Surgical emergencies

Most surgical problems in cancer patients are not urgent. Tumors rarely grow or metastasize rapidly. Surgical evaluation can usually proceed at a measured pace over a number of weeks to accurately assess the patient's underlying cancer, to define associated comorbidities that may modify treatment decisions, to consult various disciplines to devise multimodal therapies, and to work with patients and families to create care plans that account for patient preferences and family needs. In light of this panoply of issues that affect surgical decision making in cancer patients, the presence of a surgical emergency requiring prompt evaluation and intervention is especially problematic. Thorough evaluation of cardiac, pulmonary, and other comorbidities may not be feasible. Discussions with medical and radiation oncologists and other consultants may be constrained by time and availability. Attempts to inform and understand patient and family wishes may be confounded by changes in emotional state and cognitive ability caused by pain, anxiety, fear, and the need to intervene promptly.