Care for cancer patients undergoing surgical treatment

- Prepared by

Oncology guide

- Introduction

Cancer surgery is one of the common methods used in diagnosing and treating cancer. Surgery is often combined with other methods such as chemotherapy, radiation therapy, and more. The choice of the most suitable treatment methods depends on the type and stage of cancer, as well as the patient’s overall health. The goal of cancer surgery is to remove all of the cancer from the body whenever possible. To achieve this, the surgeon removes the cancer and some surrounding healthy tissue. The surgeon may also remove some lymph nodes from the same area. These lymph nodes are examined to check for cancerous cells. If the cancer has reached them, it is likely that the cancer has spread to other parts of the body.

- Common Causes for Cancer Surgery

• Prevention of Cancer: In some types of cancer, it is possible to remove the affected organ before cancer progresses. In this way, surgery helps prevent cancer.
• Diagnosis: Surgery may be used to obtain a tissue sample for laboratory analysis to determine if it is cancerous. Other tests may also be conducted to assess the genetic composition of the cells. The results help the healthcare team develop a treatment plan.
• Cancer Staging: Surgery reveals the size of the cancer and the extent of its spread. This information is used to determine the stage of cancer, allowing the doctor to understand the severity of the condition and the need for intensive treatment.
• Primary Treatment: Surgery is the primary treatment for many types of cancer.
• Tumor Mass Resection: In some cases, removing the entire cancerous tumor is not possible, so the surgeon may remove as much of the tumor as possible, which is called tumor mass resection.
• Alleviating Symptoms or Side Effects: Surgery is also used to improve the patient's quality of life. It can be used, for example, to relieve pain caused by a cancerous tumor pressing on nerves or bones or to remove a tumor that is obstructing the intestines.

- Techniques Used in Cancer Surgery

Various types of surgeries may be used to treat cancer. Researchers are still studying new methods. Other cancer surgeries include:

• Cryosurgery: This technique uses a very cold substance, such as liquid nitrogen spray or a cold probe, to freeze and destroy cancer cells.
• Electrosurgery: An electric current is used to kill cancer cells in this type of surgery.
• Laser Surgery: Laser light is used to shrink or remove cancer cells.
• Mohs Surgery: This technique removes cancer layer by layer. After each thin layer is removed, it is examined under a microscope for signs of cancer. This process is repeated until all cancerous layers are removed. Mohs surgery is used to treat cancers of sensitive areas of the skin, such as around the eyes.
• Minimally Invasive Surgery: This type of surgery involves making small incisions in the body rather than one large incision. A small camera and surgical tools are inserted through the incisions. The camera displays what it sees on a screen, and the surgeon uses it to guide the tools to remove cancer cells. Smaller incisions help the patient recover faster and reduce potential complications after surgery.
• Robotic Surgery: In robotic surgery, the surgeon sits away from the operating table and watches a 3D image of the area being operated on. The surgeon uses control buttons to guide the robot in moving the surgical tools for the procedure. Robotic surgery helps surgeons perform operations in areas that are hard to reach and can lead to faster recovery and fewer complications.
• Natural Orifice Surgery: This method involves performing surgery on abdominal organs without making a surgical incision in the skin. Surgical tools are inserted through natural body openings, such as the mouth, rectum, or vagina. This technique is a new type of surgery that may reduce risks such as infection, pain, and other post-surgical problems.

- Types of Surgical Procedures

1. Diagnostic Surgery:
• Incisional Biopsy: A small part of the tumor is removed for examination.
• Excisional Biopsy: The entire tumor is removed.
• Needle Biopsy: Tissue samples are taken using a needle.
• Endoscopy: Small parts of the tumor are removed with forceps after visual examination.
2. Treatment Surgery:
• Local Excision: Removal of the tumor with a small margin of surrounding healthy tissue. This is typically used for skin cancer.
• Wide Excision: Removal of the primary tumor, regional lymph nodes, lymphatic vessels, and adjacent structures, such as radical mastectomy

- Steps for Preparing the Patient for Surgery

Steps for Preparing the Patient Before Cancer Surgery: The patient's condition is initially assessed to ensure they are physically and mentally fit for the surgery. A series of tests and instructions are required before scheduling the surgery. If the patient is deemed fit, they are informed about the pre-operative instructions as follows:

Pre-Hospital Admission Procedures ● Pre-Surgery Tests:
A series of tests are performed to ensure there are no contraindications to the surgery, including blood and urine tests, and sometimes imaging tests depending on the case.
● Medical History Collection:
The patient's medical conditions, medications, and any specific allergies need to be documented.
● Decision on Medications:
If the patient has any chronic conditions and is using specific medications, the doctor will review whether some medications need to be stopped or continued, based on their type. For example, blood thinners are often stopped a few days before surgery to prevent excessive bleeding.

- Procedures on the Day of Surgery and the Night Before

The procedures expected on the day of the surgery or the night before may include the following:
● Fasting:
The patient may be asked to fast from food and drink, including water, starting from the night before the surgery, or follow a specific diet for several days before the surgery.
● Signing the Surgery Consent Form:
The nursing staff will ask the patient, or a family member, to sign a consent form for the surgery, which may include details about the surgery.
● Explaining Surgery Details:
The responsible surgeon will explain the surgery details, procedures to treat the patient's condition, potential side effects, and complications that may arise during the surgery.
● Discussing the Type of Anesthesia:
To alleviate the patient's anxiety, the doctor will specify the type of anesthesia to be administered, whether intravenously or through inhalation.
● Administering Pain Relievers and Sedatives:
The medical staff may give the patient pain relievers and sedatives to help them relax and sleep comfortably the night before the surgery.
● Monitoring Health Status and Vital Signs:
The nursing staff will conduct regular checks to ensure the patient's condition is stable, including temperature, blood pressure, blood sugar, heart rate, and other vital signs.
● Preparing the Surgical Site:
Depending on the surgery location, the area may need to be shaved or cleaned.
● Emptying the Stomach and Bladder:
If the surgery involves the stomach or intestines, the patient may be given an enema to empty the bladder. If the surgery involves the bladder or urinary tract, the patient may need to empty the bladder before the surgery.
● Administering Pre-Surgery Medications:
Some medications may be given before surgery, depending on the type, such as antibiotics to prevent infection, insulin to control blood sugar if the patient has diabetes, or anti-nausea medications.

- Post-Surgery Tips for Cancer Removal

After undergoing partial or total cancer removal surgery, the patient will be given some tips that may help with recovery:

1. Follow Pain Medication Instructions:
   The specialist doctor may prescribe pain relievers to help reduce the pain from cancer surgery, which can be taken in the hospital and continued at home.
2. Care for the Wound:
   Proper care and attention to the cancer removal wound and changing the bandages correctly.
3. Care for the Surgical Drain (Drains):
   Proper care of the surgical drain to avoid complications.
4. Monitor for Infection Symptoms:
   The patient should be informed of the symptoms of infection or inflammation at the surgical site, or signs of lymphedema, so they can inform the doctor if they notice them.
5. Rest:
   Getting sufficient rest during the recovery process is critical, as cancer surgery is a major operation that requires a longer healing time.
6. Avoid Showering:
   During recovery, it’s advised not to shower with water because of the presence of stitches, as this could cause them to be removed, slowing the healing process (sponging the body instead of using water is recommended).
7. Seek Help from Friends:
   Some friends may assist the patient with difficult household chores and provide moral and emotional support, helping increase comfort and happiness.
8. Follow a Healthy Diet:
   Drinking plenty of fluids and eating fiber-rich foods, as some medications may cause side effects like constipation.
9. Applying Ice:
   Using an ice pack on the chest or under the armpit may help reduce swelling and pain caused by the cancer removal surgery.
10. Follow Doctor’s Instructions:
    The specialist will provide advice after cancer surgery, and the patient should strictly follow the instructions and medications prescribed by the doctor.
11. Continue Exercise:
    Engage in light exercises such as walking for 10-15 minutes or longer to improve mental well-being and stimulate blood circulation, which may help speed up recovery.
12. Sleep:
    The patient should get enough deep sleep after cancer surgery. If sleeping on their side is difficult, the patient should consider sleeping on their back with the help of pillows.

13. Consult the Doctor Immediately If Any of the Following Occur:

• Pain that doesn’t subside with pain relievers.
• Fever or chills.
• Excessive bleeding at the wound site.
• Excessive swelling.
• Appearance of discharge or foul odor.

- Risks Associated with Cancer Surgery

The risks associated with surgery vary depending on the type of surgical procedure performed. Most cancer surgeries carry the following risks:

• Pain: Pain is one of the common side effects of most surgeries. However, some surgeries cause more pain than others. A pain management plan should be put in place, which may include medications to alleviate the pain.
• Infection: Proper care of the wound post-surgery is essential, and infection control measures should be followed when dealing with the patient due to their weakened immune system and susceptibility to infections.
• Impact on Organ Function: This occurs when a part or the whole of an organ is removed during the surgery.
• Fatigue: The patient may experience reduced energy levels and difficulty concentrating following the surgery.
• Bleeding: Bleeding is a risk associated with all surgical procedures. Some medications may increase the likelihood of bleeding.
• Blood Clots: The risk of developing blood clots can increase during recovery from surgery. Steps should be taken to reduce the chances of blood clots, such as encouraging early movement after the procedure and using certain medications to prevent clot formation.
• Changes in Bowel and Urinary Function: Immediately after surgery, the patient may experience difficulties with bowel movements or urination. These issues typically resolve after a few days, depending on the type of surgery.

- References

• Clotting problems. Cancer.Net. Link. Accessed July 3, 2022.
• Creagan ET (expert opinion). Mayo Clinic. July 5, 2022.
• Gould J. Overview of electrosurgery. Link. Accessed July 3, 2022.
• Side effects of surgery. Cancer.Net. Link. Accessed July 3, 2022.
• Townsend CM Jr, et al. Emerging technology in surgery: Informatics, electronics. In: Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. 21st ed. Elsevier; 2022. Link. Accessed July 3, 2022.
• What is cancer surgery? Cancer.Net. Link. Accessed July 3, 2022.
• What to expect when having surgery. Cancer.Net. Link. Accessed July 3, 2022.
• Wing EJ. Principles of cancer therapy. In: Cecil Essentials of Medicine. 10th ed. Elsevier; 2022. Link. Accessed July 3, 2022.