For patients with potentially curable bowel cancer, a properly performed surgical operation is essential for optimal results. In the majority of such cases, operative intervention involves a resection (removal) of the primary cancer and regional lymph nodes, along with the removal of sections of normal bowel on both sides of the cancer when treating colon cancer, and the removal of the mesorectum (the tissue attached to and supporting the rectum) when treating rectal cancer.
There are several different types of surgical procedures used in the treatment and management of bowel cancer. The size and spread of the cancer, as well as the experience of the surgeon determine the appropriate procedure.
The following list of questions is meant as a guide to the issues you should discuss with your surgeon and medical team before undergoing surgical treatment of bowel cancer.
- Are you a general surgeon or specialist colorectal surgeon?
- Do you have a specialty in surgical oncology?
- What is the stage of my cancer?
- Is surgery the standard treatment for my stage of disease?
- Why do you recommend surgery for my colon/rectal cancer?
- What type of surgery do you recommend (conventional vs. laparoscopic)?
- Can you describe the surgery that you recommend?
- What is the goal of surgery?
- What are you planning to remove during surgery (the bowel, nearby bowel tissue, rectum, mesorectum, lymph nodes)?
- How many times have you performed the recommended surgery?
- Will you personally be performing the surgery?
- What is your success rate and how do you define success?
- What is your experience with complications? What should I do if I develop complications after surgery? Number to call?
- Is a biopsy part of the surgery?
- How soon after surgery will I have all test results and a firm diagnosis?
- Will I need blood transfusions and can my family donate blood?
- Why is bowel preparation necessary for abdominal surgery?
- Will I have a catheter to drain my bladder and, if so, how long will it be in?
- Will you perform a pelvic lymph node dissection?
- I have read that at least 12 lymph nodes need to be examined to accurately stage bowel and rectal cancers. Do you routinely accomplish this? Can more than 12 lymph nodes be examined? If so, how many are you willing to examine in excess of 12?
- What happens if one or more of the lymph nodes is found to be positive?
- Do you use drains and how will you decide?
- How long will I be unable to eat?
- Will I have a nasogastric tube (NG tube) after surgery?
- What are my options for pain control after surgery?
- Do you think I will require a temporary or permanent colostomy? If so, what will this involve?
- If you find that the disease is more extensive than originally believed, what will you do?
- Considering my age and general health, am I at a higher or lower risk for complications?
- What might my recovery involve? Restrictions? Date to resume normal activities? What realistic time period should I be expecting to take off from my work commitments?
- What are my options besides surgery?
- Are there clinical trials for my stage of disease?
- Will I require adjuvant (post-surgical) therapy after my surgery?
- Are there any protocols for neo-adjuvant (before surgery) therapy for my stage of disease?
- What are the pros and cons of each type of bowel/rectal surgery for the treatment of my particular cancer?
- What diagnostic tests are needed prior to surgery and how will these assist in surgical planning?
- Do you feel it is appropriate to perform surgery even if there are metastases present in more than one place? If yes, under which conditions?
- Who will give me information about how I should get ready for surgery and a hospital stay? How long will I be in the hospital?
- Might I require special assistance at home after the procedure? If so, how can I arrange for the help I need?
- For rectal cancer: Should I have radiation therapy and chemotherapy before my rectal cancer surgery?
Questions to ask your surgeon after surgery
- What is my official diagnosis based on the results of surgery and biopsy reports?
- Can you explain my pathology report (laboratory test results) to me?
- What is my prognosis?
- What additional treatment do you recommend? Why?
- What is the goal of this treatment?
- Is it a standard treatment or part of a clinical trial?
- What are the risks and possible side effects of treatment, both in the short term and the long term?
- How will the treatment affect my daily life? Will I be able to work, exercise, engage in sexual activity and perform my usual daily activities?
- How long will it be before I can go back to work after surgery? Can I work during chemotherapy?
- What follow-up tests will I need and how often will I need them? When will I be seen for a follow-up examination?
- What support services are available to me? To my family?
Questions to ask about surgery-related side effects
- What should I expect as far as side effects are concerned?
- How long will they last?
- Which side effects should I report? To whom should I report the side effects?
- What kind of impact will this surgery have on my bladder and bowels?
- Will the surgery damage nerves to sexual organs?
- How will my sexual relations be affected and when can I resume sexual intercourse?
- What kind of pain relief will I have?
- If I have a lymph node dissection, will this cause me to be at risk for lymphedema (a condition that occurs when lymph nodes have been removed or damaged and lymphatic fluid collects in those tissues, causing swelling or oedema in the legs)? And if so, what steps can I take to avoid it?