Melanoma is a type of skin cancer. It often starts as a mole or dark spot on the skin. It spreads faster than many other types of cancer. And it can be fatal if not treated. Melanoma is often diagnosed with a biopsy. This is the removal of the abnormal skin area to be looked at under a microscope. Once a diagnosis is made, typically a larger area around the melanoma is also removed. This is called a wide local excision. If the cancer is caught early, it has a high chance of being cured.
Removing Lymph Nodes
Lymph nodes are small masses of tissue that are part of the body’s immune system. If melanoma spreads, it often goes to nearby lymph nodes first.
The sentinel node is the first lymph node tumor cells travel into. It’s the first place that cancer is likely to spread. Depending on the thickness of your tumor, the sentinel node may need to be removed and checked for cancer cells. A sentinel node biopsy is a test often done during melanoma removal surgery. This helps the healthcare provider know which lymph nodes to remove. If you will have a sentinel node biopsy, your healthcare provider can tell you more about what to expect.
If you have nearby lymph nodes that are enlarged on an imaging test such as a CT scan or can be felt during an exam, your healthcare provider will likely do a needle biopsy to see if they contain melanoma cells. If they do, the healthcare provider might remove all of the lymph nodes in this area. This is known as a lymph node dissection.
Risks and complications
Risks and possible complications include:
- Scarring at the surgery site
- Problems with the skin graft
- Failure to remove all of the cancer, requiring further treatments
- Risks of anesthesia
- Fluid build-up and swelling in an arm or leg (lymphedema) if many lymph nodes were removed
Preparing for surgery
- Tell your healthcare provider about all medicines you take. This includes over-the-counter medicines, herbs and other supplements. It also includes any blood thinners, such as warfarin, clopidogrel, or daily aspirin. You may need to stop taking some or all of them before surgery.
- If you are having general anesthesia, do not eat or drink during the 8 hours before your surgery, or as directed by your healthcare provider. This includes coffee, water, gum, and mints. (If you have been instructed to take medicines, take them with a small sip of water.)
- If you’re having a sentinel node biopsy, you may have an injection of harmless dye the day before surgery.
The day of surgery
The surgery may take up to several hours, depending on what is done. You will likely go home the same day.
Before the surgery begins:
- An IV (intravenous) line is put into a vein in your arm or hand. This line supplies fluids and medicines.
- You will be given medicine to keep you pain free during surgery. This may be general anesthesia, which puts you into a deep sleep. A tube may be inserted into your throat to help you breathe. Or you may have sedation, which makes you relaxed and sleepy. If you have sedation, local anesthesia will be injected to numb the area being worked on. If the surgery is done to remove a smaller skin tumor, you might just need local anesthesia. The anesthesiologist will discuss your options with you.
During the surgery:
- If you’re having a sentinel node biopsy, harmless blue dye is injected to help the healthcare provider locate lymph nodes where cancer may have spread.
- An incision is made at the tumor site. The tumor is removed along with some of the normal tissue around it. This helps ensure that any cancer cells that may have spread to nearby skin are removed.
- One or more lymph nodes near the tumor may be removed. These are checked for cancer cells (a sign that cancer has spread).
- The incision may be closed with stitches or staples. In some cases, a skin graft or flap may be needed to help close the site. This can come from your own body, a donor, or manmade sources. The healthcare provider will discuss the different types of grafts with you before the surgery.
After the surgery
If you had only local anesthesia, you can go home shortly after the procedure. If you had general anesthesia, you’ll be taken to a room to wake up from the anesthesia. You may feel sleepy and nauseated. If a breathing tube was used, your throat may be sore at first. You’ll be given medicine to manage pain. When it’s time for you to be released from the hospital, have an adult family member or friend ready to drive you.
Recovering at home
Once at home, follow the instructions you’ve been given. Your healthcare provider will tell you when you can return to your normal routine. Be sure to:
- Take all medicine as directed.
- Care for your incision as instructed.
- Don’t do heavy lifting or strenuous activities as directed.
- Don’t drive until your healthcare provider says it’s OK. Don’t drive if you’re taking medicine that makes you sleepy or drowsy.
- Follow your healthcare provider’s guidelines for showering. Don’t swim, take a bath, use a hot tub, or do other activities that cover the incision with water until your healthcare provider says it’s OK.
When to call your healthcare provider
Call your healthcare provider right away if you have any of the following:
- Chest pain or trouble breathing (call 911)
- Fever of 100.4°F (38°C) or higher, or as directed by your healthcare provider
- Symptoms of infection at an incision site, such as increased redness or swelling, warmth, worse pain, or foul-smelling fluid
- Pain that cannot be controlled with medicine
Laparoscopic Colon Surgery
You and your healthcare provider may decide that laparoscopic colon surgery is right for you. How well you prepare can affect the surgery’s success. Make sure you understand all instructions your provider gives you. If you’re not sure about what to do, be sure to ask. To help get your body ready, you will be given instructions before surgery. Follow these instructions carefully. Ask questions if something is unclear.
Getting ready a few weeks before surgery
- Have a medical exam. Have a full physical exam before surgery, as instructed by your provider. This checks the health of your heart and lungs.
- Ask about medicines. Tell your surgeon about all medicines you take. Ask if you should stop taking any of them. This includes prescription medicines, as well as aspirin, ibuprofen, and other over-the-counter medicines. Tell your surgeon about any herbs, street drugs, vitamins, or supplements you take.
- Quit smoking. If you smoke, do your best to quit now. Smoking raises your risks during surgery and slows healing.
- Share your alcohol history. If you drink alcohol, let your provider know how much your drink. This is very important if you are a heavy drinker or have had alcohol withdrawal symptoms in the past. Alcohol withdrawal can be dangerous. But symptoms can be safely managed if your healthcare team knows about your alcohol history.
Getting ready the day before surgery
Follow any directions you are given for taking medicines and for not eating or drinking before surgery. This includes any instructions for doing bowel prep
The day of surgery
When you arrive at the hospital, you will be asked fill out certain forms. You will then change into a gown. An IV (intravenous) line will be inserted into your arm. This provides fluids and medicines. You’ll meet with your anesthesiologist or nurse anesthetist to discuss the medicine that helps you sleep during surgery. Ask any questions you have at this time. Before surgery begins, you’ll be given general anesthesia to put you into a deep sleep. A soft tube (catheter) may be placed into your bladder to drain urine.
If open surgery is needed
During the procedure, the surgeon may find that it is safer to change to open surgery. This method uses one larger cut (incision) instead. In most cases, this change happens because of something that could not be seen on scans done before the surgery. It doesn’t mean that anything went wrong. Changing to open surgery is done to give you the best result.
During your surgery
- Your surgeon makes several small incisions.
- A long, thin tube (laparoscope) is then placed into 1 of the small incisions. This lets your surgeon see your colon on a video screen.
- The surgical tools are placed into the other incisions. (A larger incision may be made later to remove a part of the colon.)
- The problem part of the colon is removed (resected). Sometimes the 2 ends of the colon are joined. This is called an anastomosis.
- Once surgery is done, you’ll be taken to a recovery room.
|Possible incision sites|
Possible benefits of a laparoscopic approach
Types of colon resection
The idea of having part of your colon removed may sound scary. But part or all of the colon can be removed without causing serious problems. After the section of bowel is removed, the 2 ends are then reconnected (anastomosis). Below are some of the surgeries that can be performed on the colon. The type of surgery depends on the location of the colon problem.
After certain types of surgery, the colon and rectum may need to be free of stool while they heal. In other cases, the rectum has been removed or can’t be reconnected to the rest of the colon. In either case, a colostomy is needed. This creates a new opening in your belly area (abdomen) so waste can leave your body. You may need the new opening for a short time or permanently. Your healthcare provider will help you learn how to care for it.
Risks and complications
Risks and possible complications of colon surgery include the following:
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Vascular Access Port Implantation
Port implantation is surgery to place (implant) a port under the skin. For vascular access, it is placed into a vein. The port allows medicines or nutrition to be sent right into your bloodstream. Blood can also be taken or given through the port. During the procedure, a long, thin tube called a catheter is threaded into one of your large veins. The tube is then attached to the port. This usually sits under the skin of your chest and causes a small bump. To use the port, a special needle is passed through your skin and into the port. The needle can stay in your skin for up to 7 days, if needed. A port can stay in place for weeks or months or longer.
Why is a vascular access port needed?
A vascular access port may allow healthcare providers to give you:
- Chemotherapy or other cancer-fighting drugs
- IV treatments, such as antibiotics or nutrition
- Hemodialysis (for kidney failure)
The port may also be used to draw blood.
Before the procedure
Follow any instructions you are given on how to prepare.
Tell your provider about any medicines you are taking. This includes:
- All prescription medicines
- Over-the-counter medicines such as aspirin or ibuprofen
- Herbs, vitamins, and other supplements
Also be sure your provider knows:
- If you are pregnant or think you may be pregnant
- If you are allergic to any medicines or substances, especially local anesthetics or iodine
- Your full medical history, including why you will need the port
- If you plan on doing any contact sports
During the procedure
- Before the procedure, an IV may be put into a vein in your arm or hand. This gives you fluids and medicines. You may be given medicine through the IV to help you relax during the procedure. This is called sedation. But some surgeons place ports using general anesthesia.
- The chest is used most often for the port. In some cases, your belly (abdomen) or arm will be used instead.
- The skin over the insertion area is numbed with local anesthetic.
- Ultrasound or X-rays are used to help the healthcare provider guide the catheter into the proper location during the procedure.
- A cut (incision) is made in the skin where the port will be placed. A small pocket for the port is formed under the skin.
- A second small incision is made in the skin near the first incision. A tunnel under the skin is created. The catheter is put through the tunnel and into the blood vessel.
- The skin is closed over the port. It is held shut with stitches (sutures) or surgical glue or tape. The second small incision is also closed.
- A chest X-ray may be done to make sure the port is placed properly.
After the procedure
You may be taken to a recovery room where you’ll recover from the sedation. Nurses will check on you as you rest. If you have pain, nurses can give you medicine. If you are not staying in the hospital overnight, you will be sent home a few hours after the procedure is done. A healthcare provider will tell you when you can go home. An adult family member or friend will need to drive you home.
Recovering at home
- Take pain medicine as directed by your healthcare provider.
- Take it easy for 24 hours after the procedure. Avoid physical activity and heavy lifting until your healthcare provider says it’s OK.
- Keep the port clean and dry. Ask when you can shower again. You will need to keep the port dry by covering it when you shower.
- Care for the insertion site as you are directed.
- Don’t swim, bathe, or do other activities that cause water to cover the insertion site.
- To keep the port from getting blocked with blood clots, flush it as often as directed. You should be shown the proper way to flush the port before you go home. It is important to follow these directions.
Risks and possible complications of implantation
Risks and possible complications of having a port
When to seek medical care
Call your healthcare provider right away if you have any of the following:
- A fever of 100.4°F (38.0°C) or higher
- You can’t access or use the port properly
- You can’t flush the port or get a blood return
- The skin near the port is red, warm, swollen, or broken
- You have shoulder pain on the side where the port is located
- You feel a heart flutter or racing heart
- Swollen arm, if the port is placed in your arm