Medical Oncologist
CION Cancer Clinics
Are you fit enough for cancer surgery? | CION Cancer Clinics
Whether you are fit enough for cancer surgery is decided by your surgeon and anaesthetist, after tests and a check-up. They ask whether your heart, lungs, strength and other illnesses will let you come through this particular operation and its recovery. Age alone rarely decides it. If you are not fit yet, the answer is often a plan to improve, not a refusal. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
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Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed September 2026, next review due September 2027
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On this page
- Who decides if you are fit enough for cancer surgery?
- What does the team weigh before saying yes?
- How is your fitness actually assessed?
- What do families often get wrong about fitness?
- What do the fitness words on your file mean?
- What happens if you are not fit enough yet?
- Common questions about fitness for surgery
The short answer
Who decides if you are fit enough for cancer surgery?
Your surgical team decides, after tests and a check-up with the anaesthetist. Fitness means your heart, lungs and body can safely come through this particular operation and the recovery that follows it.
Fitness is measured against one operation
There is no single fitness test. A person may be fit for a short operation on the skin or breast and not yet fit for a long operation inside the chest or abdomen. The bigger the operation, the more the body is asked to do in the days after it. So the same report can mean different things for different surgeries.
Age alone does not decide it
A seventy-year-old who walks every morning may be fitter than a younger person with poorly controlled sugar and a weak heart. The team looks at how you actually live and move, not the number on your Aadhaar card.
What this page cannot tell you
It cannot tell you whether you, or your parent, should have an operation. That judgement belongs to the treating team, who have the scans, the reports and the examination in front of them.
If you have been told you are not fit yet, ask whether that means "not now" or "not this operation". The answers lead to very different next steps.What is looked at
What does the team weigh before saying yes?
No one factor settles it. The team puts these together and asks how much reserve your body has.
Heart
Whether the heart pumps well and keeps a steady rhythm under the strain of anaesthesia, blood loss and fluids.
Usually checked with
- An ECG
- An echo, if needed
Lungs
Whether you can breathe deeply and cough well after the operation. This matters most for chest and upper abdominal surgery.
Usually checked with
- A chest X-ray
- Lung function tests, for some
Nutrition and strength
Recent weight loss, low protein in the blood and weak muscles all slow healing. They are also among the easiest things to improve before the day.
Other illnesses
Diabetes, kidney disease, liver disease and breathing problems do not rule surgery out. They need to be as well controlled as possible first.
Daily activity
Can you climb a flight of stairs without stopping? Can you walk to the market and back? Everyday activity is one of the most useful clues the team has.
Not sure whether this applies to you?
Ask an oncologistThe pathway
How is your fitness actually assessed?
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The surgeon's clinic
The surgeon asks about your illnesses, medicines, habits and how active you are. Bring every prescription and report, including old ones from other hospitals.
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Tests
Blood tests, an ECG and a chest X-ray are common. Others, such as an echo or lung function tests, are added only when your history or the size of the operation calls for them.
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The pre-anaesthetic check-up
The anaesthetist reviews the results, examines you and plans how to keep you safe during the operation. This is often where the fitness question is answered.
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Other specialists, if needed
A heart, chest, kidney or diabetes doctor may be asked for an opinion. This can add days, and it is time well spent.
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The decision is explained to you
You hear whether surgery can go ahead, what the added risks are for you, and what could be improved first. Bring the family member who will help you decide.
Did you know
Fitness can change in a few weeks. Walking daily, eating enough protein, stopping smoking and getting sugar under control can all make a person safer for surgery. This preparation is called prehabilitation.
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Commonly believed
What do families often get wrong about fitness?
"He is over seventy, so they will not operate."
Many people in their seventies and eighties have major cancer operations. The team looks at strength, memory, other illnesses and daily activity. Age is one part of the picture, and rarely the deciding part on its own.
"She has diabetes and BP, so surgery is out."
These conditions are very common in people having cancer surgery. What matters is how well they are controlled. The operation may wait a little while sugar or blood pressure is brought down, and then go ahead.
"All the tests are normal, so there is no risk."
Normal tests lower the risk. They do not remove it. Every operation carries some risk, and your surgeon should explain the ones that apply to you before you sign the consent form.
"Once they say unfit, that is final."
Sometimes it means "not yet". A second look after treating a chest infection or improving nutrition can change the answer. When surgery is truly unsafe, other treatments such as radiotherapy or chemotherapy may still be possible.
On your notes
What do the fitness words on your file mean?
- Performance status
- A simple score of how much you can do for yourself in daily life. A lower score means you are more active.
- ASA grade
- The anaesthetist's rating of your general health before an operation. A higher grade means more health problems to plan around.
- Frailty
- Reduced strength and reserve, often with weight loss, slow walking and tiredness. It is measured, not guessed from age.
- Optimisation
- Improving a condition, such as sugar, blood pressure or nutrition, before the operation date.
- High-risk consent
- A consent form noting that your risk is higher than usual. It means the risk was explained, not that surgery is refused.
If you are told to wait
What happens if you are not fit enough yet?
Usually the team names what needs to improve and gives you a plan to get there. The operation is then planned again once that has happened.
Why waiting is weighed carefully
Cancer does not always allow a long wait, and the team knows it. They balance the time needed to make you safer against the time the cancer can safely be left. That is why some delays are a few days and others are longer. Ask how long they expect, and what will be checked again.
Who surgery may not suit
For some people, a large operation carries more risk than benefit. This can happen with severe heart or lung disease, or when the body is very weak. In those cases the team may suggest a smaller operation, or a treatment without surgery.
Questions worth asking
What exactly is holding things back? What can we do at home? Who will review it, and when? What are the choices if fitness does not improve?
Questions we are asked
Common questions about fitness for surgery
My father is elderly. Can he still have cancer surgery?
Often, yes. Older people have major operations every day. The team looks at how active he is, his memory, his heart and lungs, and his other illnesses. They may add a frailty check. Bring someone who knows his daily routine well, because that information helps the team more than his age does.
Can I do anything at home to become fitter before the operation?
Usually, yes. Walk a little more each day, eat regular meals with protein, stop smoking and alcohol, and keep your sugar and blood pressure medicines going as prescribed. Ask the team before starting anything strenuous. Even a short period of preparation can help recovery.
Why was my operation postponed after the check-up?
Something in your results or examination needs attention first. Common reasons are high sugar, high blood pressure, a low haemoglobin, a chest infection or a heart finding that needs a specialist's view. Ask what the reason is, what is being done about it, and when you will be seen again.
Do I need a heart doctor's clearance?
Not everyone does. It is usually asked for when there is known heart disease, chest pain, breathlessness on mild effort, an abnormal ECG or a planned major operation. The heart doctor gives an opinion on risk. The final decision still sits with the surgeon and anaesthetist together.
Will I be told my risk as a number?
Sometimes the team uses a risk score, and sometimes they describe the risk in words. Either way, you are entitled to a clear explanation of the main risks for you. If something is not clear, ask again. A good team would rather you asked twice than signed without understanding.
I was told I am unfit. Should I get a second opinion?
You can, and many families do. Take every report and scan with you. A second team may see it the same way, or may suggest a different operation or a non-surgical treatment. Either answer helps you decide with more confidence.
Does chemotherapy before surgery affect my fitness?
It can. Chemotherapy may lower blood counts, cause tiredness and reduce appetite. The team usually leaves a gap between the last cycle and the operation so the body can recover, and repeats some tests before the date is fixed. Keep eating and walking during treatment where you can.
Are the fitness tests covered by Aarogyasri or insurance?
They are often covered when they form part of an approved cancer surgery plan. Aarogyasri, CGHS, ECHS, EHS and cashless insurance each have their own rules. Call the helpline with your card or policy details and the team can check what applies to you before your visit.
Meet the Specialists
17+ senior cancer specialists. One panel for your case.
Trained at AIIMS, Tata Memorial, and leading international centres. Combined 150+ years of experience. Every complex case is reviewed by 3+ of them — together.
Medical Oncologist
Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
Medical Oncologist
Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
Medical Oncologist
Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
Medical Oncologist
Medical Oncologist
Surgical Oncologist
Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
Surgical Oncologist
Surgical Oncologist
Dr. Vinay Mamidala
MBBS, MS(General Surgery), M.Ch(Surgical Oncology), FMAS, FARIS(Ongoing)
Surgical Oncologist
Radiation Oncologist
Radiation Oncologist
Radiation Oncologist
Hematologist
Surgical Oncologist
Dr. Vajja Sandeep Kumar
MBBS, MS (General Surgery), DrNB (Surgical Oncology), FALS Oncology
Surgical Oncologist
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Sources
- Royal College of Anaesthetists — Patient information
- Cancer Research UK — Surgery for cancer
- American Cancer Society — Cancer Surgery
- Macmillan Cancer Support — Cancer information and support
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Tests Done Before Cancer SurgeryThe full list of checks and why each one is asked forPrehabilitation: Getting Stronger Before an OperationWhat you can do in the weeks before to be saferBeing Declared Unfit for Surgery: What Happens NextThe choices that remain if surgery is not safeFitness, Tests and PrehabilitationEvery guide on getting ready for an operation
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