Cancer surgery at a glance
What is cancer surgery?
Cancer surgery is a treatment in which a surgeon or another specialized doctor removes cancer from the body or as much of the cancer as possible.
Surgeries can be very different and you may have cancer surgery for different reasons. The type of surgery depends on why you need surgery. Your doctors will explain why they recommend this operation for you and what will happen before, during and after surgery.
You do not always have to stay in hospital after cancer surgery. Whether you need to stay overnight depends on the type of surgery and also your health.
Outpatient and inpatient surgery
When do doctors recommend cancer surgery?
Surgery may be a treatment option for cancers that grow as a lump or mass in the body. These cancers are called solid cancers.
You may have cancer surgery for different reasons. Your doctors may recommend surgery to
find out whether you have cancer. This kind of procedure is called a biopsy. During a biopsy, a small piece of tissue is removed and then examined in a laboratory to determine whether cancer is present.
Good to know: Most biopsies are done with a needle (called a core needle biopsy) and do not require surgery. If this is not possible, your doctor may recommend a small operation.
remove all of the cancer, or as much of it as possible.
find out how large the tumour is and whether it has spread to other parts of the body. This is called staging.
relieve symptoms caused by cancer, such as pain.
rebuild a part of the body so it looks or works better after cancer treatment. Doctors call this reconstructive surgery.
help prevent cancer in people who have a much higher chance of getting cancer. This is called preventive surgery, also known as prophylactic surgery.
When is cancer surgery not an option?
What are the main types of cancer surgery?
There are two main ways to perform cancer surgery.
In open surgeries, the surgeon makes one larger cut in the skin to reach the tumour directly. The surgeon may remove the tumour and some tissue around it.
Sometimes, the surgeon may also remove part of an organ, the whole organ, or nearby lymph nodes. Nearby lymph nodes may be removed because they are often one of the first places cancer cells spread to. Examining these lymph nodes helps doctors choose the best treatment for you. Removing lymph nodes is called lymph node dissection.
In minimally invasive surgeries, the surgeon operates through one small cut or several very small cuts. This is often called "keyhole surgery".
The surgeon uses a thin tube with a camera to see inside the body. The images appear on a screen. If needed, the surgeon also uses special tools to remove the tumour.
Because the cuts are small, people often recover faster and may have less pain than after open surgery
Examples of minimally invasive surgery include endoscopy, laparoscopy, and robotic surgery.
The type of surgery you need will depend on
your type of cancer,
where it is in your body,
how big it is,
whether the cancer has spread to other parts of the body,
and on your general health.
Additional cancer treatments before and after surgery
What happens before, during and after surgery?
Before surgery: meeting your care team
Before your surgery, you will meet your surgeon and your anaesthesist. The surgeon is the doctor who carries out the operation. The anaesthetist will give you medicine (anaesthesia) to prevent you from feeling pain during surgery.
Your surgeon will ask about your health, any medicines you take, and any allergies you have. The surgeon will then explain the surgery, including its benefits, and possible risks. Your care team will give you clear instructions on how to prepare for your surgery.
The anaesthesist will explain how pain will be managed with anaesthesia during surgery. You may have general anaesthesia, which means you are asleep during surgery. You may also have regional or local anaesthesia, which numbs part of your body. The anesthesist will also tell you when to stop eating and drinking before the operation.
During these meetings you can ask questions and talk about any concerns you have.
Questions to ask your doctor or care team:
After your doctors have answered your questions, they will ask you to agree to the surgery. This is called giving consent. You will usually need to sign a consent form. The surgery can only take place after you have given consent.
After your consent, your doctors may do additional tests. The tests you need depend on your health, your age, and the type and size of the surgery. Tests may include blood tests, physical examinations, an electrocardiogram (ECG) or imaging tests, such as X-rays or scans.
Getting ready for surgery
What happens on the day of surgery depends on the type of surgery and how extensive it is. Some people need to come to hospital a few days before the operation, while others come to hospital on the day of surgery.
Shortly before surgery, patients change into a hospital gown. They will also need to remove items such as jewellery, contact lenses, or dentures. The anaesthesia team will prepare the equipment and medicines needed for your surgery.
Who will take care of me during surgery?
Recovery after cancer surgery
Depending on the type of surgery, you may go home the same day or stay in hospital so your attending physician and the care team can check how you are recovering.
Recovery involves both physical and emotional healing. It is normal to experience a range of emotions after surgery, including relief, anxiety or frustration.
Recovery time depends on the type of surgery and your general health. After minimally invasive surgery, people often recover faster and may have less pain than after open surgery.
Getting up and moving around early can help prevent complications such as blood clots or pneumonia. Ask your doctor how much movement is safe for you.
The doctor will tell you when you can eat and drink again. You will also get clear instructions for your care at home. This includes how to care for your wound, which medicines to take, and when you can return to normal activities.
Before you leave the hospital, ask your care team:
what you can expect during your recovery after surgery,
when you should contact your doctor or get medical help,
who to call if something worries you or if you have questions
What are the possible risks of cancer surgery?
Talk to your care team
Every surgery carries some risks. However, your doctors will only recommend surgery if they believe the expected benefits outweigh the possible risks.
Smaller surgeries usually have lower risks than more complicated surgeries. Some complications may occur during surgery. Others may happen afterwards. Most side effects usually improve over time.
Common side effects:
pain
minor bleeding from the wound
swelling or bruising around the surgical wound
an infected wound
numbness
Lung infection: After some surgeries, breathing can be painful. If your wound hurts, you may take shallow breaths. This can increase the risk of a lung infection. Doctors call this pneumonia.
Physiotherapists and nurses can support you soon after surgery. They may show you breathing exercises that help clear mucus from your lungs.
Blood clots: After surgery, you may move less than usual. This can increase the risk of blood clots in the veins of your legs. Blood clots are small clumps of blood. They can block blood flow. To help prevent blood clots, your care team may give you blood-thinning medicine. Some people may also need compression stockings. These are tight stockings that help blood flow in the legs.
Blood clot in the lung: A blood clot can break loose from the veins in the leg and travel to the lungs. There, it can block blood flow. This is called a pulmonary embolism.
Moving after surgery can help lower the risk of blood clots and pulmonary embolism. Ask your care team which exercises are safe for you.
Start moving as early as possible
Frequently asked questions about cancer surgery
Can surgery cure cancer?
Surgery can cure many cancers, but it cannot cure every cancer. A cure is more likely if the cancer is only in one part of the body and the surgeon can remove the tumour completely. For some cancers, surgery needs to be combined with other treatments, such as chemotherapy or radiotherapy, to achieve a cure.
Whether surgery can cure cancer depends on:
the type of cancer,
where the cancer is in the body,
how far the tumour has spread at the site where it originated
whether cancer cells have spread to other parts of the body,
your health before surgery.
What are "clear margins"?
When a surgeon removes a tumour, they often remove a small area of healthy tissue around the tumour. Doctors call this area a margin.
After surgery, specialised doctors (pathologists) examine the tissue removed during the operation. They look at it under a microscope. If they do not find any cancer cells at the edge of this tissue, the margins are called clear.
If your doctor tells you that your tumour has “clear margins”, it means there is a lower chance that cancer cells were left behind in your body after the surgery. This may reduce the risk of the cancer coming back in the same area.
Having clear margins does not always mean that no further treatment is needed. Your doctor will discuss whether additional treatment is recommended based on your individual situation.
Why do I need chemotherapy before surgery?
Chemotherapy before surgery can make your tumour smaller. Doctors may suggest chemotherapy before surgery because a smaller tumour may be easier to remove. This is what specialists refer to as neoadjuvant chemotherapy.
Good to know: Even if a tumour seems to be in only one place, very small cancer cells can sometimes spread to other parts of the body. Surgery removes the tumour in one area. Chemotherapy works throughout the body and can help destroy these cancer cells.
Can cancer return after surgery?
Yes, cancer can come back after surgery. This can happen if cancer cells remain in the body after surgery. It can also happen if some cancer cells have already spread to other parts of the body. These cancer cells may be too small to be found with medical tests.
Doctors may recommend other treatments before or after surgery to lower the risk of cancer coming back. This type of treatment prior to surgery is known as neoadjuvant therapy. After surgery, it is referred to as adjuvant therapy .
These treatments can include chemotherapy, targeted therapy, immunotherapy or radiotherapy. Your care team can explain your own risk and whether you need more treatment.
Additional resources and reliable information
Evidence-based guidelines
Medical guidelines help doctors decide when surgery may be recommended. These guidelines are based on the best available evidence and expert advice.
A compilation of guidelines for different cancer types is provided by Leitlinienprogramm Onkologie (in German). Many of the guidelines have a version for patients.
Leitlinienprogramm Onkologie also provides a german guideline that focuses on surgery for tumors of the digestive system, including the stomach and intestines.
Information Websites
Cancer Information Service (DKFZ): Overview on surgery and other cancer treatments.
Cancer Research UK: Overview on surgery and other cancer treatments.
American Cancer Society: Overview on surgery and other cancer treatments.
National Cancer Institute (NCI): Overview on surgery and other cancer treatments.
Professional articles
Sauro KM, Smith C, Ibadin S, Thomas A, Ganshorn H, Bakunda L, Bajgain B, Bisch SP, Nelson G. Enhanced Recovery After Surgery Guidelines and Hospital Length of Stay, Readmission, Complications, and Mortality: A Meta-Analysis of Randomized Clinical Trials. JAMA Netw Open. 2024 Jun 3;7(6):e2417310. doi: 10.1001/jamanetworkopen.2024.17310. Erratum in: JAMA Netw Open. 2024 Jul 1;7(7):e2428433. doi: 10.1001/
Adjuvant treatment
Adjuvant treatment is an extra cancer treatment given after a surgery to remove the tumour. It may include chemotherapy, radiotherapy or other cancer treatments. It aims to destroy cancer cells that may still remain in the body after surgery. These cells could cause the cancer to come back or spread to other parts of the body.
Anaesthesia
Anaesthesia is the use of medicines to prevent you from feeling pain during a medical test or surgery. Depending on the type of anaesthesia, the medicines may make part of your body numb or make you unconscious. This allows doctors to carry out the treatment safely while keeping you as comfortable as possible.Your healthcare team watches you closely throughout the test or surgery.
Anaesthesist
An anaesthetist is a doctor who gives anaesthesia before and during a medical test or surgery. They make sure you do not feel pain and carefully check your breathing, heart rate, and blood pressure throughout the procedure. They also help keep you safe and comfortable while you are under anaesthesia. The role of an anaesthetist can be different in different countries.
Blood clot
Blood clots are small clumps of blood that stick together. They help stop bleeding when you are injured. Sometimes they can form inside a blood vessel and make it harder for blood to flow normally.
Clear margin
Clear margin means that no cancer cells are found in the safety margin around the cancer that was removed during surgery. This suggests that all of the cancer that could be detected was removed. It may reduce the chance of the cancer coming back in the same area.
Endoscopy
Endoscopy is a medical test. It allows a doctor to look inside parts of the body using a thin tube with a small camera. Doctors can examine areas such as the stomach, bowels (intestines), or airways (the tubes that carry air to and from the lungs). It may be used to remove cells that could later turn into cancer. It can also help find cancer, take a small tissue sample for testing, or check how far a cancer has spread.
Laparoscopy
Laparoscopy is a medical test that allows doctors to look inside the belly area using a thin tube with a small camera. Doctors make small cuts in the skin to insert the camera and small surgical tools. It may be used to diagnose cancer or to remove some cancers through small cuts.
Lymph node
Explanation already existing
Margin
Margin is the rim of healthy tissue that is removed along with a cancer during surgery. This extra tissue acts as a safety margin around the cancer. Doctors examine the margin to see whether any cancer cells are present. This helps show whether all of the cancer has been removed.
Neoadjuvant treatment
Neoadjuvant treatment is a cancer treatment given before surgery. It may include chemotherapy, radiotherapy or other cancer treatments. It aims to make the tumour smaller before surgery. A smaller tumour may be easier to remove. In some cases, neoadjuvant treatment can make surgery possible.
Pneumonia
Pneumonia is an infection in one or both lungs. It can cause symptoms such as cough, fever, chest pain, and breathing difficulties. Pneumonia can sometimes occur after surgery and may make recovery more difficult.
Solid cancer
Solid cancers are cancers that form a lump or mass in an organ or body tissue. They develop when cells grow in an unusual and uncontrolled way. Solid cancers can occur in many parts of the body, such as the breast, lung, or bowel.
Tumour
Explanation already existing
Robotic surgery
Robotic surgery is a type of surgery that uses special surgical tools attached to a robotic system. The surgeon fully controls these tools using a computer system. It may be used to remove cancer and can help surgeons perform some operations through smaller cuts.
https://www.krebsliga.ch/ueber-krebs/therapien/operationen-bei-krebs
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2820097).