# Surgery Support; Before and After Care Surgery can be necessary, life-saving, and sometimes curative. They can also create a short biological window in which inflammation rises, immune surveillance drops, and residual tumour cells may gain an advantage. This page focuses on the practical perioperative questions that matter most before and after cancer surgery. > **Related group discussion thread (older thread title):**\ > [Surgery Pre and Post Do's and Don'ts](https://www.facebook.com/groups/healingcancerstudysupport/permalink/384807872434835/) ### Related pages * [Dormant Cancer Cells](/myhealingcommunity-docs/treatment-resistance/treatment-resistance/dormant-cancer-cells-2.md) * [Biopsy Support; Before and After Care](/myhealingcommunity-docs/biopsy-support-before-and-after-care.md) * [Surgery — Member Experiences & Open Questions](/myhealingcommunity-docs/surgery-support-before-and-after-care/surgery-member-experiences-and-open-questions.md) {% hint style="warning" %} This page is educational only. It is not medical advice. Always review perioperative medication, supplement, and anaesthesia decisions with your surgeon, anaesthetist, oncologist, and any integrative practitioner involved. {% endhint %} *** ### What this page is for Use this page when planning around: * lumpectomy * mastectomy * tumour resection * debulking surgery * other cancer-related procedures The goal is not to avoid surgery when it is needed. The goal is to reduce avoidable perioperative risk. *** ### Why surgery can increase recurrence risk Surgery removes the tumour. It also creates tissue injury, stress signalling, and a wound-healing response. That matters because the perioperative period can temporarily favour the survival of residual cancer cells. #### Main mechanisms * **Surgical immunosuppression** — NK-cell and T-cell activity can fall after major tissue injury. * **Adrenergic stress signalling** — catecholamines rise and may support tumour-cell survival, migration, and immune evasion. * **COX-2 and prostaglandin signalling** — post-surgical inflammation may suppress anti-tumour immunity and support adhesion and angiogenesis. * **Wound-healing stemness signals** — normal repair biology may also support more aggressive behaviour in residual tumour cells. * **Dormant micrometastatic outgrowth** — some recurrence patterns suggest surgery can help trigger growth of previously controlled microscopic disease. This is the biological rationale behind interest in perioperative beta-blockade, NSAID use, ERAS protocols, and anaesthetic choice. *** ### What is worth monitoring There is no single routine blood test for “surgical metastasis risk”. Some perioperative markers are still worth following.
ParameterMethodTimingWhy it matters
Inflammatory markersCRP, IL-6, white cell countPre-op baseline, then early post-opHigher inflammation often tracks with worse recovery biology
NK-cell activitySpecialist immune assayPre- and post-op when availableResearch-level marker of immune competence
Galectin-3Blood testPre-op and follow-upSometimes used when modified citrus pectin is being considered
Tumour markersStandard blood tests such as CA15-3 or CEABaseline, then follow-upCan help with early recurrence surveillance in selected cancers
Wound assessmentClinical reviewPost-op visitsDetects infection, seroma, dehiscence, and delayed healing
Nutritional statusAlbumin, pre-albumin, BMI, intake reviewPre-opStrongly affects recovery and wound healing
Ask the team what they routinely check. If you are implementing a more deliberate perioperative protocol, it is reasonable to ask about inflammatory markers after surgery. *** ### The strongest perioperative strategies #### Propranolol plus etodolac This is one of the most important evidence-backed perioperative combinations. The rationale is dual blockade of: * **beta-adrenergic stress signalling** * **COX-2-driven prostaglandin signalling** Human perioperative trials have shown favourable effects on metastatic biomarkers, inflammatory markers, and tumour microenvironment signals. A colorectal phase III trial also reported *lower* 5-year recurrence risk with combined propranolol plus etodolac. This is promising. It is not a self-directed protocol. **Important cautions:** * propranolol is not suitable for everyone * asthma, hypotension, bradycardia, and some rhythm disorders matter * NSAID timing must be coordinated with the surgeon because of bleeding risk * this approach requires prescription-level oversight *** #### Propofol-based TIVA Anaesthetic choice may matter more than many patients are told. Large observational studies and meta-analyses suggest **propofol-based total intravenous anaesthesia (TIVA)** may be associated with better cancer outcomes than volatile inhaled anaesthetics. The likely reasons include effects on: * angiogenesis * inflammatory signalling * NK-cell preservation * tumour-cell invasion biology This evidence is still mostly observational. A definitive RCT answer is still pending. Even so, asking the anaesthetist whether **propofol-based TIVA** is appropriate is a reasonable perioperative question. *** #### ERAS protocol **Enhanced Recovery After Surgery (ERAS)** is already guideline-backed. This is not fringe. It is mainstream perioperative optimisation. Key parts include: * avoiding unnecessarily long fasting * allowing clear fluids closer to surgery where protocol permits * carbohydrate loading when appropriate * early mobilisation * early nutrition * immunonutrition in selected cases ERAS helps reduce complications, shorten hospital stay, and blunt some of the surgical stress response. Ask whether your hospital uses an ERAS pathway. *** ### Integrative supports with early but incomplete evidence These options have biologic rationale or early human signal, but most do **not** yet have large perioperative oncology RCT data. #### Modified citrus pectin Modified citrus pectin is used to target **galectin-3**, a molecule involved in adhesion and metastatic behaviour. The main evidence is preclinical, with limited human data. It is best understood as a plausible adjunct rather than a proven perioperative anti-metastatic tool. *** #### Boswellia serrata Boswellia has early human window-of-opportunity data showing reduced tumour proliferation markers in breast-cancer tissue. That makes it more than a purely theoretical option. It may be relevant before surgery due to its anti-inflammatory effects, including modulation of COX-2 and 5-LOX. This still needs careful timing review with the surgical team. There is also a more specific **brain metastasis/cerebral oedema angle worth noting**. In irradiated brain-tumour patients, Boswellia has been studied for reducing cerebral oedema, with doses up to **4200 mg/day** reported without major adverse effects. The main practical limitation was pill fatigue. A later retrospective study in patients with **cerebral radiation necrosis after stereotactic radiosurgery for brain metastases** used target doses around **4050 to 4500 mg/day** for at least 2 months. In that uncontrolled series, some patients had complete or partial regression of necrosis or oedema, while others remained stable or progressed. This is **not direct surgery-trial evidence**. It is still relevant for brain-metastasis patients because perioperative brain care often overlaps with radiation history, oedema control, and steroid-sparing questions. The main practical takeaway is that **higher Boswellia dosing has been used under specialist supervision in neuro-oncology settings**, so standard supplement-label doses may not reflect the dose ranges studied for cerebral oedema. For broader context, see [Boswellia in Oncology](broken://spaces/Iyy2bZWxLPaSj5B4dS3v/pages/2tcZKQ9tiUok7zBsB1qu). *** #### Iodine Molecular iodine has human breast-cancer data suggesting benefit when used around surgery, with changes in invasiveness, apoptosis, and immune infiltration. This is not the same as casually using Lugol’s. Form matters. Dose matters. Medical supervision matters. *** #### Wound-healing nutrients The strongest general wound-healing support evidence is around: * **zinc** * **vitamin C** These are not cancer-specific breakthroughs. They are basic recovery supports with reasonable evidence in wound-healing settings. They may still be worth reviewing if nutritional status is poor. *** #### Topical scar and wound support Once the incision is fully closed, options with reasonable supportive use include: * silicone gel sheets * rosehip oil * aloe vera gel These are mainly scar-management and skin-recovery tools. They are not recurrence-prevention tools. *** ### Pre-op stop list This is one of the most practical parts of the page. Many supplements that feel harmless in everyday life become relevant around surgery because they may affect: * bleeding * blood pressure * sedation * anaesthetic metabolism * platelet function Always give the surgeon and anaesthetist a full medication and supplement list well before the procedure. #### Common examples that are often paused about one week before surgery These are commonly reviewed because of sedation, anaesthesia, or blood-pressure concerns: * St John’s wort * valerian * kava * ginseng * passion flower * hops * melatonin * 5-HTP * GABA * ephedra * high-dose licorice root * ginkgo #### Common examples often paused at least 3 days before surgery These are commonly reviewed because of bleeding or clotting concerns: * garlic * bromelain * ginger * curcumin * salvia * reishi * cordyceps * CoQ10 * resveratrol * green tea extract * high-dose vitamin E The exact timing varies. The surgical team needs to get the final say. *** ### Post-op red flags Escalate urgently for: * fever above **38°C** within the first week after surgery * increasing redness, heat, swelling, or discharge from the wound * wound opening or rapidly worsening pain * shortness of breath or chest pain * major limb swelling * persistent vomiting that prevents fluid or medication intake * confusion, persistent drowsiness, or unexpected altered consciousness * a sharp and unexplained tumour-marker rise during follow-up Do not wait for the next routine appointment if these happen. *** ### Themes from group experience The group discussion around surgery repeatedly highlights the same themes: * anaesthetic choice is often not discussed unless the patient raises it * supplement timing is frequently left too late * emotional preparation changes the recovery experience for many people * wound healing and scar outcome can differ a lot depending on surgical approach, nutrition, and post-op support These are not substitutes for evidence. They are still useful signals about what patients often wish they had asked earlier. For the fuller community-sourced archive, see [Surgery — Member Experiences & Open Questions](/myhealingcommunity-docs/surgery-support-before-and-after-care/surgery-member-experiences-and-open-questions.md). *** ### Questions to ask your team 1. Is **propofol-based TIVA** appropriate for me? 2. Does the hospital use an **ERAS** protocol? 3. Are there any perioperative **beta-blocker** or **NSAID** strategies appropriate in my case? 4. Which supplements do you want me to stop, and on what date? 5. What is the planned surgical approach, and what are the cosmetic versus tissue-trauma trade-offs? 6. What do you want me to watch for in the first week after surgery? 7. Which inflammatory or recovery markers are worth checking after surgery? 8. If I am nutritionally depleted, what is the plan for wound-healing support? *** ### Bottom line The perioperative period is not passive downtime. It is an active biological phase that can influence inflammation, immunity, healing, and possibly recurrence risk. The most evidence-supported practical priorities are: * ask about **propofol-based TIVA** * ask whether your care follows **ERAS** principles * review whether **propranolol plus etodolac** is appropriate in your case * stop bleeding-risk and anaesthetic-interaction supplements on time * treat wound infection and clotting symptoms as urgent Integrative supports such as modified citrus pectin, Boswellia, iodine, and wound-healing nutrients may have a place. They are best treated as adjuncts, not substitutes for perioperative medical planning. *** ### Key References The systemic response to surgery triggers the outgrowth of distant immune-controlled tumors\ Surgical trauma-induced immunosuppression in cancer\ Perioperative events influence cancer recurrence risk after surgery\ Reducing the risk of post-surgical cancer recurrence\ Perioperative COX-2 and β-Adrenergic Blockade Improves Metastatic Biomarkers in Breast Cancer Patients\ Impact of propofol-based TIVA versus inhalational anesthesia on overall survival following cancer surgery\ Anesthetic technique and cancer outcomes: a meta-analysis of total intravenous versus volatile anesthesia\ ERAS Society Guidelines\ The anti-proliferative effects of a frankincense extract in a window of opportunity Phase Ia clinical trial for patients with breast cancer\ Boswellia serrata acts on cerebral edema in patients irradiated for brain tumors\ Boswellia serrata for cerebral radiation necrosis after radiosurgery for brain metastases\ Exploring the promising therapeutic benefits of iodine and cancer\ Systematic review and meta-analysis of the effect of zinc on wound healing\ A Systematic Review on the Role of Vitamin C in Tissue Healing\ Treatment with supplementary arginine, vitamin C and zinc in patients with pressure ulcers\ Herbal Medicines and Perioperative Care\ {% hint style="warning" %} This information is for education only. It is not medical advice, diagnosis, or treatment. Please speak with a qualified clinician before making changes to care, medication, or supplement use. {% endhint %} {% hint style="info" %} © 2026 Abbey Mitchell. All rights reserved. Please share by URL rather than copying page text. {% endhint %} --- # Agent Instructions: Querying This Documentation If you need additional information that is not directly available in this page, you can query the documentation dynamically by asking a question. Perform an HTTP GET request on the current page URL with the `ask` query parameter: ``` GET https://myhealingcommunity.gitbook.io/myhealingcommunity-docs/surgery-support-before-and-after-care.md?ask= ``` The question should be specific, self-contained, and written in natural language. The response will contain a direct answer to the question and relevant excerpts and sources from the documentation. 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