Steps can be taken to prevent such a situation from arising in the first place. Your surgeon can greatly reduce the chance of finding something unexpected during an operation by checking you carefully beforehand. This means getting a detailed history of your symptoms, examining you carefully, and arranging, with your agreement, whatever tests are necessary to provide a complete picture. In the example I have described, there would probably have been bladder symptoms such as burning, or passing urine more frequently, and/or in smaller amounts than normal. There may have been obvious blood passed or if not, traces of blood would probably have been found in the urine by testing. Special contrast X-rays or endoscopic examination of the bladder (cystoscopy) could have confirmed bladder involvement by the cancer. If the true situation had been established before operating, this person could have had control over the treatment decision, and surgeon would not have been placed in a dilemma.
Here is how to be as sure as possible that your surgeon will be able to carry out the operation you have agreed to. When your surgeon recommends a certain operation, ask how sure he or she is that this operation will be possible. For example, if the aim of the operation is complete removal and possible cure, ask whether the diagnosis of cancer is definite and the exact type known. Ask whether the cancer has already spread into nearby organs. Have the appropriate tests been done to check this? How does your rpe of cancer usually spread? How sure are they that it as not already spread to nearby lymph glands or through the bloodstream? How can the likely sites for secondary growths be checked? These questions apply in the case of potentially curative surgery. Later in this chapter I will give you some idea of what should be known before attempting surgery that has various other aims.
*226/40/1*
