Surgery

Surgery is a medical procedure that involves the use of operative tools and techniques to diagnose or treat patients with disease or injury. Surgery is often performed under anaesthesia, as it is invasive and may cause pain. Anaesthesia administered to the patient can be general anaesthesia where a patient is completely asleep or local anaesthesia, which involves injecting a numbing agent in the part of the body where the surgery will be performed.

Surgery for cancer is performed for two main purposes:

To cure cancer by removing cancer tumours or cells
To relieve symptoms that are caused by a cancerous growth

When cancer cells are confined within a region or organ that can be fully removed, surgery has the potential to cure cancer. Careful planning is required before surgery to ensure that the cancerous growth is removed, and the draining lymph nodes are removed as well, with clear margins of normal tissue.

Surgery may be used either before or after other cancer treatments such as chemotherapy or radiation therapy, to ensure the best treatment outcomes.

When cancer is aggressive and cannot be fully removed, curative surgery may not be possible. However, if the cancerous growth continues to grow and cause symptoms such as bleeding, pain, blockage or rupture, surgery may be required to resolve these symptoms and improve the patient’s quality of life.

There are two main surgical approaches in cancer surgery:

Open surgery is the traditional mode of surgery that involves a cut on the skin surface. The scar left behind may be small or large depending on the type of surgery required.
Minimally invasive surgery is also known as ‘keyhole’ or laparoscopic surgery whereby only a small cut is needed to introduce a small instrument into the body to perform the surgery. The patient may have several small cuts on the skin surface as multiple instruments are often required. The benefit of this approach is potentially less pain and faster recovery post-surgery due to the smaller wounds.

Cancer can occur in any organ system. The type of surgery performed would differ according to the cancer type and organ system involved.

Cancer Type	Surgery Involved
Colon	Removal of a portion of the colon with good margins of normal tissue and draining lymph nodes. The remaining portions of the colon are then joined back together. Sometimes, a stoma (a surgical opening on the abdomen that is connected to the digestive system for waste removal) may be required and is considered on a case-by-case basis. This can be temporary or permanent.
Breast	Removal of part of or the entire breast with or without removal of lymph nodes in the underarm region. This can be followed by breast reconstruction performed by plastic surgeons.
Head and Neck	Head and Neck cancer is usually treated by radiation therapy. Surgery is performed only for specific cancer types e.g. thyroid, tongue cancers or when the cancer recurs or does not respond well to radiation.
Stomach	Removal of part of or the whole stomach. To allow for normal food intake after surgery, a portion of the small intestine is used to connect the remaining stomach or food pipe.
Liver	Removal of a portion of the liver. Liver transplant surgery may also be performed – this involves removing the entire diseased liver and replacing it with a new liver from a deceased organ donor or a living donor.
Pancreas	Removal of a portion or the whole pancreas.
Kidney	Removal of a portion or the entire kidney. As there are two functioning kidneys, removal of one kidney is possible and the patient would not usually require dialysis.
Gynaecological Organs (Uterus, Cervix, Ovaries)	Cervical cancer is usually treated with radiation therapy. Surgery is only recommended for patients whose cancer recurs after radiation. In ovarian and uterine cancer, a common surgical approach is to remove both ovaries and the uterus. Preservation of some gynaecological organs is possible and considered on a case-by-case basis for patients who want to have children.

Complications may arise from anaesthesia given during surgery or from the surgery itself.

Possible complications of anaesthesia include:

Heart attack
Stroke
Allergic reactions
Respiratory infections

Possible complications of surgery include:

Bleeding
Wound infection
Injury to surrounding structures or organs

There are also specific complications related to surgery performed for different organ systems, which your surgeon will explain to you before surgery.

To ensure a safe and smooth recovery, patients are monitored closely after surgery to detect and treat any complications as early as possible.

After a patient is diagnosed with cancer, a clinical consult with a specialist surgeon is required to determine if surgery is suitable.

Before surgery, blood tests and a chest X-ray are routinely performed to ensure that the patient is fit and ready for the surgery and anaesthesia.

Depending on the type of surgery performed, some patients may have to be admitted to hospital a day before the surgery to ensure necessary preparations are made. Other patients may be required to report to hospital in the morning on the day of the surgery.

Immediately after surgery

After surgery, the length of hospitalisation varies depending on the complexity of the surgery and if there were any complications that occurred. Your surgeon will advise the expected duration of your hospital stay.

Upon discharge, your surgeon will advise when you can resume your normal activities. As there will be a surgical wound, it is advisable to avoid heavy and strenuous activity or swimming to prevent wound infection and breakdown. Should you feel unwell after surgery, please call the NCCS, so that your surgeon can be informed and advise you on next steps.

A few weeks after surgery

The cancerous growth removed during surgery would have been sent to the lab for testing so that the stage of your cancer can be determined. Depending on the stage, you may require chemotherapy or radiation therapy after the surgery. These treatments can start when your surgical wounds have completely healed and there are no complications from the surgery.

A few months after surgery

All cancer patients need regular follow ups for at least 5 years after curative surgery. This involves 3 to 6 monthly clinic visits, periodic blood tests as well as regular imaging surveillance such as Computed Topography (CT) or Magnetic Resolution Imaging (MRI) scans.

Additional tests or appointments may be required depending on the patient’s cancer type. This helps ensure the early detection of new cancer cells should there be a relapse.

The cost of surgery depends on: