Understanding Surgery. Dr. Joel Psy.D. Berman

educated manner. They can visualize bile ducts and remove stones, obviating the need for most common bile duct surgery. They can place tubes in the stomach through the abdominal wall for tube feedings and are trained in giving total parenteral nutrition (TPN) to support the pre- and post-opera-tive patient who cannot take food by mouth.

      The pulmonologists use bronchoscopes to examine the lungs and take biopsies, as well as managing peri and postoperative lung problems from pneumonia, to mucus plugs (mucus that gets stuck in the bronchi or tubes in the lungs, which prevents a patient from breathing adequately), and managing respirators and all pulmonary problems with the latest medications.

      We have discussed infectious disease doctors and hematologists in prior chapters. Their contributions to the support team are invaluable. The oncologists manage the cancer patients. Many years ago the surgeons would manage all aspects of cancer therapy, but this is rarely the case today.

      So the surgical care of a patient is a comprehensive one, and the surgeon who uses all the help at hand will be doing his patient a great service.

      Chapter 29

      CHEMOTHERAPY AND RADIATION THERAPY FOR CANCER

      It's important that we say enough,

      That cancer treatment's sometimes rough.

      In this chapter I'll be brief:

      It ain't all roses, but it's not all grief!

      Let me make it clear at the outset: This is not a book about cancer and cancer therapy. It is about surgery. But many times the patient undergoing a surgery for cancer will have preoperative or postoperative chemotherapy or radiation therapy. I want to give you at least an introduction to what you can expect in terms of side effects and treatment of these side effects.

      Their effects and complications must be explained to the patient and a decision has to be made about their use. I have outlined the function of an infusion center, a place where chemotherapy and other medication therapy is given, in my book on “Comprehensive Breast Care,” and outlined the prevention and treatment of side effects, such as nausea, vomiting, low red blood count, white blood count, and platelet count. Chemotherapy is very strong medicine and is designed to kill cancer cells. Unfortunately, most chemotherapeutic agents are not completely and solely specific for the cancer cells and attack and destroy some healthy normal cells during the treatment of the cancer. Of course, the pharmaceutical companies and your oncologists understand this and have to weigh the benefits of the drug with the disadvantages and side effects. Although most of the side effects are transient, such as hair loss, anemia, rash, bleeding possibilities, and tiredness, there are some that may be more permanent. Some of the strongest drugs may have toxicity or injury potential to the heart and the kidneys and even the liver, but, when there is no alternative, these potential problems have to be explained. Complications of chemotherapy include lethargy or tiredness, headache, depression, weight gain, skin changes, mouth sores, tingling of the hands and feet, and others. But remember that some patients develop minimal side effects and the side effects, are directly related to the type of medication you receive and the dosage. In the past few years, there has been tremendous progress in treatment of these side effects with new medication for all but eliminating nausea and vomiting. And there are drugs to increase your blood count. It is beyond this chapter to go into all the side effects and their treatment, but your oncologists will explain this to you in detail prior to starting the treatment. The American Cancer Society has wig banks and “Look Good, Feel Better” programs to help with the changes during chemotherapy, and most good cancer treatment programs have strong psychosocial departments to help the patient cope with the stresses of the disease and the treatment. Every surgeon should make his/her patient aware of all the programs available in any comprehensive cancer program.

      Radiation therapy may last for up to eight or ten weeks, usually taking a few minutes each day. The radiation therapist will explain to you about the treatment and the side effects. The one I hear about most frequently is tiredness, and rest is very important while going through this therapy. The other side effects will depend on the area being treated. Skin can develop a sunburn or rash, which may be painful. Abdominal radiation may cause nausea and vomiting, diarrhea, urinary symptoms of burning and pain and, if near the pelvis, can cause rectal pain and vaginal dryness. Radiation to the head and neck can cause pain, ulcers, and irritation to the throat and tongue. Again, the physician will clearly outline the course of therapy, the side effects, and the treatments available, and then you can discuss this with all your doctors and decide if you want to go through with it. I find that most of my patients tolerate radiation therapy very well as long as they understand what is going on and get the appropriate psychosocial support and medications to treat the side effects.

      Let us now move on to Part II and an in-depth discussion of the surgical specialties and some of their more common cases.