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Before Surgery
"Do I need treatments before surgery?"
There is no proof that treatment of colon cancer before surgery
alters the surgery or decreases the risk of recurrence or improves
the cure rate. There is controversy with regard to rectal cancers.
Most surgeons would radiate large rectal cancers before surgery.
However, for most cancers of the rectum, it is not clear that preoperative
radiation and chemotherapy improves cure rates. There is evidence
that it will help to prevent local recurrence, however. By the same
token, however, radiation can also be offered after surgery. For
routine rectal cancers, we favor postoperative radiation since at
least half of our patients will be shown to not benefit from the
radiation once staging is established. Once the staging is completed,
it is only patients whose tumor goes through the bowel (T3), or
there are lymph nodes involved with the rectal cancer (N1 or N2)
that would benefit from radiation or chemotherapy.
"Do I need tests before my surgery?"
Tests before the surgery are recommended to make sure the surgery
can be performed safely. This generally includes a chest x-ray,
a blood count, an electrolyte measurement, and a urinalysis. An
EKG is also recommended. The electrolytes may be altered in the
body after the bowel preparation, and a repeat examination of the
electrolytes should be carried out the day of surgery. In particular,
potassium can be low and should be replaced prior to the operation.
The colon itself needs to be examined to make sure that the location
of the tumor is well identified, but also that the rest of the colon
is normal. If there is a growth or tumor in one area of the colon,
there are increased risks that there will be growths or tumors in
other areas of the colon, and these should be dealt with at the
same operation.
Carcinoembryonic Antigen (CEA) is often measured before surgery.
All of the data, however, that has been generated as to the value
of CEA's is based only on the postoperative value. If the preoperative
value is elevated and the CEA returns to normal, this is a favorable
prognostic sign. If, however, it remains elevated after surgery,
then aggressive efforts should be made to see if there is any evidence
of residual tumor.
Preparing for Surgery
From the beginning of anesthesia, your body will draw on all its
resources to respond to what it perceives as an injury. However,
you only have the resources that you build into your body before
you enter the operating room. It is important to start in optimal
condition.
Hydration is important. The bowel preparation you will undergo
may cause some dehydration. You do not want to aggravate this dehydration
and compound the problems it may cause. Most of us are well hydrated
most of the time, but there are two common sources of dehydration
that are controllable. Exercise is a common cause of dehydration.
It is unwise to exercise heavily on the day of your surgery - particularly
if you perspire when you exercise - because this will dehydrate
you. Usually you are not allowed to eat or drink anything after
midnight the night before surgery. If you exercise in the morning
before surgery, you will not be able to drink fluids and you will
start surgery dehydrated. Don't exercise the morning of surgery
if you have been told not to eat or drink fluids before surgery.
Alcohol is the second major cause of dehydration. Dehydration is
part of why you feel bad if you drink too much. Don't drink alcohol
of any kind the day before surgery.
Exercise is an important part of being prepared for surgery. The
better the condition of your muscles before surgery, the faster
you will recover. If you exercise regularly, continue your routine
of exercise until the day before surgery. This is not a good time,
however, to begin a new exercise program. If you do not already
exercise regularly, you may harm yourself if you start to exercise
aggressively. If there is a week before your surgery, try walking
for ten minutes every day. If there are two weeks, walk twenty minutes
a day during the second week.
If you are a smoker, now is the time and reason to stop. Infection
and failure of wound healing are more common in smokers. Smoking
just one cigarette cuts the blood flow to your skin by 40 percent
for 45 minutes. From you body's perspective, your colon is part
of the skin so, if you smoke, the blood flow needed for healing
will be decreased drastically.
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