Colon Cancer Surgery
What is colon cancer surgery?
Surgery is the most common form of treatment for any stage of colon cancer or rectal cancer. There are different surgical options depending on the stage of the cancer and where it is inside the colon. The colon is also called the large intestine. The rectum is the last six inches of the colon. Colorectal surgery can be performed either laparoscopically or as open surgery.
Types of colorectal cancer surgery
Colonoscopy: While this isn’t a true surgery, a colonoscopy is a way to remove polyps (polypectomy) or superficial cancers in the earliest stages. It prevents the need for open and invasive abdominal surgery. Rectal cancer can be treated similarly—through the anus without open surgery.
Colostomy: This surgery is when the colon is diverted outside the abdomen. Colostomies may be temporary or permanent.
Low anterior resection: If the cancer is just in the rectum, your doctor can perform a low anterior resection to remove the rectum.
Proctectomy: This is the removal of the entire rectum. The colon is then reattached to the anus.
Abdominoperineal resection: The doctor will make an incision in the abdomen and remove the rectum, anus and sphincter muscle. A permanent colostomy is necessary after this type of resection.
Pelvic exenteration: This type of colorectal cancer surgery will remove cancer that has spread to the bladder and prostate (in men) or uterus (in women).
Why is colon cancer surgery performed?
Surgery to treat colon and rectal cancer can have different goals, depending on the specific circumstances. For people with early stage cancer, the goal of surgery is to completely remove the cancer. If the cancer has spread and blocked the large intestine, a surgeon may first need to cut the colon and create a colostomy, also called a stoma. This allows the body to get rid of stool despite the blockage, but it doesn’t remove the cancer. In these cases, the goal of a colostomy is to help the person become healthy enough to undergo other cancer treatments, such as chemotherapy.
Who performs colon cancer surgery?
The surgeons with the most focused training performing surgery on the colon and rectum are colon and rectal surgeons. Colorectal surgeons typically train as general surgeons first, but they have advanced training in the treatment of colon and rectal problems, including cancer. These specialists have also been called proctologists in the past. Surgical oncologists specialize in cancer surgery, particularly complex surgical cases.
Gastroenterologists perform colonoscopies with or without polyp removal. Colorectal surgeons and general surgeons can also perform colonoscopies.
To improve your chances of a successful surgery, be sure the surgeon you choose is an accomplished surgeon with significant experience performing the type of surgery you need to treat the form of colon cancer you have.
How is colon cancer surgery performed?
Several factors will affect the way your surgeon performs the procedure. Where the cancer is located within the colon, the type of cancer, how large the tumor is, and whether it has spread, all play a role in the decision. If the cancer cannot be removed during a colonoscopy, the doctor may suggest other procedures. Both laparoscopic and open surgery will require anesthesia and a hospital stay. You will stay at the hospital from 1 to 2 days up to a week.
Laparoscopic surgery is a minimally invasive form of colon cancer surgery. The surgeon will make small incisions in the abdomen and insert a thin tube with a video camera into one of the incisions. While viewing the surgical area on a video monitor, the surgeon inserts specialized surgical instruments into the other openings to remove the cancerous portion of the colon. Because the incisions are much smaller than for open surgery, patients typically recover more quickly. Laparoscopic surgery should be performed by a colorectal surgeon who has special expertise with the procedure.
Open surgery requires a longer incision in the abdomen. There is a greater chance of complications with this type of incision, recovery time is typically longer, and you may have a longer hospital stay. However, open surgery is an effective method of treating colon cancer and may be the only option.
What to expect the day of your colon cancer surgery
In general, this is what happens the day of your surgery:
You will receive general anesthesia.
You will be connected to several monitors to check your heart rate, blood pressure, and oxygen levels during surgery.
For laparoscopic surgery, the doctor will make several small incisions in your abdomen. If you’re having open surgery, the doctor will make a long incision in your abdomen to access the colon directly.
The surgeon will remove the cancerous tissue and some healthy tissue surrounding the cancer. If necessary, the surgeon will perform the colostomy.
When surgery is complete, you will be taken to a recovery room.
What are the risks and potential complications of colon cancer surgery?
Risks and complications depend on your general health and the type of colon cancer surgery you have.
Potential complications of colon cancer surgery
All types of surgery come with some risks. Complications of colon cancer surgery you could experience are:
Anesthesia reaction, such as an allergic reaction and problems with breathing
Bleeding in the abdomen
Formation of scar tissue that may block the small intestine
Damage to nearby organs, such as the bladder or small intestine
Waste leaking from where the colon or small intestine and rectum were reconnected
Infection or re-opening at the site of the incision
Reducing your risk of complications
You can reduce your risk of complications by:
How do I prepare for colon cancer surgery?
To increase the chance for a safe and successful surgery, you can do several things to prepare. You should:
Follow the diet your doctor recommends, typically only clear liquids for 1 or 2 days before surgery
Stop smoking and temporarily stop drinking alcohol if you drink
Don’t eat anything after midnight the day before your surgery
Clean out your bowels before surgery, either with laxatives or an enema. If your doctor orders it, your care team will give you detailed instructions on how to properly empty your bowel.
Questions to ask your doctor
Make sure you have all your questions answered before your surgery so you will know what’s ahead. Questions you might want to ask are:
How much pain will I be in after the procedure?
How long will recovery take?
How likely is it that the cancer will return?
What can I expect after colon cancer surgery?
Knowing what to expect ahead of time can help ease any concerns you might have.
How long will it take to recover?
Colon cancer surgery recovery time depends partially on whether you have laparoscopic or open surgery. People who have laparoscopic surgery typically recover more quickly. Most people leave the hospital within 2 to 4 days after the surgery, although it could be longer. Before you can leave the hospital, you must be able to drink liquids without feeling sick and walk without assistance. At home, you may tire more easily, and you may also have irregular bowel movements for a while. This is normal. Recovery at home will take at least a couple of weeks for laparoscopic surgery.
Light exercise, such as walking, will benefit you in your recovery by strengthening your muscles, helping to prevent blood clots, and keeping your lungs clear. Be careful not to lift or push heavy things (over 30 pounds) or do any abdominal exercises for at least six weeks after surgery.
Will I feel pain?
You will experience some pain as you recover from surgery. In the hospital, you may receive injections of painkillers. At home, you’ll likely be able to take regular pain medicine, such as ibuprofen or acetaminophen (Tylenol).
When should I call my doctor?
If you experience any of the following symptoms, call your doctor right away:
Throwing up or feeling nauseated
Pain that continues to get worse
Redness or drainage at the site of the incision
How might colon cancer surgery affect my everyday life?
You may be on a liquid or soft food diet until your bowel is healthy enough to form normal stool. If you have a total colectomy, you may have several more bowel movements per day than you’re used to, but this is normal. By the time you’re fully recovered from surgery, you should be able to do all the same activities you did before the procedure.
If you have a colostomy, there will be some lifestyle changes because waste will collect in a bag outside your body. An ostomy nurse will teach you how to use it properly. Some patients may need to follow up the surgery with chemotherapy or another treatment like radiation. Your surgeon and oncologist work together to devise a treatment plan with the greatest chance of completely eliminating signs of cancer.