Surgery for colon cancer
Surgery is the most common treatment for colon cancer and should be carried out by a surgeon who specialises in bowel surgery.
The type of surgery you have will depend on the stage of the cancer and where it is in the bowel. Your doctor will discuss this with you.
Enhanced recovery programme (ERP)
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Some hospitals follow an enhanced recovery programme, which can help reduce complications following surgery and speed up your recovery. The programme involves careful planning before your operation. This makes sure that you’re properly prepared and any arrangements that are needed for you to go home are already in place. You’ll be encouraged to take high-protein and high-calorie supplements before and after your surgery. Also you’ll be encouraged to start moving around as soon as possible, sometimes on the day of the operation.
The surgeon will try not to use any tubes or drains unless absolutely needed. Any catheters and fluids through a vein will be removed soon after surgery. You’ll also be allowed to eat and drink soon after surgery. After you’ve gone home, you’ll be regularly reviewed to make sure that you’re recovering well. You can ask your doctor whether you will be suitable for this type of surgery. Not all hospitals use the ERP, and it’s not suitable for everyone.
Before your surgery, the doctor and specialist nurses will explain the operation to you. They’ll tell you what to expect immediately after the surgery and in the few days after it. This is a good opportunity to ask any questions about the operation.
You may be admitted to the ward the day before your operation, so that the doctors and nurses can do any further tests. Some hospitals ensure that all of these tests are done beforehand and admit patients on the day of their surgery.
To make sure that your bowel is completely empty, you may be asked to follow a strict diet and take a medicine (laxative) to help empty your bowels the day before surgery. Your nurse or the doctor will explain this to you. You’ll be given antibiotics as an injection into a vein (intravenously) just before surgery to prevent infections.
Types of colon cancer surgery
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Removal of the whole colon is called a total colectomy. Removal of half of the colon is known as a hemi-colectomy. Either the left side or the right side may be removed, depending on where the cancer is. In a left hemi-colectomy the left half of the transverse colon and the descending colon is removed. During a right hemi-colectomy the right half of the transverse colon and the ascending colon is removed.
Some people have a sigmoid-colectomy, (removal of the sigmoid colon), or a transverse colectomy (removal of the transverse colon). The sigmoid colon and transverse colon are shown below.
During the surgery, the piece of bowel that contains the cancer is removed and the two open ends are then joined together. The join is known as an anastomosis. The lymph nodes near the colon are also removed, because this is usually the first place the cancer spreads to.
After surgery to remove a cancer in the colon, you’ll usually have a wound that goes in a straight line from just below your breastbone (sternum) to just above the level of your hipbone.
Laparoscopic (keyhole) colectomy
This operation uses four or five small cuts in the abdomen rather than one bigger incision. A laparoscope (a thin tube with a light and camera) is passed into the abdomen through one of the cuts and the cancer is removed. Recovery from this operation is usually quicker. This type of surgery is used by many hospitals. Your surgeon will discuss this with you if it’s appropriate for you.
Very early-stage colon cancers can sometimes be removed using an operation called local resection. Using an endoscope, similar to the one used to take a biopsy, the surgeon will remove the cancer from the lining of the bowel. A pathologist will examine the cancer that’s been removed. If it’s found to be high-grade, your surgeon may recommend that you have a second operation. This is to remove more of the colon to make sure that no cancer cells have been left behind.
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If the ends of the bowel can’t be joined together, the upper end can be brought out onto the skin of the abdominal wall. This is known as a stoma and can be either an ileostomy, which is usually temporary, or a colostomy, which is often permanent. A bag is worn over the stoma to collect the stool (bowel motions). A temporary stoma allows the newly joined bowel to heal. Another operation to rejoin the bowel needs be done a few months later. The operation to rejoin the bowel is known as a stoma reversal. Permanent stomas (usually colostomies) are created because it has not been possible to reconnect the bowel. Only a small number of people with cancer of the colon will need a permanent stoma.
Stool passed through an ileostomy always contains more liquid than a colostomy, and the amount is dependent on what you eat. This can be more difficult to deal with than a colostomy. Your stoma nurse will give you advice and guidelines on how to manage an ileostomy.
Surgery for advanced colon cancer
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If the cancer is too large to be removed and is pressing on the bowel causing it to narrow, it may be possible to insert a thin metal tube (a stent) into the bowel to keep it open. The stent is inserted using a colonoscope often with the guidance of x-ray imaging. You’ll be given a mild sedative to help you relax and you may have a short stay in hospital.
The most common place for colon cancer to spread to is the liver. Over the last few years, better surgical techniques mean that it’s now more possible for surgeons to remove cancers that have spread to the liver. This can sometimes lead to a cure. Chemotherapy may be given before or after the operation.
This treatment is not possible for everyone whose colon cancer has spread to the liver. Your doctor or specialist nurse can discuss this with you further.
Surgery may sometimes be used to remove the cancer when it has spread to the lungs. Sometimes chemotherapy may be given before or after the surgery.
We have more information about secondary cancer in the liver and secondary cancer in the lungs.
Eileen talks about being diagnosed with colon cancer and the surgery she had to treat it.
Clinical nurse specialist for stoma care talks about having a stoma after surgery for cancer.