Deciding on surgery

The topic of whether cancer surgery does more harm than good is a valid issue. Surgery can be a curative treatment by itself or with other treatments such as chemotherapy or radiation. However, in addition to promoting a cure and healing, surgery may also create conditions that may increase your risk of metastasis.1Tohme S, Simmons RL, Tsung A. Surgery for cancer: a trigger for metastases. Cancer Research. 2017 Apr 1;77(7):1548-1552. 

Even though surgery is a routine treatment for solid tumors, surgery itself can promote the development of metastasis by releasing tumor cells into circulation, suppressing important immune defenses such as your cellular immune system and promoting the development of blood vessels to supply tumors (angiogenesis).2Kim SY, Kim NK et al. Effects of postoperative pain management on immune function after laparoscopic resection of colorectal cancer: a randomized study. Medicine (Baltimore). 2016 Jun 17;95(24):e4641.

Consider taking this handbook with you to discuss with your surgeon.


Inflammation from surgery is another condition that may increase risk of metastasis. Inflammation is a normal response to tissue being cut and is necessary in the process of healing wounds. However, evidence suggests that inflammation related to tissue trauma from surgery can also inhibit your natural immune response against cancer, leading to cancer growth and spread. The type of anesthesia used and other factors can also impact your anticancer immune response. Surgery is somewhat literally a classic “double-edged sword”, with the potential for both good and harm.

Low body temperature during surgery

Mild low body temperature (hypothermia) also worsens the suppression of your immune response from abdominal surgery.3Khanna AK, Perez ER, Laudanski K, Moraska A, Cummings KC. Perioperative care and cancer recurrence: Is there a connection? World Journal of Anesthesiology. 2014;3(1):31-45; Dang Y, Shi X, Xu W, Zuo M. The effect of anesthesia on the immune system in colorectal cancer patients. Canadian Journal of Gastroenterology & Hepatology. 2018 Apr1;2018:7940603. Hypothermia may impair your immune system’s ability to stop infection and kill cancer cells. Maintaining your body temperature during surgery will reduce your risk of immune suppression. Your surgical team will need to maintain your body temperature. You may want to ask about your surgery team’s approach.

Blood transfusions

Use of blood transfusion products can cause suppression of your immune response and increase your risk of recurrence.4Dang Y, Shi X, Xu W, Zuo M. The effect of anesthesia on the immune system in colorectal cancer patients. Canadian Journal of Gastroenterology & Hepatology. 2018 Apr 1;2018:7940603; Gelman D, Gelmanas A et al. Role of multimodal analgesia in the evolving enhanced recovery after surgery pathways. Medicina. 2018 May; 54(2): 20. Blood transfusion using your own blood (autologous transfusion) may reduce your risk of recurrence, though this is unclear and may not be recommended if you are anemic.5Khanna AK, Perez ER, Laudanski K, Moraska A, Cummings KC. Perioperative care and cancer recurrence: Is there a connection? World Journal of Anesthesiology. 2014;3(1):31-45.

Your stress response

Your stress level and other characteristics around the time of surgery can affect your immune system and may increase your risk of recurrence:

Find guidance on managing your stress response in this handbook.

Surgery or not?

Your decision to undergo surgery needs a full, open discussion with your oncology team about both benefits and risks.

Consider an analogy: You’re at home on a cold, snowy day, and suddenly you realize your house is on fire. If you stay in the house, the fire may kill you. If you go outside, you may develop pneumonia, and that may kill you down the road. 

The cancer in your body is like the fire. It might kill you pretty quickly if you do nothing, but that depends on how big the cancer (fire) is, how quickly it’s spreading, whether you’ve fireproofed your home, whether you have a fire extinguisher, and more. 

The threat of cancer spread or metastasis from surgery is like the risk of pneumonia. It’s a risk, but not a sure thing. And you may be able to take action to reduce that risk. Grabbing some warm clothes or contacting a neighbor could dramatically reduce your risk of pneumonia. Some surgical techniques and options can similarly reduce your risk of cancer spread related to surgery. 

This handbook discusses factors that can contribute to inflammation and immune dysfunction, and also measures that you and your surgical team can take to reduce the risk of cancer spread related to surgery. Options are available to reduce the risks of poor cancer outcomes posed by the anesthetic, blood transfusion, low body temperature (hypothermia), and complications after surgery.10Tohme S, Simmons RL, Tsung A. Surgery for cancer: a trigger for metastases. Cancer Research. 2017 Apr 1;77(7):1548-1552. 

Before deciding whether surgery is your best option, you need to discuss questions such as these with your oncology team and get clear answers:  

  1. What will likely happen if I don’t have surgery?
  2. What can I do to prepare myself to improve my immune function and reduce inflammation? (also see Preparing for surgery ›)
  3. How long can I take to bolster myself before surgery?
  4. What will the surgery team do to reduce inflammation and minimize the risk of cancer spread?
  5. What can I do after surgery to reduce my risks of cancer spread and metastasis? (also see In remission ›)

Reducing risks from surgery

You or your surgery team may be able to modify many of the risk factors linked to increased risk of cancer spread. See specific steps to reduce risks of recurrence and metastasis in Preparing for surgery › and On your surgery day ›

Chronic use of opioids decreases immune response. Minimizing use of opioids, while still maintaining the level of pain control you need, may also lead to better immune function and cancer outcomes. See Pain › for details.

A health professional who is trained in integrative approaches may have more tools to help you reduce inflammation, improve immune function, and improve your resilience before and after surgery. If your team doesn’t include someone with this expertise, consider adding an integrative oncologist, naturopathic oncologist, or functional medicine physician to your team if possible.

Helpful links

Keep reading about integrative approaches to surgery


Laura Pole, MSN, RN, OCNS

Senior Clinical Consultant
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Laura Pole is senior clinical consultant for CancerChoices. Laura is an oncology clinical nurse specialist who has been providing integrative oncology clinical care, navigation, consultation, and education services for over 40 years. She is the co-creator and co-coordinator of the Integrative Oncology Navigation Training at Smith Center for Healing and the Arts in Washington, DC. Laura also manages the “Media Watch Cancer News That You Can Use” listserv for Smith Center/Commonweal. In her role as a palliative care educator and consultant, Laura has served as statewide Respecting Choices Faculty for the Virginia POST (Physician Orders for Scope of Treatment) Collaborative as well as provided statewide professional education on palliative and end-of-life care for the Virginia Association for Hospices and Palliative Care.

For CancerChoices, Laura curates content and research, networks with clinical and organizational partners, brings awareness and education of integrative oncology at professional and patient conferences and programs, and translates research into information relevant to the patient experience as well as clinical practice.

Laura sees her work with CancerChoices as a perfect alignment of all her passions, knowledge and skills in integrative oncology care. She is honored to serve you.

Laura Pole, MSN, RN, OCNS Senior Clinical Consultant

Nancy Hepp, MS

Lead Researcher
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Ms. Hepp is a researcher and communicator who has been writing and editing educational content on varied health topics for more than 20 years. She serves as lead researcher and writer for CancerChoices and also served as the first program manager. Her graduate work in research and cognitive psychology, her master’s degree in instructional design, and her certificate in web design have all guided her in writing and presenting information for a wide variety of audiences and uses. Nancy’s service as faculty development coordinator in the Department of Family Medicine at Wright State University also provided experience in medical research, plus insights into medical education and medical care from the professional’s perspective.

Nancy Hepp, MS Lead Researcher


Diljeet Singh, MD, DrPH

Gynecologic Oncologist
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Dr. Singh practices gynecologic oncology with Virginia Oncology Associates Integrative Gynecology Oncology. She was named a “Top Doctor” by Northern Virginia Magazine in 2016.

Diljeet Singh, MD, DrPH Gynecologic Oncologist

Whitney You, MD, MPH

Maternal-Fetal Medicine Physician
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Dr. You is a physician specializing in maternal-fetal medicine (MFM) with a specific interest in cancer in the context of pregnancy. She completed a postdoctoral fellowship in health services research with a focus in health literacy and received a Master of Public Health.

Whitney You, MD, MPH Maternal-Fetal Medicine Physician

Last update: May 13, 2024

CancerChoices provides information about integrative in cancer care, a patient-centered approach combining the best of conventional care, self care and evidence-informed complementary care in an integrated plan cancer care. We review complementaryin cancer care, complementary care involves the use of therapies intended to enhance or add to standard conventional treatments; examples include supplements, mind-body approaches such as yoga or psychosocial therapy, and acupuncture therapies and self-care lifestyle actions and behaviors that may impact cancer outcomes; examples include eating health-promoting foods, limiting alcohol, increasing physical activity, and managing stress practices to help patients and professionals explore and integrate the best combination of conventionalthe cancer care offered by conventionally trained physicians and most hospitals; examples are chemotherapy, surgery, and radiotherapy and complementary therapies and practices for each person.

Our staff have no financial conflicts of interest to declare. We receive no funds from any manufacturers or retailers gaining financial profit by promoting or discouraging therapies mentioned on this site.

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