongoing problems with food and eating after surgery. They can also help you choose the best foods for your situation. Visit Dietitians Australia for more information.

The timing of your first follow-up appointment will depend on the type of surgery and your recovery. You may see the surgeon or your GP, depending on where you live and what the medical team recommends.

Your doctor will check your wound and remove any stitches, staples, adhesives or drains that are still in place. If your pathology results are available, your doctor will discuss these with you and tell you whether you will need any further treatment. You will also be given advice about getting back to your normal activities. You may need to ask about your specific concerns, such as driving, exercising and going back to work.

You may continue to have regular appointments with your surgeon to monitor your health, manage any long-term side effects and check that the cancer hasn’t come back or spread. During these check-ups, you will usually have a physical examination and you may have blood tests, x-rays or scans. You will also be able to discuss how you’re feeling and mention any concerns you may have.

When a follow-up appointment or test is approaching, many people find that they think more about the cancer and may feel anxious. Talk to your treatment team or call Cancer Council 13 11 20 if you are finding it hard to manage this anxiety.

How often you will need to see your doctor will depend on the type and stage of cancer. Check with your doctor if you are unsure about your follow-up plan. Check-ups will be needed less often if you have no further problems. Between follow-up appointments, let your doctor know immediately of any symptoms or health problems.