Before your operation for neuroendocrine cancer

The pre assessment appointment

Your pre assessment appointment prepares you for your operation. This usually happens in the 2 weeks before your surgery.

At your appointment the pre assessment team may:

• ask you questions about your health and any medicines you are taking

• tell you when to stop eating and drinking before your operation

• tell you if you need to stop taking any medicines before the operation

• check your weight, blood pressure, pulse and temperature

• ask what help and support you have at home

The pre assessment team will tell you how to prepare for your operation. What you need to do depends on what operation you are having.

They may also give you a leaflet about breathing and leg exercises to do after your operation. This is to help prevent chest infections and blood clots.

It helps to write down any questions you have and take them with you. The more you know about what is going to happen, the less frightening it will seem. You can ask more questions when you go into hospital so don’t worry if you forget to ask some.

Enhanced Recovery After Surgery (ERAS) Programme

The pre assessment team might tell you about the Enhanced Recovery After Surgery (ERAS) Programme. This is for people having a big operation and is to help you recover quicker. It starts before you have your operation and continues for a short time after you have gone home.

For example, they might give you carbohydrate drinks to have before your operation. How many drinks you have depends on what brand of drink the hospital uses. And when you have them depends on what time of day your operation is.

After your operation your nurses will encourage you to do breathing exercises. They will help you with getting out of bed and walking as soon as you can. And start you eating and drinking as soon as possible. This depends on the type of operation you’ve had. But your doctor will tell you when you are ready to do this.

Prehabilitation

Some people might also be asked to take part in prehabilitation (prehab). Prehabilitation means getting ready for cancer treatment in whatever time you have before it starts. It is a programme of support and advice that some NHS hospitals are using. It covers three particular parts of your health:

• what you're eating and your weight

• physical activity or exercise

• mental wellbeing

Not all hospitals have a prehabilitation programme. Sometimes the programme is run at local leisure centres. You will be told where you need to go.

Read more about prehabilitation and where you have it

Who you might meet before your operation

You will see your surgeon before your operation. You may also see an anaesthetist, pharmacist or other members of your treatment team. You may see them during your pre assessment or at a separate appointment.

The surgeon

A member of the surgical team will tell you about:

• the operation you are going to have

• the benefits of having surgery

• the possible risks

• what to expect afterwards

The anaesthetist

The anaesthetist gives you the anaesthetic and they look after you during the operation. The anaesthetic is the medicine that keeps you asleep during your operation. They make sure you’re fit enough for the surgery.

The nurse specialist

Your specialist nurse is usually there to support you throughout your treatment. They can check what help and support you have, to see what you will need when you go home.

The physiotherapist

The physiotherapist assesses how well you can move around. They let the doctors know if there is anything that could affect your recovery.

The physiotherapist also teaches you leg and breathing exercises to do after your operation to help with recovery. Learning how to do the exercises beforehand makes it easier afterwards.

The dietitian

The dietitian gives you help and advice about managing your diet. They:

• help you get as well as possible before your operation

• explain how the surgery affects your diet

• give useful tips on how to increase your nutrients and calories

They might give you nutritional supplement drinks to have before surgery.

Some people need a feeding tube in their stomach or small bowel. This makes sure you get the nutrition you need before your surgery.

Read more about diet problems and neuroendocrine cancer

Tests before your operation

You have tests before your operation to check:

• you are well enough to have an operation and anaesthetic

• that you’ll make a good recovery from surgery

The tests you have depend on what operation you are having and any other health conditions you have. You might have some or all of the following tests:

• blood tests to check the level of ​blood cells​ and how well your kidneys are working

• a swab test to rule out some infections

• an ​ECG​  (electrocardiogram) or ​echo​ (echocardiogram) to check that your heart is healthy - some people might have both

• breathing tests (called lung function tests)

• a chest x-ray to check that your lungs are healthy

• a ​cardiopulmonary exercise test​ 

The pre operative assessment team will explain what these tests are for and how to prepare for them. You might have these tests as part of your pre operative assessment appointment. Sometimes you have them at a separate appointment.

Preventing carcinoid crisis

Some ​neuroendocrine tumours (NETs) make large amounts of ​hormones. This can cause a collection of symptoms called carcinoid syndrome. Carcinoid crisis is a more serious version of carcinoid syndrome. 

Sometimes surgery can set off a carcinoid crisis. Your doctors will assess your risk of this. To prevent carcinoid crisis, you might have a ​somatostatin analogue​ medicine called octreotide. You can have it as an injection, or as a continuous drip into your vein. You might have this before, during and after surgery.

Read more about carcinoid crisis

Learning breathing and leg exercises

Breathing exercises help to stop you from getting a chest infection after surgery. If you smoke, it helps if you can stop at least a few weeks before your operation.

Leg exercises help to stop blood clots forming in your legs. You might also have medicines to stop the blood from clotting. You have them as small injections under the skin.

You start the injections after your operation. You might also wear anti embolism stockings or have pumps on your calves to help the circulation.

Your nurse and physiotherapist will get you up out of bed quite quickly after your surgery. This is to help prevent chest infections and blood clots forming.

This 3-minute video shows you how to do the breathing and leg exercises.

Going into hospital

You'll probably go into hospital on the day of your operation. Some people may need to go in the day before.

What to take with you

Take in:

• nightgowns or pyjamas

• underwear

• dressing gown

• slippers

• contact lenses, solution, glasses and a case

• wash bag with soap, a flannel or sponge, toothbrush and toothpaste etc

• sanitary wear or tampons

• towel

• small amount of money

• medicines you normally take

• magazines, books, playing cards

• headphones and music to listen to

• a tablet or smartphone for web browsing, entertainment and phone calls

• chargers for electronic devices

• a copy of your last clinic letter (if you have one)

Family and friends

Before you go into hospital, it might be worth checking:

• whether the ward is allowing visitors

• if they have set visiting times

• the best number for friends and family to phone, to find out how you are

The letter you receive before your operation may contain this information. But if not, you can phone the ward or hospital reception to find out.

You can use your mobile phone in hospital. But there may be some time before and after your operation when you won’t have your mobile nearby. And you may not feel like talking.

Before you go into hospital

It’s worth sorting out a few things before you go into hospital. These might include:

• taking time off work

• care for children or other loved ones

• care for your pets

• care for your house

• cancelling your milk, newspapers or food deliveries