Cancer Surgery

General Information

As a general surgery branch, we have to deal with many types of cancer related to various tissues and organ systems. These primarily include thyroid cancers, breast cancer, esophageal cancer, stomach cancer, colon cancer, liver-gallbladder-bile ducts, and pancreatic cancers. 

As with cancers of all tissues and organ systems, early diagnosis and treatment are life-saving for cancers relevant to the general surgery specialty.

Who is eligible for surgery?

The golden key to effective surgical treatment lies in the early diagnosis of your disease. Therefore, if you have recently developed: Loss of appetite Weight loss Fatigue/Weakness Nausea Vomiting Difficulty swallowing (Dysphagia) Presence of a palpable mass Jaundice Pain resistant to painkillers (especially abdominal and back pain) Bleeding from the rectum Disruption of bowel habits (Constipation and especially the feeling of frequently needing to defecate, but exiting the toilet without relief after passing small pieces of stool, known as tenesmus) It is important that you consult a healthcare institution without delay if these symptoms are present. Remember that early diagnosis saves lives. Cancer surgery can be applied to all patients who have been diagnosed with cancer. There are two options for surgical treatment to be applied.

The first is curative surgical treatment, which is the complete removal of the cancerous tissue by surgery in a manner that no visible cancerous tissue remains behind. The second alternative in cancer surgery is palliative surgical treatment. This type of treatment, when the tumor is diagnosed at an advanced stage, aims to remove as much tumor tissue as possible, leaving a portion of the tumor tissue that cannot be removed. 

Palliative surgical treatment can also be performed to eliminate or reduce symptoms (bowel obstruction, jaundice, pain, etc.) caused by the unresectable tumor tissue. The most effective method for disease control and survival is curative surgical treatment. 

Curative surgery can only be performed if the disease is diagnosed at an early stage. Therefore, seeking our consultation without delay if certain new symptoms occur is important for the early diagnosis and effective treatment of your disease.

What preparations are required before surgery?

A safe surgery is inextricably linked to a good and complete patient evaluation before the operation. The first step to be planned for this purpose is a detailed patient-doctor consultation. 

After this consultation, your doctor will have: Obtained your physical data (height, weight, BMI, etc.) Learned your expectations from the surgery, Learned the physical and psychological damage caused by your current complaints, Understood which tissue and organ system your complaints may be related to, Made a comment about your general health status and made a preliminary decision on what kind of preparations should be made for the planned surgery. The next stage is to conduct a detailed pre-operative evaluation in the hospital. 

At this stage, studies are carried out regarding both the diagnosis of your disease (biopsy and pathological examination) and its extent and clinical staging. In the hospital, the following are performed:

• Detailed blood tests,

• Abdominal ultrasonography,

• Computed tomography (whole-body tomography, generally with oral and intravenous contrast administration, to clarify the presence of the tumor, its regional spread, and metastasis status),

• Gastric endoscopy (as needed),

• Chest X-ray,

• Pulmonary function tests (as needed),

• Biopsy and pathology procedure targeting the suspected tissue,

• Doppler ultrasonography of your vessels (if suspicion exists),

• ECG, Echocardiography tests (as needed),

• Cardiologist examination (as needed),

• Internal medicine specialist examination,

• Anesthesiologist evaluation is performed to assess whether you are suitable for a safe operation.

How is it done?

Tumor surgery can be performed with open or closed (Laparoscopic or Robotic) surgery depending on the tissue and organ systems where the disease originates, and your surgeon’s experience and preference.

What preparations are required before hospital admission?

If your surgery is planned to be performed on the digestive system:

• Generally, it is useful to start consuming liquid food 1-2 days before the surgery, so that your intestines are empty during the operation and your need to use the toilet is delayed and easier afterward.

• If you are using blood-thinning medications, you must warn your doctor about this and give your doctor time to stop these medications and start alternative ones instead.

• It is safe to continue using the routine medications you must take, except for blood thinners, until the night before the surgery. Blood pressure medication and heart medication can be taken on the morning of the surgery with a small amount of water, at least 2 hours before the operation, with your doctor’s knowledge.

• If you smoke, it is absolutely necessary to quit smoking at least 1 week before the surgery or reduce it to the lowest possible level. This is a situation that will directly affect your lung performance after the surgery.

• Generally, you should stop all solid or liquid food intake around 10-11 PM the night before the surgery, and you should be ready with at least 6 hours of fasting on the morning of the surgery.

• Take a bath at home before being admitted to the hospital for the surgery. Remember that you will not have the opportunity to bathe for at least 2 or 3 days.

• Do not wear nylon underwear when coming to the hospital. Nylon underwear can interact with some electrical devices used during surgery and cause skin burns.

• It is useful to bring slippers, personal hygiene supplies (toothbrush, toothpaste, shaving kit, etc.), and sufficient underwear when coming to the hospital.

How long will I stay in the hospital?

Although your hospital stay is affected by many factors such as whether you were admitted the night before the surgery or on the morning of the surgery, how long your surgeon makes it a principle to keep the patient in the hospital after the surgery, and whether a surgical problem has developed after the surgery, it is generally about 1-2 nights for surgeries outside the digestive system (thyroid surgery) and an average of 3-4 nights for surgeries related to the digestive system.

What will happen during my stay in the hospital?

If you were admitted to the hospital the night before the surgery, you should use a protective blood thinner in the hospital. If you are admitted on the morning of the surgery, you should use it at home. This treatment will be planned and administered by your doctor. Be sure to use the toilet before going down to the operating room on the morning of the surgery. 

The time between being taken from your bed for the surgery and returning to your bed will generally be a time frame of about 3-4 hours, although this varies depending on the surgery to be performed. This entire period is not the time spent on the surgery; the pre-operative preparation period in the operating room, your surgery, and your awakening procedure after the surgery are included in this process.

Whether you are taken to the intensive care unit after the surgery will be determined by your surgeon and anesthesiologist, evaluating factors related to the tissue system where the surgery was performed, your general health status, the type of surgery, and events experienced during the surgery. 

If you have undergone a surgery related to the digestive system and have been taken to your bed without the need for intensive care, the process in the days following the surgery is as follows:

• Day of Surgery: Approximately 5-6 hours after returning to your bed, you get up with the help of hospital staff for your first walk and take a small walk inside the room. All your treatments on the day of surgery are administered intravenously, and food intake is not permitted.

• 1st Day After Surgery: Generally, this is the day you start drinking water sip by sip. Whether to start food intake (drinking water) at this stage is decided by your surgeon, again based on the characteristics of the surgery performed. We encourage you to increase the amount of walking during the day and have a more active day.

• 2nd Day After Surgery: Today, if a drain was placed in your surgical site and there is no significant amount of fluid coming from the drain, we remove your drain and start you on foods such as soup, compote, and fruit juice. The 2nd day is the main day when the transition to oral feeding begins. Following the removal of your drain, we also allow you to take a bath. Again, it will be beneficial for you to take plenty of walks.

• 3rd Day After Surgery: The 3rd day is the day your discharge planning is made after we see that everything is going well. If you have no problems with food intake and we believe there are no surgery-related complications, we discharge you on the 3rd day following the surgery. The discharge period may be extended by a few more days, again depending on the characteristics of your surgery and your surgeon’s patient follow-up criteria.

What will happen after hospital discharge and when can I start my normal life?

Although your return to normal life varies depending on the surgery performed and your general health status, you can generally return to your normal life one week after Laparoscopic surgeries, and 10-12 days after open surgical operations.

An important issue to be planned after being discharged from the hospital is the planning of medical treatment for the tumor, which includes chemotherapy and radiotherapy. Generally, these treatments are shaped after the pathological examination of the tumor tissue removed during surgery. 

Oncology and radiation oncology specialists evaluate many parameters, such as how much of the tumor in your body was removed during surgery, its microscopic cellular features, its proliferation rate, and some chemical properties, to determine the pathological staging of your disease and consequently the details of the chemotherapy and radiotherapy treatment they will administer. 

Usually, chemo and radiotherapy after surgery are allowed 10-15 days after the operation to allow for tissue healing and physical supplementation. During this intervening period, the pathological evaluation and reporting of the specimen removed during surgery are carried out.

What will my control and follow-up process be like?

Implementing a regular control plan after both surgical and medical treatment is essential for the cancer treatment process. For this purpose, surgery, oncology, and radiation oncology specialists will create a joint follow-up plan and inform you.

SOME CANCER TYPES

• Esophageal cancer

• Stomach cancer

• Colon (large intestine) cancer

• Breast cancer

• Thyroid cancer