Gearing up for surgery for reproductive system cancers in women: checklist

Investigations for gynecological cancers: checklist

A] For diagnosis:

• Cervical cancer: PAP smear, Cervical biopsy or endocervical curettage.
• Endometrial cancer: dilatation and curettage
• Ovarian cancer: ascitic fluid cytology or FNAC or Tru cut biopsy of ovarian mass or deposit.

B] Metastatic work up:

Whole body PET CT. or, CECT abdomen and pelvis, Ct chest

C] Local extent or resectability:

•      MRI pelvis with CECTAbdomen/ whole body PET CT: in case of cervical or endometrial cancer
•      CECT abdomen and pelvis or whole body PET CT: for ovarian cancer.

D] for assessment of fitness for surgery:

❏  CBC/ hemogram,

❏  LFT [liver function tests],

❏  RFT [renal / kidney function tests],   

❏  PT,PTT,INR  [coagulation profile],

❏  BG: blood group

❏  Random blood sugar, Urine routine examination,

❏  Viral markers: HIV, HCV, HBsAg

❏  Cardiac assessment: Chest X Ray, ECG, 2D ECHO

❏  Other tests as per individual risk factors

❏  Fitness evaluation from Physician and anesthesiologist

Declare:

 ❏  Previous surgeries– be it any,

❏  Allergies: drug allergy, sticking allergy or any substance allergy.

❏  Comorbidities like hypertension or high BP, diabetes, previous heart attack, arrhythmias, previous cardiac stenting or bypass surgery, asthma etc

❏  If you are taking blood thinner [commonly used being aspirin or clopidogrel], it needs to be stopped at least 5 days prior with your cardiologist’s advice.

❏  Policy for blood reservation: usually blood transfusions are not needed in this surgery unless the patient has anemia in pre op assessments. However on the safer side blood is reserved so it can be given in untoward emergencies.

Pre surgical checklist:Dos & Don’ts 

Pre-Operative

❏Blood thinners: Stop clopidogrel, aspirin or similar medications prior to the surgery with the physician’s advice.

❏Nil by mouth & Bowel preparation: In anticipated major or supra major surgeries and those involving surgery on rectum or colon or small intestines, emptying of intestines by medications &/or enemas are given. 

The Peglec powder is to be mixed in water with strong lemon juice to make it acceptable and mask its taste. Such 1 lt solution is to be consumed sip by sip over one hour an evening prior to surgery. Patient  would thereafter pass stools and the intestines would be cleansed medically thereby. She can consume clear liquids till midnight or 6-8 hrs scheduled time of surgery. Patients need to maintain 8 hours of fasting prior to surgery, conventionally. The newer ERAS protocols allow the patient to take clear energy drinks containing glucose, salts etc upto 4-6 hrs prior to surgery. The RMO or Nurses would communicate the plan for you

❏Shower: 

Shower the night before and the day of surgery.

 • Use approximately one ounce of antiseptic soap (CHLORHEXIDINE OR SAVLON      soap :  30 ml), washing below the neck only. You may use your regular soap / shower gel or shampoo for face and hair.

 • Rinse well.

 • Repeat above steps.

 • Use a freshly laundered towel to dry off after each shower.

 • Put on freshly laundered garments (night clothes, underwear, etc.).

 WARNINGS – This soap is for external use only. DO NOT USE ON FACE. Keep soap out of your eyes, ears, and mouth. Misuse around eyes could cause serious and permanent eye injury. If soap should contact the eyes or ears, rinse out thoroughly and promptly with water. NOT for use as a shampoo or douche.

❏Arrange for a family member, friend or near keen to bring you to the hospital, sign consent as a responsible and near relative.  

❏The secretary from the Suyog Cancer clinic or RMO doctor will get in touch with you in the evening before surgery to confirm time and location for check in for your surgery. If you have not received a call by 4 p.m., you may call on 9819073781 . 

❏Please discuss any medications you usually take in the morning with the on duty RMO at hospital.

 Day of Surgery   

❏  Leave jewellery and valuables at home.  NO METAL CONTAINING THING ON PATIENT’S BODY DURING SURGERY like chain, ear ring or rings in toes, bracelet etc

❏  Wear your glasses instead of contacts if you have them. Hand it over to relatives before entering the operating room.

❏  Please do not use deodorant or lotions on your skin and nail paints too.

❏      Avoid using hair spray or gel.

❏      Wear comfortable clothing and hospital clothings only.

Post surgery: 

•  Food after surgery: depending on extensive surgery, Dr and nurses will inform about food intake. Usually, patients are kept nil by mouth for 8-12 hours. Thereafter clear liquids are started as per patient’s tolerance. If no intestines are operated during the surgery, semisolid foods are given on day 1 or 2 and slowly escalated towards solids and normal diet.

•  Position after surgery: Better to remain 30- 45 degree head and back inclined up till full recovery.

•  Post op treatment: Nurses will give the IV fluids as per instruction and sugars will be timely checked as ordered. Antibiotics,anti acidity  and pain medications will be given for 1-3 days and oral medications thereafter.
• Epidural catheter: there could be a tiny bore tube inserted before surgery into the spine by an anesthesiologist, called an epidural catheter. It is used to deliver medicines to alleviate pain post surgery. It is usually kept in place for 3 days after surgery.

• Patient’s previous medicines for comorbidities like blood pressure or diabetes etc can be resumed after the physician’s advice.

• Dressings & Suture removal: Dressing will be changed before discharge. It is advisable to actively learn and follow the dressing technique so relatives can do it at home as required. My patients are advocated to take bath with soap and water over the surgical clips, keep it clean and observe it thereby, if need be , click a photo and send across for any concern. Clips are usually removed after 14 days post surgery.

Post anesthesia recovery symptomes: 

You may feel drowsy and have minor side effects after your procedure or surgery with anesthesia. These side effects include:

• Sore throat        • Headache        • Muscle aches • Dizziness off and on

• Nausea               • Vomiting (rarely) 

Some of these symptoms may be from the pain medicine you are taking. The side effects from anesthesia usually go away quickly in the hours after your procedure. Still, it may take several days for your body to recover from the stress of surgery and anesthesia.Urination: there would be a urinary catheter for 3-5 days post surgery. So patients need not get out of bed for micturition.