Surgery is the most common treatment for colon cancer. The type of surgery you have will depend on the size of the cancer, where it is in the bowel and whether it has spread.

About surgery for colon cancer

Surgery is the most common treatment for colon cancer. The type of surgery you have will depend on the size of the cancer, where it is in the bowel and whether it has spread. Your doctor will discuss this with you.

There are things you can do before and after surgery to help you prepare and recover.

Local resection

Very early-stage colon cancers can sometimes be removed using an operation called a local resection. During this operation, the surgeon uses a colonoscope to remove the cancer from the lining of the bowel. A pathologist will examine the cancer that has been removed. If it is a high-grade, your surgeon may recommend that you have a second operation to remove more of the colon. This is to make sure that no cancer cells are left behind.

Removing part or all of the colon

If you have colon cancer, you may have an operation to remove part or all of the colon. This is called a colectomy.

Colon cancer may be treated with surgery to remove part of all of the colon. This type of operation is called a colectomy. Removing the whole colon is called a total colectomy. Removing half of the colon is called a hemi-colectomy. Depending on where the cancer is, either the left side or the right side may be removed.

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 opposite below show the parts of the colon that are removed during these operations.

A left hemi-colectomy

A left hemi-colectomy

A right hemi-colectomy

A right hemi-colectomy

 

A sigmoid colectomy

Some people have an operation to remove the sigmoid colon. This is called a sigmoid colectomy.

A sigmoid colectomy

A transverse colectomy

Some people have their transverse colon removed, which is called a transverse colectomy.

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.

Having surgery for colon cancer

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 (abdomen) instead.

In laparoscopic surgery, the surgeon makes four or five small cuts in the tummy rather than one big cut. They pass a laparoscope into the tummy through one of the cuts. A laparoscope is a thin tube containing a light and camera. They then pass specially designed surgical tools through the other cuts to remove the cancer.

Laparoscopic surgery is sometimes used when the cancer is small. It uses a specialised technique and is not available in all hospitals. If this surgery is the best type for you to have, you may be referred to another hospital to have it done. Recovery from laparoscopic surgery is usually quicker than recovery from open surgery. Your surgeon will talk to you about which type of surgery is likely to be best in your situation.

Stomas (colostomy or ileostomy)

During the operation to remove the cancer, an opening is sometimes made through the tummy (abdominal) wall. This lets the bowel connect to the surface of the tummy. It is called a stoma.

Stomas can be temporary or permanent. A surgeon may make a temporary stoma to allow the bowel to heal after surgery.

Your surgeon will tell you whether you are likely to have a stoma after your operation, and whether it will be temporary or permanent.

If you need to have a stoma, you will be referred to a stoma nurse who specialises in stoma care.

Stoma reversal

If you have a temporary stoma, you can usually have an operation to reverse the stoma when your treatment is over. This means you will pass poo (stools) from your bottom again.

The timing of a stoma reversal operation varies from person to person. It can range from a few months after the stoma was made, to one or two years later.

How stoma reversal is done depends on whether you have a loop stoma or an end stoma.

To reverse a loop stoma, the surgeon closes the opening in the loop of bowel that was used. They then remove the stitches holding the loop of bowel in place on the skin. The bowel goes back inside the tummy (abdomen).

To reverse an end stoma, the surgeon removes the stitches that are holding the piece of bowel up to the skin. The piece of bowel is rejoined to the rest of the bowel inside the tummy.

After a stoma reversal, it may take some time for your bowel habit to get back to normal.

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