Preparing for your cancer surgery

There are a number of things that happen before you have surgery for cancer. This includes having a pre operative assessment appointment.

There are also things that you can do to prepare for your time in hospital and when you come home.

Deciding to have surgery

If your surgeon thinks an operation is the best treatment, they will talk with you about:

• why they think surgery is the best option
• what operation they think is best
• what happens during the operation
• possible side effects
• the risks and benefits
• other options if you decide not to have surgery
• any questions you have

This can be a lot of information to take in. It might help to have someone with you at the appointment. They can ask questions and take notes to help you remember what your surgeon says. You are normally given written information about the operation to take home.

It is important you understand everything your surgeon has said before you make your decision. But you might not be able to decide straight away. You may need time to think, especially if it is a large operation. And you may want to talk to family and friends first.

If you have a specialist nurse, you may also find it helpful to talk to them before you make your decision.

Signing the consent form

Before you have any operation, you need to sign a consent form. This is a written agreement between you and your surgeon. You are signing to say you give them permission to do the operation.

You should only sign the consent form if you fully understand about the operation. If you are still not sure about something, ask your surgeon to explain before you sign.

The hospital will give you a date for the operation if you decide to have surgery.

Waiting for your surgery date

You may have to wait a few weeks for the operation. This can be a difficult time emotionally, but it does give you time to prepare yourself. It is also a chance to sort anything at home or work that you need to.

Prehabilitation

Your surgeon might recommend you take part in prehabilitation while you are waiting for your operation. This is a support and advice programme offered by some NHS trusts. It is to help you improve your physical and emotional health in the time you have before treatment.

Smoking

Smoking can increase the risk of heart and lung complications after an operation. It can also increase the risk of problems with wound healing. Stopping smoking as early as possible before surgery can reduce these risks.

It can be difficult to stop smoking. There are a range of support services and different products to help you.

Some people may not be able to stop before their operation. And others may not want to. But even not smoking in the 1 to 2 days before your surgery helps. This is because the amount of oxygen your blood carries around your body increases if you don’t smoke for a couple of days.

You will not be able to smoke while you are in hospital. The pre operative assessment team can tell you about ways they can help you during this time. This may include giving you nicotine replacement patches to wear during your stay.

Alcohol

Heavy alcohol use can also increase the risk of complications after surgery. This includes infections, bleeding and heart problems. It may also take longer to recover.

The pre operative assessment team will ask you how much alcohol you drink and how often you drink it. If you drink more than the recommended amount a week, they may ask you to have extra tests and scans. They will also talk to you about ways to try and reduce the amount of alcohol you drink. If necessary, they will refer you for additional support to help you.

Alcohol can affect how well the liver works. If tests show your liver isn’t working properly, they may refer you to a specialist liver or stomach doctor. Some people may go into hospital before their operation to help them cope with the effects of stopping drinking.

Even if you don’t drink more than the recommended weekly amount, you are normally asked not to drink alcohol for 1 to 2 days before your operation.

What is a pre operative assessment?

You have a pre operative assessment appointment while you are waiting for your operation. Sometimes you might have the appointment before you are given a date for surgery.

The assessment is to make sure you are well enough to have the anaesthetic and operation. It is also to give you information on how to prepare for surgery.

The hospital might ask you to fill out a questionnaire before your appointment. This asks about your general health and any medication you take. It helps the pre operative assessment team decide who you need to see at your appointment. The team can include:

• nurses
• anaesthetists
• medical doctors
• surgeons
• pharmacists
• the pain management team
• other health professionals

Who you see at your assessment depends on factors including:

• your general health
• what operation you are having

For example, if you have heart problems you may see a consultant anaesthetist and have some extra tests. This is because there may be a higher risk of problems during and after the operation. The anaesthetist will talk to you about these risks and what you both can do to lower them. Your hospital might call this a high risk anaesthetic assessment.  

What happens during your pre operative assessment?

At the appointment, the pre operative assessment team:

• check your weight, blood pressure, pulse and temperature
• check your neck movement and how wide you can open your mouth – it may be more difficult for the anaesthetist to give you a general anaesthetic if you can only open your mouth or move your neck a small amount
• ask what help and support you have at home
• ask you more questions about your health and medication
• ask you about any other operations you have had
• ask if you or any of your relatives have had problems with anaesthetics
• talk to you about smoking and drinking alcohol before surgery
• tell you what to expect on the day of surgery and afterwards

The pre operative assessment team will use this information to plan for your admission, time in hospital and discharge home.

Preparing for the operation

During your appointment they will also give you information about how to prepare for the operation. This includes:

• when to stop eating and drinking before surgery
• if you need to stop taking any medicines before the operation
• showering before surgery and what you can put on your body afterwards such as deodorant

Anything else you need to do depends on what operation you are having. But it may include:

• using special soap or wipes to clean your skin before you come to the hospital
• taking bowel preparation – this might be if you are having bowel surgery

It is important that you follow all the information you are given, otherwise your operation may have to be postponed.

Enhanced recovery after surgery

If you are having a larger operation, the pre operative assessment team normally talk to you about the Enhanced Recovery After Surgery (ERAS) programme. This uses research to help people recover quicker after an operation.

Surgery is stressful for your body, especially if it is a large or complex operation. This is because your body must work hard afterwards to get back to normal. Cancer and other health problems can make this more difficult.

Your healthcare team in the hospital help you recover quicker by:

• making sure you are physically and emotionally ready for the operation
• keeping the amount of stress on your body as low as possible during surgery
• helping you get back to normal as quickly as possible afterwards

How they do this depends on what operation you are having. But you can also help with some of these.

Before surgery

You talk with your healthcare team about your surgery and recovery. This can include your pre operative assessment team, surgeon and anaesthetist. It may also include other healthcare professionals such as a physiotherapist or dietitian. They ensure you have the correct information about what to expect. Between you, you set goals for your recovery and start planning your discharge.

They may also give you carbohydrate drinks to have before your operation. This is because the stress of surgery makes your body release certain hormones. These increase the amount of sugar in your blood (hyperglycaemia). This can lead to infections, heart and kidney problems and muscle weakness.

Carbohydrate drinks can keep your blood sugar levels stable and prevent these problems. This means you can get up and start moving about sooner after your operation.

During surgery

Your surgeon and anaesthetist will try and reduce the stress your body is under by:

• making sure you are not too hot or too cold
• giving you as short an anaesthetic as possible - they will also use regional anaesthetic when they can
• giving you medicines to stop you feeling sick
• using a range of painkillers that don’t make you sleepy or feel sick
• making the wounds as small as possible
• using as few drips and drains as they can

After surgery

You have regular painkillers to help you get back to normal as soon as possible. This means you normally should be able to sit out in a chair soon after your operation. You will also start going for very short walks in the ward a couple of times a day. You slowly build up how far you walk.

Your doctor will ask for any drips and drains to be removed as soon as they are no longer needed. This means you can move around more easily.

You normally start drinking water soon after you wake up. And you will start eating a few hours afterwards. If you are having surgery on your tummy (abdomen), you usually wait until your doctor is happy that your bowel is working properly before you start. This is because it can slow down and stop working for a short while after an operation.

Some people may even be able to go home the same day as their surgery.

Tests

Before surgery you may need to have some tests. These are to make sure you are well enough to have the anaesthetic and operation. Some of these can be done as part of your pre operative assessment. But you might need to come back to the hospital for others.

Whether you have tests and what ones you need, depends on your general health and what operation you are having.

Blood tests

Your pre operative assessment team may ask you to have some blood tests. This is to check your general health and to make sure certain parts of your body are working normally.

You might have blood tests to check:

• you don’t have an infection and that you can fight an infection if you get one
• your blood can clot normally
• you do not have anaemia
• how well your kidneys are working
• your blood group – this is in case you need a blood transfusion during the operation

Sometimes you might have other blood tests. The pre operative assessment team can explain what they are for.

Checking for MRSA

The pre operative assessment team might ask to take a swab from:

• the inside of your nose
• your groin
• other areas of your body

They run a small stick like a cotton bud around the area. It is to check for a bacteria called methicillin resistant staphylococcus aureus (MRSA). Staphylococcus aureus is a bacteria which can cause lots of different types of infection. MRSA is a particular type (strain) of staphylococcus aureus bacteria which does not respond to many commonly used antibiotics.

Some people carry MRSA on their skin without it causing them any problems. But it can make them ill if it gets into their body during an operation.

If you have MRSA, you are normally given an antibiotic body wash and nasal cream to use before surgery. Your doctor also gives you antibiotics while you are in hospital.

Electrocardiogram (ECG)

An ECG checks how well your heart is working. You have small sticky pads put on your chest, wrists and ankles. These are attached to wires which are part of an ECG machine.

The machine shows your heartbeat and heart rhythm as an electrical trace on a screen. It can also be printed out on paper.  

Echo (echocardiogram)

An echo is an ultrasound scan of your heart. It shows how well the heart muscles and valves are working. The heart valves are where blood passes from one part of the heart to another.

Your anaesthetist may want you to have an echo to check that the valves in your heart work properly. Or to check that your heart is able to pump enough blood around your body.

Having an echo isn’t painful, but you usually have to lay on your side. Tell the person doing the scan if this is uncomfortable.

Other tests

Sometimes the pre operative assessment team will ask you to have other tests. This might include:

• a chest x-ray to check your lungs look healthy
• breathing tests – these are called lung function tests or pulmonary function tests
• a test that measures your ability to exercise (cardio pulmonary exercise test)
• a urine test – this is to check for an infection in your bladder or kidneys

The pre operative assessment team will explain what the tests are for and how to prepare for them.

Preventing blood clots

The pre operative assessment team usually tell you about breathing and leg exercises to do after your operation. This can reduce the risk of chest infections and blood clots. These can develop if you don’t move around for a while. 

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

Questions to ask about your hospital admission

Going into hospital for cancer surgery can be stressful. Knowing the answers to a few questions might make it easier for you to prepare. You might want to ask:

How long will I be in hospital for?

You might be able to go home the same day as your operation. This is called day surgery. Or you might need to stay one or more nights as an inpatient. This depends on the type of surgery you are having and your recovery.

When and where do I have to go?

Make sure you know what time you should be at the hospital. And which department you need to go to. Tell them if you are going to have problems getting there on time.

Is my operation on the day I go into hospital?

You normally go into hospital on the morning of your operation. Sometimes you may go in the night before. This can depend on the hospital.

Can I have visitors?

Hospital wards normally have set visiting times. This can be different for each ward. They may only let you have a certain number of visitors at one time. And they might not allow young children to visit.

Visitors are not normally allowed on the day surgery unit.

Am I able to call my friends and relatives while I'm in hospital?

You can normally use your mobile phone in hospital. And you might want to take some headphones that connect to your phone. But there may be times when you won’t have your phone nearby. And sometimes you may not feel like talking.

Some hospitals have phone and television systems above the beds. You normally have to pay to use these.

Making arrangements for your time in hospital

You might need to sort out a few things before you go into hospital. This can include:

• taking time off work
• arranging care for children or other loved ones
• arranging care for your pets
• finding someone to look after your house
• cancelling regular deliveries such as milk, newspapers or food deliveries
• having false nails, gel, acrylic or other types of long lasting nail varnish removed – you usually need to have these taken off before you go into hospital
• arranging how you will get home after your operation

What to take with you into hospital

The pre operative assessment team will suggest what to take into hospital.

They may ask you to only take the essentials when you first go in. You can ask your relatives or friends to bring anything else you need when they visit. Let the pre operative assessment team know if this will not be possible.

Some examples of what to take are:

• your medicines
• nightwear
• underwear
• dressing gown
• slippers
• comfortable day clothes and shoes to wear after your operation
• any glasses or contact lenses you wear – including any cleaning solution or a glasses case
• wash bag with soap, a flannel or sponge, toothbrush and toothpaste
• sanitary wear or tampons
• a razor
• a towel – hospital towels tend to be quite small
• a small amount of money
• magazines, books, playing cards
• headphones and music to listen to
• your mobile phone or a tablet and charger
• a copy of your last clinic letter (if you have one)

Planning for when you get home

People often go home very early after surgery. But it is important that you don’t do too much when you get back. It may help to make some plans in advance. 

Meals

You might want to prepare or buy some meals that you can heat up once you are at home. You may also want to arrange to have your shopping delivered.

Driving

You might not be able to drive for a while after surgery. This depends on what operation you have had. You may need to arrange for a friend or relative to drive you.

Lifting

You may not be able to lift anything heavy after surgery. So, you may need help with small children and essential jobs around the house such as clothes washing.

How you might feel

It is normal to feel nervous about going into hospital and having an operation. You may find it helpful to try some relaxation techniques.

If you need help to manage your feelings about your operation, speak to your GP or the hospital where you are having the surgery.