Surgery is the oldest medical treatment of cancer and is still the first approach used in treating many forms of cancer. Surgical removal often results in a cure, especially if the tumor is small–and localized, not having yet spread to neighboring tissues. Cancer surgery may involve a relatively minor procedure, such as removing a skin lesion. Or it can be extremely invasive, resulting in the removal of all or part of an organ, such as the lung, liver, or colon. In addition to removing tumors, surgery is often used as a means to control the spread of the tumor, relieve pain, or deal with other problems such as intestinal blockage or nerve damage.

If surgery alone is likely to cure the disease, it certainly makes complete sense to follow this course of action. Your physicians may also recommend using chemotherapy or radiation prior to surgery to shrink the tumor and reduce the likelihood of damage to nearby tissues.

Surgery does not produce the same type or degree of toxic side effects as chemotherapy or radiation, but operations carry a spectrum of risk. Although minor procedures are usually very safe, major surgery can cause serious, even life-threatening, complications, such as postsurgical infections and reactions to anesthetics.

Laser Surgery

Ordinary light, such as that from a lightbulb, contains many wavelengths and spreads in all directions. Laser light is very different; it uses one or more specific wavelengths and is focused in a narrow beam. Lasers can cut through steel or shape diamonds. They also can be used for very precise surgical work, such as repairing a damaged retina or cutting through delicate tissue.

Lasers were first used on skin tumors in 1961, and today one of the most common medical applications of lasers is in cancer treatment. Lasers are often used with endoscopes-tubes that allow physicians to see into certain areas of the body, such as the bladder. The light from some lasers can be transmitted through a flexible endoscope fitted with fiber optics. This allows physicians to see and work in parts of the body that could not otherwise be reached except by open surgery. Endoscopes allow surgeons to aim their laser beams very precisely. Lasers also can be used with low-power microscopes, giving the doctor a clear view of the site being treated. When used with a micromanipulator, laser systems can produce a cutting area as small as 200 microns in diameterless than the width of a very fine thread.

Lasers are used to treat several kinds of cancer. They can remove precancerous polyps from the colon and can remove early cancers of the cervix, vagina, and vulva. Laser surgery for other cancers, such as breast cancer, is becoming more common. Among the advantages of this approach are shorter hospital stays and less risk of pain. A recent innovation is the contact laser, also known as a laser scalpel. To a surgeon, using this tool “feels” more like a performing a standard operation with a steel scalpel.

Lasers have several advantages over standard surgical tools:

• Lasers are more precise than scalpels. Tissue near an incision is protected, since there is little contact with skin or other tissue.
• The heat produced by lasers sterilizes the surgery site.
• Less operating time may be needed, because the precision of the laser allows for a smaller incision.
• Healing time is often shortened; since laser heat seals the blood vessels, there is less bleeding, swelling, and scarring.
• More procedures can be done on an outpatient basis.

Cryosurgery

Cryosurgery is a technique that uses extremely cold temperatures to freeze and destroy cancer cells. Most often, cryosurgery is used to treat cervical cancer and skin tumors, but recent technological advances have made it possible to use the method on tumors arising inside the body, such as in the prostate gland and the liver. Researchers also are studying its effectiveness as a treatment for some tumors of the bone, for brain and spinal rumors, and for tumors in the windpipe that may develop along with non-small-cell lung cancer. Some investigators use cryosurgery in combination with other treatments such as radiation, surgery, and hormone therapy. While initial results have been encouraging, more studies are needed to show the long-term effectiveness of this method.

Cryosurgery offers some advantages over conventional surgery. It’s less invasive, involving only a small incision to allow insertion of the cryoprobe through the skin. Consequently, the risk of pain, bleeding, and other complications of surgery is minimized. Cryosurgery may be less expensive than other treatments and usually requires shorter hospital stays and recovery times. Because physicians can focus cryosurgical treatment on a limited area, they can avoid the destruction of nearby healthy tissue. The treatment can be safely repeated and can be used along with standard treatments such as conventional surgery, chemotherapy, and radiation. Furthermore, cryosurgery might offer an option for treating cancers that once were considered inoperable or that do not respond to standard treatments.

Use of cryosurgery for internal tumors is still in the experimental stage, so many insurance companies will refuse to pay for it. Another disadvantage is that sometimes it can be difficult for the surgeon to control how much tissue is frozen. If the probe goes too deep, healthy tissue adjacent to the tumor can be damaged. In prostate cancer, for example, this may result in damage to the urethra (the tube through which urine flows), resulting in difficulty urinating.

Dietary Support for Surgery

Please follow the general guidelines given in Chapter 7. Battling Cancer Through Diet, prior to your surgery, along with any specific dietary instrucions given by your physician.

Supplemental Support for Surgery

How aggressive should you be in using natural remedies as part of your surgical treatment? That depends on how extensive your operation will be. Someone undergoing a relatively minor operation, such as a woman who undergoes a simple lumpectomy requires only minimal support, while another who has a complete mastectomy or major abdominal surgery needs much more extensive and continued support.

High-quality nutrition is essential for promoting recovery from any surgery. Extensive surgery, in particular, imposes extreme demands. Your body will need to create new tissue and blood vessels, repair damaged tissue, and manufacture extra cells needed to heal the wound, fight infection, and control inflammation. If you are lacking any of the essential nutrients necessary for creating these cells and regulating these healing systems, your recovery will take longer and you’re more likely to experience complications. Nutrients like protein, vitamins A and C, magnesium, copper, iron, and zinc are especially important in promoting wound repair and overall healing after a surgery.

Making sure that your body has plenty of reserves for healing prior to and after a surgery should become a primary goal to give yourself the best chance of success and a speedy recovery.

Important Warnings Before Surgery

It is essential that you notify your physicians and other caregivers about all the natural products you’re using. Ask specifically if there are any supplements or herbal medicines you should avoid before or after the operation. In all cases, be sure to follow the guidelines and recommendations given to you by the surgeon and other health care staff.

Even something as simple as vitamin E can cause a problem during surgery. Specifically, vitamin E at doses above 200 IU per day may increase your risk of bleeding. You will need to stop using vitamin E supplements at least two weeks prior to surgery, or at least be sure your daily dose is less than 200 IU. Also, discontinue use of fish oils two weeks prior to the operation, because of their ability to prolong bleeding time. Here are some other natural products that you may be using that might increase the risk of bleeding during a surgery and when their use should be discontinued prior to a surgery:

• Garlic (Allium sativum): Discontinue at least seven days before surgery.
• Ginkgo (Ginkgo biloba): Discontinue at least 36 hours before surgery.
• Ginseng (Panax ginseng, Panax quinquefolius): Discontinue at least seven days before surgery.

In addition, it’s wise to discontinue some herbs that may increase or interfere with the effects of anesthesia:

• Kava (Piper methysticum): Discontinue at least 24 hours before surgery.
• St. John’s wort (Hypericum perforatum): Discontinue at least five days before surgery.
• Valerian (Valeriana officinalis): Discontinue at least five days be fore surgery.

These recommendations are based more on theoretical concerns than actual case reports or clinical trials. Still, discontinuing their use prior to surgery is a prudent precaution.

Modified Citrus Pectin (MCP)

One of the most important times to take MCP is when having any biopsy or surgery that could release tumor cells into circulation. It is well accepted that increased levels of tumor cells in circulation occur after the surgical removal of any primary tumor. Even relatively noninvasive procedures such as fine-needle biopsies of breast tumors can release free tumor cells into circulation. Having high levels of MCP in the bloodstream at these times can reduce the risk of the cancer being spread by the very procedures being done to treat it.

Like other fiber sources, MCP may interfere with the proper absorption of drugs. If you are taking any oral chemotherapy agents, you must time your dose of MCP carefully. Take it midway between doses of your chemotherapy medicine. For example, if you take a drug every eight hours, take MCP four hours after the last dose (four hours before the next one). This makes sure your body will get the full benefit out of both your cancer medication and the MCP.

Take either modified citrus pectin (MCP) at a dosage of 6 g dissolved by blending in water or juice twice daily. To ensure the best absorption, MCP should be taken on an empty stomach.

Probiotics Are Essential

If you are undergoing a major surgery, it is absolutely imperative that you take a probiotic before and after the surgery. Why? Just prior to and after a major surgery, you will be given antibiotics to reduce the likelihood of an infection. You will need to comply with this prescription, but we want to add another of our own-probiotics.

Probiotic supplements have shown good results in preventing and treating antibiotic-induced diarrhea. Antibiotics often cause diarrhea by altering the type of bacteria in the colon or by promoting the overgrowth of Candida albicans. Antibiotic use can result in a severe form of diarrhea known as pseudomembranous enterocolitis. This condition is attributed to an overgrowth of a bacterium (Clostridium difficele), resulting from the death of the bacteria that normally keep this Clostridium under control. Pseudomembranous enterocolitis can be quite serious and even deadly

. Reductions of friendly bacteria, the development of pseudomembranous enterocolitis, and/or infection with antibiotic-resistant bacteria may be prevented by administering probiotics products during antibiotic therapy, in particular, a specific strain-Lactobacillus rhamnosus.

Although it is commonly believed that acidophilus supplements are not effective if taken during antibiotic therapy, research actually supports the use of L. rhamnosus during antibiotic administration. A dosage of 10 to 20 billion organisms is required. Lactobacillus preparations do not appear to interfere with the effectiveness of antibiotics, but just to be as safe as possible, take the L. rhamnosus supplement as long as possible after taking the antibiotic.

If pseudomembranous enterocolitis does develop, then you will need to take L. rhamnosus and another probiotic product-Saccharomyces boulardii. The effectiveness of this yeast in reducing recurrences of pseudomembranous enterocolitis has been proven in clinical trials and is even mentioned in many medical textbooks as an important adjunct to antibiotic therapy in the treatment of pseudomembranous enterocolitis. The dosage of Saccharomyces boulardii in this application is 3 bil. lion live organisms daily.

Gotu Kola (Centella asiatica)

Gotu kola is an herbal product that promotes wound healing by stimulating the manufacture of structural proteins like collagen. Gotu kola extract has demonstrated impressive clinical results in promoting wound repair. The types of wounds healed include surgical wounds such as episiotomies and ear-nose-throat surgeries, skin ulcers due to arterial or venous insufficiency, traumatic injuries to the skin, gangrene, and skin grafts.

It is very important to use gotu kola to prevent the formation of adhesions. Adhesions are large internal scars that can be quite problematic. For example, the formation of adhesions after an abdominal operation can lead to bowel obstruction–a potentially life-threatening scenario.

The majority of clinical studies have used an extract of gotu kola containing only molecules known as triterpenic acids at a dosage of 50 to 100 mg daily. This dry powdered extract is available in capsules and tablets at your local health food store. Gotu kola is also available in crude form (bulk or in capsules, tablets, or tea bags), tinctures, and fluid extracts, but since the concentration of triterpenes in gotu kola can vary

between 1.1 and 8 percent, it is best to use extracts standardized for triterpenic acids. Here are the approximate dosages for other forms:

• Crude dried plant leaves: 1 to 2 g twice daily
• Tincture (1:5): 5 to 10 ml twice daily
• Tincture (1:5): 5 to 10 ml twice daily

Proteolytic Enzymes

Proteolytic enzymes (see page 166) can help promote recovery after survery, but they should not be used prior to surgery, as they may increase bleeding time. For best results, begin taking them no sooner than three days after surgery.

Several clinical studies have shown that, in addition to reducing infammation and swelling, proteolytic enzymes can prevent the development of lymphedema. Lymphedema refers to a buildup of lymphatic fluid that results in swelling. In lymphedema, the swelling can be so severe that it results in permanent loss of function of an arm or leg.

The lymphatic system collects fluid from body tissues, filters out harmful substances, and returns the fluid to the bloodstream. In a sense, the lymphatic system is a crucial part of your body’s water-treatment facility. The lymph nodes are like little filtering stations. Sometimes lymph nodes are removed during surgery, especially following a mastectomy, creating a blockage in lymph flow and the development of lymphedema.

Edema can occur if the fluid contains too many large particles, such as fragments of bacteria or the debris from dead cells. This often happens when the system is working hard to manage a serious disease, such as infection or cancer. Like a sewage drain, the system can become clogged. The fluid then backs up, causing swelling. The most frequently affected lymph nodes are those in the pelvis and the legs and under the arms.

In many cases, the lymphedema after a surgery is quite mild and subsides in less than six months. But some people suffer from chronic lymphedema, which is constant or recurs frequently. This can happen if the lymph nodes are removed or if a tumor recurs or grows in an area where there are lymph nodes.

Patients at risk for lymphedema are those with

• Breast cancer if they have received radiation therapy or had lymph nodes removed. Radiation to the underarm area after the lymph nodes have been removed increases the occurrence of lymphedema.
• Melanoma of the arms or legs, especially if the patient has had lymph nodes removed from the underarm area and/or received radiation therapy.
• Prostate cancer treated by surgery or by radiation therapy to the whole pelvis.
• Cancer of the female reproductive tract that is advanced, treated with surgery to remove the lymph nodes, or treated with radiation therapy.
• Cancer that has spread to the lower abdomen, such as metastatic ovarian, testicular, colorectal, pancreatic, or liver cancer. The pressure from the growing tumor can destroy the lymphatic vessels and block lymphatic drainage.

Proteolytic enzymes can dramatically improve lymphedema, according to published clinical trials. The best results occur when enzymes are combined with complex decongestive therapy (CDT), a technique that includes massage, the use of special compression wraps or clothing, individualized exercises, weight loss, and skin care.