The most common treatment for all stages of colon cancer and rectal cancer
Unlike some other cancers where many treatment choices are available, surgery is the most common treatment for removing the cancer from your bowel.
However, some people will also require chemotherapy and radiotherapy to reduce the size of the tumour and prevent progression of the disease. If surgery is not an option, then chemotherapy and radiotherapy are offered to halt progression of the disease and to help control the symptoms.
What happens during surgery?
During the operation the piece of bowel that contains the cancer is removed and the two open ends are joined together (anastomosis). The lymph nodes near the bowel may also be removed because this is the first place to which the cancer may spread.
You will usually stay in hospital for about 10 days after surgery, and will be given antibiotics to prevent any infection.
You may want to ask your doctor these questions before having surgery:
- What kind of operation do you recommend for me?
- Do I need any lymph nodes removed?
- Will other tissues be removed?
- Why?
- What are the risks of surgery?
- Will I have any lasting side effects?
- Will I need a colostomy?
- If so, will the stoma be permanent?
- How will I feel after the operation?
- If I have pain, how will it be controlled?
- How long will I be in the hospital?
- When can I get back to my normal activities?
Will you need a colostomy bag?
Most people diagnosed with bowel cancer do not need a colostomy bag. However, in some cases, the bowel cannot be rejoined straight away, and one end if brought out onto the skin of the abdominal wall. This is called a colostomy, and the opening of the bowel is known as a stoma. Bowel motions pass through the stoma into a colostomy bag, which is worn over the stoma.
For most people, the stoma is temporary and can be reversed after a few months. It is needed only until the colon or rectum heals from surgery. After healing takes place, the surgeon reconnects the parts of the bowel and closes the stoma.
Only a very small number of people with bowel cancer cannot have a stoma reversal. Some people, especially those with a tumour in the lower rectum, need a permanent stoma.
If you do need a colostomy bag after surgery, you will be given support and advice from specialist stoma care nurses. People who have a colostomy bag may have irritation of the skin around the stoma. Your doctor or nurse can teach you how to clean the area and prevent irritation and infection. Life can carry on as normal with a stoma, including sporting activities.
Open surgery or keyhole surgery?
Open surgery
Open surgery is currently the most common form of surgery for bowel cancer patients. In the majority of cases, open surgery to remove bowel cancer is highly successful and can be completely curative if the cancer is caught at an early enough stage.
After open surgery you will have a wound (incision) that goes in a straight line from just below the breastbone for a variable length down to the pelvis. However, this scar will heal and fade over time. You can expect to be in hospital for an average of 8-10 days.
The time it takes to heal after surgery is different for each person. You may be uncomfortable for the first few days. Medicine can help control your pain. Before surgery, you should discuss the plan for pain relief with your doctor or nurse. After surgery, your doctor can adjust the plan if you need more pain relief.
It is common to feel tired or weak for a while. Also, surgery sometimes causes constipation or diarrhoea. Your health care team monitors you for signs of bleeding, infection, or other problems requiring immediate treatment.
Open surgery explained
Removal of a segment of colon is called a colectomy. If your cancer is on the right side of the large bowel, half of the colon is removed. This is called a right hemicolectomy. If the cancer is on the left, the operation is called a left hemi colectomy. If it is in the sigmoid colon, it is a sigmoid colectomy and so on.
Keyhole surgery
National Health & Medical Research Council (NHMRC) guidelines recommend laparoscopic (or keyhole) surgery, in experienced hands, as a safe and feasible alternative to open surgery for benign bowel cancer.
The decision about whether to use open or laparoscopic surgery should be made after informed discussion between your and your surgeon. In particular, you should talk about whether your condition is suitable for laparoscopic surgery, the risks and benefits of the two procedures, and he surgeon's experience.
Laparoscopic surgery involves carrying out an operation through small cuts in the abdomen. This type of procedure is often called keyhole surgery. The surgeon inserts a narrow telescope attached to a camera and other special instruments through the cuts to remove the part of the bowel with the tumour. Most of the operation is performed through these small cuts, but a slightly larger opening is needed to remove the section of bowel from the body.
Laparoscopically assisted surgery is similar, but involves using the larger opening to carry out part of the surgery as well as to remove the section of bowel. Both procedures need smaller cuts than open surgery.
Patients who have had laparascopic surgery usually have shorter hospitalisation (you can expect to be home within 3 to 4 days) and also quicker recovery time (you will hopefully be fully recovered within 3 to 4 weeks). There can also be a quicker resumption of diet for patients who have undertaken this procedure. Scarring is also less visible than the scars from traditional open surgery.
Although research shows that this type of surgery will be used more and more often in the future, it may not be available at every hospital.
It requires the surgeon to have been specially trained and have particular expertise. Also, not all patients are suitable for this type of surgery. The most common reasons for not being offered this alternative is obesity, tumours that are too large to be removed this way, and other more complicated situations.
Open surgery resection | Keyhole surgery resection
Surgery (removing the cancer in an operation) is the most common treatment for all stages of colon cancer.
A doctor may remove the cancer using one of the following types of surgery:
| Local excision |
If the cancer is found at a very early stage, the doctor may remove it without cutting through the abdominal wall.
Instead, the doctor may put a colonoscope (tube with a cutting tool) through the rectum into the colon and cut the cancer out. This is called a local excision. If the cancer is found in a polyp (a small bulging area of tissue), the operation is called a polypectomy.
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| Resection of the colon with anastomosis | If the cancer is larger, the doctor will perform a partialcolectomy (removing the cancer and a small amount of healthy tissue around it). The doctor may then perform an anastomosis (sewing the healthy parts of the colon together). The doctor will also usually remove lymph nodes near the colon and examine them under a microscope to see whether they contain cancer. |
 Cancer detected during colonoscopy
 Resection of the colon with anastomosis
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 If the left side of the colon is removed, the operation is called a left hemi colectomy
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 If the middle part of the bowel is removed (the transverse colon) it is called a transverse colectomy
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 If the right side of the colon is removed, it is called a right hemi colectomy
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 If the sigmoid colon is removed it is called a sigmoid colectomy
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| Resection of the colon with colostomy |
If the doctor is not able to sew the two ends of the colon back together, a stoma (an opening) is made on the outside of the body for waste to pass through. This procedure is called a colostomy.
A bag is placed around the stoma to collect the waste. Sometimes the colostomy is needed only until the lower colon has healed, and then it can be reversed. If the doctor needs to remove the entire lower colon, however, the colostomy may be permanent.
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 Colostomy
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Even if the doctor removes all the cancer that can be seen at the time of the operation, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left.
Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.
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Surgery is the most common treatment for all stages of rectal cancer.
The cancer is removed using one of the following types of surgery:
| Polypectomy | If the cancer is found in a polyp (a small piece of bulging tissue), the polyp is often removed during a colonoscopy. |
| Cryosurgery | A treatment that uses an instrument to freeze and destroy abnormal tissue, such as carcinoma in situ. This type of treatment is also called cryotherapy. |
| Local excision | If the cancer is found on the inside surface of the rectum and has not spread into the wall of the rectum, the cancer and a small amount of surrounding healthy tissue is removed. |
| Resection |
If the cancer has spread into the wall of the rectum, the section of the rectum with cancer and nearby healthy tissue is removed. Sometimes the tissue between the rectum and theabdominal wall is also removed. The lymph nodes near the rectum are removed and checked under a microscope for signs of cancer.
If the cancer is in the rectum, the operation is called an anterior resection. If the cancer is in the lower rectum and you have to have a permanent colostomy, all of the rectum and anus along with the sphincter muscles are removed. This is called an abdomino-perineal excision. Another form of specialised rectal cancer surgery is known as a Total Mesorectal Excision (TME), which sees the removal of the cancerous area of the rectum, including the fatty regions where the lymph nodes are located. This operation aims to catch cancer cells that may have spread outside the wall of the rectum, and also often reduces the likelihood of a permanent colostomy.
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| Radiofrequency ablation | The use of a special probe with tiny electrodes that kill cancer cells. Sometimes the probe is inserted directly through the skin and only local anesthesia is needed. In other cases, the probe is inserted through an incision in the abdomen. This is done in the hospital with general anesthesia. |
| Pelvic exenteration |
If the cancer has spread to other organs near the rectum, the lower colon, rectum, and bladder are removed.
In women, the cervix, vagina, ovaries, and nearby lymph nodes may be removed.
In men, the prostate may be removed.
Artificial openings (stoma) are made for urine and stool to flow from the body to a collection bag.
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After the cancer is removed, the surgeron will either:
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 Cancer detected during colonoscopy
 Resection of the rectum with anastomosis
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Radiation therapy or chemotherapy may be given before surgery to shrink the tumor, make it easier to remove the cancer, and lessen problems with bowel control after surgery.
Treatment given before surgery is called neoadjuvant therapy.
Even if all the cancer that can be seen at the time of the operation is removed, some patients may be given radiation therapy or chemotherapy after surgery to kill any cancer cells that are left.
Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.
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