What is cancer surgery?
Surgery is also called an operation. It is a procedure where a specialist doctor called a surgeon removes or repairs some of the tissue in your body. Normally you have an 
before you have an operation.
You can have cancer surgery for a number of different reasons. But an operation isn't an option for all cancer types or for all people.
Who can have surgery for cancer?
Whether you can have surgery depends on many factors including:
- whether it is a
solid cancer (cancerous tumour) or if the cancer started in the blood or lymphatic system - how big the cancer is and if it has spread – this is called the stage
- where the cancer is in your body
- your general health
Solid cancers
Solid cancers such as breast or bowel cancer, tend to start as a lump or abnormal area of tissue. Surgeons may be able to remove all of a solid cancer with an operation. This is because they normally start in one place.
You may also have surgery for other reasons as well as the operation to remove the cancer. This depends on the type of solid cancer you have. But it may include an operation to help diagnose cancer. Or to reconstruct part of the body you had removed.
Cancers of the blood or lymphatic system
Cancers that start in the blood and include:
leukaemia lymphoma myeloma
You cannot have an operation to remove these types of cancer. This is because the cancer cells are spread throughout the body. But you may have surgery for other reasons, including to help diagnose cancer. Or to relieve symptoms. Sometimes you might have surgery as part of another cancer treatment. Such as collecting stem cells from your for a .
Stage of the cancer
Knowing the stage of a cancer is important. This is because it helps your healthcare team recommend the best treatment for you.
They may suggest surgery if the cancer is in just one place. If the cancer has spread, they may recommend you have a treatment that reaches your whole body instead. This might include , or . Your doctor will talk with you about which other treatments are suitable for you.
How close the cancer is to other parts of your body
Unfortunately, your surgeon may not be able to operate if the cancer is near very delicate tissues or vital body parts. For example, if the cancer is very close to major blood vessels. If this happens, your healthcare team will talk with you about other treatments. These will depend on the type and stage of the cancer and your general health.
Your general health
Having an operation is stressful for your body. It has to work hard to repair itself afterwards. So, you need to be reasonably well beforehand. You will have an appointment and tests to make sure you are well enough to have surgery. This is called a pre operative assessment.
Sometimes you may need treatment to improve your general health before an operation. Your surgeon will talk to you about the risks and benefits of delaying surgery to have the treatment.
Sadly, some people may never be well enough to have surgery. Your healthcare team will talk with you about other treatment options if this happens.
Having an anaesthetic
You have an anaesthetic before an operation so that you will not feel any pain.
There are different types of anaesthetic. Which ones you have, depends on what surgery you need as well as your general fitness.
You might have a:
- local anaesthetic to numb a small area
- regional anaesthetic to numb a large area or part of your body
- general anaesthetic so you are asleep during the operation
- medicine to make you relax – this is called sedation
If you have a local or regional anaesthetic you might have sedation as well.
Surgery to find out if you have cancer
You might have surgery to find out what is causing your symptoms.
If you have any lumps or abnormal areas of tissue, your surgeon usually removes either:
- part of the lump, or a piece of tissue from the abnormal area
- the whole lump or abnormal area
This is called a biopsy. A specialist doctor called a pathologist looks at the biopsy under a microscope. They can see if there are cancer cells in it. If there are, they can tell what type of cancer it is and how slowly or quickly it might grow. This is called the cancer grade.
Some people might be diagnosed with cancer after having surgery for something else.
Surgery to remove cancer
Surgery is one of the main treatments for cancer. It might be the only treatment you need if:
- the cancer is only in one area of your body
- your surgeon can completely remove all of the cancer
Treatment before or after surgery
Some people may have treatment before surgery to help shrink a cancer and make it easier to remove. This is called neo adjuvant treatment. And some people may need treatment after surgery to reduce the risk of the cancer coming back. This is called adjuvant treatment.
During the operation
The operation lets your surgeon see the size of the cancer and other nearby organs and lymph nodes. This means they can see if the cancer has spread. They remove:
- the cancer
- some normal tissue around it - this is called the margin
They might also remove the nearby lymph nodes. This is to check if they contain cancer cells. Or if your surgeon knows from a lymph node biopsy they contain them.
After the operation
A pathologist looks at the cancer under a microscope. They measure the size and check for cancer cells in the margin. This tells them the stage of the cancer. They also check the cancer grade. Knowing these help your healthcare team decide if you need any further treatment.
If the cancer cannot be removed or has spread
Usually, the earlier a cancer is found the easier it is to remove. But unfortunately, not everybody is able to have the cancer taken out. And sometimes during an operation, the surgeon may find the cancer has spread. If this happens, the surgery might take longer than planned. Or they may not be able to do the operation they were going to do.
Surgery to help control the symptoms of cancer
You might have an operation even if your surgeon can't remove the cancer. Or if the cancer has spread. Cancer that has spread elsewhere in your body is called advanced cancer. Where the cancer has spread to is called a secondary cancer or metastasis.
The aim of surgery is normally to:
- relieve your symptoms
- improve your quality of life
- help you live longer
For example, cancers in the tummy (abdomen) can sometimes block the bowel. This can cause sickness and pain. An operation to remove or bypass the blockage can relieve these symptoms.
Surgery might also help to control pain. For example, your surgeon may remove a cancer that is pressing on a body organ or nerve. They may do this even if the cancer has spread elsewhere in the body.
A very small number of people may be able to have a secondary cancer completely removed. But this is usually people with certain types of cancer who have a limited number of metastases.
Surgery as part of other cancer treatments
You might have an operation as part of another cancer treatment. This may include surgery to:
- give you chemotherapy just into your arm or leg (isolated limb perfusion) - this is a treatment for melanoma skin cancer
- put radioactive seeds into your body for
brachytherapy – a treatment for prostate, cervix, womb and vaginal cancers - collect stem cells from your bone marrow – this is before you have a
stem cell transplant of your own cells - put a
central line into a main vein in your chest – you have cancer drugs through the line
Surgery to reconstruct a part of the body
It might be possible to have an operation to recreate part of your body after surgery to remove cancer. This is called reconstructive surgery. Your surgeon might be able to recreate the part of the body using your other body tissues. Or they might use a false body part (prosthesis).
For example, after a you may be able to have breast reconstruction. Or it may be possible to make a new bladder if you’ve had to have your bladder removed.
You can have some of these operations at the same time as surgery to remove the cancer. Or you may have them at a later date. This can be a big decision to make. But your doctor and specialist nurse will talk with you about the options for your cancer type.
Surgery to reduce the risk of cancer
Some people have a higher risk of developing a particular type of cancer. In certain cases, these people may be able to have surgery to reduce that risk. For example:
- people with a rare inherited condition called Familial Adenomatous Polyposis (FAP) may choose to have surgery to remove their large bowel - this is because they have an increased risk of bowel cancer
- women who have a high risk of breast cancer may choose to have their breasts removed
This can be a big decision to make. Your healthcare team will talk with you about your risk and choices.
How your surgeon does your operation
There are different ways your surgeon can do an operation. This depends on where the cancer is. Sometimes they might combine these.
Open surgery
Your surgeon does the operation through a large cut (incision) in your skin.
Keyhole (laparoscopic) surgery
Your surgeon makes several small incisions through your skin. They use a laparoscope to look inside your body and do the operation.
Robotic surgery
Your surgeon uses a robotic machine to help with laparoscopic surgery.
Endoscopic surgery
Your surgeon does the operation through a tube (endoscope) which they pass into your body. This is usually through your mouth or back passage (rectum).
