Common questions about surgery

How is surgery done?

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.

Could an infection affect my surgery?

If you have COVID-19, a fever or another infection such as influenza (the flu), or you are recovering from one, your planned surgery may be delayed for a few weeks. This helps ensure you have recovered and the surgery can be done safely. Your hospital will let you know if there are any specific precautions you need to follow.

Some hospitals have extra procedures in place to reduce the spread of infections and illness among patients. For example, you may be asked to do a rapid antigen test (RAT) to test for COVID-19 before arriving on the day of surgery, visitor numbers may be limited, and you might need to wear a mask while in hospital.

Will I stay in hospital?

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.

How much does surgery cost?

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. You can also get a second opinion from another specialist, or have the surgery as a public patient.

Can surgery spread the cancer?

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.

What is a surgical margin?

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.

What is the role of my GP?

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.

Which health professionals will I see?

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 youfor 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