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.
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Surgery is the most common treatment for colon cancer. The type you have will depend on the stage of the cancer and where it is in the colon. If cancer has spread to the liver or lungs, it is generally treated with chemotherapy. Some people may have an operation to remove the cancer.
If you have a very early stage cancer, the surgeon may remove this from the bowel with a colonoscope. But surgery usually involves removing part of the colon and lymph nodes nearby. Lymph nodes are part of the lymphatic system and are often the first place a cancer spreads to.
A surgeon who specialises in bowel cancers will do the operation. This may be done as open surgery or keyhole surgery. In keyhole surgery, the surgeon makes a few small cuts rather than one big cut. This means recovery is usually quicker.
After your operation, you may need a stoma. This is an opening in the tummy wall that poo passes out from into a disposable bag that is worn over the stoma. A stoma is usually temporary, but can be permanent for a small number of people.
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 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 below show the parts of the colon that are removed during these operations.
Some people have an operation to remove the sigmoid colon. This is called a sigmoid colectomy.
Some people have their transverse colon removed, which is 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.
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 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.
During the operation to remove the cancer, an opening is sometimes made through the tummy (abdominal) wall.
This lets the bowel connect onto the surface of the tummy. It is called a stoma. It is round or oval, and it looks pink and moist. The stoma has no nerve supply, so it doesn’t hurt. Poo (stools) will no longer 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.
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 is 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 heal after surgery.
There are two kinds of stoma:
To make a loop stoma, the surgeon pulls a small loop of bowel out through a cut in the tummy. 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 to the surface of the tummy and stitches it into place. This forms a stoma. The inactive end of bowel, which leads to the rectum (back passage), is stitched closed and left inside the tummy.
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.
If you need to have a stoma, you will be referred to a stoma nurse who specialises in stoma care.
The most common areas of the body that colon cancer might spread to are the liver and the lungs.
If colon cancer has spread to the liver (secondary liver cancer), the most common treatment is chemotherapy. The aim is to shrink the cancer and 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 three to seven 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.
Sometimes the liver resection is done at the same time as an operation to remove the cancer in the colon. But it is usually done 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 information about other treatments for secondary liver cancer.
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 usually only possible if the cancer is in just one lung, although some surgeons will operate on both lungs in certain circumstances.
Radiofrequency ablation may sometimes be used.
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.
The surgeon uses a colonoscope 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.
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.
A member of your surgical team will talk to you about your operation and make sure you understand what will happen.
Your specialist nurse will help you recover after surgery. You will probably be ready to go home after three to seven days.
If you have problems with bowel function after surgery, talk to your surgeon or nurse. There are treatments that can help.
Adjusting to a stoma takes time but most people manage well with support from their stoma care nurse.
You will have follow-up appointments after your surgery to check on your recovery and any new symptoms.
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