Surgery for colon cancer
Surgery is the most common treatment for colon cancer. A surgeon who specialises in treating bowel cancer should do it.
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.
Surgery to remove colon cancer
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Very early-stage colon cancers can sometimes be removed using an operation called local resection. The surgeon will remove the cancer from the lining of the bowel using a colonoscope. 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 are left behind.
Removing part or all of the colon
Removing the whole colon is called a total colectomy.
Removing half of the colon is called 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. In a right hemi-colectomy, the right half of the transverse colon and the ascending colon is removed. The diagrams below show the parts of the colon that are removed during these operations.
Operations to remove part of the colon
Some people have an operation to remove the sigmoid colon, called a sigmoid colectomy. Some people have their transverse colon removed, called a transverse colectomy.
During surgery, the piece of bowel that contains the cancer is removed. 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.
Open or laparoscopic surgery
Your operation may be carried out as open surgery or as laparoscopic (keyhole) surgery.
Open surgery means the surgeon makes one large cut (incision). Afterwards, you have a wound that goes down in a line from just below your breastbone (sternum) to just below the level of your tummy button (navel). Some people have a wound that goes across their tummy instead.
In laparoscopic (keyhole) surgery, the surgeon makes four or five small cuts in the abdomen rather than one big cut. They pass a laparoscope into the abdomen through one of the cuts. A laparoscope is a thin tube containing a light and camera. Then they pass specially designed surgical tools through the other cuts to remove the cancer.
Recovery from laparoscopic surgery is usually quicker than recovery from open surgery. Your surgeon will talk to you about which type of surgery is appropriate.
After an operation to remove colon cancer, some people will go to the toilet in a different way. They will have an opening on their tummy wall through which they pass bowel motions. This is called a stoma. A bag is worn over the stoma to collect bowel motions.
The stoma is made from an opening in part of the bowel. If the stoma is made from an opening in the colon it is called a colostomy. If it’s made from an opening in the small bowel (ileum) it is called an ileostomy.
Stomas can be temporary or permanent. Only a small number of people with colon cancer need a permanent stoma.
A surgeon may make a temporary stoma to allow the bowel to rest after colon cancer surgery.
There are two kinds of stoma: a loop stoma and an end stoma. To make a loop stoma, the surgeon pulls a small loop of bowel out through a cut in the tummy (abdomen). They then make an opening in the loop of bowel and stitch the loop to the skin. This forms the stoma.
To make an end stoma, the surgeon removes the section of bowel that contains cancer. This leaves two open ends of bowel. The surgeon brings the active end out onto the skin and stitches it into place. This forms a stoma. The inactive end of bowel, which leads to the rectum (back passage), is sewn closed and left inside the abdomen.
If you have a temporary stoma, you will usually have a second smaller operation a few months later to close the stoma and rejoin the bowel. This operation is called a stoma reversal.
Clinical nurse specialist for stoma care talks about having a stoma after surgery for cancer.
Surgery for advanced colon cancer
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If colon cancer has spread to the liver, the most common treatment is chemotherapy. The aim is to shrink the cancer and to control it for as long as possible.
Some people may be able to have surgery to remove the part of the liver affected by cancer. This operation is called a liver resection. It can sometimes lead to a cure.
Liver resection is a major operation that takes 3–7 hours. It is done by surgeons experienced in liver surgery (hepatobiliary surgeons) in specialist hospitals. This treatment is only suitable for a few people with secondary liver cancer.
An operation to remove the cancer in the colon may be done at the same time or as a separate operation.
If you have secondary liver cancer, you can talk to your doctor about whether this surgery may be helpful for you. A course of chemotherapy is usually given before liver resection.
We have more information about other treatments for secondary cancer in the liver.
The main treatment for cancer that has spread to the lungs is chemotherapy. But occasionally, people may be offered surgery to remove the affected part of the lung. This is only if the cancer is in just one area of the lung and nowhere else in the body.
Treating a blocked bowel (bowel obstruction)
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Sometimes, colon cancer can narrow the bowel, stopping bowel motions from passing through. This can cause symptoms such as tummy pain and vomiting. It usually needs to be treated urgently. It can be treated in one of two ways.
Stenting to relieve a blocked bowel
The surgeon uses a colonoscope (see page 19) to insert an expandable metal tube (stent) into the blockage. The tube then expands to hold the bowel open.
The cancer causing the blockage can usually be removed with an operation at a later date.
Surgery to relieve a blocked bowel
Sometimes, a bowel obstruction is treated with an operation to remove the blocked section of bowel. Most people will have a temporary or permanent stoma after this operation. The surgeon may remove the cancer at the same time or do this later in another operation.