Common questions about surgery

Many cancers that are found early can be removed with surgery, and this may be the only treatment needed. However, not all cancers can be removed surgically. Doctors often follow medical standards called clinical practice guidelines, which outline the best available treatments for particular cancers. For some cancers, surgery is recommended as the most effective approach, either on its own or in combination with other treatments. In other cancers, non-surgical treatments have been proven more effective. Generally, surgery is not recommended if you are unwell or if the cancer has spread to many places in the body.

There are several reasons why surgery is used for cancer:

Prevention – Preventive or prophylactic surgery removes healthy tissue that doctors believe will probably become cancerous. It will reduce a person’s risk of developing cancer. For example, a woman with a strong family history of ovarian cancer, but no actual signs of cancer, may have surgery to remove her healthy ovaries. The decision to have preventive surgery should be made after talking to qualified health professionals, including a genetic counsellor.

Diagnosis – 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.

Staging – Surgery can help the doctor determine the size of the tumour and whether the cancer has spread to other tissues or lymph nodes. This is called staging. The results of the surgery, imaging scans and other tests will help the doctor work out the stage and decide on appropriate treatment.

Primary treatment – Small, early-stage cancers that haven’t spread are often successfully treated with surgery. If the cancer is confined to one part of the body, the surgeon will remove the cancerous tissue or a whole organ.

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

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

Supporting other treatments – Supportive surgery is done to aid another cancer treatment. For example, you may have day surgery to insert a tube (catheter) into a large vein in your chest to make it easier to receive chemotherapy.

Palliative treatment – Surgery can be used to improve quality of life by easing cancer symptoms and treatment side effects. For example, surgery may be done if the cancer grows very large and blocks the bowel (obstruction). Other surgical procedures can help to reduce pain.

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

There are many different approaches, and not all involve making cuts. Each method has advantages in particular situations – your doctor will advise which approach is most suitable for you.

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 from small to quite large. An open approach might also be used for staging surgery.

Open surgery is a well-established technique and widely available. It is often used for cancers in the abdomen 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 one large cut used in open surgery.

The surgeon will insert a tiny 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 for guidance.

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. Some people have keyhole surgery followed by open surgery.

Robotic surgery – This is a type of keyhole surgery where the surgical instruments are moved by robotic arms controlled by the surgeon, who sits at a console next to the operating table.

Laser surgery – A laser can be used to remove or destroy cancerous tissue. In some cases, laser surgery can be less invasive than other types of surgery.

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

It’s common to have to wait for surgery. How long you have to wait depends on the type of cancer you have, its stage, the surgery you are having, and the hospital’s schedule. The waiting list is organised by how urgently people need surgery. This ensures that people are treated in turn but without waiting for periods of time that would be harmful. Waiting for surgery to begin can be a stressful time – if you are anxious or concerned speak to your surgeon or call Cancer Council 13 11 20.

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 at home after you are discharged.

It may be possible to have surgery as an outpatient (day surgery). This means you can go home soon after the surgery – you don’t have to stay overnight in hospital, provided there are no complications. Your doctor will tell you whether you will have surgery as an inpatient or outpatient.

It’s important to ask questions about the type of surgery recommended to you, including the risks, possible complications and how long it will take to recover. Also remember to ask your surgeon about their training and experience.

The surrounding tissue that is removed with the cancer is known as the surgical margin. A pathologist checks the margin under a microscope to make sure the cancer has been completely removed. If there aren’t any cancer cells in the 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 require further treatment.

In some rare cases it is possible for surgery to spread the cancer. In this situation, surgeons take precautions and will still operate if the benefits of the surgery outweigh the risk of not having it.

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.

Some people think cancer can spread if it’s exposed to air during surgery. This is incorrect. One reason people may believe this myth is if the surgeon finds more cancer than expected. In this case, the diagnostic tests and scans may not have shown all of the cancer, but the cancer was already there – surgery didn’t spread it.

If you are concerned about the cancer spreading during surgery, talk to your surgeon. 

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

Timing of other cancer treatments

neoadjuvant therapy – Drug therapies or radiation therapy may be given before surgery to try to shrink the tumour and make it easier to remove.

simultaneous therapy – Two types of treatment are sometimes given at the same time – for example, radiation therapy or heated chemotherapy may be given during surgery.

adjuvant therapy – Drug therapies or radiation therapy may be given once 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.

Before, during and after surgery you will be cared for by a range of health professionals who specialise in different aspects of your care. Your treatment options may be discussed with other health professionals at what is known as a multidisciplinary team (MDT) meeting. This means health professionals work together to plan treatment and manage care.

It is important to maintain or develop a relationship with a general practitioner (GP). This health professional will be involved in your ongoing care, particularly once the cancer treatment finishes. For example, GPs can help with pain control, prescriptions for medicines, or follow-up blood tests.

Download our booklet about the type of cancer you have for more detail about the people you may see.

GP – assists you with treatment decisions and works with your specialists in providing follow-up care after surgery

surgeon – surgically removes tumours and performs some biopsies; specialist cancer surgeons are called surgical oncologists

anaesthetist – assesses your fitness for surgery; administers anaesthesia before the operation and monitors you during the surgery; commonly looks after your pain in the first days 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-in-training, including registrars, fellows and resident medical officers, who look after surgical patients under the supervision of a surgeon or anaesthetist

cancer care coordinator – coordinates your care, liaises with other members of the MDT and supports you and your family throughout treatment; care may also be coordinated by a clinical nurse consultant (CNC) or clinical nurse specialist (CNS)

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

dietitian – recommends an eating plan to follow while you’re in treatment and recovery

psychiatrist, psychologist, counsellor – help you manage your emotional response to diagnosis and treatment

physiotherapist – helps with restoring movement and mobility, and preventing further complications

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

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

exercise physiologist – prescribes exercise to help you improve your overall health, fitness, strength and energy levels