Surgery for colon cancer

Surgery is the most common type of treatment for colon cancer and should be carried out by a surgeon who specialises in bowel surgery.

There are different types of colon cancer surgery. Your doctor will discuss with you the most appropriate type of surgery, depending on the stage| of your cancer and where it is in your bowel.

 

Before your operation Back to top

Before your surgery the doctor and specialist nurses will explain the operation to you. They will tell you what to expect immediately after the surgery and in the few days following. This is a good opportunity to ask any questions you may have about the operation.

You’ll probably be admitted to the ward the day before your operation, so that the doctors and nurses can do any further tests. To make sure that your bowel is completely empty, you’ll be asked to follow a strict diet and take a medicine (laxative) to help your bowels to empty 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 and after surgery to prevent infections.

Types of colon cancer surgery Back to top

Removal of all or part of the colon

Removal of the whole colon is called a total colectomy.

If only half of the colon needs to be removed, this is known as a hemi-colectomy . Either the left side or the right side may be removed, depending on where the cancer is.

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 in the diagram in our section on the  large bowel|.

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 to 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 will usually have a wound that goes in a straight line from just below your breast bone (sternum) to just above your pelvis.

Laparoscopic colectomy

This operation uses four or five small cuts in the abdomen rather than one bigger incision. A laparoscope (a thin, flexible tube containing 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. However, this is a new operation that is currently being researched to find out its risks and benefits. 

Local resection

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 has been removed. If it’s found to be high-grade| your surgeon may recommend that you have a second operation. This is done to remove more of the colon to make sure that no cancer cells have been left behind. 

Colostomy Back to top

If the ends of the bowel can’t be rejoined, the upper end can be brought out onto the skin of the abdominal wall. This is known as a colostomy, and the opening of the bowel is known as a stoma|. A bag is worn over the stoma to collect the stool (bowel motions). Sometimes a colostomy is only temporary and another operation to rejoin the bowel can be done a few months later.

The operation to rejoin the bowel is known as stoma reversal. If it isn’t possible to reverse the colostomy, the stoma is permanent. However, only a small number of people with cancer of the colon will need a permanent colostomy. 

Ileostomy Back to top

Some people need to have an operation called an ileostomy. Here, the end of the small bowel (ileum), or a loop of ileum, is brought out onto the right side of the abdominal wall. As with a colostomy, stools are then collected in a bag worn over the stoma.

For people with cancer of the colon, this is generally a temporary operation. If it’s likely that at a later date the bowel will be rejoined and the stoma removed (reversed), your specialist nurse will discuss this with you. 

Surgery for advanced colon cancer Back to top

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|. You will be given a mild sedative to help you relax and may have a short stay in hospital. 

Surgery may sometimes be used to remove the cancer when it has spread to another part of the body, such as the liver or lungs. Sometimes chemotherapy may be given before or after the surgery.

You may find our sections on secondary liver cancer| and  secondary lung cancer| helpful.