Surgery for rectal cancer
The type of operation you need will depend on the stage of the cancer and where it is in the rectum.
Surgery is the most common treatment for rectal cancer.
You may have radiotherapy or chemoradiation before surgery. This can make it easier to remove the cancer. It also lowers the risk of the cancer coming back in the rectum or in the tissues close to it.
- the stage of the cancer
- where it is in the rectum
- your general health.
Surgery to remove part, or all, of the rectum is called a resection.
After the operation, all the tissue that the surgeon has removed is sent to a pathologist. They check the tissue carefully for any cancer cells close to the edge. The edge is called the margin. If they find cancer cells in the margin, there might be a higher risk of cancer coming back. This is not common, but if it happens you may be offered a second operation or radiotherapy.
If you have a very small, stage 1 rectal cancer you may have an operation called a local resection. This is a small operation to remove the cancer and some healthy tissue surrounding it. The cancer can usually be removed through the anus. This means the surgeon does not have to make a cut in your tummy (abdomen).
The surgeon passes a long, flexible tube with a tiny camera at the end (an endoscope) into the anus and the rectum. This allows the surgeon to find and remove the tumour precisely. This surgery is called transanal endoscopic microsurgery (TEM) or transanal minimally invasive surgery (TAMIS), depending on the surgical instrument used.
If the cancer is very low in the rectum and close to the anus, the surgeon may be able to remove the cancer through the anus without using an endoscope. This is called a transanal rectal resection.
If you have locally advanced rectal cancer, the type of surgery you have depends on:
- where the cancer is in the rectum
- the size of the tumour
- how far it is from the anus.
Open or laparoscopic surgery
Your operation may be done as open surgery or as laparoscopic (keyhole) surgery.
Open surgery means the surgeon makes one large cut (incision), usually near the tummy button. The length of the cut depends on the size of the cancer and where it is.
Laparoscopic surgery means the surgeon makes four or five small cuts in the tummy rather than one large cut. They pass a thin tube with a small camera (a laparoscope) into the tummy through one of the cuts. They then pass specially designed surgical tools through the other cuts to remove the cancer. Laparoscopic surgery is sometimes called keyhole surgery or minimally invasive surgery.
You usually recover more quickly from this type of surgery that from open surgery. Laparoscopic surgery may also be done using a technique called robotic-assisted surgery. This is when the surgeon uses surgical tools attached to the end of robotic arms to remove the cancer. Robotic surgery is still a new technique and is not available in all hospitals in the UK.
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, sometimes the surgeon needs to create a stoma. This is an opening that is made through the tummy (abdominal) wall. It connects the bowel to the surface of the tummy.
Having a stoma means stools (poo) will not pass out of the rectum and anus in the usual way. Instead, it will pass out of the stoma, into a disposable bag that is worn over the stoma. Stomas may be temporary or permanent.
Your surgeon will tell you whether you are likely to have a stoma after your operation, and whether it will be temporary or permanent.
We have more information on stomas.
Total mesorectal excision (TME)
If you have a larger rectal cancer, you will usually need to have most of the rectum removed. This is usually done using an operation called total mesorectal excision (TME).
A TME is when the surgeon removes some of the fatty tissue around the rectum (mesorectum). The fatty tissue contains lymph nodes and blood vessels. This means all the lymph nodes near to the tumour are removed, which reduces the risk of the cancer coming back. If possible, the surgeon joins the colon to the top of the anus.
Most people with rectal cancer have a TME as part of their surgery. We have more information about the different types of surgery used to treat rectal cancer.
The large bowel and mesorectum
In the illustration , the black dotted line shows an example of the tissue that may be removed during a TME operation.
If the cancer has spread to the liver, the most common treatment is chemotherapy. The aim is to shrink the cancer and control it for as long as possible.
You may be able to have surgery to remove the part of the liver that is affected by the cancer. This operation is called a liver resection. It can sometimes lead to a cure.
A liver resection is a major operation. It is done by a surgeon who is experienced in liver surgery (hepatobiliary surgeon) in a specialist hospital. This treatment is only suitable for a few people with secondary liver cancer.
Sometimes the liver resection is done at the same time as an operation to remove the cancer in the rectum.
If you have secondary liver cancer, you can talk to your cancer doctor about whether this surgery may be helpful for you. You may have a course of chemotherapy before a liver resection.
The main treatment for cancer that has spread to the lungs is chemotherapy. But you may be offered surgery to remove the affected part of the lung.
Radiofrequency ablation or microwave ablation are sometimes used to treat bowel cancer that has spread to the liver or lungs. These treatments destroy cancer cells using heat.
Below is a sample of the sources used in our rectal cancer information. If you would like more information about the sources we use, please contact us at firstname.lastname@example.org
R Glynne-Jones, PJ Nilson, C Aschele et al. ESMO-ESSO-ESTRO Clinical practice guidelines for diagnosis, treatment and follow up for anal cancer. July 2014. European Society of Medical Oncology. Available from www.esmo.org/Guidelines/Gastrointestinal-Cancers/Anal-Cancer (accessed October 2019).
National Institute for Health and Excellence (NICE). Colorectal cancer: diagnosis and management clinical guidelines. Updated December 2014. Available from www.nice.org.uk/guidance/cg131 (accessed October 2019).
Association of Coloproctology of Great Britain & Ireland (ACPGBI). Volume 19. Issue S1. Guidelines for the management of cancer of the colon, rectum and anus. 2017. Available from www.onlinelibrary.wiley.com/toc/14631318/19/S1 (accessed October 2019).
National Institute for Health and Care Excellence. Preoperative high dose rate brachytherapy for rectal cancer. 2015. Available from www.nice.org.uk/guidance/ipg531 (accessed October 2019).
BMJ. Best practice colorectal cancer. Updated 2018. Available from www.bestpractice.bmj.com/topics/en-gb/258 (accessed October 2019).
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Chief Medical Editor, Professor Tim Iveson, Consultant Medical Oncologist.
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