Preparing Yourself for Cancer Surgery - Cancer Preop Checklist and Guidelines

There are several things you can do to maximize your chance for a successful operation and minimize your risk for complications.

1. Ask your surgeon about your daily routines. Do you need to change your eating or exercise habits before surgery?

Stop smoking. Stopping smoking is very important to minimize your risk of lung complications following surgery. Your doctor can provide nicotine patches and refer you to smoking cessation programs to help you quit.

2. Ask about medications. Which medications do you need to take prior to surgery? Which ones should you stop taking? If you take a blood-thinning medication such as Coumadin, aspirin, or Motrin, stop taking it at least seven days before your surgery. Also, let your doctor know about any herbal preparations or vitamin/mineral supplements you take. Some of them have been associated with complications.

3. Ask your doctor about taking home an incentive spirometer. This device is effective for improving breathing immediately after surgery. No bigger than a bread-box, it is light and mobile and has a plastic tube that you blow into. Take one home and practice with it one week before your operation.

4. Carefully follow your bowel prep instructions. Proper bowel prep can minimize infection and maximize the success of your surgery. Your surgeon should provide you with step-by-step instructions. Two days prior to surgery, you'll need to begin a liquid diet as directed by your doctor. The next step involves drinking either a gallon of a lime-flavored purging liquid or several tablespoons of Fleets Phosphosoda mixed with water. In addition, your doctor will give you several antibiotic pills to complete the bowel preparation process.

5. Consider your own blood. Some people worry about receiving tainted blood in a blood transfusion during or after surgery. All donated blood is rigorously tested, so the risk of receiving tainted blood is very low, less than 0.01 percent. However, to alleviate this concern, you can donate your own blood weeks in advance of the operation or have a relative with the same blood type donate blood for you. By setting up your own (autologous) blood or a relative's donated blood, the risk' of receiving tainted blood drops to zero. Prior to your operation, ask your surgeon about the chances of requiring a blood transfusion and the feasibility of donating your own blood.

Operation Day

At the hospital on the morning of your operation, you'll be asked to fill out several admission and registration forms. Next you'll change into a hospital gown and enter the preoperative holding area, the last stop before entering the operating room. Loved ones will be able to stay with you in the holding area right up to the time you go into the operating room. Here, you'll meet the nurses and the anesthesiologist who will be involved in your operation. Your surgeon may also come by to see if you have any last-minute questions or concerns.

While you're in the preoperative holding area, an intravenous (IV) line will be started in your arm, and your medical chart will be examined for completeness. You will also be given antibiotics through the IV. Just before you enter the operating room, the anesthesiologist will give you an intravenous medicine to ease any nervousness you may have.

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Cancer Therapy - Radiation, X-Rays, Mammograms, And CT Scans

As with chemotherapy, certain forms of medical radiation can lead to an increased risk of cancer. The benefits of using these types of medical radiation, however, generally far outweigh the risks associated with them.

Radiation Therapy: Radiation therapy uses high-energy ionizing radiation to destroy cancer cells and treat or control cancer. Radiation therapy's cancer-causing potential was recognized many years ago. In fact, much of our knowledge about ionizing radiation has come from studying the survivors of the atomic bombs and their radiation in Japan, from workers' occupational exposure to radiation, and from patients treated with radiation therapy for malignant and nonmalignant disease. Despite being relatively rare, the development of a second cancer is more common among those who receive radiation therapy than those who do not.

It's a fine balance. You have to weigh the risk against the medical benefit. If you have a cancer and you're going to be treated with radiation, you should be concerned about the risk of developing a second cancer, but not to the extent that you turn down possible treatment. On the other hand, you should certainly discuss the treatment options fully with your doctor.

Most cases of leukemia related to radiation exposure develop within a few years of exposure, peaking at five to nine years then slowly declining. Most other forms of cancer do not occur until ten years after radiation exposure, and some cancers are diagnosed even fifteen or more years later. Radiation-related leukemia risk depends on a number of factors, such as the amount of radiation received, the percentage of bone marrow exposed to radiation, and whether the patient was also treated with chemotherapy.

Studies of radiation-related breast cancer have found the greatest risk in women who were irradiated as children and adolescents for other conditions. (The most common reason for adolescents to have chest radiation is Hodgkin's disease, a type of lymphoma.) Oncologists (doctors specializing in cancer treatment) know about the increased risk of breast cancer in these women and generally recommend that they have vigilant lifetime screening for breast cancer. However, most studies of individuals with Hodgkin's disease have found no increased breast cancer risk among women who receive radiation at 30 years and older.

X-rays and Mammography: Many people are concerned about their exposure to x-rays. X-rays (including mammograms, x-rays of the breast) use doses of radiation that are many times lower than those used in radiation therapy. As with radiation therapy, studies in the past have shown that there appears to be some risk in receiving many x-ray examinations, particularly for children who have multiple x-rays. The level of radiation in modern x-rays is much lower than that used even 25 years ago and poses much less of a risk. While it's a good idea to minimize repeat exposures whenever possible, especially in children, it's important not to avoid necessary x-rays.

CT Scans: Computed tomography (CT) scans use larger doses of radiation than those found in conventional x-rays. Again, concern has been raised over the possibility of an increased cancer risk in children who receive multiple CT scans. Ways to lower radiation doses without compromising medical value are encouraged.

Another potential source of exposure to radiation are whole-body CT scans, which some people are now requesting as part of a regular health checkup as a way to screen for cancer and other diseases. Many groups, including the PDA, have expressed concern over this practice because there is little evidence of its usefulness, and it exposes people to unnecessary radiation. Sometimes CT scans are available in shopping malls. They are advertising for healthy people to come in and get whole-body scans. This is unnecessary and inappropriate.

However, whole-body CT scans do have their place. They can save the lives of accident victims who need quick evaluation to determine if they have a ruptured spleen or punctured lung. They are also effective in diagnosing some chronic conditions.

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