Navigating Cancer Care: Surgery
Surgery is a recommended part of the treatment plan for many people with cancer. There are several things that can be done to help you prepare physically and emotionally for surgery. In this section we’ll discuss physical activity, nutrition, and mind-body approaches to prepare for surgery, as well as post-surgical recovery.
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Mind-Body for Surgery
It is normal to have anxiety before surgery or any medical procedure. There are a variety of mind-body exercises that can reduce anxiety and also improve recovery.
A John’s Hopkin’s program that included guided imagery and deep relaxation, showed that people who participated in their 2-week mind-body program before surgery had:
- Decreased anxiety and more peaceful feelings
- Reduced pain medications after surgery
- Decreased nausea after surgery
- Faster recovery of bowel and bladder function
- Shorter hospital stays
The majority of people will not have access to a mind-body class leading up to surgery. Luckily, there are many mind-body tools such as guided imagery or medical hypnosis recordings available for free or for sale online. These can be listened to daily in the weeks preceding surgery and perhaps even in the first days of recovery. If a particular recording makes you uncomfortable or isn’t comforting, consider trying a different one, as there are different styles or voices that suit different people.
Mind-body tools like breath work, guided imagery, and relaxation practices can be useful after surgery, to aid your recovery, reduce pain, improve sleep, and decrease anxiety.
Before Surgery
Eating a healthy Mediterranean-type diet filled with many vegetables is a good idea most of the time, including during the weeks preceding surgery. Getting the right nutrients can help ensure that your body has all of the micronutrients needed for a healthy immune system and speedier recovery. Many nutrition experts also recommend increasing protein intake in the weeks before surgery. Foods such as cottage cheese, yogurt, fish, chicken, turkey, eggs, legumes (beans), and soy are healthy ways to increase protein during those weeks.
Excellent hydration is also critical in the weeks and days preceding surgery. Be sure to drink plenty of water to ensure proper blood flow and to protect your organs such as your kidneys. Hydration is important before and after surgery.
When to stop eating/drinking pre-surgery
Your surgical team will instruct you about when to stop eating and drinking in anticipation of your surgery. Often people are asked to stop eating or drinking after dinner the night before surgery is scheduled to reduce chances of surgical complications while under anesthesia.
After Surgery
After surgery, your surgical team will instruct you about when you can return to a normal healthy diet. Some people will need to advance their diet slowly, especially after abdominal or gastrointestinal surgeries, starting with fluids, or soft “clear” foods, without fiber in the days immediately following surgery. Others can start on a normal diet a day or so after surgery. After several days, you should be able to return to a normal, healthy diet. Your surgical team will guide you in this process.
Registered Dietitian: Board Certified Specialist in Oncology Nutrition
Most hospitals and cancer centers offer certified dietitians to help guide you. Look for RDs certified as specialists in oncology.
For most people scheduled for cancer surgery, gentle physical activity is safe and even advised. Exceptions to this include unstable bone fractures, infection, some heart or lung conditions, recent recovery from surgery or other procedures, or individuals at high risk of falling. If you are unsure, ask your surgeon or physician what types of physical activity might be safe for you.
Getting active before surgery has many advantages. Recovery from surgery can take weeks, sometimes much longer. Being physically fit, to the best of your ability, before surgery will improve your recovery and help you bounce back more quickly to your usual state of fitness. Most experts recommend 150 minutes of exercise weekly, which can convert to 30 minutes 5 days per week. For some people, this is a goal to work towards, while others are able to comfortably endure much higher levels of physical activity.
Prehabilitation (Prehab)
A growing number of cancer centers now offer opportunities for ‘prehabilitation’, or prehab. Prehab is a program dedicated to preparing patients for surgery with physical activity and physical therapy exercises designed to speed recovery. Ask your surgery team if there are prehab opportunities in your community.
Even if you can’t find a prehabilitation program in your community, be sure to stay as fit and active as you safely can in the weeks preceding surgery.
After Surgery
After surgery, there is usually a period of rest that can last days to weeks. Different types of surgery will require different periods of rest. Physical activity modifications may be necessary depending on which part of the body was operated on, and the outcome of the surgery. It is important to start moving your body within the week following surgery with activities such as walking and gentle stretching. Gently increase physical activity as soon as you safely can.
Many cancer centers offer rehabilitation, or rehab programs or referrals. These programs are usually covered by medical insurance and are designed to increase function soon after surgery, guided by a professional.
Even if you don’t qualify for a certified rehabilitation program, be sure to get moving when you safely can, using gentle stretching and movement early in your recovery period. Not only can early activity help restore function, it may decrease scarring and other surgical complications. For those 65 and older, a health and fitness program called SilverSneakers® is included in many Medicare plans to get access to fitness classes and workout equipment. Livestrong also has programs that are affiliated with YMCAs in several communities around the country. Find out what types of resources are available in your community.
Please see Cancer and Physical Activity for more information
Lymphedema and Manual Lymphatic Drainage
Lymphedema is a condition that occurs when lymphatic flow is disrupted in some way. In cancer, lymphatic flow can be disrupted by multiple mechanisms. Surgeries that remove lymph nodes to evaluate them for malignancy (cancer) have the potential to cause lymphedema as a side effect. For this reason, in a few cancers such as breast cancer or melanoma, some surgeons practice ‘sentinel node biopsy’. This is a process of finding the lymph node(s) that the primary tumor might drain into during the actually surgery, leading to the removal of fewer lymph nodes. The removal of fewer lymph reduces the risk of lymphedema of the nearest limb or body region.
You can also reduce the risk of lymphedema by staying fit before surgery with regular physical activity. Excess body weight is associated with higher risk of lymphedema. Light weight lifting or weight bearing exercise, especially in the extremities at risk, can increase muscle mass and reduce body fat, decreasing chances of limb swelling after surgery.
Staying hydrated with water, reducing salt intake, decreasing processed foods, and eating a diet rich in vegetables, whole grains and fruits, with adequate healthy protein might also help reduce risk of lymphedema.
Manual lymphatic drainage (MLD) is a type of very light massage that encourages lymphatic flow In the body in people who have developed lymphedema. The touch is directed gently along the skin towards the thoracic duct, which is located in the center of the chest area near the heart. This type of therapy should begin with a professional, such as a physical therapist, or massage therapist with specialized training in lymphatic drainage.
Manual lymphatic drainage should be avoided in areas where there is infection or risk of infection, open wounds, areas over blood clots or thrombosis, or over a tumor that is close to the skin.
Compression bandages or extremity sleeves can also be beneficial to direct lymphatic flow. These can be used in the upper or lower limbs, such as arm sleeves or leg compression wraps. Physical therapists trained in lymphatic drainage can help with recommendations.
